Employee Handbook


Prepare

a 260-word document in which you create a representation of actual sections of an employee handbook.

Note: The handbook must be original student content and work.

In addition to describing the company to which the employee handbook applies, also address the issues of privacy, employee or applicant testing, and performance evaluations in the global workplace. This assignment must include, but is not limited to, the consideration of the following questions in drafting your handbook sections:

  • What privacy rights issues must be addressed?
  • What must the company’s position be in response to privacy rights issues?

100 words in length, assess one risk associated with exercise. Support this response with one scholarly source formatted in APA style.

100 words in length, assess one risk associated with exercise. Support this response with one scholarly source formatted in APA style.

The dose-response in exercise refers to the way in which the body will react to varying levels of exercise to reach a certain outcome. Frequency, intensity, type, and duration of the exercise are all contributing factors to the benefits you will receive from performing an exercise. Meaning we can adjust our workouts in accordance with our goals. For example, if the goal is to improve aerobic output, increase the intensity and duration of a chosen cardio exercise, or perform a variety.

Our bodies change physiologically and psychologically when we exercise. Psychologically our mood is improved. Symptoms of anxiety and depression will dissipate, we become more focused, coping with stress is easier, and we have a greater quality of life. Physically, of course we lose weight, muscle strength and endurance is enhanced, our heart enlarges and becomes more efficient, blood pressure decreases, cholesterol levels are balanced, and the risk for disease and illness significantly decreases.

According to the Physical Activity Guidelines, it is recommended that an individual get a either a minimum of 150 minutes (30 minutes, 5 days/week) each week of moderately intense exercise, 75 minutes a week of vigorous-intensity exercise, or a combination of both. Be sure to do a variety of exercise as to target all areas of the body. Once an appropriate personal fitness level is achieved, adjustments to duration and intensity can be made to accommodate the continued health benefits.

References

American College of Sports Medicine. (2014). ACSM’s guidelines for exercise testing and prescription (9th ed.). Baltimore, MD: Lippincott Williams & Wilkins

Office of Disease Prevention and Health Promotion. (2017). Physical Activity Guidelines. Retrieved from https://health.gov/paguidelines/guidelines/adults.aspx

Teresa Jones, the Head of HR for a large telemarking company, was approached by Bob Green, the head of the Communications department of the organization with information obtained through several job b


Teresa Jones, the Head of HR for a large telemarking company, was approached by Bob Green, the head of the Communications department of the organization with information obtained through several job blogging sites.


The feedback was two-fold.  First, there were many comments from job applicants regarding dissatisfaction with the recruitment and selection processes.  Many of the comments had to do with the lack of follow up regarding job status after interviews have been conducted.  Other comments had to do with a general lack of respect for job candidates, including re- scheduling/canceling interviews with little notice, managers not being prepared for interviews and not having accurate job descriptions.


Second, Bob also found comments on various job blogs from either current or former employees that were “venting” about the lack of training and development opportunities, including job progression and a general disregard for employees in general.


Bob then handed Teresa a print out of some of the comments:

·

When I complained about having to continually cover for other people my manager told me, “take it (the job) or leave it, but good luck finding another job in this economy”


actually want me to do, classic “bait and switch”

·

#takethisjobandshoveit

·

After taking the time to interview 3 times, they never got back to me about whether or not they filled the job

·

DO NOT WORK FOR THIS COMPANY, THEY TREATEMPLOYEES LIKE ****

·

Dead end jobs – unless you want to be a telemarketer for the next 10 years, I would avoid this company

·

When I asked about a promotion my manager said, “You’ll move up when I think you are ready to move up, until then, just do your job.  Really inspiring words!

·

I had to take vacation from my current job to interview with this company and when I arrived, they had no idea who was supposed to be interviewing me or for what position.  After waiting in the lobby for 20 minutes, I ended up “interviewing” with a supervisor from another department who wasn’t in charge of the area I was applying to be in, what a complete waste of my time!


After speaking with Bob and reviewing the comments, Teresa became very concerned about the future of the organization.  She had heard similar comments from employees in terms of dissatisfaction with training and development opportunities and also had heard of situations where there were problems with recruitment activities.  Now that the economy was recovering and unemployment was lower than it had been in previous years, the company had begun to see a rise in turnover.   Teresa decided that she needed to address this issue by preparing an action plan to address the issues at her organization.

post your action plan.

This should include

any training and development issues

related to this scenario (hint: consider this from different perspectives/functions).

My action plan is as follows.


Action Plan

To restore order in the organization, there are serious problems where it has poor leadership strategies, lack of customer satisfaction, or even motivation of employees. Other challenges include poor working conditions and failure of use of office etiquette. To restore order, the company’s top management should come up with an action plan that would be used in bringing up reforms on the organization’s culture, have leaders that are reliable and competent every time. The main activities that would be required to do this are as follows:


Activity


Expected results


Actual results


Who performs this task


When is this task due?


Status


Re-Election of leaders–managers

The step of eliminating ineffective leadership. They are replaced by a good manager.

Proper leadership qualities.

The company’s senior staff—the members, would experiment so that they get some idea of who would be best at it.

This task is ongoing.

Pending

Ensure top-notch service delivery.

The organization will investigate the issue of gaining the confidence of the customers, to have as many customers as possible.

The increment of customers and change of reviews to positive ones.

The organization’s top officials, employees, managers.

The task does not require

A given amount of time.

Pending

Ensure employee satisfaction

This would involve making sure that all employees in the organization, are more productive.

The actual results would be an increment in some customers, better employee’s performance.

All members of management and HR.

No due time

Pending

Construction of a good working environment

Even in this case, performance is dependent on various factors, which include being in the working environment.

The relativeincrease in employee productivity.

The management of the organization and HR Management

No due time

Pending

Exercise the rules and policies of an organization.

There would be order in the workplace, without some individuals misbehaving or acting like they do not care.

A conducive working environment would be created.

The management of the organization and HR Management.

No due time

Pending

.

How would you evaluate if your strategies to reduce turnover were

“successful”?

Your response to this question should include applicable

quantitative

and

qualitative

metrics used for evaluation purposes.

This assignment needs references and citations in APA format. Not a term paper. This last half, just above, is what needs answered.

for njosh only

Discussion 1

Discussionn 2

Assignment

In Week Five of this course, you will submit a four- to five-page Literary Analysis in response to one of the topics from the approved List of Writing Prompts. This week, you will choose the topic you would like to explore, offer some information on what interests you about this topic, and supply a working thesis and key ideas you would like to develop. Though it might seem early to choose your topic, with only five weeks in the course, it is important to start early to best set yourself up for success.

