Patient Satisfaction in Chamber Setting

Patient Satisfaction in Chamber Setting Patient Satisfaction in Chamber Setting in Bangladesh measured by Patient-Doctor Relationship Questionnaire (PDRQ-9 Bangla) Abstract Background: Assessment of patient satisfaction is crucial but there is significant lagging in this sector. Patient satisfaction is an important indicator of health care quality as well as a predictor of treatment adherence. The Good patient-doctor relationship is considered as an integral part of the patient satisfaction. In Bangladesh, this domain is yet to be explored in a large scale. Aim: It was aimed to look into the patient satisfaction level in chamber setting in Bangladesh measured using the patient-doctor relationship questionnaire (PDRQ-9 Bangla). Methods: PDRQ-9 is a short yet excellent tool for assessing the patient-doctor relationship. The data collection was done in private chamber setting by the PDRQ-9 and analyzed. Results: Though the result was not completely in line with the existing literature, the PDRQ-9 was found to a useful and brief measurement tool in the context of the patient-doctor relationship. Conclusion: Large-scale research in this particular aspect of patient satisfaction in future may provide a more succinct result. Keywords: PDRQ-9 Bangla, Patient Satisfaction, Chamber Practice, Doctor-Patient, Bangladesh. Introduction Being as old as the civilization the field of medicine is evolving rapidly [1] but there is a significant lagging in the assessment of patient satisfaction which is considered as equally important as other health measures and a significant indicator of efficiency of health care delivery [2]. As stated by Lender et al. patient satisfaction may be defined as positive evaluations of distinct dimensions of health care [3]. A parallel interaction is present in between patient satisfaction, continuity of care, accessibility of treatment and physician, as patient prefer the availability and accessibility of the same physician. The measurement of patient satisfaction is thus useful is assessing the quality of care and also subsequent health-related behaviors and adherence to treatment, at the same time knowing the patient priorities would facilitate the improvement of patient experience [4,5]. Thus patient satisfaction might be considered as an indicator of institutional performance as well as patient`s wish to become more compliance and recommendation for others, which are all related to the socio-demographic condition, the health status of community and more over Patient-Doctor Relationship [6,7,8]. Patient-Doctor Relationship, a dynamic, vital yet complex interpersonal relationship which has been put under the microscope for quite a long over the century and this mutual relationship is intermingled with the idea of patient satisfaction, compliance with treatment and eventually driving the treatment outcome [9]. Over the time the concept of patient-doctor relationship has evolved a lot and currently, patient-centeredness is the most preferred by the patients hence the health care provider focuses of patient autonomy and more emphasis over patient satisfaction [10, 11, 12]. Despite being widely advocated, the practicality of patient-centered model is yet under consideration on the basis of time constraint in consultation as the physician has to perform the daunting task of providing comprehensive, coordinated yet satisfactory to the patient and above all make sure the accessibility of the care [13, 14]. Whether being psychiatric or non-psychiatric patient it is reported that succ essful and both way, a perfect relationship between patient and physician is crucial for the adherence and better outcome of treatment [15]. For assessing the patient-doctor relationship, a brief, concise yet having excellent psychometric characteristics scale has been developed and validated known as the 9-item patient -doctor relationship questionnaire (PDRQ-9) [14,15,16, 17,18] which essentially evaluates the therapeutic aspect of the patient-doctor relationship based on the perspective of the patient in the primary health care setting [14,15]. PDRQ-9 gives the opportunity to quantify the communication, level of satisfaction and availability in dealing with the physician in regard to patient`s point of view [18]. Initially validated by Van der Feltz-Cornelis et al. this is to be reported that there is internal consistency among the items of the scale [17] and later was to validated by multiple researchers [14,15,16,18]. Bangladesh, a developing country having about 160 million people and achieving the health-related goal of MDG but