Bridge

The ingeniousness and beauty of Roman architecture has not been lost on us in the 2000 years since it was built. Even today, we still marvel at what incredible builders the Romans were, and at the sheer scale and integrity of many of their projects. It is hard to argue that today’s architecture will maintain the same lasting grandeur as that which the Romans built. If we can still respect and admire the grandeur of Rome as it was in it’s day, one can only imagine how much of an influence people of the time felt, due to the incredible innovations that the Romans brought to the new regions of their empire.

In fact, it is because of the superior engineering skills and architectural ideas possessed by the Romans, and respected by others, that allowed them to conquer, influence and rule such a vast area of the world, for such an extended period of time. Citizens of regions conquered by Rome were the beneficiaries of Roman innovations such as a (public) fresh water supply, bridges over previously impassable rivers, roads linking all parts of the empire (especially to the capital) and incredible public buildings like the forums and baths.

They were more easily persuaded into acceptance once the Romans arrived when they saw or heard of these innovations which they realized could have such a huge and beneficial impact on their lifestyles. The first thing the Romans did upon entering a new region, after winning the war that gained them their new territory, was construct roads and bridges. This was the best way to “Romanize” the new areas, as it permitted easier communication between the colony and the mother country.

The roads all led to the capital, which solidified its position as the centre of power, and also allowed the rulers easier and faster access to the colonies when necessary. It has been said that at the peak of Rome’s power, one could travel from the English Channel all the way to Rome without ever fording a stream, simply because the Romans had built so many bridges to link its colonies. As the Romans were the first to master bridge building on such a large scale, they had a huge influence on the people in even the most remote regions. Places that had been impassible could suddenly be crossed by bridge.

The bridges were a commanding presence on the landscape as well, easily conveying the sense of who was in power and influencing the people of the region. The Puente Alcantara in Spain can perhaps best show the expansive influence that the Romans held through their bridges, (Images 1 and 2). Built in AD100 and still standing today, Puente Alcantara reaches 164 feet at its highest point, is 600 feet long and has ps of 92 to 98 feet wide. Such an example of architecture so far from the centre of power is a lasting monument to the influential power once held by the Romans.

People were drawn into conformity when they saw the superior skills of the Romans, who also perfected pile driving for the construction of bridges and built each bridge arch as self-supporting to avoid damage to the entire structure if only one portion was damaged. The Roman use of the arch itself, which had never been used to such a great extent before, is itself the main reason they were able to build the huge and influential structures that they were. The use of the arch was of course not limited to bridges; it was common in all Roman architecture of the time.

The next major use for it in the new colonies, however, was in the construction of a water supply system—the system of Roman aqueducts. Rome already had an extensive system of aqueducts to supply the city with fresh water, and the Romans used the same system in other regions to civilize the “barbarian” tribes they had just subdued. Such a system was unheard of in other civilizations. The Romans were a very sanitary and hygienic people to whom fresh water was very important. The new colonies had never been concerned about such sanitation.

The Romans, however, were able to bring fresh water to the towns from long distances away by carrying it through tunnels and over valleys with their towering aqueducts. This water was then used for the public baths and toilets, besides the expected drinking water. The fact that this water was for the public, and not reserved for private use, pleased people in the new colonies even more, and made them even more accepting of Roman control. The actual aqueducts themselves, built by the Romans to carry the water, were perhaps even more influential.

Aqueducts like Pont du Gard at Nimes (Images 3 and 4), or Segovia in Spain (Image 5), the latter of which still carries water today, were monumental landmarks in the colonies where they were built and still are today. That the Romans would build such magnificent and monumental structures for the sole purpose of supplying water to its colonies was likely overwhelming to those benefiting from it. So the Romans supplied the towns with water, and made travel between towns easier. But what about improving life within the town itself?

It is in the public buildings such as the bath, the forum and the amphitheater, which people used and experienced daily, where Rome was able to exert its greatest influence. The fact that these buildings were open to all and not reserved for an elitist group of society only increased their significance. It is arguable that the grandness of the baths has yet to be surpassed in any public building since. These were huge, lavishly ornamented structures where citizens would go not only to bathe, but also for sports, club-life and exhibitions of art.

The baths acted as a community centre, uniting citizens in the towns in which they were located. There was also the Roman invention of the forum, today’s equivalent of which would be city hall, the law courts, a marketplace and a church all combined in a single structure. It was a novel idea that one could go to a single building at the centre of town and find everything they needed. People were also allowed open discussion here and were able to publicly voice their opinions and socialize with fellow citizens.

However, the forum’s accessibility and openness should not hide the fact that it was used by the Romans as a control centre, where legislative duties for the town were carried out, giving Rome further influence over the citizens. The amphitheaters cannot be forgotten, as they were used by the Romans to please and placate people through the presentation of spectacles. Their architectural grandeur was also influential, however, as they were usually four stories tall, could be covered by a canopy, and were the size of two theatres put together.

