Federal District Court Alleging First Amendment Violations...

I was recently asked to provide some prospective on a lawsuit that was filed in federal district court alleging first amendment violations against the former Sheriff of El Paso County, Terry Maketa, former Undersheriff, Paula Presley, as well as, the El Paso County Board of County Commissioners. It brings up a lot of interesting legal issues regarding federal civil rights complaints that I think are important to discuss. The Law the Action is Brought Under The lawsuit is brought under 42 U.S.C.  § 1983. Section 1983, or civil actions for deprivation of rights, is an amended version of the Civil Rights Act of 1871. The statute provides that: Every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State or Territory or the District of Columbia, subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured in an action at law†¦Ã¢â‚¬  Thus, the two main requirements for a  § 1983 claim are (1) â€Å"state actors† and (2) â€Å"acting under the color of law.† â€Å"Color of law† has been defined by the United States Supreme Court as the [m]isuse of power, possessed by virtue of state law and made possible only because the wrongdoer is clothed with the authority of state law. U.S. v. Classic, 313 U.S. 299, 326 (1941). So, if Maketa and Preseley are the state actors, why

Operative Case Study Patient Data - 1738 Words

Peri-Operative Case Study Patient Data Patient CB is a 36 year old African American Female. She has a past medical history of hypertension, acid reflux, heartburn, and a hernia repair one year ago. She is a nonsmoker and reports never taking recreational drugs. Diagnostic tests related to her diagnosis include an abdominal ultrasound showing gallstones, an x-ray to verify stone presence, and tenderness with touch on the abdomin. CB was having a cholecystectomy because she was having pain in her abdomen related to gallstones. Her hernia was a result of a weakening of the abdominal wall. Surgery CB underwent a laparoscopic cholecystectomy with open incisional hernia repair in the Surgery Center of Pinehurst. This means that she had†¦show more content†¦This is due to the fact that the muscles must be paralyzed so the patient does not move around during the procedure. Fentanyl, Diazepam, and Propofol were administered to put CB to sleep, paralyze her muscles, and provide relaxation and memory loss of the procedure (Deglin). Potential post-operative complications from this procedure include malignant hypertension, hypoventilation, and nausea. Post Anesthesia Care Unit (PACU) The first assessment of CB in the PACU revealed that she was still deeply sedated. The anesthesiologist almost had to administer Narcan to reverse her anesthesia because she was having such a difficult time waking up. She had clear breath sounds bilaterally and her skin was warm to the touch. Her initial blood pressure reading was 134/72. Her bladder was non-distended and her pain rating was 9/10 in her abdomen. An IV push of 2 grams of Dilaudid was given for her pain. Additionally CB was given Zofran for nausea. Specifically in the PACU the nurses are monitoring the patient’s airway, their pain, level of consciousness, any bleeding at the incision site, and nausea. CB was kept in the PACU, or stage I as it is referred to in the Surgery Center, for an hour until she was alert and able to breath on her own without a nonrebreather mask. Every patient is put on a nonrebreather and EKG when they arrive in stage I. Vitals are taken every five minutes times four, then once before they leave. There is a specific documentation

Alcohol Abuse in the Restaurant Industry Free Essays

string(95) " is going to be a slow night, and everyone could probably pull together to cover Sues section\." Alcohol Abuse in the Restaurant Industry Shelsie Ann Lawrence University of West Florida Alcohol Abuse in the Restaurant Industry The purpose of this paper is to look at the high incidence of alcohol abuse in the restaurant industry and the possible causes. I will use studies done, but also incidences from my own personal experience of 15 years in the restaurant industry. Background The American Psychological Association defines alcohol abuse as, â€Å"a drinking pattern that results in significant and recurrent adverse consequences. We will write a custom essay sample on Alcohol Abuse in the Restaurant Industry or any similar topic only for you Order Now † (http://www. apa. org/helpcenter/alcohol-disorders. spx). These consequences can be lost work days, vehicle accidents, the breakdown and loss of relationships, serious illnesses. Alcohol abuse is extremely high in the restaurant industry. It is readily available and consistently used as a reward for good behavior. The consequences of alcohol abuse are much more tolerated. I worked for a chef that would come in to work hung over and late. She would clock in, and then sit down to have a beer to help the hangover. After the beer was consumed, it was time to make something to eat, all of this eating up the first 30 minutes of her work day. She would not be punished for this behavior, because chances are, she was out drinking with one of our owners the night before. This scene would play itself out at least once a week. I also had a co-worker that was allowed to go home, due to a hangover. We will call her Sue. Sue was not