lacking significantly in regard to conceptual similarity in health services between physician and patients, hence there exists violence against the doctor and lack of compliance with treatment and eventually patient satisfaction [1,9,19-20]. But unfortunately, there is little to be found in terms of literature regarding the patient satisfaction and patient-doctor relationship. So the authors aimed to look into the patient satisfaction level in public hospital and private chamber setting in Bangladesh measured using the patient-doctor relationship questionnaire (PDRQ-9 Bangla). Methods Setting: The data collection procedure was carried out in 3 different hospitals by 3 different physicians. Instrument: The Bangla version of 9 item based Patient-Doctor Relationship Questionnaire (PDRQ-9) was used as the tool for questioning patients which have 5 points Likert-type scale from 1: not at all appropriate, to 5: totally appropriate. Design and Subject: The study was carried out in the outpatient department of Dhaka Medical College and some private chambers in the city of Dhaka over the period of January 2016 to December 2016 from 214 patients with the Bangla version of Patient-Doctor Relationship Questionnaire (PDRQ-9) with purposive sampling. The filling out of the questionnaire was totally voluntary and completed by the participant themselves and assistance weas provided to respondents who were not able to understand any question. Patients who were willing to participate and able to understand Bangla were included in the study and patients who were not willing were excluded. After proper collection of data, the analysis was done by SPSS 16 and Microsoft Excel 2010. Data Collection Method: Self-reporting PDRQ-9 Bangla questionnaire and providing assistance when the patient could not understand the questionnaire. Results Table 1 [VM1] Demographic Variables Age Completed years Percent Gender Gender Percent 14-25 29.3 Male 40.2 26-35 26.9 Female 59.8 36-45 20.7 Religion Religion Percent 46-55 10.7 Islam 93 56-65 11.7 Sanatan 7 Mean  ± SD (Range) 37 ± 9.92 Marital Situation Status Percent Residence Area Percent Unmarried 19.9 Urbane 57.8 Married 78.7 Suburban 14.3 Widow 0.5 Village 28 Divorced 0.5 Educational Qualification Status Percent Occupation Status Percent Below SSC 40.9 Student 32.2 SSC 16.2 Service Holder 16.4 HSC 18.8 Business 7.5 Graduation/ Equivalents 12.3 Housewife 23.8 Post graduation 11.7 Others 7.9 Monthly Family Income Taka Percent Family Family Type Percent 1.73 Nuclear 52.8 5000-10000 10.98 Joint Family 45.8 10000-15000 15.03 15000-20000 12.14 20000-25000 13.29 25000-30000 24.28 >30000 21.97 Demographic Picture of the Respondents. In this study, authors considered age, gender, religion, residence, educational qualification, monthly income, marital status, occupation and family type as demographic variables. Age of the respondents was found Mean  ± SD (Range): 37 ± 9.92 (14-65) years; 40.2 % respondents were male and 59.8% female; 57.8% resided in urban area where as 14.3% in suburb and 28 % in village; 78.7% were married and 19.9% were unmarried; 52.8% belonged to nuclear family and 45.8% were from joint family (Table 1). Table 2: Level of satisfaction in regards to item wise responses (n=214) Statistics Q-1 Q- 2 Q- 3 Q- 4 Q-5 Q- 6 Q- 7 Q- 8 Q-9 Mean 4.29 4.35 4.50 4.17 4.44 4.23 4.31 4.28 3.86 Median 5 5 5 4 4 4.5 5 5 4 Mode 5 5 5 5 5 5 5 5 5 Std. Deviation 0.99 0.99 0.85 0.97 3.53 0.91 1.02 1.06 1.17 Minimum 1 1 1 1 1 1 1 1 1 Maximum 5 5 5 5 5 5 5 5 5 The level of satisfaction among the Respondents. Among the 9-items of the PDRQ-9, there was a general trend of the mean being about 4.17 to 4.50. The lowest mean was found in the 9th question I find my physician easily accessible which was 3.86. I trust my physician the 3rd item had the highest mean of 4.50. The Standard deviation for the items was around 0.99 to 3.53. 5th question My physician is dedicated to help me had the highest standard deviation of 3.53 (Table 2). Table 3: Distribution of responses of PDRQ-9 Bangla items not at all appropriate somewhat appropriate appropriate mostly appropriate totally appropriate Total Item F (%) F (%) F (%) F (%) F (%) F (%) Q 1 4 (1.87) 11 (5.14) 26 (12.15) 51 (23.83) 122 (57.01) 214 (100) Q 2 2 (.93) 16 (7.48) 20 (9.35) 43 (20.09) 133 (62.15) 214 (100) Q 3 3 (1.40) 3 (1.40) 24 (11.21) 37 (17.29) 147 (68.69) 214 (100) Q 4 4 (1.87) 10 (4.76) 30 (14.02) 71 (33.18) 99 (46.26) 214 (100) Q 5 2 (.93) 15 (7.01) 22 (10.28) 71 (33.18) 103 (48.13) 214 (100) Q 6 2 (.93) 6 (2.80) 40 (18.69) 59 (27.57) 107 (50) 214 (100) Q 7 3 (1.40) 17 (7.96) 19 (8.88) 47 (21.96) 128 (59.81) 