The Return: Shadow Souls Chapter 36

â€Å"What?† shouted Damon over the music, while adding: Run – go! telepathically to Elena. If it had merely been Elena's life, she would have been glad enough to die here with the thunderous beauty of Firebird all around her, rathr than facing those steep, invisible steps alone. But it wasn't just her life. It was Stefan's life, too. Still, the flower maiden didn't look particularly menacing, and Elena couldn't summon up enough adrenaline to try making it down that hidous stairway. Damon, let's both go. We have to search the Great Ballroom outside. Only you're strong enough†¦. A hesitation. Damon would rather fight than face that enormous, impossible green field outside, Elena thought. But Bloddeuwedd, despite her words, was now spinning the room around them again, so that she, at the edge of some invisible walkway, could find the exact orb she wanted. Damon lifted Elena in his arms and said: Shut your eyes. Elena not only shut her eyes, but put her hands over them as well. If Damon was going to drop her, she wasn't going to help matters by shouting â€Å"Look out!† as he did it. The sensations themselves were sickening enough. Damon leaped from step to step like an ibex. He seemed barely to touch the steps in going down and Elena wondered – quite suddenly – if anything were after them. If so, it was information she needed to know. She began to lift her hands and heard Damon whisper-snarl â€Å"Keep them shut!† in a voice that few people liked to argue with. Elena peeked out between her hands, met Damon's exasperated eyes, and saw nothing following them. She clamped her hands back together and prayed. If you were really a slave, you wouldn't last a day here, you know, Damon informed her, taking a final leap into space and then setting her down on invisible – but at least level – ground. I wouldn't want to, Elena sent coldly. I swear, I'd rather die. Be careful what you promise, Damon flashed his splendid smile down at her suddenly. You may end up in other dimensions trying to fulfill your word. Elena didn't even try to one-up him. They were out, free, and racing through the glass house down to the stairs to the lower floor – a little tricky in her state of mind, but bearable – and finally out the door. On the grass of the Great Ballroom they found Meredith and Bonnie†¦and Sage. He was actually in white tie as well, although his jacket strained at his shoulders. In addition, Talon was sitting on one – so the problem might be taken care of fairly soon, as she was ripping the material and drawing blood. Sage didn't seem aware of it. Saber was at his master's side, looking at Elena with eyes too thoughtful to be mere animal eyes, but without malice. â€Å"Thank God you came back!† Bonnie cried, running to them. â€Å"Sage came and he has a marvelous idea.† Even Meredith was excited. â€Å"You remember how Damon said we should have brought a diviner? Well, we have two now.† She turned to Sage. â€Å"Please tell them.† â€Å"As a rule, I don't take these two to parties.† Sage reached down to scratch under Saber's throat. â€Å"But a little bird told me that you might be in trouble.† His hand moved up to stroke Talon, ruffling the falcon's feathers slightly. â€Å"So, dites-moi, please: Just how much have you two been handling the half-key you do possess?† â€Å"I touched it tonight and in the beginning, the night we found it,† said Elena. â€Å"But Lady Ulma handled it and Lucen made a chest for it and we've all handled that.† â€Å"But outside the box?† â€Å"I've held it and looked at it once or twice,† said Damon. â€Å"Eh bien! The kitsune smells should be much stronger on it. And kitsune have very distinctive smells.† â€Å"So you mean that Saber – † Elena's voice gave out for pure faintness. â€Å"Can sniff out anything with the smell of kitsune on it. Meanwhile, Talon has very good eyesight. She can fly overhead and look for the glint of gold in case it's in plain sight somewhere. Now show them what they will be searching for.† Elena obligingly held out the crescent shaped half-key for Saber to sniff. â€Å"Voil! And Talon, now you take a good look.† Sage backed away to what was, Elena supposed, Talon's optimal seeing distance. Then when he came back, he said, † Commen;ons!† and the black dog exploded away, nose to ground, while the falcon took off in grand, high, sweeping circles. â€Å"So you think the kitsune were on this grass?† Elena asked Sage, as Saber began racing back and forth, nose still just above the grass – and then suddenly veered out onto the middle of the marble steps. â€Å"But assuredly, they were here. You see how Saber runs, like a black panther, with his head low, and his tail straight? He has business in hand, him! He is hot on the scent.† I know someone else who gives off the same feeling, Elena thought as she glanced back at Damon, who stood with his arms folded, motionless, coiled like a spring, waiting for whatever news the animals would bring. She happened to glance at Sage at the same moment, and she saw an expression on his face that – well, it was probably the same expression she'd been wearing a minute ago. He glanced at her and she blushed. â€Å"Pardonnez-moi, Monsieur,† she said, looking away quickly. â€Å"Parlez-vous fran;ais, Madame?† â€Å"Un peu,† Elena said humbly – an unusual condition for her. â€Å"I can't really keep up a serious conversation. But I loved going to France.† She was about to say something else, when Saber barked once, sharply, to attract attention and then sat bolt upright at the curb. â€Å"They came or left in a carriage or litter,† Sage translated. â€Å"But what did they do in the house? I need a trail going the other way,† Damon said, looking up at Sage with something like raw desperation. â€Å"All right, all right. Saber! Contremarche!