much of a drinker. I would say, she probably went out once a month. Sue gets off work, and almost all her co-workers are at the bar drinking. At this particular restaurant, the kitchen and servers would close down the restaurant between the hours of 10:00pm and 11:00 pm, this would put the time staff gets off work around 11:00pm or midnight. The bar would then stay open until 2:00 am. To set the stage a bit more, it is also important to note a few other things about this particular restaurant. Staff was allowed to start drinking for free, any beer on tap and any wine sold by the glass, one hour prior to closing. Any other drinks, i. e. : cocktails, wine by the bottle, and bottled beers, were discounted half off. This restaurant did very well, and had minimal staff turnover, so they could afford to allow this. The staff dinner was served after the kitchen was cleaned and the wait staff done with all their tables. Staff meal is also called â€Å"Family Meal†, in the restaurant world. Family is what your co-workers become, in a restaurant. You spend more of your time with your co-workers, then anyone else. Restaurants are open on the days other people are off spending time with their families. You work every weekend together. You work every holiday together. You work every night together. Together you build contempt for those with â€Å"normal jobs† This is all shared together. These are things that only your co-workers and other â€Å"industry† people can understand. Most bars, in Seattle, when I cooked there, even offered â€Å"industry† discounts. Even if you aren’t drinking at the place you work, you still get a discount. You are still awarded with alcohol. So, on this night, Sue gets off work to find all her co-workers finishing up dinner and pouring more rounds of drinks. She had a particularly good night and made a hundred dollars in tips. She has been working at this restaurant for six months and hasn’t found herself fitting in yet. Fitting in, becoming friends with her co-workers, can afford many benefits. Servers are more likely to switch a shift with someone they like and know. They are more likely to help you out, by delivering food to your table, if you are someone they like. She usually eats her dinner, than goes home, while the rest of the staff stays drinking and talking about their work night. They stay because the drinks are free; they stay because when they go home, if there is someone at home, they won’t be awake to hear the stories of their work day. Sue decides to stay and have a drink, maybe get her co-workers to warm up to her a bit more. As soon as everyone see’s that Sue is staying they cheer. Everyone has wanted to get to know her more, but feels that since she never stays after work, that she is probably stuck up. Her manager buys her a shot, for a job well done that night at work. She pours a beer and immediately feels comfortable with everyone, partly because of the cheer, but also because she is now sitting down to her second drink of the evening. The evening progresses similarly to how it started. As more staff gets off work, more shots are bought. Other restaurant workers, friends of the staff are getting off work, and showing up. Pretty soon, the bar is filled with mainly employees and other restaurant workers. Before anyone notices, it is closing time. Now, if the owner of the restaurant was round, and chances are he was, he would allow the bartender to go home, or have a seat at the bar, and he would continue to serve the staff, with the front door locked, well after closing time. Tonight, the staff all drank until 4:00 am. Sue stayed right along with everyone. Sue comes to work the next day, green and doubled over. Everyone is setting up the dining room for dinner service later. Her c o-workers look their normal tired selves, but keep in mind, they drink heavily and often, this is just another day for them. Everyone see Sue and immediately cheers. One server comments on how great it was that Sue hung out with everyone the night before. Sue runs straight for the bathroom. After some discussion, they decide that it is going to be a slow night, and everyone could probably pull together to cover Sues section. You read "Alcohol Abuse in the Restaurant Industry" in category "Essay examples" They send someone in to the bathroom to tell Sue she can go home. No one chastises her. She is not written up. She will miss getting paid for the evening, but it was going to be a slow night anyway. She goes home, goes back to bed, and wakes up the next day to go back to work, back to everything being normal. This is a perfect example of the lack of consequences, in the restaurant industry, for alcohol abuse. Sue is practically rewarded for her bad behavior. By staying and drinking, she formed a bond with her co-workers. All her drinks were either free or heavily discounted, so she didn’t feel any financial burden. When she showed up for work, unable to perform her duties, her co-workers pulled together to allow her to go home. According to them, they had been there before. One reason for such a high rate of alcohol abuse, in the restaurant industry is the high rate of young adults employed. In a study done on young adult restaurant workers, 41% reported problem drinking. Young adults make up the majority of restaurant workers. Restaurant jobs offer the most pay, for