214 (100) Q 8 6 (2.80) 14 (6.54) 20 (9.35) 49 (22.90) 125 (58.41) 214 (100) Q 9 8 (3.74) 19 (8.88) 58 (27.10) 39 (18.22) 90 (42.06) 214 (100) Distribution of responses. Among all the 9 items and 5 responses, there was an overall tendency of answering the 5th option totally appropriate by the respondents as evident by the frequency ranging from 42.06% to 68.69% which were the highest for all the 9-items. Not at all appropriate had the lowest frequency ranging around 0.93% to 3.74%. Other three options had all most equal distribution though a greater tendency for the mostly appropriate was observed (Table 3). Discussion Patient-Doctor Relationship is a strong indicator of patient satisfaction as well as the predictor of treatment adherence and quality of health care. Patient satisfaction, on the other hand, depends largely on the availability of care and caregiver. Patient-Doctor Relationship Questionnaire-9 (PDRQ-9) is a brief and excellent tool for assessing the quality of patient-doctor relationship on the regards of patient`s experience and therefore a useful instrument for measuring patient satisfaction. Originally developed by Van Der Feltz-Cornelis et al. in 2004 it was based on Helping Alliance Questionnaire of Luborsky (HAQ), a scale that measures the therapeutic alliance in psychotherapy [17]. Later, numerous attempts were taken to validate PDRQ-9 in different languages. In Ad ´an et al. validated the Spanish version and Mergen et al. in 2012 validated the Turkish version, in 2014 Zenger et al. validated the German version of PDRQ-9 and in 2016 Arafat validated the Bangla version wh ich was the tool for this particular study [16, 17, 18, 21, 22]. On demographic basis Age of the respondents was found Mean  ± SD (Range): 37 ± 9.92 (14-65) years which was close enough to the Bangla validation study where Age of the respondents was found as mean  ± SD (range): 35.6  ± 10.71 and also with Nigerian version where mean age was 40.12 but not consistent with the German validation where Mean age was 50.58 for men and 50.87 for women and also in this particular study 52.8% respondents belonged to nuclear family and 45.8% were from joint family which also aligned with the Bangla validation study where 52% had nuclear family and 48% belonged to joint family environment [16, 18]. 40.2 % respondents were male and 59.8% female which was not in line with the Bangla version where 62% were male and 38% were female but was close to the Nigerian validation where male sex frequency was 47.6% and the female was 52.4%[15, 18].The origin of the respondents which in this study was 57.8% from an urban area where as 14.3% from suburb and 28 % from the village, but in the Bangla Validation version 64% lived in town, 16% in mini town, and 20% in the village [18]. On the 9-items the Mean was found 4.29, 4.35, 4.50, 4.17, 4.44, 4.23, 4.31, 4.28 and 3.86 respectively which were not consistence with either the original Dutch or later validated Spanish, Turkish, Nigerian or Bangla version [15,17, 18, 22] but the German Validation study showed means of the 9-items which were almost similar to this study[16]. It was seemed to be found that the respondents chose to answer mostly appropriate in this particular study. However, as observed by Arafat SMY most of the people in Bangladesh has the perception that, the role of the physicians here are motivated by financial gain only and thus not fully justified which often lead to violence against doctor as well as the health services providers which do not completely fit with the result of this particular study [9]. Also, the doctor leads a hectic life in this country and the overwhelming number of patients per physician also make it difficult to provide quality and patient-centered care [1]. The overall result of the study might not reflect the picture on basis of the currently available literature in this context. Limitations of the Study The majority of the data was collected from private chamber setting which might have been the cause of a result not in line with the other articles. Moreover, in some respondents assistance was provided to fill out the questionnaire. Conclusion The result from the analysis indicated a better level of satisfaction among the patients which was not quite in line with the premeditated concept of the authors as it did not fall in line with the available data. Despite this fact, the Bangla validated the version of PDRQ-9 was found as a very helpful as an instrument for assessing the relationship between patient and doctor in a very short time and both in public and private health care facility. As the scale bears only patients perspective it was very proficient for measuring patient satisfaction. In a developing country like Bangladesh, future large-scale studies to substantiate the findings of this particular study and further evaluate the patient satisfaction on the basis of patient-doctor relationship may provide a clearer picture. References 1. Andalib A, Arafat SMY. Practicing Pattern of Physicians in Bangladesh. International Journal of Perceptions in Public Health. 