The Romans didn’t build the public buildings just for their own good, they were used to show “who’s boss” and keep people appeased. These buildings were superior to anything else that had been or was being built, which helped Rome keep the territory it had conquered. It is still difficult to comprehend that the Romans were able to create an empire as vast and as powerful as they did. Lasting several centuries and covering Europe, Asia Minor and Northern Africa and even overtaking their historical enemies the Greeks, their empire was of a magnitude that has been unsurpassed but often dreamed. When we look back at how they chieved such widespread influence there is no doubt that the principal factor in their achievements was due to their superior skills in architecture and engineering of the day. They brought fresh clean water to the towns and cities they conquered using the aqueducts which are still inspiring and influential monuments today. We can only imagine the significance they held 2000 years ago. As Frontius said of the aqueducts, they are “…a signal testimony to the greatness of the Roman Empire. ” The water brought by the aqueducts was then distributed to the public and used in even more magnificent structures like the baths.

How could people not be influenced by such great inventions as these and the forum and the amphitheater, which were used by the Romans not only to please the people but also to help maintain power? The Romans built bridges and roads to link their new colonies and built them so they were a lasting and powerful presence. These bridges were not just a show of power in their grandeur, but were also used by the Romans as quick access to the colonies they needed to keep under control. People of the world were not nearly as advanced in terms of the engineering ability of the Romans, and were persuaded to accept Roman rule.

They respected and admired the Roman’s superior abilities and innovations and were therefore easier to conquer and less likely to revolt, allowing the Romans to expand their empire and maintain their influence for such a long time. The Romans no doubt improved their quality of life upon conquering them, and it is hard not to accept a new ruling class if such improvements are occurring. The greatness of the Roman Empire as it was is a direct result of the fact that they were such superior engineers and architects.

A View from the Bridge – Notes “Just remember, kid, you can quicker get back a million dollars that was stole than a word that you gave away. ” Eddie speaks this quote in Act I, while eating dinner with Beatrice and Catherine. This quote reveals the irony and madness of Eddie’s character. In the beginning of the play, Eddie tells the story of a young boy who called immigration on his relatives. Eddie lectures Catherine about how they must tell no one about Marco and Rodolpho, the illegal immigrant cousins the family will be hiding. However, in the end of the play, Eddie obviously calls Immigration on these cousins, just like the boy.

Miller sets up Eddie so vehemently against betrayal that his transition to the betrayer seems illogical. The set-up requires Eddie to undergo a drastic change, if not complete breakdown, within the play to make such a transition. The force of this transition reveals no only his self-destructive madness, but the deepness of his unspoken love for his niece. This quote also reveals that Eddie knows his own fate—he knows what will happen to him, but cannot escape his fate. Much like Alfieri, Eddie watches himself make decisions he knows will not only ruin his reputation in the community, but also possibly kill him.

Eddie may know the consequence of what he does, but remains powerless or too mad to stop it. “His eyes were like tunnels; my first thought was that he had committed a crime, but soon I saw it was only a passion that had moved into his body, like a stranger. ” In this quote, found in Act I, Alferi describes Eddie’s appearance at their first meeting, to the audience. Alfieri almost seems to fear Eddie as a paranormal beast, a remnant of the great Greek or Roman tragedy. Alfieri truly believes that Eddie was possessed with, “passion that has moved into his body, like a stranger,” and was unable to control him.

The passion that Alfieri describes is the passion for his niece Catherine. The passion, unreleased and suppressed in his unconscious was a stranger to Eddie’s conscious self that actively denied any thoughts of incest or otherwise. This quote also reveals the style of Alfieri. Alfieri tells the tale of Eddie Carbone as if he is a legend. Eddie is described with dramatic and literary descriptions that are unusual in the dramatic form. “Eddie: Then why—Oh, B.! Beatrice: Yes, yes! Eddie: My B.! ” This quote occurs at the conclusion of the play and is spoken between Eddie and Beatrice.

As Eddie lies dying in Beatrice’s arms, the couple finds some sort of reconciliation and repair of their torn and battered relationship. Beatrice, even under such horrible circumstances, is able to forgive Eddie. Eddie constantly dominates Beatrice throughout the play, but in this tiny moment Eddie needs Beatrice more than she needs him. It is the first time the audience hears that Eddie needs and it is the first time that he honestly needs Beatrice. Beatrice is the tirelessly forgiving character of the play. She is terribly jealous of her niece, who receives more attention from her husband than she does, but still forgives Eddie in the end.