the least amount of skill and time. Some restaurants require a degree to work in the kitchen, but no education is required to work as a server. If you are a student, and need a part time job, chances are you have worked, or do work as a server. College students consume large amounts of alcohol, with 31% meeting the criteria for alcohol abuse. (http://www. ollegedrinkingprevention. gov/statssummaries/snapshot. aspx) Serving positions allow for the flexibility needed for college students. You make the most pay, for the least amount of hours worked. The schedule is very flexible. If you need a night off to finish up homework, you can always call a co-worker to cover your shift. Chances are there is someone who needs money and can cover your shift. Even if you can’t get someone to cover your shift, you ca n be sure that if you do have to work, you can get off work early if the restaurant is slow that night. Less servers equal more tips for the rest of the staff, and like most servers, they always need more money. Restaurant workers live paycheck to paycheck. Most have no benefits, no health insurance, and are just one missed paycheck away from being completely broke. Out of the 10 restaurants I have worked in, only two offered health insurance. According to the Bureau of Labor Statistics, the median hourly wage of a food sever in 2008, including tips, was $8. 01. The median yearly salary of a restaurant cook, in 2008 was $21,990. There are exceptions to the rule, but the majority live at the poverty line. When no vacations can be afforded, one can take a mini vacation at the bar. With no health insurance, no one is getting annual checkups. You can stay in denial about any health problems that might arise from alcohol abuse, because chances are you haven’t been to a doctor in years. I had a co-worker that couldn’t afford to go to the dentist to get a much needed filling. We can call him Bob. Bob had been complaining of an aching tooth for weeks. He just kept taking aspirin and upping his nightly alcohol intake to allow him to sleep through the night. He knew eventually he would have to see a dentist, but he just didn’t have the money to go see one at this point. In the end, he had to go to an emergency clinic to have his tooth pulled. He was put on pain killers and antibiotics. This all ended up costing him five hundred dollars. This was more than a week of pay for him. Bob was trying to save up to go on a vacation with his girlfriend. He hadn’t taken a single day off of work in over a year. Now his prospects seemed even dimmer. He gets off work, pours a drink, and sits down to complain to his other co-workers. They all understand. Only a few of them have taken time off that year. At the very least, they can all sit around, and have a few drinks together to ease the pain. They are depressed and find solace in each other. This is the point when alcohol abuse can become cyclical. Alcohol is a depressant. When a depressed person self medicates with alcohol they are only making the problem worse. Method The method used for this paper was through personal experience in the restaurant industry backed by research in journals and studies on alcohol abuse and restaurant workers. Findings There are many causes for alcohol abuse; some of those being depression, the availability of alcohol, peer pressure and social factors, impulsiveness and low self esteem. Restaurants workers have alcohol readily available. They have discounts, and free drinks. They are awarded for good behavior with alcohol. The social factors that are prevalent in restaurant workers also play a role in alcohol abuse. Drinking becomes social with restaurant workers. It becomes their outlet. It is their way of bonding. They can definitely feel the peer pressure from co-workers to drink. In my story of Sue, she felt that drinking with her co-workers was the only way she would be able to fit in. She wanted to be friends with everyone; she wanted the benefits of that friendship. They wanted her to drink with them. She knew that the only way to penetrate the group was by drinking with them after work. After a few times of hanging out, after work with everyone, it can easily become a habit. I would see people actually get upset and offended when someone that usually stayed for drinks, just went home after their shift. Results There is definitely a high rate of alcohol abuse amongst restaurant workers or many reasons; ranging from the social aspects, the availability of alcohol, the high stress work environment, the prevalence of poverty amongst the workers, the late hours and just the acceptance of heavy drinking among the staff and management. I don’t see a change in the behaviors and attitudes of restaurant staff. I think this is a problem that will continue unt il stricter laws and rules are enforced. References ARTHUR H. FRIEDLANDER, D. , STEPHEN. (2003). Alcohol abuse and dependence:Psychopathology, medical management and dental implications. J Am Dent Assoc. Peter E. Nathan, P. John Wallace, P. , Joan Zweben, P. , and A. Thomas Horvath, P. (2010). Understanding Alcohol Use Disorders and Their Treatment. American Psychological Association . Rachel R. Doern, S. M. (2008). THE SOCIAL MEANINGS OF DRINKING: STRENGTHENING THE SOCIAL BONDS OF RESTAURANT EMPLOYEES. Advances in Consumer Research Volume 25 , 481-485. Roland S. Moore, P. C. (2009). Dimensions of Problem Drinking among Young Adult Restaurant Workers. AM J Drug Alcohol Abuse , 329-333. http://www. bls. gov/oco/ocos162. htm http://www. ohsrep. org. au/hazards/fatigue-impairment/alcohol-and-work/index. cfm How to cite Alcohol Abuse in the Restaurant Industry, Essay examples