After reviewing the list of prompts, choose one that you would like to explore. In addition, you should choose a literary work to discuss that relates to your topic of choice. The suggested literary works for each topic are listed beneath each prompt.

Once you have decided on a prompt and text, respond to the directives below using the Proposal for Final Paper Worksheet. Please make sure your document is double spaced. See the Sample Proposal for guidance.

Helping Process Phases Presentation

PLEASE DO NOT PLAGIARIZE….. PLEASE CITE PROPERLY… I ONLY PAY THE AMOUNT THAT I POST FOR NO MORE DONT ASK!!!

I NEED 3 SLIDES FOR A POWER POINT PRESENTATION. PLEASE HAVE SPEAKER NOTE AND REFERANCES.

Develop 2 to 3 slides about how the helping-process phases can assist a student they selected at Kelsey High School.

Explain how you would use assessment and planning to best support the student with his or her goals upon graduation.

“Needs Assessment and Use of a Specific Type of Needs Assessment” Please respond to the following:•Distinguish between organizational needs assessment and strategic planning, and assess how each can

“Needs Assessment and Use of a Specific Type of Needs Assessment” Please respond to the following:

•Distinguish between organizational needs assessment and strategic planning, and assess how each can be helpful to identify the needs of an organization.

•Review the theories and models described at the Needs Assessment Website located at http://www.needsassessment.org/. Next, using two models or theories from the e-Activity, justify the conditions in which a person analysis would be critical to the development and delivery of effective HRD programs.

Compliance Work – Administrative or Clinical?

Do you think that a Compliance Officer should have a clinical background such as a Nurse or Physician? Or should he or she have an administrative background with experience in management? Before you discuss, search the Internet to review a few job postings for a compliance officer. Which background is best suited for the position and why?

Due dates for your initial and response posts can be found by checking the Course Syllabus and Course Calendar.

Which of the following best define Risk analysis?A process used by the person or the person’s assigned risk management functions to determine the potential severity of the loss from an identified ri

  1. Which of the following best define Risk analysis?

    A process used by the person or the person’s assigned risk management functions to determine the potential severity of the loss from an identified risk, the probability that the loss will happen, and alternatives for dealing with the risk.

    Working with business units to assist the leaders in understanding risk in business transactions

    Advising staff and leaders on the best approach to manage the new or emerging risk for the organization

    Providing leadership to maintain an understanding of the organization’s mission and goals, and defining who is able to provide direction

2 points

QUESTION 2

  1. The purpose of patient safety is to provide a safe environment, to explore the possibility of failure, and to create “defenses” that will change the current system of operation in order to reduce the potential for failure.

    True

    False

2 points

QUESTION 3

  1. Patient safety is about the organizational tactics to fix problems. Focus is on individual case, Post- event investigation, Implement tactics to address the event rather than the system failures, Relationship with legal standard of care, Unexpected outcomes drive the process.

    True

    False

2 points

QUESTION 4

  1. Which of the followings is not a characteristic of board engagement in quality improvement and patient safety identified by the Executive Quality Improvement Survey?

    The board receives a formal quality-performance- measurement report.

    There is a high level of interaction between the board and the medical staff on quality strategy.

    The senior executives’ compensation is based in part on quality performance.

    The board sets clear policies and procedures to guide the medical staff.

2 points

QUESTION 5

  1. Duty of care requires the board to make responsible and informed decisions on behalf of the organization

    True

    False

2 points

QUESTION 6

  1. Duty of obedience is the obligation to further the purposes of the organization as set forth in its articles of incorporation or bylaws.

    True

    False

2 points

QUESTION 7

  1. Medical malpractice, a professional-liability subset of negligence law, has never been criticized on the grounds of inefficiency and poor distribution

    True

    False

2 points

QUESTION 8

  1. Medical malpractice is the longest- standing social- incentive structure that attempts to promote safety in healthcare delivery and represents an ethos of individual responsibility

    True

    False

2 points

QUESTION 9

  1. Which of the following best describe Enterprise Risk Management?

    Enterprise risk management is a comprehensive process which evaluates all risk exposures confronting an organization from the top down.

    Enterprise risk management is a process, effected by an entity’s board of directors, management and other personnel, applied in strategy setting and across the enterprise, designed to identify potential events that may affect the entity, and manage risks to be within its risk appetite

    Enterprise risk management process is a broad- based discipline requiring the active involvement of all in healthcare and has risk identification and analysis, risk prioritization, and the implementation and monitoring of risk mitigation initiatives at its core.

    Enterprise risk management is an enterprise- wide process designed to identify potential events that may affect the entity, determine the enterprise’s appetite for risk, and manage the event risk according to enterprise objectives.

    All of the above.

2 points

QUESTION 10

  1. Which of the following best define Financial Risk?

    The business of health care is the delivery of care that is safe, timely, effective, efficient, and patient-centered within diverse populations.

    These risks affect the profitability, cash position, access to capital or external financial ratings through business relationships, or the timing and recognition of revenue and expenses.

    Risks associated with brand and reputation, business strategy, and failure to adapt to a changing healthcare environment, changing customer priorities, and competition.

    Refer to the organization’s most valuable asset: its workforce. This is an explosive area of exposure in today’s tight labor and economic markets

2 points

QUESTION 11

  1. Which of the following best define Operational Risks?

    The business of health care is the delivery of care that is safe, timely, effective, efficient, and patient centered within diverse populations.

    These risks affect the profitability, cash position, access to capital or external financial ratings through business relationships, or the timing and recognition of revenue and expenses.

    Risks associated with brand and reputation, business strategy, and failure to adapt to a changing healthcare environment, changing customer priorities, and competition.

    Refer to the organization’s most valuable asset: its workforce. This is an explosive area of exposure in today’s tight labor and economic markets

2 points

QUESTION 12

  1. The Sarbanes– Oxley Act of 2002 (SOX) requires management of public companies, both large and small, to annually assess and report on the effectiveness of internal control over financial reporting.

    True

    False

2 points

QUESTION 13

  1. Which of the following best define Benchmarking?

    Allows risk managers or healthcare organizations to look outside their own setting to identify best performers in the industry. When processes are to be evaluated, healthcare organizations may wish to look outside the healthcare industry to identify other service providers who have excelled at the same or similar function.