This final scene was one of the major alterations of the revised script of A View from the Bridge. In the original version, Eddie dies at the feet of Catherine. However, because of Beatrice’s increased presence in the revised version and downscaling of the relationship between Eddie and Catherine—Eddie must return to Beatrice. Beatrice is the only female who, in the end, needs him. Catherine, now beyond his control, no longer seeks his approval. Thus, Eddie is drawn to Beatrice and for the first time he seeks out Beatrice, her forgiveness and love. “Beatrice: You want somethin’ else, Eddie, and you can never have her! ”

This quote, spoken by Beatrice in the conclusion of Act II to Eddie, is the first time that Eddie seems to realize his true feelings for Catherine and recognize his own madness. Until this moment, no one has directly spoken about Eddie’s feelings for Catherine. Although they are obviously known by Beatrice and Alfieri, know one has dared to actually tell Eddie what is wrong with him. But even when Eddie realizes his demon, the love for his niece, he is powerless to stop it. Eddie lunges forward and attempts to kill Marco. In this moment of Sicilian revenge, Eddie cannot pull himself back or regain any sense of reason.

Perhaps even the recognition of the sexual taboo makes Eddie even more determined to seek revenge or at least find some sort of success or honor in his death. Eddie does not even have the power to deny Beatrice’s claim, but instead follows through his destructive path. This moment may bring Eddie out of his madness enough to lie in Beatrice’s arms as he bleeds to death. Once he has recognized his sinful love for Catherine, Eddie seems to find himself once again—which may explain why he is able to reconcile his relationship with Beatrice. “Most of the time we settle for half and I like it better.

Even as I know how wrong he was, and his death useless, I tremble, for I confess that something perversely pure calls to me from his memory—not purely good, but himself purely And yet, it is better to settle for half, it must be! And so I mourn him—I admit it—with a certain alarm. ” This quote deals with the central conflict of A View from the Bridge: the self will verses the will of the community. The whole man that Alfieri describes in Eddie is the self-interested man. Eddie’s actions within the play are completely motivated by his own desires at the expense of others.

Thus, humans must act halfway to preserve the rules of the community and lives of others. The idea that Alfieri suggests, that Eddie acted as a whole person, unrestrained and uninhibited is true. However, Eddie’s wholeness was at the expense of his own family and eventually himself. He only escaped restraint because he escaped consideration of other people or the community at large. Eddie’s wholeness is a whole interest in his own life. His tragic flaw is this self-interest—a flaw that seems both admirable and alarming to Alfieri. Themes The irrational human animal pic][pic]Eddie looses control of his actions in the play. Driven and possessed by incestuous love for his niece, Eddie resorts to desperate measures to protect his identity and name in the community. Alfieri’s commentary often remarks on this theme. Alfieri seems constantly amazed by Eddie’s actions and his own reactions to the events of the play. Alfieri sees his own irrational thinking, just as he recognizes Eddie’s irrational behavior. Irrationality is also how Alfieri defines acting wholly. The human animal becomes irrational when he acts fully on his instincts—just as Eddie does in the play.

Alfieri proposes that humans must act as a half, or restrain some of our instinctual needs or wants for reason. Nonetheless, Alfieri still admires the irrational—the unleashed human spirit that reacts as it will. Allegiance to community law There is great conflict between community and American law in the play. The community abides by Sicilian-American customs protects illegal immigrants within their homes, values respect and family, is hard working and know the shipping culture, has strong associations with names, believes in trust and wants revenge when a member has been wronged.

Some of these values, however, come in conflict with those of the American system of justice. Eddie Carbone chooses to turn against his community and abide by the state laws. He looses the respect of his community and friends—the name and personal identity he treasures. Eddie Carbone, with a stronger allegiance to the community, reverts back to another custom of Sicilian-Americans: revenge. Not only is Eddie pulled back to the values of his community, but the final victor of the play is symbolic of community values—the Italian, Marco. Thus, the small community is stronger than American law.

Motifs Homosexuality Although specifically articulated, homosexuality or what makes a man “not right” is a persistent theme of the novel. Eddie obviously identifies Rodolpho as homosexual because Rodolpho sings, cooks and sews a dress for Catherine. Eddie also questions Rodolpho because he does not like to work and has bleach blonde hair that makes him look more feminine. Eddie gives Rodolpho several tests of his masculinity. In the first he teaches Rodolpho how to box and the second, more blatantly, Eddie kisses Rodolpho on the lips.

Many critics think that this kiss is a sign of Eddie’s own suppressed homosexual feelings, an easy parallel with his kiss with Catherine. Miller seems to take no stand either way, and the sexuality of Rodolpho or Eddie is unclear. However, the stereotypes of the gay man and societal implications of being gay are obvious. Louis and Mike, when talking about Rodolpho, clearly think there is something wrong with him and Eddie speaks directly to Alfieri about the specific things that bother him about Rodolpho. Womanhood The idea of what makes a woman or what defines a woman is very prevalent in the text.

Catherine and Beatrice talk specifically about the terms in their conversation in Act I. Beatrice thinks Catherine needs to grow up and become a woman. To do this she needs to decide by herself whether she wants to marry Rodolpho. She needs to stop walking around the house in her slip in front of Eddie, and not sit on the edge of the tub while Eddie shaves his beard. In essence, being a woman means reserve and modesty in front of men, and independently making decisions. The idea of independence or separation from Eddie is coupled with the decision to find another male to attach to, a husband.