Hospital Management of SWOT And PESTEL assignment essay

Question: Discuss about the Hospital Management for SWOT and PESTEL. Answer: Introduction The Dubai Health Authority has decided to set up a Multi Specialties to provide better quality treatment for the patients having eye problems. Using the experience of the Super Eye Hospital, which is one of the key eye health care centers of Dubai, the health department of Dubai has decided to open up the new hospital. However, due to high cost of medical expense the multispecialty hospital have to suffer from incurred loss. In this report, the reason for the loss of the multi-specialty hospital has been analyzed using popular tools like SWOT and PESTEL analysis. Detailed recommendation has also been provided, which will help to improve the performance of the hospital governing body and hospital management. SWOT analysis for reasons success and loss Van Durme et al. (2014), have stated that in order to conduct the SWOT for evaluating the strength, weakness, opportunity and threats of a healthcare organization, it is important sufficient relevant data. The data and the information related to the health status and medical care that is highly important for this purpose. It is important to analyze the data that is related to the decisions that are being made by the healthcare management. The strength of the hospital is that it is designed to provide the latest techniques of treatment related to the eye care. Being a multispecialty hospital, it is equipped with all the latest forms of equipment that are needed for providing treatment. The management of the hospital has gained significant experience from the Super Eye Hospital, which was able to make significant profit due to high rate of bed occupancy. The total numbers of successful treatment that is provided by the hospital has also helped to increase the reputation among the people of Dubai. The location of the hospital is one of the prime positions of Dubai, which makes it easily accessible for the all the people of UAE to seek treatment. The major weakness of the health care institute however is the lack of proper marketing plan. The management of the hospital has failed to raise the level of awareness among the people about the importance of getting the latest form of eye treatment. Moreover, the high level of cost of medical service that is needed to provide treatment has discouraged the patients belonging from the middle and weaker section of the society to seek treatment. The hospital also lacks the proper healthcare workers, who have the skills to deal with the latest equipment of eye treatment. However, the latest form of medical technology provides the opportunity to provide better quality of treatment. There is also no other multi-specialty hospital at Dubai, which provides the opportunity of easier competition. Nevertheless, the adverse changes, which is taking place in the medical field is posing major threat to the healthcare organization. The patients are also demanding cost-effective forms of treatment, which is one of the major challenges for the hospital. There are also the issues of crisis of skilled healthcare workers, who have proper training with the use of heavy medical instruments. PESTEL analysis for the reason of success and loss With the help of the PESTEL analysis it is possible to investigate all the elements that have the capacity to influence all the business performance of the industry. The PESTEL analysis is the acronym for political, economic, social, technological, environmental and legal factors, which helps to determine the success rate of business (Yksel et al. 2012). The healthcare industry of Dubai is one of the fastest growing sectors of the nation, which is highly affected by all the major issues related socio-economic aspects. Dubai is considered to be one of the developed cities of the world and is also one of the major cities in the Middle East regions (Laeequddin, et al. 2016). The political system of Dubai is made up of federal structure and hence, there are no political parties in the nation. However, the country often face crisis due to political crisis. The seven different types of Emirates with the Saudi Arab region have allowed the nation to enjoy the flexible mode of governance (ANDREI and PRISECARU 2014). The frequent political conflicts within the nation disturb the business environment of the nation. The economic condition is another important element of the external business environment. The high GDP and per capita of UAE has helped the multi-specialty eye hospital to make significant process. Nevertheless, the nation also faced issues due lower rate of employment and poor level of income. Thus, a major section of the people of the nation does not have the money to afford for high level of medical treatment. Hence, the target group of the Eye hospital is limited to smaller section of the society. On the other hand, the high flow of foreign investment that is being received by the country has helped the Eye hospital to provide