2016;1(1):9-13. 2. Linda .MS P, editor. PATIENT SATISFACTION SURVEYS FOR CRITICAL ACCESS HOSPITALS. First ed. 1607 West Jefferson Street Boise, Idaho 82702: 2001. 3. Linder-Pelz S. Toward a theory of patient satisfaction. Social Science Medicine. 1982 Jan;16(5):577-82. 4. Raivio R, Jà ¤Ãƒ ¤skelà ¤inen J, Holmberg-Marttila D, Mattila KJ. Decreasing trends in patient satisfaction, accessibility and continuity of care in Finnish primary health care a 14-year follow-up questionnaire study. BMC Family Practice. 2014 May 15;15(1). 5. Paddison CAM, Abel GA, Roland MO, Elliott MN, Lyratzopoulos G, Campbell JL. Drivers of overall satisfaction with primary care: Evidence from the English general practice patient survey. Health Expectations. 2013 May 30;18(5):1081-92. 6. Konà © Pà ©foyo AJ, Wodchis WP. Organizational performance impacting patient satisfaction in Ontario hospitals: A multilevel analysis. BMC Research Notes. 2013;6(1):509. 7. Jackson JL, Chamberlin J, Kroenke K. Predictors of patient satisfaction. Social Science Medicine. 2001 Feb;52(4):609-20. 8. Rahmqvist M, Bara A. Patient characteristics and quality dimensions related to patient satisfaction. International Journal for Quality in Health Care. 2010 Feb 3;22(2):86-92. 9. Arafat SMY. Doctor Patient Relationship: an Untouched Issue in Bangladesh. International Journal of Psychiatry. 2016 Jul 16;1(1):2. 10. Kaba R, Sooriakumaran P. The evolution of the doctor-patient relationship. International Journal of Surgery. 2007 Feb;5(1):57-65. 11. Ridd M, Shaw A, Lewis G, Salisbury C. The patient-doctor relationship: A synthesis of the qualitative literature on patients perspectives. British Journal of General Practice. 2009 Apr 1;59(561):116-33. 12. Bensing JM, Tromp F, van Dulmen S, van den Brink-Muinen A, Verheul W, Schellevis FG. Shifts in doctor-patient communication between 1986 and 2002: A study of videotaped general practice consultations with hypertension patients. BMC Family Practice. 2006 Oct 25;7(1). 13. Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001 Oct 20;323(7318):908-11. 14. Porcerelli JH, Murdoch W, Morris P, Fowler S. The Patient-Doctor relationship questionnaire (PDRQ-9) in primary care: A validity study. Journal of Clinical Psychology in Medical Settings. 2014 Aug 9;21(3):291-6. 15. Aloba O, Esan O, Alimi T. Psychometric qualities of the 9 item patient doctor relationship questionnaire in stable Nigerian patients with schizophrenia. Journal of Behavioral Health. 2015;4(4):112. 16. Zenger M, Schaefert R, van der Feltz-Cornelis C, Brà ¤hler E, Hà ¤user W. Validation of the patient-doctor-relationship questionnaire (PDRQ-9) in a representative cross-sectional German Population survey. PLoS ONE. 2014 Mar 17;9(3):e91964. 17. Van der Feltz-Cornelis CM, Van Oppen P, Van Marwijk HWJ, De Beurs E, Van Dyck R. A patient-doctor relationship questionnaire (PDRQ-9) in primary care: Development and psychometric evaluation. General Hospital Psychiatry. 2004 Mar;26(2):115-20. 18. Arafat SMY. Psychometric validation of the Bangla version of the patient-doctor relationship questionnaire. Psychiatry Journal. 2016;2016:4. 19. Uddin MS, Ahmed MSR, Arafat SMY. Does mind exist in physicians mind? A brief phone survey in Bangladesh. International Journal of Neurorehabilitation. 2016;03(06):234 20. Arafat SMY, Uddin MS, Chowdhury EZ, Huq N, Chouudhury SR, Chowdhury MHR. Demography and Diagnosis of Patients Received Emergency Medical Service from Two Private Psychiatric Hospital in Dhaka City. Int J Neurorehabilitation. 2016;3(6):240. 21. Mergen H, Van der Feltz-Cornelis CM, KaraoÄÅ ¸lu N, Ongel K. Validity of the Turkish patient-doctor relationship questionnaire (PDRQ-Turkish) in comparison with the Europe instrument in a family medicine center. Healthmed. 2012 Feb;6(5):1763-70. 22. J. C. Mingote A, B. Moreno J, R. Rodrà ­guez C, M. Gà ¡lvez H, P. Ruiz L. Psychometric validation of the Spanish version of the Patient-Doctor Relationship Questionnaire (PDRQ). Actas Esp Psiquiatr. 2009;37(2):94-100. [VM1]Please enter the title of the Table 1. Also tables should be below the mentioned text. Copy the text of table 1 before the table. It goes for every table subsequently.