Catherine’s attempt at womanhood is deciding to marry Rodolpho and follow his rules rather than Eddie’s. Community Community is a powerful context for the play; it dictates very specific norms and rules for the family that controls the actions of the characters. All of the characters are forced to reconcile between American culture and the Italian community culture that surrounds. The cultural and moral difference between the two provides one of the great conflicts in the play. The tight community around them also creates great tension in the Carbone family because they are constantly being watched.

The neighbors knew when Marco and Rodolpho arrived, saw Marco spit in Eddie’s face and Eddie die by Marco’s hand. The community is the watcher; the group controls and monitors the behavior of every member. Although Eddie takes a substantial turn away from the community by calling the Immigration Bureau, he still needs acceptance and spends his last moments fighting Marco for his good name in the community. Symbols High Heels [pic][pic]For Catherine, high heels are representative of womanhood, flirtation and sexiness.

She has just started wearing high heels around the community and to school and obviously enjoys the attention she gets from men. They are also symbolic as a rite-of-passage to womanhood. As Eddie strongly disapproves of her wearing them, Catherine purposefully rebels against her uncle every time she puts them on. The high heels give her sexual power over men—they look, stare and gawk at her beauty. Eddie thinks the heels are threatening for the same reasons Catherine loves them. Eddie is fearful that, if she looks attractive, some man will ask her out and she will leave the house.

Eddie has a powerful reaction when she wears the high heels, as if she must take them off so they do not arouse him or anyone else. Brooklyn Bridge The Brooklyn Bridge is symbolic of a pathway of opportunity to Manhattan and also the linkage between American and Italian cultures. The bridge, which is very close to the Red Hook community, is a constant reminder of American opportunity and industry. From the bridge, one can see the community below and, like the title of the book, one can see the entire community and seek greater abstract meaning from his viewpoint.

Alfieri is symbolic of the person on the bridge looking down upon the Red Hook community or, perhaps, he is the bridge himself, allowing the people to cross into Manhattan and modern, intellectual American culture. Alfieri attempts to unite the American laws with Italian cultural practices and negotiate a place in between the two. Alfieri, narrating the story from the present looking back to the past, has the same vantage point as one looking from the bridge. After some time passes, he is able to process the events and see the greater societal and moral implications it has for the community as a whole. Italy

The origin of the majority of the people in the Red Hook community, Italy represents homeland, origin and culture. What the country means to characters greatly varies. Catherine associates Italy with mystery, romance and beauty. Rodolpho, on the other hand, is actually from Italy, and thinks it is a place with little opportunity that he would like to escape from. All of the characters, as much as love the benefit of living in the U. S. , still strongly hold to Italian traditions and identify it as home. Italy is the basis of the cultural traditions in Red Hook and unites the community in common social practices and religion.

Abstract: A novel three-point method using a grating eddy current absolute position sensor (GECS) for bridge deflection estimation is proposed in this paper. Real spatial positions of the measuring points along the p axis are directly used as relative reference points of each other rather than using any other auxiliary static reference points for measuring devices in a conventional method. Every three adjacent measuring points are defined as a measuring unit and a straight connecting bar with a GECS fixed on the center section of it links the two endpoints.

In each measuring unit, the displacement of the mid-measuring point relative to the connecting bar measured by the GECS is defined as the relative deflection. Absolute deflections of each measuring point can be calculated from the relative deflections of all the measuring units directly without any correcting approaches. Principles of the three-point method and displacement measurement of the GECS are introduced in detail.

Both static and dynamic experiments have been carried out on a simple beam bridge model, which demonstrate that the three-point deflection estimation method using the GECS is effective and offers a reliable way for bridge deflection estimation, especially for long-term monitoring. Keywords: three-point method; deflection estimation; relative deflection; absolute deflection; grating eddy current sensor (GECS) OPEN ACCESS Sensors 2012, 12 9988 1. Introduction. After a bridge is put into use, gradual deterioration is inevitable because of loading, temperature changes or other environmental factors. In order to guarantee the safety and durability of those bridges which are expensive and closely related with people’s livelihood, long-term and continuous structural health monitoring is an essential part of the maintenance management. Among the various structural performance evaluations, vertical deflection is an important parameter that can directly and effectively indicate a bridge’s behavior.

In terms of instrumentation for deflection estimation, there are contact and non-contact deflection estimation methods. Traditional displacement sensors such as mechanical dial gauges or linear variable differential transducers (LVDTs) are used in contact measurement, through which static or real-time displacement values can be obtained directly or fed into a computer for processing and displaying via a data cable. This method, however, requires access under the bridge and installation of a temporary supporting system to mount sensors, which is time consuming and not very efficienct.