lower cost medical treatment (Balasopoulou et al. 2016). The choice of the people in the society of the people of UAE to choose high quality medical service has also helped the health institute to make significant profit. However, the discrimination that exists in the society has not allowed the monitories in the society of UAE to avail better quality care in high standard healthcare center. This is one of the major causes of loss faced by the Eye hospital. The poor technological infrastructure of the nation has been challenging for the Eye hospital as they require the use of the latest forms of medical equipment. The health authority of Dubai also does not have proper plans for the improvement of the application of technological equipment in the medical care centers. The hot and dry weather in the nation of UAE makes a challenging environment for proper business operating process. There no specific guidelines for the legal system in UAE and hence, this factor do not pose special challenge for the business environment. Nevertheless, the absence of proper business laws has allowed many unethical practices within the Eye hospital. Reason for huge incurred loss The lack of planning process by the Dubai Health Authority, which is a government organization, is the prime cause for the failure of the Eye hospital for making significant profit. The multi-specialty hospital also requires proper technological infrastructure and the lack the system has resulted in the poor implication of the medical equipment. The lack of proper leadership meant that the decisions that were taken by the health workers were not able to meet the requirements of the patients of the hospital. The price of the medical cost that is provided by the Eye hospital is highly expensive that has resulted in lower number of patients. Moreover, due to poor planning process the Eye Hospital has to suffer financial loss due to the lack of proper planning. The healthcare failed to provide treatment to the patients requiring quick treatment action as they lack proper skilled working staffs. The lack professional doctors also lowered the reputation as the patients lost their faith about the quality of treatment that is being provided. The hospital also lacked the ability to deal with critically sick patients. The cost of the supply has gone up significantly due to increased expense of the supply of medical needs. The operation process of the hospital also requires high expense, which increased the overall expenditure of the hospital management. Recommendations for the Hospital governing Board The Dubai Health Authority is the primary governing body of Dubai, which provide guidelines of health regulation within the city of Dubai. The authority is responsible for providing the health infrastructure that is needed for providing high quality health service. They have the responsibility to deal with all the major issues related to the health service that is available in Dubai. The primary role of the health authority of Dubai is to monitor the performance of all the hospitals and healthcare centers (Hussein et al. 2015). The change in the modern forms of treatment demands modifications in the treatment techniques, which will help to meet the growing demand of high quality health service. The economic change in the global health market is caused due to the introduction of the modern forms of equipment in the health service. However, due to lack of proper planning for the future the Eye Hospital in Dubai has sufferer as they failed to the implement the guidelines (Singer et al. 2015). It is important for the health authority of Dubai to attract investors from all sectors, which will help in the process of fund raising process for the healthcare sectors in Dubai. For effective hospital management project it is important to improve the market environment of the healthcare sectors. The tax for the manufacturing of healthcare products needs to be decreased. This will help the healthcare sectors to reduce the expense and thereby provide healthcare at lower costs. The health authority needs to raise the level of awareness about the importance of using the modern form of treatments. They also need to monitor whether all the healthcare centers are following the guidelines of the ethical conduct, which includes providing minimum wages to all the healthcare workers and not allow any forms of discrimination while providing treatment to the patients (Wagner et al. 2014). Protecting the needs of the environment and promoting the healthcare policies are the other important duti es of the health authority, which will help to improve the healthcare market of Dubai. Recommendations for Hospital and Operation Management There are certain key performance indicators, which will help the Eye Hospital to deal with the issues regarding high cost and lower quality of health service. The management of the hospital needs to collect significant amount of data related to the clinical and financial service. In order to increase the profit margin for the hospital, it is important to use the ten major indicators for the in the management and operation department of the hospital (Tracey 2015). With the help of the survey with the clients of the hospital, it is possible for the management of the hospital to understand the needs of the patients. The measuring elements of the Likert Scale are used as the indicators to measure the satisfaction level of the customers. The survey regarding the safety level of the customers will help the hospital to take measures increase the level of safety within the hospital. Following are the ten key performance indicators for the hospitals. Performance Indicators Description and Justification Rating According to Likert Scale Accommodation This is the primary requirements of the hospital. The management of the hospital needs to maximize the total number of accommodations. However, it is important to ensure that all the beds have proper equipment for proper life support. The occupancy rate helps to identify the total number of patients, who are admitted in the hospital. 