Andy Warhol :: Biography Biographies

andy warhol1 Biography On August 6, 1928, Ondrej and Julia Zavacky Warhola gave birth to their son, Andrew Warhola, in Forest City, Pennsylvania. Ondrej and Julia came to the United States from Czechoslovakia where he worked as a construction worker. The family later moved to Pittsburgh where Andrew suffered from several nervous breakdowns throughout his teen-aged years. Overcoming this he graduated from high school and enrolled in the Carnegie Institute of Technology where he graduated in 1949. After graduation he lived in several Manhattan apartments and met Tina Fredericks, the art editor of Glamour Magazine. His early jobs for the magazine were several drawings. Andy drew shoes as an assignment in 1949 for an article named, â€Å"Succes is a Job in New York,† and the credit mistakenly read, â€Å"Drawings by Warhol.† Andy soon changed his surname to Warhol. Andy’s other work included drawings for advertising in various magazines, such as Vogue and Harper’s Bazzar, book jackets, and holiday greeting cards. As his work grew so did his fame, and in 1952 his first solo exhibition was held at Hugo Gallery featuring his drawings to illustrate stories by Truman Capote. Soon he was designing sets for theatre groups, publishing his own books, and beginning to paint. In 1960 his first paintings were based on comic strips. Using the Dick Tracy comic strip, he designed a window display for Lord and Taylor. At this time major art galleries around the world were beginning to notice his work. In 1962 his paintings of dollar bills and Campbell soup cans were included in an important exhibition of pop art, The New Realists, which was held at Sidney Janis Gallery in New York. After three years of painting Andy dived into a new medium of work and began making his first film with his assistant Gerald Malanga. He also produced am album for the band, â€Å"The Velvet Underground and Nico.† He was working with multimedia and a show soon developed, which featured â€Å"The Velvet Underground and Nico† center stage with Andy’s films projected while colored lights of images fell over the band. Because of the publicity from the show more of Andy’s films began to be seen and shown in commercial theatres. On June 3, 1968 Andy was shot by actress, Valerie Solnis, who appeared in Andy’s movie, â€Å"I, a man.† He survived the shooting after spending two months in the hospital.

Great Expectations Paper Essay

When an individual loves someone else, it is difficult to let the person go or accept his/her return, because of the poor decision that one person made to leave his/her loved one. However, since the person already left, is it worth the pain and agony in the end to accept that person into the hurt individual’s life once again? In his Victorian Literature novel, Charles Dickens satirizes the Victorian Era multiple times within Great Expectations. For example, in the 1800’s the masculine class were the regulators of the family and weren’t aggravated by women, but in this novel the females obtain the upper position, like how Mrs. Joe overpowers Orlick. Charles Dickens named the novel Great Expectations, because its means that an individual is positive that something significant will occur with no warning if the individual wants it bad enough, but in English Victorian society, achieving expectations meant that someone was destined to collect vast sums of riches and success. Throughout Pips three stages in the novel Great Expectations, Charles Dickens utilizes the character of Joe, who out of compassion and sympathy demonstrates that suffering is a sacrifice one is willing to endure for the love of another individual, and how this idea changes what Pip’s views, personality, and values are at the end of his high expectations. During Pip’s first stage of expectations, Joe explicates that he suffers greatly because of Orlick, Mrs. Joe and Pip, but only wishes to steer Pip in the right direction and to have given enough ‘love’ to change Pip’s views and expectations. First, Orlick takes Joe by surprise when he starts to get angry and jealous of Pip and tells him â€Å"No favoring in this shop. Be a man!†(15.65), but because Joe wants no trouble he lets him have the day off which makes Mrs. Joe terribly angry. Additionally, when Orlick offends Mrs. Joe, Joe defends her even though she was mad at him, because he loves her and is willing to suffer through Orlicks harsh words. Pip’s troublesome behavior at the table is brought to attention when Joe states, â€Å"You and me is always friends, and I’d be the last to tell upon you, any time†¦But such as a most uncommon bolt as that!