In addition, it might even be unavailable when bridges are over rivers, highways or have high clearance. Another contact sensor is the fiber optic Bragg-grating (FBG) sensor through which the deflection is calculated from the measured strain data and displacement-strain relationship [1,2]. In this way, however, the calculated displacement from strain data is sensitive to noise, and the sensors are expensive and must be embedded into the structure, which to a certain degree is difficult for bridges in service.

To cope with those inconveniences in contact measuring methods, various non-contact approaches have been proposed. Based on the detection of the Doppler shift of the laser light, a laser Doppler vibrometer (LDV) equipped with displacement and velocity signal decoders can measure both bridge deflection and vibration simultaneously [3]. In this way, a static reference point (usually underneath the bridge) is needed for device mounting, and the device should be attended, which limits it’s usability for long-term monitoring.

Among image methods, dynamic deflection with high resolution of the bridge can be obtained through using digital image processing techniques [4], while deflection distribution from the images of the bridge girder surface recorded by a digital camera before and after deformation can be evaluated by digital image correlation techniques [5], and digital close-range terrestrial photogrammetry (DCRTP) can measure the spatial coordination in three-dimensions [6,7].

Like the LDV, devices such as video cameras used in image methods cannot be left unattended and they are easily affected by weather conditions. Use of a Global Positioning System (GPS) can provide spatial locations of the measuring points on the bridge in real-time by comparing with a continuing operational reference station (CROS). It offers a long-term monitoring approach without being affected by climatic factors [8,9], but due to its relatively low accuracy, it is only applied to those bridges with significant deformations.

All the non-contact methods mentioned above, although they differ in instrumentation, have one thing in common, a static reference point or CROS that is kept a certain distance away from the bridge is selected for installation of the measuring device, otherwise measurements cannot be carried out. Another method is using inclinometers which can be installed on the bridge directly along a line paralleling the bridge p axis [10,11], and both static and dynamic deflection time history curves can be calculated through curve-fitting technology based on the accurate angle records of the inclinometers.

An outstanding feature of the inclinometer is that static reference Sensors 2012, 12 9989 points mentioned above are no longer needed. This approach reduces the dependence on environmental conditions and it is suitable for long-term monitoring. To avoid those deficiencies in conventional estimating deflection methods mentioned above, a novel three-point deflection estimation method is presented in this paper. Measuring points along lines paralleling the bridge p axis are chosen equidistantly.

Among these measuring points, every three adjacent measuring points are defined as a measuring unit in which a straight connecting bar linking the two endpoints is taken as a relative reference line. Relative deflection of the mid-measuring point relative to the intermediate point of the connecting bar on which a displacement sensor is fixed can be measured, and thus the absolute deflection of each measuring point can be calculated from the relative deflections of all the measuring units.

Compared with the contact and non-contact methods mentioned above, only real spatial positions of the measuring points are taken as relative references without any other static reference points. Moreover, the selected displacement sensor is the grating eddy current absolute position sensor (GECS) which is different from traditional eddy current sensors based on vertical characteristics [12,13]. Since the structure of grating reflective conductors is adopted, the measurement range is extended but without compromising the accuracy.

In addition, as an inductive sensor, the GECS is waterproof and dustproof in principle, thus it can work under bad weather conditions, which makes it ideal for long-term monitoring. In this paper, both the principles of the three-point method and displacement measurement of the GECS are presented. Then, this three-point method for deflection estimation is verified in a simply supported girder bridge model in the laboratory. Comprehensive static and dynamic experiment results on the laboratory tests demonstrate this method is effective and offers an alternative way for bridge deflection estimation.

Unhappy Ending I think that the outcome of Ambrose Bierce’s story, “An Occurrence at Owl Creek Bridge,” was credible because Bierce hints that Peyton Farquhar, the main character, is dead throughout his journey. If the reader pays close attention to the story, it becomes obvious that the escape is imagined and he is actually going to be hanged. The first piece of evidence that Farquhar is hallucinating is how unaware he is of his own struggle to free himself underwater.

Farquhar states that “he was not conscious of an effort, but a sharp pain in his wrist [told] him that he was trying to free his hands” suggesting that he isn’t actually aware of his own attempts at escape (Bierce 493). Some may argue that Farquhar wasn’t aware of his effort because he had an adrenaline rush, but the injuries are too close to the injuries of a hanging to be ignored. The second piece of evidence that Farquhar didn’t escape is the pain in his neck and head.

As he is fighting to get free, Farquhar describes how “his neck ached horribly; [and] his brain was on fire” (Bierce 494). A person struggling at the end of a hanging rope would experience the same pain. He simply imagines breaking free as he dies, but in reality, the intense pain is caused from the noose tightening and eventually choking Farquhar. His freedom swim is clearly a dying dream. The third piece of evidence that proves that Farquhar imagined his freedom is the unbelievable detailed description of nature.