    Collect only data elements from within their own organization. The data can be analyzed after the first data collection to identify best performers at the unit or department levels.

    Process of collecting and analyzing data to identify trends in performance and, when compared with other collectors of the same data, identifying best performers and determining if interventions that were introduced to address identified problems yielded the desired results.

    All of the above

2 points

QUESTION 14

  1. Which of the following best define Internal Benchmarking?

    Allows risk managers or healthcare organizations to look outside their own setting to identify best performers in the industry. When processes are to be evaluated, healthcare organizations may wish to look outside the healthcare industry to identify other service providers who have excelled at the same or similar function.

    Collect only data elements from within their own organization. The data can be analyzed after the first data collection to identify best performers at the unit or department levels.

    Process of collecting and analyzing data to identify trends in performance and, when compared with other collectors of the same data, identifying best performers and determining if interventions that were introduced to address identified problems yielded the desired results.

    All of the above

2 points

QUESTION 15

  1. Which of the following best define External or Competitive Benchmarking?

    Allows risk managers or healthcare organizations to look outside their own setting to identify best performers in the industry. When processes are to be evaluated, healthcare organizations may wish to look outside the healthcare industry to identify other service providers who have excelled at the same or similar function.

    Collect only data elements from within their own organization. The data can be analyzed after the first data collection to identify best performers at the unit or department levels.

    Process of collecting and analyzing data to identify trends in performance and, when compared with other collectors of the same data, identifying best performers and determining if interventions that were introduced to address identified problems yielded the desired results.

    All of the above.

2 points

QUESTION 16

  1. Which of the following are the claims data collected as part of the benchmarking process aggregated to establish rates?

    Number of incidents per year.

    Number of potentially compensable events.

    Number of claims per year.

    All of the above.

2 points

QUESTION 17

  1. Benchmarking is risk management can be both a challenging and exciting activity, yielding valuable information that can provide direction to the organization.

    True

    False

2 points

QUESTION 18

  1. Which areas could Risk Managers add value to the administration of Workers Compensation?

    Risk Financing

    Loss Prevention

    Loss Mitigation

    Claims Administration

    All of the above

2 points

QUESTION 19

  1. Claims Administration: handling workers’ compensation claims bears some resemblance to handling professional-liability or general- liability claims, except fewer issues are subject to dispute and the payments are controlled by statutory schedules. The extensive medical knowledge gained from professional liability claims becomes very beneficial in workers’ compensation because most issues are resolved by medical opinion.

    True

    False

2 points

QUESTION 20

  1. Loss Mitigation: Reducing the accidents giving rise to workers’ compensation claims can be incorporated easily into the risk manager’s role. Given the volume of workers’ compensation incidents, it is usually possible not only to analyze the loss history to pinpoint likely sources of problems but also to demonstrate improvements using the loss data.

    True

    False

2 points

QUESTION 21

  1. Which of the followings is NOT one of the 10 events on the National Quality Forum’s “never-events” list?

    Objects left in the body during surgery

    Mismatched blood transfusion

    Air embolism

    Cancer

2 points

QUESTION 22

  1. Is Vascular-catheter- associated infections one of the 10 events on the National Quality Forum “never-events” list?

    True

    False

2 points

QUESTION 23

  1. Obstetrics and Neonatology, Anesthesia and Emergency Medicine were those clinical areas given early risk modification efforts because:

    Patients were often highly vulnerable to errors.

    Providing care required or was supplemented by the use of complex technology.

    The injuries suffered were significant and often deadly.

    A and B only

    All of the above

2 points

QUESTION 24

  1. A high-reliability organization (HRO) is a complex high-hazard organization that is prone to unexpected error or injury.

    True

    False

2 points

QUESTION 25

  1. The platform for patient safety and the rationality of promoting a culture of high reliability is predicated on multiple important competencies:

    The ability to reinforce the systems and structures to promote safety based on evidence drawn from the science of safety.

    The ability to create a culture that develops and supports those who provide care and services to allow for greater capacity for teamwork, risk awareness, risk mitigation, and resiliency.

    The ability to focus and align resources to create and promote advancements in safety.

    The commitment to assure that evidence-based, patient-centered and system-centered work is done.

    All of the above

2 points

QUESTION 26

  1. Which of the following states the concept that reduces the probability of accident and harm?

    Health care is a complex system, and complex systems are inherently risk-prone, particularly operating rooms, intensive care units, and emergency rooms.

    People, no matter how competent and vigilant, are fallible because they are human and therefore physically and psychologically limited in memory capacity and the ability to deal with simultaneous multiple cognitive demands.

    People create safety by defending against risk and intercepting error before it reaches the patient.

    Safety is a system and can pose threats of failure from inadequate or clumsy equipment, fatigue- inducing schedules, flawed or incomplete procedures, excessive incentives for production, and risk-prone professional and organizational cultures often associated with faulty communications.

    All of the above.

2 points

QUESTION 27

  1. Which of the following are safety principles from industry to incorporate into daily work?

    An employee- training process that trains staff in effective teamwork, decision making, risk awareness, and error management.

    Policies and procedures that simplify and standardize work processes and products.

    A commitment to designing self-correcting systems or redundant systems.

    Systems and processes that reduce reliance on human memory through protocols, checklists, and automated systems.

    All of the above.

2 points

QUESTION 28

  1. Which of the following are generally the most common allegations of malpractice problems associated with emergency medicine related to a failure to diagnose?

    Fractures

    Myocardial Infarctions

    Complications of lacerations, including tendons and nerves

    Foreign bodies in wounds

    All of the above.

2 points

QUESTION 29

  1. Which of the following is considered Primary Allegations Arising out of Obstetric Neonatal Care?

    Infant neuromuscular development problems

    Maternal hemorrhage

    Maternal or infant death

    Delay in failure to treat fetal distress–delayed Cesarean section

    All of the above

2 points

QUESTION 30

  1. The most frequent allegations related to surgery are:

    Postoperative complications, including death

    Inadvertent acts and Inappropriate procedures

    Unnecessary surgery and Retained foreign bodies

    d. Postoperative infection

    All of the above

2 points

QUESTION 31

  1. Informed Consent is not important when discussing risk management in surgery and anesthesia.

    True

    False

2 points

QUESTION 32

  1. Which of the following is an example of engineered patient safety practice?

    Requiring computerized physician order entry

    Mandating pre-procedure “time-outs” and checklists

    Communication tools including situation background analysis recommendation

    The use of approved and restricted abbreviation lists for clinical documentation

    All of the above

2 points

QUESTION 33

  1. Lean organizations see that every problem and cause of variation, whether a highly visible severe harm event must be addressed to prevent the problem from becoming a severe harm.