†(2.8) Pip’s actions got Joe in trouble while he was trying to help P ip, because the helpful advice made Joe ignore Mrs. Joe and which made him have to face consequences such as being â€Å"pounced on† and â€Å"knocked [in] his head for a little while against the wall behind him† (2.8). Also, it expresses how Joe dealt with Mrs. Joe’s and Pip’s spiteful behavior all because he cared for them and was compassionate to all people. Pip’s behavior shows readers that as a child he didn’t have any expectations but eventually set the bar higher which was not what Joe truly wanted to happen. This helps readers understand how having sympathy and a good heart doesn’t always payoff at first, but latter lets people become the best of friends in the long run, like Pip and Joe. While sitting by the warm fire at night Joe explains to Pip that â€Å"When [he] got acquainted with his sister, it were the talk how she was bringing him up by hand†¦. [And] how small and flabby and mean he was†¦Ã¢â‚¬  and how he â€Å"†¦would have formed the most contemptible opinion of himself self!† (7.38) which makes Pip start to cry because he felt ashamed by how he acted, but grateful that Mrs. Joe and Joe stayed with him. At that time Pip, a commoner, didn’t care about anyone and just wanted to do what he wanted, although it made him look bad and unkind. In the long run Pip’s disobedient attitude and Joe’s loving heart was worth it because he and Joe became best friends which was held together by a strong bond of love. Lastly, Joe was affectionate and loving towards Pip even when Pip was cruel to him which shows readers the sacrifice Joe endured with Pip. The forfeit Pip watched Joe go through changed him because it made him want to do something more and become someone higher who wont have to deal with pain and sacrifice. In conclusion, Pip starts to change into the gentleman he wants to become while Joe is still remaining at is side, longing for his ‘old chap’. During Pip’s second stage of his expectations Joe sacrificed his dignity and friendship for Pip, because he felt sympathy towards him which makes readers wonder if Joe gave Pip enough ‘love’ to not make him leave his dear friend, Joe, and change his personality. To, begin, Joes love is tested and questionable when he tells Pip, â€Å"But if you think as Money can make compensation to me for the loss of the little child†¦and ever the best of friends!†(18.116). Pip is shocked by how much he means to Joe, but still but doesn’t see how much Joe really loves him. Pip deserts Joe â€Å"whom he was so ready to leave and so unthankful to†(18.115), and thinks to himself â€Å"I’ll see you again†Ã¢â‚¬ ¦and â€Å"I’ll feel the loving tremble of your hand upon my arm, as solemnly this day as if it had been the rustle of an angel’s wing! †¦ â€Å"(18.115), which proves that Pip has not realized that this decision mak es Joe sacrifice and suffer all the more. Furthermore, Joe had to scornfully respect his decision to leave and become a gentleman and bear the loneliness while he was away, but still loved him and waited for when Pip realized he should go back to Joe. Moreover, Pip changes his view on his future when Joe explains that â€Å"Divisions among such must come, and must be met as they come†¦ You and me is not two figures to be together in London; nor anywhere else but where is private, and beknown, and understood among friends.†(27.246) Likewise, when Joe is in London with Mr. Wopsle he wants to put pity on Pip and explain to him that they are different people in separate worlds and he wants to show Pip how it hurts when people leave their loved ones. Joe thinks he has sacrificed enough and wants Pip to come back, but now Joe realizes that they are separate people with different expectations. Additionally, Pip and Joe are still great friends; however their breaking relationship hurts Pip and makes him want to restart his life and be with Joe, but he still stays a gentleman. All in all, Joe leaving Pip just as Pip did to him, once again creates Pip to think differently and regret some of his decisions in the past. Throughout Pip’s final stage of expectations, Joe’s compassionate attitude is expected to make Pip change his values and stop Joe from suffering, but makes Joe ponder if he gave Pip enough sympathy to make him come back to him. Firstly, after Pip’s benefactor, Magwitch, dies Pip starts to become ill and also gets arrested because of his debt. While sitting back at his house Pip starts to realize that he always has someone there for him, Joe, and expresses his regret by saying â€Å"O Joe, you break my heart! Look angry at me, Joe. Strike me, Joe. Tell me of my ingratitude. Don’t be so good to me!