There is no sort of adrenaline rush that could show the “prismatic colors in all the dewdrops upon a million blades of grass” just for Farquhar (Bierce 494). It is more probable that Farquhar imagined his escape right as he strangled to death. In conclusion, the ending of “An Occurrence at Owl Creek Bridge” was credible and powerful because it hints to the reader that Farquhar doesn’t survive and merely dreams of the beautiful escape from his horrible fate.

Introduction

The London Bridge Hospital has many facilities like air conditioned rooms that ensure that the patients are comfortable while receiving treatment at the hospital. It is easily accessible from both the city and the southern counties. The London Bridge Hospital just like other hospitals within the United Kingdom is a large and complex organization that heavily relies on different strategies to provide good care to the patients. Healthcare operations management as a discipline integrates both qualitative and quantitative aspects of management in determining the most optimal and efficient methods of offering support to the patients in the hospitals (Teoh, Pan & Ramchand, 2012, p. 588). The London Bridge Hospital uses operations management methods and strategies in understanding and improving labor productivity, shortening cycle times, improving the overall experience of patients, and reducing waiting lines. All these contribute to the overall financial health of the hospital.

Operational methods and strategies in the Healthcare Industry

In the healthcare industry and in particular hospitals, healthcare operations is a summation of all the functions that allow the hospital staff to offer their services to the patients in the best possible way. Chahal (2010, p. 362) says that the various transformations going on in the healthcare industry across the world are driving the people working in hospitals and other healthcare facilities to also adopt the reforms in their daily operations. The management of the London Bridge Hospital is aware of the fact that operational efficiency is critical to the success of any business organization. This is particularly so because the opinions developed by the patients on the hospital plays a big role in determining not only whether they will come back or not but also on the messages that they pass to their peers who are also potential clients to the hospital (Stock & McDermott, 2011, p. 145).

The London Bridge Hospital faces many different challenges that range from resource utilization, improvement of care, to lowering the costs to the patients. Reduction of the bottlenecks and implementation of solutions to the common problems are vital in ensuring the success of the hospital in both the short and long run. The hospital has both internal and external customers. The external customers of the London Bridge Hospital are the patients and other people who visit the hospital and its other premises for help. In particular it includes the patients, their friends, family members or any other representatives. Harper (2002, p. 169) says that the internal customers on the other hand are the facilities and the hospital staff. The employees of the hospital often buy products like medicine from the hospital store, come for treatment whenever they get sick and refer their friends and relatives to come to the hospital. The latter category of customers is very important in determining the success or failure of the hospital as they are not only customers of the hospital, but also offer service to the external customers. This is why the management of the London Bridge Hospital does its best to ensure that its employees are well remunerated and have good working terms.

As already outlined, the external customers are the people receiving services from the hospital. These customers expect the hospital staff to adapt a more personal approach in executing their service and willingness to keep them happy. The internal customers on the other hand expect that the different departments in the hospital should function efficiently in order to improve their work experience. For example, the central department should always ensure that all the instruments used in patient care are properly sterilized and stored in their right places (Dwyer et al 2010, p 519). They should also ensure that the doctors get the right instruments when they need them. This is an important department in the hospital as the nurses, other hospital staff and doctors depend directly on it and its efficiency has a direct impact on the external customers.

Operational objectives

Healthcare operations management as a discipline integrates different principles of scientific management in determining the most optimal and efficient methods in supporting the delivery of care to the patients. Although the London Bridge Hospital does not have a department named operational management, most of the positions in the hospital involve roles of coordination and execution of different operations. Nearly 85% of hospitals are nonprofit in nature as they are there to serve the community in which they operate (Dey, Hariharan, & Clegg, 2006, p. 861). Some nonprofits hospitals are often exempt from paying some taxes and are not required to continuously show positive growth rates or large profit margins like is done by most publicly traded companies. However, if a hospital fails to show positive return on the capital invested then there will be negative consequences on the economy. For instance, if a hospital fails to show reasonable margins, then the public bond market (the public bond market finances most of the healthcare growth today) will likely record sub-par credit ratings. Sachdeva, Williams & Quigley (2007, p. 162) claim that the consequence of this is that the bonds will have poor yields hence rendering the hospitals less than stellar investments for bondholders.

The limited profit margins imply that there will be little money to invest back in the business to ensure that the buildings are updated, technology innovated, equipment replaced and clinical programs continue to expand and be enhanced. Without the investments, the hospitals will lose the ability to attract the most qualified administrators and physicians and the downward spiral will continue. While some healthcare systems and hospitals at times wait for changes in public health policy to save them, some competitive and successful ones like the London Bridge Hospital act in advance in order to save their margins. The current economic climate is characterized by perpetual pricing pressures that affect the top of the line income statement. In fact more than 50% of all hospitals report negative profit margins (Sinreich, & Jabali, 2007, p. 301). This is why it is essential for hospitals to start looking forward toward more sophisticated business strategies in order to succeed. The London Bridge Hospital uses differentiated marketing strategies and programs, long term planning on service lines and broader use of advertising in order to be able to succeed in its business operations. It does this in tandem with adopting broader logistical and operational techniques into the business affairs of the hospital.