    True

    False

2 points

QUESTION 34

  1. Which of the following is one of the Applicability to Risk Management?

    Prevention of adverse events

    Mitigation of outcomes

    Reduction of claim likelihood

    A and C

    e. A, B, and C

2 points

QUESTION 35

  1. Which of the following procedures requires Express Consent?

    Surgery (major/minor)

    Anesthesia

    Radiographic imaging

    Blood, blood product transfusion, and Biopsies

    All of the above

2 points

QUESTION 36

  1. The two principal types of consent are implied consent and expressed consent.

    True

    False

2 points

QUESTION 37

  1. The implied consent is based on either verbal or written expression from the patient that a proposed course of treatment is acceptable.

    True

    False

2 points

QUESTION 38

  1. Expressed Consent is based on an unspoken understanding between the treating physician and the patient that a proposed method of treatment is advisable and suitable to both parties.

    True

    False

2 points

QUESTION 39

  1. Components of clear communication include the ability to speak and write plainly about health information, to effectively use visual aids, to implement teach-back techniques in which patients’ true comprehension is tested, to provide interpreter services when required, and to provide culturally competent care to all patients.

    True

    False

2 points

QUESTION 40

  1. The Joint Commission Resources published “ Strategies for Addressing Health Care Worker Fatigue” and named education as the foundation of raising awareness and thereby reducing fatigue in the workplace.

    True

    False

2 points

QUESTION 41

  1. Handoff communication is the contemporaneous, interactive process of passing patient-specific information from one caregiver or team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care.

    True

    False

2 points

QUESTION 42

  1. Which of the followings are elements that should be included in handoff?

    Interactive communication that allows for the opportunity for questioning between the giver and receiver of patient information

    Up- to- date information regarding the patient’s condition, care, treatment, medications, services, and any recent or anticipated changes.

    An opportunity for the receiver of the handoff information to review relevant patient historical data

    Interruptions during handoffs are limited to minimize the possibility that information fails to be conveyed

    e. All of the above

2 points

QUESTION 43

  1. SBAR stands for Situation, Background, Assessment, and Recommendation

    True

    False

2 points

QUESTION 44

  1. The SBAR system is helpful but does not always meet the criteria needed for a complete and safe handoff.

    True

    False

2 points

QUESTION 45

  1. The hospital setting most handoff communication policies for nurses include the following:

    Handoffs must be interactive so that the nurse receiving the patient has the opportunity to question and confirm what is reported.

    There should be minimal interruptions. The content of the report should be objective, concise, and related to the patient’s care.

    Nurses are responsible for all handoff communications to contain specific information such as age, gender, diagnosis, allergies, medications, and code status.

    A and B only

    All of the above

2 points

QUESTION 46

  1. Plan-do-check-act is an approach to systematic process improvement and patient safety promotion.

    True

    False

2 points

QUESTION 47

  1. There is no fundamental responsibility of the hospital board to the community regarding patient safety or quality care.

    True

    False

2 points

QUESTION 48

  1. When managing clinical risk, the initiative should include hiring the right staff or offering additional training to current staff.

    True

    False

2 points

QUESTION 49

  1. The CMS strategy of pay for performance helps place patient safety responsibility on physicians.

    True

    False

2 points

QUESTION 50

  1. A focus on physician competency and the requirement for medical staff to be active in QA initiatives  can ensure safe, quality care.

    True

    False

This week’s topic: Healthcare Policies and Accreditation Read and discuss the following three articles: 1. ACAs Performance Based Healthcare Standards ACAsPerformanceBasedHealthCareStandards.pdf 2. Ro

This week’s topic: Healthcare Policies and Accreditation Read and discuss the following three articles: 1. ACAs Performance Based Healthcare Standards ACAsPerformanceBasedHealthCareStandards.pdf 2. Ro


This week’s topic: Healthcare Policies and Accreditation

Read and discuss the following three articles: (attatched)  Case 15 also addresses the link between QI and accreditation (see page 296). For example, here are some questions to answer and discuss:Does accreditation impact quality? Are there less errors in hospitals that are accredited? What is the value of accreditation? Do quality concerns initiate changes in staff behavior? Should accreditation be based on results?