†(57.388). This statement said by Pip when Joe is by his side, expresses the point that even though Pip did wrong, Joe will always be there to comfort him and make him feel better, and that Pip thinks he should not be treated good by Joe at this point. Furthermore, Pip now understands, â€Å"There was no change whatever in Joe. Exactly what he had been in my eyes then, he was in my eyes still; just as simply faithful, and as simply right†(57.389), which proves that the compassion from other individuals do change peoples values and outlooks on all things in life and expectations. Likewise, Pip appreciates that Joe was faithful to him even though endures suffering because of his high expectations and dire choice to be a gentleman. Moreover, since Pip â€Å"†¦soon began to understand that the cause of it was in [him], and that the fault of it was all [his].†(58.395), he started to feel for his dear friend Joe, again as he once did and wanted to have never of met his benefactor that lead him to leave Joe. This connects to the main point because it finalizes how love is stronger then the pain someone causes another person and how it can shape an individual in different ways. Additionally, when the shameful Pip says, â€Å"Don’t tell him, Joe, that I was thankless; don’t tell him, Biddy, that I was ungenerous and unjust; only tell him that I honored you both, because you were both so good and true, and that†¦ I said it would be natural to him to grow up a much better man than I did.†(59.404), it shows Joe and Biddy how much Pip is truly sorry for the choice he made and, reluctantly, they responded with, â€Å"God knows as I forgive you, if I have anythink to forgive!†(59.404). All in all, Joe’s compassionate and sympathetic heart pays of and lets him forfeit no more, which proves the point that suffering is a sacrifice one is willing to endure for the love of another individual even if the other person doesn’t see the good you are doing until the end. In conclusion, all of the suffering and sacrifice Joe endures, because of much love and compassion he has for others in Great Expectations did prove to make his ‘dear old chap’ Pip reconsider his views, personality and values towards life and his own expectations. The significance in this novel is that sacrificing yourself out of sympathy is a step anyone should be willing to take to have an even stronger bond within the relationship. The idea of sacrifice and suffering for another individual is in the real word, like how a mama bear feeds her cubs before herself, because she cares for them, and just like how Joe suffers and hates being away from ‘his cub’ Pip. All in all, without sacrifice and suffering people won’t have as much compassion for each other and would not endure the pain if they didn’t truly care for them.

Maverick Lodging Case Analysis - 1710 Words

Maverick Lodging Case Study Notes * 1/2000: VP of Asset Management (Cindy Baum) was reviewing the 1999 balanced scorecard results for Maverick Lodging; she had developed amp; implemented the balanced scorecard throughout 1998 * 1999: first full year of results using the balanced scorecard approach * Designing a balanced scorecard had been a considerable challenge because of the complicated nature of the hotel industry * Maverick Lodging: managed hotels on behalf of 3rd party owners who had franchise agreements with Marriott * Maverick concentrated on managing 3 specific types of Marriott properties: Fairfield Inns, Courtyards, amp; Resident Inns * Fairfield amp; Courtyards: offered typical†¦show more content†¦emedy this * The balanced scorecard was implemented at the hotel level, amp; was used as a management control/ performance measurement system for each hotel’s general manager (typically 25-35 years old w/a college degree but little management experience) * As a result, Baum felt that the balanced scorecard needed to be comprehensive but not overly complex Designing Maverick’s Balanced Scorecard * Baum involved the 4 other VPs amp; 3 regional managers in the balanced scorecard design process; there was considerable disagreement, but the entire team agreed to create a scorecard with the following attributes: * Tracks financial performance; * tracks non-financial measures important for LT growth amp; value creation; * communicates franchisees’/owners’ objectives for growth, profitability amp; physical maintenance; * is understandable amp; acceptable to hotel general managers amp; it provides them w/useful amp; relevant info; * is understandable, useful, amp; relevant to management Balanced Scorecard as a Performance Measurement System * Prior to the introduction of the balanced scorecard, the regional managers had a great deal of discretion in determining the amount of each hotel manager’s bonus * Average bonus ranged between 20-40% of the hotel managers $40,000-$50,000 salary * Bonus depended on size of bonus pool, hotel profitability, amp; the regional manager’s assessment of the hotelShow MoreRelatedMaverick Case968 Words   |  4 PagesCase 4 Maverick Lodging Objective The Maverick Lodging case concerns the initial results of installing a new, comprehensive performance review system. 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