3 Average Room Rate This is measure of the earnings that is made by the hospital from each room. The rate depends upon the total number of beds that is available in each of the rooms. 3 Patient Satisfaction It is the measure of the satisfaction by which the employees are satisfied with the service provided by the health care centre. This is the most important indicators, which helps to indicate about the service quality, which is provided by the healthcare center. 4 Labor cost Ratio This is the measurement of the salary given to every health workers. With the help of this indicator it is possible to evaluate the quality of service provided by patients. 3 Inpatient raw mortality rate This is the statistical measure of the total number of deaths that occurs among the admitted patients of the hospital. Low mortality rate indicates better quality service for the hospital. 4 Revenue per available room: It is the measure of the amount earned from the beds available per rooms. Higher the rate of revenue earned, higher is the rate of success for the healthcare center. 3 Readmission rate This is the indicator of the total number of patients, who got re-admitted in the hospital after getting discharge from the hospital. Higher the rate of readmission, greater is the performance rate of the hospital. 3 Average Length of Stay It is the average length of stay that is calculated by dividing the number of patient admission with same diagnosis related problems. Lower the average length of stay, higher is the chance of success. 4 Claims denial rate It is the measure of the total number of denial faced by the patient while claiming any health service from the hospital. Lower the number of denial rate, higher is the chance of success. 4 Stakeholders Reliability This is the measure of participation, taken by the stakeholders of the hospital. Greater the value of stakeholders reliability, greater in the chance of success for the healthcare center. 3 These indicators are used by the hospital management in order to improve the performance of and also measure the progress they are having in making business. Rating according to the Likert Scale Highly Satisfied Satisfied Neutral Dissatisfied Highly Dissatisfied 5 4 3 2 1 Conclusions In order to provide better health service, it is important for the Eye hospital, which is equipped with the latest forms of medical technology to lower the cost of medical service. It is also the duty of the hospital management to use operational skills in order to implement cost effective forms of treatment. The use of the KPIs is one of the main indicators, which will help to measure the performance level of the hospital. The management of the hospital will use the elements of the KPIs to improve the business performance of the hospital. Reference Andrei, V. and PRISECARU, I., 2014. The use of PESTEL analysis in development of the Romanian geological repository.UPB Sci. Bull. Series C,76, pp.247-254. Balasopoulou, A., Latsou, D., Kousoulakou, H., Michael, N., Mc Kenzie, D., Mair, A., Vontetsianos, T. and Geitona, M., 2016. The use of PESTEL as a change management tool to inform change management of polypharmacy and adherence within SIMPATHY program.International Journal of Integrated Care,16(6). Hussein, H., 2015. Predictors of Patient Satisfaction Among Diabetic Population Attending Primary Health Care Centers at Dubai Health Authority.Quality in Primary Care. Laeequddin, M., Laeequddin, M., Abdul Waheed, K. and Abdul Waheed, K., 2016. Strategic management in cartelized environment: case of Hisham Packaging, Dubai.Emerald Emerging Markets Case Studies,6(2), pp.1-16. Singer, S.J., Hayes, J.E., Gray, G.C. and Kiang, M.V., 2015. Making time for learning-oriented leadership in multidisciplinary hospital management groups.Health care management review,40(4), pp.300-312. Tracey, J.B., 2015. Hospitality HR and Big Data: Highlights from the 2015 Roundtable. Van Durme, T., Macq, J., Anthierens, S., Symons, L., Schmitz, O., Paulus, D., Van den Heede, K. and Remmen, R., 2014. Stakeholders perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms.BMC health services research,14(1), p.1. Wagner, C., Groene, O., DerSarkissian, M., Thompson, C.A., Klazinga, N.S., Arah, O.A., Suol, R. and DUQuE Project Consortium, 2014. The use of on-site visits to assess compliance and implementation of quality management at hospital level.International Journal for Quality in Health Care,26(suppl 1), pp.27-35. Yksel, I., 2012. Developing a multi-criteria decision making model for PESTEL analysis.International Journal of Business and Management,7(24), p.52.