This week’s topic: Healthcare Policies and Accreditation Read and discuss the following three articles: 1. ACAs Performance Based Healthcare Standards ACAsPerformanceBasedHealthCareStandards.pdf 2. Ro
JCAHO accreditation and quality of care for acute myocardial infarction Chen, Jer sey ; Rathore, Saif S ; Radford, Martha J ; Krumholz, Harlan M . Health Affairs 22. 2 (Mar/Apr 2003): 243 -54. Turn on hit highlighting for speaking browsers Abstract (summary) Translate Abstract This paper examines the association between JCAHO accreditation of hospitals, those hospitals’ quality of care, and survival among Medicare patients hospi talized for acute myocardial infarction. Hospitals not surveyed by JCAHO had, on average, lower quality (less likely to use aspirin, beta -blockers, and reperfusion therapy) and higher 30 -day mortality rates than did surveyed hospitals. However, there was c onsiderable variation within accreditation categories in quality of care and mortality among surveyed hospitals, which indicates that JCAHO accreditation levels have limited usefulness in distinguishing individual performance among accredited hospitals. Th ese findings support current efforts to incorporate quality of care in accreditation decisions. Besides selecting appropriate performance measures, establishing standardized benchmarks, and codifying the effects of quality on accreditation, several additio nal key elements are necessary if accreditation is to have a substantial and lasting public role for monitoring hospital quality: 1. publication of quality measures, 2. rewards for success, and 3. influence of government. Full Text  Translate Full text  Headnote ACCREDITATION Headnote A higher JCAHO accreditation level did not necessarily guarantee higher -quality care or better outcomes in the management of AMI. Headnote ABSTRACT: We examined the association between JCAHO accreditation of hospitals, those hospitals’ quality of care, and survival amo ng Medicare patients hospitalized for acute myocardial infarction. Hospitals not surveyed by JCAHO had, on average, lower quality (less likely to use aspirin, beta -blockers, and reperfusion therapy) and higher thirty -day mortality rates than did surveyed h ospitals. However, there was considerable variation within accreditation categories in quality of care and mortality among surveyed hospitals, which indicates that JCAHO accreditation levels have limited usefulness in distinguishing individual performance among accredited hospitals. These findings support current efforts to incorporate quality of care in accreditation decisions. THE JOINT COMMISSION on Accreditation of Healthcare Organizations (JCAHO) is an independent, not -for -profit organization that is the nation’s leading accreditor of hospitals.1 Obtaining JCAHO accreditation is important for hospitals, as the Medicare Act of 1965 decreed that accredited hospitals were deemed to have satisfied federal health and safety requirements necessary to partici pate in Medicare.2 Hospitals also have considerable incentive to become accredited for marketing purposes, often using JCAHO accreditation as a “thirdparty endorsement of quality.”3 As a result, approximately 80 percent of the 6,000 U.S. hospitals have sou ght JCAHO accreditation.4 JCAHO accreditation is awarded on the basis of a hospital’s compliance with a set of standards, which surveyors use in assessing performance during hospital site visits.5 Standards are assessed in patient assessment and care, pat ients’ rights, clinical ethics, organizational leadership, human resources management, and information management.6 JCAHO’s philosophy is that “if hospitals complied with relevant standards then hospitals would be likely to achieve good outcomes.”7 However , evidence demonstrating that JCAHO accreditation can distinguish differences in hospitals’ quality of care or patient outcomes is limited. Studies have found little correlation between accreditation and general hospital mortality, and no differences in ra tes of medication error between accredited and nonaccredited hospitals.8 However, a robust assessment of whether JCAHO accreditation correlates with disease -specific quality measures has yet to be conducted. Acute myocardial infarction (AMI) is well suite d for a study of accreditation because it is a common diagnosis and a major cause of mortality for which quality performance measures have been established from authoritative clinical guidelines. The availability of data from the Cooperative Cardiovascular Project (CCP), a national project to assess and improve the care of Medicare patients hospitalized with AMI, provides a unique opportunity to assess whether JCAHO hospital accreditation is associated with use of guideline -recommended therapies and clinica l outcomes. Study Methods * JCAHO accreditation. A hospital seeking to obtain JCAHO accreditation is visited every three years by a survey team that observes hospital operations, conducts interviews, and reviews medical documentation for compliance with a set of standards in forty -five performance areas.9 JCAHO surveyors assign a score in each performance area and determine an “accreditation level” based on a hospital’s overall score and whether JCAHO cited specific areas for improvement (for example, typ e I recommendations, which indicate the need to resolve unsatisfactory compliance). JCAHO accreditation levels during our study period were (in descending order of compliance) accreditation with commendation, accreditation without (type I) recommendations (hereafter referred to as “accreditation”), accreditation with (type I) recommendations, conditional accreditation, and not accredited. We obtained data from JCAHO on hospital accreditation level and summary scores for hospitals surveyed between 1994 and 1998. Hospitals that had neither a summary score nor an accreditation level reported were considered to be not surveyed. * Cooperative Cardiovascular Project. The CCP sample included 234,769 feefor -service (FFS) Medicare hospitalizations from acute care, n ongovernmental hospitals with a principal discharge diagnosis of AMI, excluding readmissions for AMI, between January 1994 and February 1996 in all fifty states and the District of Columbia.10 Medical records of sampled patients were abstracted for patient s’ clinical characteristics, in -hospital treatments, and vital status. Our study consisted of CCP patients age sixty -five and older who were hospitalized with clinically confirmed AMI. We excluded patients who did not have confirmed AMI (n = 31,186), were younger than age sixty -five (17,593), were readmitted for AMI (25,185), were admitted by interhospital transfer (42,277), had a terminal illness or metastatic cancer (4,616), were hospitalized outside the United States (1,760), had unverified mortality (357), and were admitted to hospitals for which American Hospital Associat ion (AHA) data were unavailable (2,363). We also excluded patients admitted to hospitals surveyed by JCAHO for which data were not available (14,598). In total, the study cohort comprised 134,579 patients. * Quality of AMI care and outcomes. Quality of ca re for AMI was assessed using a set of clinical performance measures from the Centers for Medicare and Medicaid Services (CMS) that assess the use of therapies among patients (ideal candidates) who would benefit from and did not have contraindications for particular treatments. We evaluated the following quality performance measures: use of aspirin or beta -blockers within forty -eight hours of admission, aspirin or beta – blockers anytime during hospitalization, and acute reperfusion therapy (thrombolytic agen ts or primary angioplasty) within six hours of admission.11 We examined patient outcomes using thirty -day mortality because the benefits of high -quality hospital care should be evident within this period. Dates of death were obtained from the Medicare Enro llment Database and the Social Security Administration’s Master Beneficiary Record. * Statistical analysis. Chi -square tests and analyses of variance were used to