The London Bridge Hospital monitors and maximizes labor productivity for all the medical support and allied health professionals as a way of maintaining salary expenses. The other strategies that other hospitals have adopted but are not currently in use by the London Bridge Hospital include:

Incorporation of methods of scheduling optimization and queuing theory to eliminate time wastage and cycle time out of hospitals.
Incorporation of techniques of logistical and supply chain in reducing operational expenses.
Elimination of excess safety stocks.
General improvement on the management of the working capital.
Use of technology in the automation and streamlining of all the hospital operations to reduce operational costs and maximize efficiency.

The hospitals and other healthcare organizations cannot depend on the extrinsic factors like shifts in managed care market structures and health policy as tools for changing their margin potentials. Although the macro level issues are important, the organizational and micro economic issues are more important as they have a strong and direct impact on a particular organization. In fact all the microeconomic issues are a function of operational management. As such, operational management is a set of intrinsic decisions and processes that assist in addressing productivity, costs, process and technology (Ford et al 2004, p.26).

Healthcare is a primary service sector because the industry provides intangible goods to the customers. The goods here cannot be seen or touched. The services provided by the London Bridge Hospital and other hospitals in the industry are somewhat unique, differentiated, knowledge based and have high levels of customer interaction (Teoh, Pan, & Ramchand, 2012, p.588). There are also physical goods that accompany the service in the hospitals which the supply chain procures and replenishes. The hospitals also store medical supplies and pharmaceuticals. Therefore, in this regard hospitals have a mix of both tangible and intangible characteristics. It is these attributes that make operations management in hospitals a little different from those of other industries that strictly produce physical goods.

It is in this regard that Harper (2002, p 171) defines healthcare operations management as the quantitative management of processes and supporting business systems that transform resources (inputs) into healthcare services (outputs). Inputs in this case refer to the resources and assets like equipment, labor, technology, cash, personnel and space. The outputs include actual production and delivery of healthcare services. Quantitative management uses extensive quality improvement techniques, optimization and analytical tools to drive improved results. Healthcare operations management integrates quantitative or scientific principles in determining the most optimal and efficient methods of supporting patient care delivery.

Functions of Healthcare Operations Management

Healthcare operational management is a relatively new field in healthcare although it has been in existence in the other industries for many years. Its scope includes all functions related to business processes and management systems that underlie clinical care. It includes physical labor, physical network optimization, workflow, process engineering, supply chain and logistics management, capacity design, staffing and productivity management (Lorence & Jameson 2002, p 749). The healthcare operations and logistics management includes all the business functions that provide job opportunities for the people like administrators, operations supervisors and scheduling manager.

Operations Management Objectives or Issue to consider
Workflow processHow many manual processes exist?

Are there ways of reducing steps, cycle time and choke points for the key processes?

Can we improve speed and patient satisfaction?

Are there too many departments or people performing the same task?

Capacity design and planningHow to reduce bottlenecks to improve the experience of patients?

In which case to increase the use of technology to improve labor productivity?

Staffing levels and productivity managementHow much output to expect from the employees?

Have we maximized the use of automation and electronic commerce in increasing productivity?
Quality, planning and process improvementDo we know how to compare the key competitors?

Do we use advanced tools for tracking projects?

Have we identified the quality issues that affect the goals of customer satisfaction and efficacy?

Physical layoutAre the hospital facilities designed with the consideration of traffic flow, operational efficiency and consideration of speed?
Physical network optimizationHow to strategically utilize vendors and their facilities

Where to strategically position the different facilities like pharmacy satellites, supplies and warehouses in order to minimize costs and resources.

Supply chain and logistics managementHow much inventory needed at a particular time

Whether or not to use perpetual inventory in ensuring stringent internal controls and accurate financial reporting

Have we built collaborative planning and forecasting processes to standardize items and reduce total costs?

The goals of operational management

The operational management team in the hospital is tasked with different goals and functions in the hospital that include reduction of variability, costs, improve logistics, business processes, productivity, flow of logistics, and quality of customer service. These are explained in more details in the following sections

Reduce costs

The primary role of operational management is to take out the costs of the healthcare system. It finds waste, improves utilization, stabilizes and reduces the overall costs of service delivery. A hospital that has an appropriate management and tracking system with the ability to isolate material, personnel and other resources utilized for delivery of care is more likely to reduce the costs of operation because it has a good understanding of the underlying cost structure (Teoh, Pan, & Ramchand, 2012, p. 591). Once the costs have been identified and all unnecessary wastes eliminated then an organization can operate efficiently.