compare differences across hospitals, and the Cochrane -Armitage test was used to evaluate fo r linear trends in therapy or mortality rates associated with higher accreditation ranking. We compared hospitals’ risk – standardized thirty -day mortality rates using the Medicare Mortality Predictor System (MMPS), a disease -specific mortality prediction mo del for elderly patients.12 Using logistic regression, we calculated a risk -standardized mortality rate that estimated thirty -day mortality for hospitals in each JCAHO accreditation group, assuming that they had the same patient characteristics as the over all sample. Because of the correlation between hospital characteristics, physician characteristics, and JCAHO accreditation, the primary analyses were risk -adjusted for patient characteristics only; secondary analyses that added adjustment for hospital and physician characteristics were also performed. To assess the heterogeneity of hospitals’ performance within JCAHO accreditation categories, we calculated the observed use of AMI therapies in ideal patients and risk -standardized thirty – day mortality for i ndividual hospitals. Standard deviations and twenty -fifth through seventy -fifth percentiles were evaluated to determine variations within categories in AMI therapy use and thirty -day mortality rates within a particular JCAHO accreditation group. To ensure stability in these estimates, we restricted our analyses to hospitals with at least twenty -five observations. Statistical calculations were performed using STATA 7.0. Study Results The final study cohort consisted of 134,579 patients treated at 4,221 hos pitals. Approximately one -quarter of hospitals in the study sample were not surveyed by JCAHO (Exhibit 1). Most of the surveyed hospitals received accreditation with recommendations. Nonsurveyed hospitals were more likely than surveyed hospitals were to be smaller -volume centers, nonteaching hospitals, publicly owned, and located in a rural setting, and most lacked on -site facilities for cardiac procedures. Surveyed hospitals with higher accreditation levels tended to be larger — volume teaching centers and to be located in urban settings with on -site facilities for cardiac procedures (Exhibit 1). On average, patients in our cohort were elderly (mean age, seventy -six years) and predominantly white (90.9 percent). Although several patient characteristics dif fered across JCAHO accreditation levels, the magnitude of these differences was small (Exhibit 2). * AMI therapy use. The proportion of patients who were classified as ideal candidates for AMI therapy was generally similar across JCAHO hospital accreditat ion levels and between surveyed and nonsurveyed hospitals (Exhibit 3). Patients admitted to nonsurveyed hospitals were less likely to receive aspirin and beta -blockers, both on admission and during hospitalization, as well as acute reperfusion therapy, tha n were patients treated at surveyed hospitals. Among surveyed hospitals, the use of aspirin on admission was highest in hospitals accredited with recommendations and lowest in hospitals with conditional accreditation (Exhibit 3). Aspirin use at any time du ring hospitalization was similar across accreditation categories. Patients admitted to hospitals accredited with commendation had the highest use of betablockers on admission and at any time during hospitalization, while patients admitted to hospitals with conditional accreditation had the lowest use. Acute reperfusion therapy rates were lowest among patients admitted to conditionally accredited hospitals. These findings were consistent in secondary analyses that adjusted for hospital and physician characte ristics. Exhibit 4 illustrates the wide heterogeneity in performance within each JCAHO accreditation level. There was considerable overlap in the proportion of patients receiving aspirin or beta – blockers by hospital accreditation categories. The extensive overlap demonstrates that many hospitals accredited with commendation had rates of aspirin and beta -blocker use that were comparable to, and in some cases lower than, those of hospitals that had received conditional accreditation or nonsurveyed hospitals, and vice versa. * Mortality. Hospitals accredited with commendation had lower thirty -day mortality rates than the overall risk -standardized rate; nonsurveyed hospitals had rates that were higher (Exhibit 3). Compared with hospitals accredited with commen dation, thirty -day mortality was higher on average for accredited hospitals (hazard ratio [HR] 1.15, p = .01) and hospitals accredited with recommendations (HR 1.06, p <.01). There was a trend toward higher mortality among conditionally accredited hospital s (HR 1.11, p = .39). Further adjustment for hospital and physician characteristics attenuated the relative hazard rates, but the results were consistent with those from the primary analysis (accredited hospitals HR 1.11, p = .05; accredited with recommend ations HR 1.05, p = .02; conditional accreditation HR 1.03, p = 0.80; accredited with commendation HR 1.00 [referent]). Nonsurveyed hospitals had higher thirty -day mortality rates than surveyed hospitals had (HR 1.15, p < .001) when patient characteristic s were adjusted for. The increased hazard associated with nonsurveyed hospitals was attenuated after adjustment for hospital and physician characteristics, but remained significant (HR 1.08, p <.001). However, we found considerable variation in risk -stand ardized thirty -day mortality rates within each accreditation level (Exhibit 4). The interquartile ranges of risk -standardized thirty -day mortality were primarily located between 15 percent and 25 percent across all accreditation levels. Discussion In our study, nonsurveyed hospitals had lower use of AMI therapies and worse thirty -day outcomes than did hospitals surveyed by JCAHO. However, among surveyed hospitals there were only modest differences in the use of AMI therapies, with the greatest variation o bserved for the use of beta -blockers. Patients admitted to hospitals accredited with commendation had lower thirty -day mortality rates than those of patients admitted to hospitals in lower accreditation levels. However, we observed much variation in qualit y measures and outcomes within each JCAHO accreditation category across hospitals. These findings suggest that the JCAHO standards -based accreditation system has only a modest ability to assess quality of AMI clinical care at any particular hospital. Accr editation does provide some information concerning hospitals’ quality of care and outcomes in the aggregate. Indeed, knowing that a hospital participated in the JCAHO survey process suggests superior quality and outcomes compared with nonsurveyed hospitals . It is unknown, however, whether the process of undergoing JCAHO accreditation improves quality of care or whether this association reflects self -selection against JCAHO evaluation by more poorly performing hospitals. In contrast, accreditation levels we re of limited value in differentiating quality among surveyed hospitals. Although beta -blocker use was higher across successive accreditation levels, the absolute differences in rates across accreditation groups were small. Furthermore, there was considera ble hospital -level variation in the use of aspirin therapy, the use of beta -blocker therapy, and thirty -day mortality rates within all JCAHO accreditation groups. There were hospitals with high and low rates of AMI therapy use and thirty -day outcomes in al l JCAHO accreditation categories, even among hospitals with JCAHO conditional accreditation and non – surveyed hospitals. Thus, a higher JCAHO accreditation level was not necessarily a guarantee of higher -quality care or better outcomes in the management of AMI. To place the mortality difference across accreditation categories in perspective, the relative difference in risk for thirty -day mortality between surveyed and non — surveyed hospitals was approximately 15 percent. In contrast, an examination of hosp ital volume and AMI mortality in the CCP data set identified a 17 percent relative risk difference in thirty -day mortality between the smallest and largest hospital volume quartiles.13 Accreditations ability to predict short -term mortality after AMI appear s comparable to that of hospital volume. * Reasons for lack of quality differentiation. There are several reasons why standards -based JCAHO accreditation levels may not be able to differentiate hospitals on the basis of quality. First, many of the JCAHO s tandards do not assess quality in day -to-day patient care activities. For example, a high degree of compliance with administrative or managerial standards is unlikely to have much bearing on whether patients receive aspirin on admission for AMI, yet these areas account for more than half of all points in a JCAHO survey. Identifying hospitals that are well managed, while informative, is likely to be different than identifying hospitals that provide high -quality clinical care. Second, the wide range of hospi tal compliance with JCAHO standards within a single accreditation level may dilute any differences in quality. For example, the category of “accredited with type I recommendations” does not distinguish between hospitals with a single recommendation or many . Similarly, hospitals are assigned conditional accreditation whether they received one citation or several. Third, JCAHO surveyors exhibit discretion when determining how deeply to probe for potential problems during a survey visit.14 The impact of varia tion by and between observers and the reliability of the JCAHO accreditation process are unknown. The Joint Commission itself has recognized that levels of accreditation can be subjective. Commenting on the recent removal of the accreditation with commenda tion rating, JCAHO president Dennis O’Leary stated that “the distinction between those who get commendation and those who fall just short is artificial in many respects.”15 * JCAHO as an accreditor of quality. Given that JCAHO accreditation cannot differe ntiate hospitals on the basis of clinical performance, the question is whether JCAHO would be an effective force for assessing and improving quality There would be several potential advantages for having JCAHO evaluate quality in addition to its current st andards -based accreditation. First,JCAHO has the administrative machinery necessary to evaluate hospitals. Thus, there are financial and logistical benefits to having it evaluate both standards and quality. Second, JCAHO accreditation is sought nearly uni versally; as a result, the effect of codifying quality into accreditation decisions would be readily disseminated across the country. Third, as the nation’s most widely accepted accreditor, JCAHO would likely meet with less resistance from hospitals to the inclusion of quality measures as a natural extension of the accreditation process rather than an entirely new review process. In spite of the advantages, several challenges remain. First, although JCAHO is an independent institution, it has close ties to the industry it oversees. In a recent critique, the Office of Inspector General of the Department of Health and Human Services reported that JCAHO’s stance is “moving towards collegiality rather than regulatory,” suggesting a lack of impartiality in evalu ating hospitals.16 Similar concerns have been raised by public -interest groups, which note that half of the members of JCAHO’s board of commissioners are from within the industry it is supposed to regulate (the American Hospital Association and the America n Medical Association).17 Second, while JCAHO has indicated a willingness to incorporate quality into accreditation decisions, the specific details are lacking. It is less likely that hospitals will feel an incentive to improve quality if their accreditat ion is not placed at risk. However, critics contend that very few hospitals are denied accreditation.18 Whether placing accreditation in jeopardy on the basis of quality will lead to quality improvement remains to be seen. Third, JCAHO’s current system fo r quality measurement is limited. To its credit, JCAHO has recognized that standards and performance measurement are complementary to assessment of hospital care and has embarked upon a program to integrate clinical performance measures into accreditation decisions.19 In the mid -1990s JCAHO began requiring accredited hospitals to submit performance data through its “Oryx initiative.” Hospitals contracted with vendors to collect data and developed automated databases that feed performance measures back to ho spitals and JCAHO each quarter. However, the Oryx methodology raises questions regarding its validity for measuring quality. Hospitals could select any six of more than 2,000 performance measures. This is problematic because of the potential for hospitals to “game the system” by selecting measures at which they already do well. Also, there is wide variation in clinical importance in the performance measures, which range from length -of-stay, mortality or readmission rates, use of procedures such as cesarean section, patient fall rates, or use of restraints. There is no guarantee that a particular hospital -chosen performance measure represents meaningful differences in quality. Finally, hospitals are evaluated against peers, but the comparison groups are diff erent for each vendor’s system. The benchmark group could range from hospitals that used the same vendor’s measure, or it may include nonvendor data from the CMS or state health departments, all of which limit Oryx’s ability to determine national benchmark s for quality. To mitigate these limitations, JCAHO recently began requiring hospitals to report a set of -core performance measures” from among four medical conditions (AMI, heart failure, community – acquired pneumonia, and pregnancy) with specific defini tions for numerators and denominators.20 The advantages of using these core measures is that the clinical consensus underlying the quality indicators ensures that they can be compared across both hospitals and time. It is too early to tell whether the repo rting of these core measures will affect hospital accreditation or lead to improvements in patient care and outcomes. * Additional elements of success. Besides selecting appropriate performance measures, establishing standardized benchmarks, and codifying the effects of quality on accreditation, we believe that several additional key elements are necessary if accreditation is to have a substantial and lasting public role for monitoring hospital quality. Publication of quality measures. Public release of comparative hospital data will allow patients and purchasers to make purchasing decisions based on quality. Consumers would “vote with their feet” in selecting health plans incorporating hospitals that emphasize quality. Purchasers could contract for care based on quality and thereby receive greater value for their health care dollars. Moreover, providers could use explicit measures of quality when negotiating contracts, rather than relying on subjective measures or purchasers’ perception s of quality. Rewards for success. Purchasers’ decisions to contract on the basis of quality need not be punitive. The Pacific Business Group on Health (PBGH) has negotiated with several health plans in California to place $8 million at risk for meeting p erformance measures on patient satisfaction, preventive care measures, and cesarean section rates.21 In addition, the Leapfrog Group has embarked on a program to reward hospitals for meeting requirements for hospital safety, evidence -based hospital referra l, and physician staffing in intensive care units.22 These examples demonstrate that purchasers are amenable to pursuing reimbursement that rewards superior quality. Influence of government. The federal government is uniquely positioned to motivate change s in JCAHO accreditation because of accreditations role in securing hospitals’ Medicare reimbursement. This criterion could be leveraged to improve the quality of care for the elderly by having Medicare pay more (or