Reduce variability and improve the flow of logistics

The operations management team should continually look for more efficient and optimal ways of moving both physical and information resources. This should go together with reducing variability. Chahal (2010, p355) defines variability as the inconsistency or dispersion of inputs and outputs. Variability disrupts processes because it leads to uncertainty, too few or many resources and inconsistent results. For instance, if there are 30 patients seeking treatment in a certain hospital within a specific period, and then in the following period the number doubles or triples it creates problems for the employees in terms of controlling waiting times and general management of patient flows. An improvement in flows means higher yields or throughput with the same level of resource input. Shapiro & Shapiro (2003, p246) define throughput as the velocity or rate at which goods are delivered or services performed. In the hospital situation, if a hospital attends to ten patients per hour and can increase the number to 15 per hour then this represents a 50% improvement in throughput and logistical flow (Miller, Sumner, & Deane, 2009, p. 156).

In the same manner, if the number of patients in the hospital doubles and the hospital manages to maintain the same historical inventory levels of pharmaceutical supplies then this is a significant improvement in material flow owing to the higher level of capacity utilization. Resource consumption and staffing should be directly tied to workload and patient volumes (Cowen, 2008, p.410). If the number of patients increases the quantity of the resources should equally increase. Good management of this variability allows a change in staffing mix and scheduling to accommodate the changes without staffing at the low points, valleys or peaks.

Improve Productivity

Improving productivity means looking for higher levels of output from all employees and other assets. This ensures that the hospital is operating optimally with high levels of efficiency by not only eliminating bottlenecks but also making efficient use of the available resources within the organization (Leury, Jean-Louis, & Sicotte, 2003, p58).

Improve the quality of customer care

Improving quality means reducing medical errors and improving the safety of the patients. Additionally, constant improvement and maintenance of high quality service levels in terms of both patient care and other business services like admissions and cafeteria is also important. In the healthcare industry just like other industries, higher quality services leads to the ability to secure higher prices and this has the effect of driving an increase in operating margins and market shares (McCue & McCluer, 2008, p 36). Ensuring an improvement in the patient satisfaction levels and reducing waiting and response times simultaneously ensures that the patients get higher quality services.

Continuously improve Business Processes

In the highly structured organizations like hospitals, business processes often tend to be unique in all departments as they are not integrated or highly cross functional. For example the operating room of a hospital may handle the procurement of a certain good in a certain way while the gynecology department of the same hospital handles it in a totally different way. Miller, Sumner, & Deane (2009, p. 110) assert that in large hospitals most departments operate as independent businesses which lead to multiple problems of efficiency. This is where operations management comes in as it ensures that efficiency and effectiveness are greatly improved in the organization.

Recommended Changes

From the analysis it is clear that the London Bridge Hospital is performing fairly well in terms of operational management although there are areas that the hospital management needs to work on in order to improve the general performance of the organization. First off the hospital should incorporate methods of scheduling optimization and queuing theory to eliminate time wastage and cycle time out of hospitals. Efficient scheduling and queuing methods will improve the experience of the customers by eliminating unnecessary time wastage. The hospital should also incorporate techniques of logistical and supply chain as a way of reducing operational expenses.Improved logistics and throughput in the hospital will increase the workflow and overall capacity (Noon et al 2003, p97). The London Bridge Hospital should tie staffing and resource consumption directly with workload and patient volumes. This will ensure that if the number of patients increase, then the number of resources should equally increase as a response. Once the hospital manages to efficiently deal with the variability in the number of patients, it will have created a change in the staffing mix and scheduling to accommodate any changes. Staffing at the peaks leads to excessive costs whereas staffing for the valleys leads to periodic long lines because of the limited resources. The success or failure of the hospital depends directly on its readiness to cope well with the valleys and peaks without disrupting the normal flow of operations. This is where technology comes in as it automates most if not all of the manual processes. It also improves transaction processing capabilities and the quality of analysis, reports and organizational decisions. This will alter all the economics of the hospital because mechanization allows for faster production and delivery using relatively less resources. Substituting capital or technology for labor especially in the department of business support services will reduce transactional and processing costs in the long run. As such, the role of technology in enhancing productivity is one which the London Bridge Hospital should take into consideration.

Conclusion

Although operations management is a relatively new phenomenon in the healthcare industry compared to the other industries, it is important to the industry because hospitals face the same challenges just like the other business organizations. The London Bridge Hospital is already making use of most of the principles of operational management although it still needs to implement some changes in its way of operation as highlighted in the discussion. These changes will ensure that the hospital continues to perform well both in the short and long run. Hospital operational management will help the London Bridge Hospital to deal efficiently with the challenges that it is currently facing. Additionally, this paper has shown that the manner in which the hospital responds to the valleys and peaks is critical to its performance. Hospital operational management has the solution for this as it puts in place mechanisms that ensure that the organization makes optimal and efficient use of its resources to achieve the best results without any shortages or wastages in terms of resource allocation and utilization.

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