less) depending on providers’ quality me asures for diseases prevalent in the elderly; by providing a highly visible distinction for hospitals that achieve high standards of performance; or even by tying participation in Medicare to minimum quality -of -care standards. OUR STUDY SUGGESTS that an e xclusively standards -based accreditation is a limited tool for comparing hospital quality of care, because of the considerable heterogeneity of performance within accreditation levels across hospitals; this highlights the need to measure and report quality indicators directly. The integration of standardized quality measures into the next generation of JCAHO accreditation may address this deficiency. Nevertheless, there are major challenges for JCAHO, as it ponders how to integrate quality into its accredit ation process. The authors thank Maria johnson for her editorial assistance, Yun Wang, Paul Hung, and Bryon Butts for their technical assistance Jerod Loeb for his review of prior drafts; and the people and organizations involved in the Cooperative Cardio vascular Project. Harlan Krumholz was a chair of the Cardiovascular Conditions Clinical Advisory Panel for the development of JCAHO’s core indicators. The analyses upon which this manuscript is based were performed under Contract no. 500 -99 -CTOl, titled “U tilization and duality Control Peer Review Organization for the State of Connecticut,” from the Centers for Medicare and Medicaid Services (CMS), U.S. Department of Health and Human Services (HHS). The content of this paper does not necessarily reflect the views or policies of HHS, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This paper is a dir ect result of the Health Care duality Improvement Project initiated by the CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of the cont ractor. Footnote NOTES Footnote 1. J.S. Roberts, J.G. Coale, and R.R. Redman, “A History of the Joint Commission on Accreditation of Hospitals,” Journal of the American Medical Association 258, no. 7 (1987): 936 -940, with a published erratum in the Journ al of the American Medical Association 258, no. 19 (1987): 2698. 2. Ibid; and Social Security Act, Sec. 1865,42 U.S. Code 1395bb. 3. “Plastering Its Gold Seal Everywhere, Bridgeport Shows Off Its Commendation,” Profiles in Healthcare Marketing 13, no. 1 (1997): 27 -32. 4. U.S. Department of Health and Human Services, Office of Inspector General, The External Review of Hospital Quality: A Call for Greater Accountability, Pub. no. OEI -01 -97 -00050 (Boston: DHHS, 1999). 5. A. Flanagan, “Ensuring Health Care Quality: JCAHO’s Perspective,” Clinical Therapeutics 19, no. 6 (1997): 1540 -1544. Footnote 6. joint Commission on Accreditation of Healthcare Organizations, The Complete Guide to the 1996 Hospital Survey Process (Oakbrook Terrace, Ill.: JCAHO, 1996). 7. D.S. O’Leary, “Performance Measures. How Are They Developed, Validated, and Used?” Medical Care 33, Suppl. 1 (1995):JS13 -JS17 8. JR. Griffith, S.R. Knutzen, and J.A. Alexander, “Structural versus Outcomes Measures in Hospitals: A Comparison of Joint Commi ssion and Medicare Outcomes Scores in Hospitals,” Quality Management in Health Care 10, no. 2 (2002): 29 -38; and K.N. Barker et al., “Medication Errors Observed in Thirty -six Health Care Facilities,” Archives of Internal Medicine 162, no. 16 (2002):1897 -19 03. 9. JCAHO, “Understanding the 1996 Hospital Performance Report,” www.jcaho.org/lwapps/perfrep/ undrstd/hap/1996.htm (4 February 2003); and JCAHO, The Complete Guide. 10. TA. Marciniak et al., “Improving the Quality of Care for Medicare Patients vA -ith Acute Myocardial Infarction: Results from the Cooperative Cardiovascular Project,” Journal of the American Medical Association 279, no. 17 (1998):1351 -1357. Footnote 11. E.F. Ellerbeck et al., Quality of Care for Medicare Patients with Acute Myocardial Infarction: A FourState Pilot Study from the Cooperative Cardiovascular Project,” Journal of the American Medical Association 273, no. 19 (1995):1509 -1514. 12. J. Daley et aL, “Predicting Hospital -Associated Mortality for Medicare Patients: A Method for Pa tients with Stroke, Pneumonia, Acute Myocardial Infarction, and Congestive Heart Failure, Journal of the American Medical Association 260, no. 24 (1988): 3617 -3624. 13. DR Thiemann et al., “The Association between Hospital Volume and Survival after Acute Myocardial Infarction in Elderly Patients,” New England Journal of Medicine 340, no. 21 (1999): 1640 -1648. 14. DHHS, OIG, The External Review of Hospital quality: The Role of Accreditation, Pub. no. OEI -01 -97 -00051 (Boston: DHHS, 1999). 15. J.D. Moore Jr ., JCAHO Drops a Survey Rating; Board Says `Commendation Award Has Several Weaknesses,” Modern Healthcare 29, no. 46 (1999):15. 16. DHHS, OIG, The External Review of Hospital Quality. 17. L. Dame and S.M. Wolfe, The Failure of “Private” Hospital Regulati on: An Analysis of the Joint Commission on Accreditation of Healthcare Organizations’ Inadequate Oversight of Hospitals (Washington: Public Citizen Health Research Group, July 1996). 18. Ibid. Footnote 19. O’Leary, “Performance Measures”; D.S. O’Leary, “The Joint Commission Looks to the Future, Journal of the American Medical Association 258, no. 7 (1987): 951 -952; and D.S. O’Leary, “Reordering Performance Measurement Priorities,” Health Affairs (July/Au g 1998): 38 – 39. 20. B.I. Braun, RG. Koss, and J.M. Loeb, “Integrating Performance Measure Data into the Joint Commission Accreditation Process,” Evaluation and the Health Professions 22, no. 3 (1999): 283 -297. 21. H.H. Schauffler, C. Brown, and A. Milste in, “Raising the Bar: The Use of Performance Guarantees by the Pacific Business Group on Health,” Health Affairs (Mar/Apr 1999): 134 -142. 22. K. Sandrick, “Raising the Bar: Purchasers and Providers Must Work Together to Meet the Qualityof -Care Challenge,” Trustee 54, no. 9 (2001):12 -17. AuthorAffiliation At the time this research was conducted, Jersey Chen was a student at Yale University School of Medicine; he is now a resident in internal medicine at Beth Israel Deaconess Medical Center in Boston. Saif Rathore is a lecturer at the Yale University School of Medicine. Martha Radford is system director at Yale New Haven Health in New Haven, Connecticut. Harlan Krumholz is a professor at the Yale University School of Medicine. Copyright The People to People Health Foundation, Inc., Project HOPE Mar/Apr 2003

University of Florida Engineering & Accounting Discussion

Description

Question 1:

For your final discussion board post, I would like each of you to reflect on what you have learned this semester. What was your impression of managerial accounting before the semester started vs. what you think about it now? Focus on one or two topics that we have covered which you feel will be beneficial to your work and/or personal life. While you may not work in the accounting field, many of these topics can be useful in your work as a manager.

Course name: AC5255 Accounting for Leaders_eMBA

(400-450 words in word document with references 6 years or less old)(Please follow APA format) Please 3 references from journals or books will be appreciated. Write everything in own words.

Question 2:

Throughout the term you have explored an examined numerous topics around management and leadership. Successful organizations require an environment of support, sustainability, and life-long learning. As an emerging leader share two lessons learned and how you will implement them within your current role and organization

Course name: Leadership and change in organizaion.

(400-450 words in word document with references 6 years or less old)(Please follow APA format) Please 3 references from journals or books will be appreciated. Write everything in own words.

Question 3:

Do you believe Artificial Intelligence or Machine Learning is the future of cybersecurity? Explain why or why not

(400-450 words in word document with references 6 years or less old)(Please follow APA format) Please 3 references from journals or books will be appreciated. Write everything in own words.