† The black dog instantly turned around, put its nose to the ground as if it afforded him the greatest delight, and began running back and forth across the stairs and the lawn that formed the â€Å"Great Ballroom† – now becoming pitted with holes as people took shovels, pickaxes, and even large spoons to it. â€Å"Kitsune are hard to catch,† Elena murmured into Damon's ear. He nodded, glancing at his watch. â€Å"I hope we are, too,† he murmured back. There was a sharp bark from Saber. Elena's heart leaped in her chest. â€Å"What?† she cried. â€Å"What is it?† Damon passed her, grabbed her hand, and dragged her in his wake. â€Å"What has he found?† Elena gasped as they all reached the same point simultaneously. â€Å"I don't know. It's not part of the Great Ballroom,† replied Meredith. Saber was sitting up proudly in front of a bed of tall, clustering pale lavender (deep violet) hydrangeas. â€Å"They don't look like they're doing too well,† said Bonnie. â€Å"And it's not below any of the upper ballrooms, either,† Meredith said, stooping to get at Saber's height and then look up. â€Å"There's just the library.† â€Å"Well, I know one thing without a question,† Damon said. â€Å"We're going to have to dig up this flower patch and I don't fancy asking Ms. Larkspur-eyes-Now-I-have-to-kill-you for her permission.† â€Å"Oh, did you think they were larkspur, her eyes? Because I thought of bluebells, rahthah,† said a guest behind Bonnie. â€Å"Did she really say she had to kill you? But why?† another guest, nearer to Elena asked nervously. Elena ignored them. â€Å"Well, let's put it this way, she's certainly not going to like it. But it's the only clue we've got.† Except, I suppose, if the kitsune meant to leave it here, but then took off in a coach, she added voicelessly to Damon. â€Å"So that means the show can commence,† cried one of the young vampire fans, stepping toward Elena. â€Å"But I don't have my amulet back,† Damon said flatly, moving in front of Elena like an impenetrable wall. â€Å"But you will in minutes, surely. Look, couldn't some fellows backtrack with the dog to wherever the bad guys came from – came to the estate from, if you get me? And meanwhile we can be getting on with the show?† â€Å"Can Saber do that?† Damon asked. â€Å"Follow a carriage?† â€Å"With a fox in it? But of course. Actually, I could go with them,† Sage said quietly. â€Å"I could make sure that these two enemies are caught if they are on the other end of the trail. Show them to me.† â€Å"These are the only shapes I know.† Damon reached out two fingers and touched Sage's temple. â€Å"But, of course, they'll have more forms, possibly infinite ones.† â€Å"Well, they are not our priority, I assume. The, ah, amulet is.† â€Å"Yes,† Damon said. â€Å"Even if you don't land a blow on them, get the key half and race back.† â€Å"So? Even more important than revenge,† Sage said softly, shaking his head in wonder. Then he added quickly. â€Å"Well, I will wish us good luck. Any adventurous types who want to go with me? Ah, good, four – very well, five, Madame – is enough.† And he was gone. Elena looked at Damon, who was looking back with blank, black eyes. â€Å"You really expect me to do – that – again?† â€Å"All you need to do is stand there. I'll make sure you lose as little blood as possible. And if you ever want to stop we can have a signal.† â€Å"Yes, but now I understand. And I can't handle it.† His face went cold suddenly. Shutting her out. â€Å"You're not required to handle anything. Besides, isn't it enough if I say it's a fair bargain for Stefan?† Stefan! Elena's entire body went through some sort of elemental change. â€Å"Let me share it,† she begged, and knew that she was begging and knew what Damon was going to say. â€Å"Stefan is going to need you when we get out. Just make sure you can handle that.† Stop. Think. Don't bash his head in, Elena's brain told her. He's pushing your buttons. He knows how to do it. Don't let him push your buttons. â€Å"I can handle both,† she said. â€Å"Please, Damon. Don't treat me as if I were – one of your one-nighters, or even your Princess of Darkness. Talk to me as if I were Sage.† â€Å"Sage? Sage is the most frustrating, cunning – â€Å" â€Å"I know. But you talk to him. And you used to talk to me, and now you're not. Listen to me. I can't bear to go through this scenario again. I'll scream.† â€Å"Now you're threatening – â€Å" â€Å"No! I'm telling you what will happen. Unless you gag me, I'll scream. And scream. As I would scream for Stefan. I can't help it. Maybe I'm breaking down†¦.† â€Å"But don't you see?† Suddenly he had whirled around and taken hold of her hands. â€Å"We're almost at the end. You, who've been the strongest all along – you can't break down now.† â€Å"The strongest†¦Ã¢â‚¬  Elena was shaking her head. â€Å"I thought we were right there, on the verge of understanding each other.† â€Å"All right.† His words came as hard chips of marble now. â€Å"What if we do five?† â€Å"Five?† â€Å"Five strokes instead of ten. We'll promise to do the other five when the ‘amulet' is found, but we'll run when we do find it.† â€Å"You would have to break your word.† â€Å"If it takes that – â€Å" â€Å"No,† she said flatly. â€Å"You say nothing. I'll tell them. I'm a liar and a cheat and I've always played with men. We'll see if I can't finally put my talents to good use. And there's no point in trying any of the other girls,† she added, glancing up. â€Å"Bonnie and Meredith are wearing gowns that would fall right off if you slashed them. Only I have a bare back.† She pirouetted in place to show off how her dress met only very high at the neck in a halter and very low in the back in a V. â€Å"Then we're agreed.† Damon had a slave refill his goblet and Elena thought: we're going to be the tipsiest act in history, if nothing else. She couldn't help but shiver. The last time she had felt an inner trembling was from Damon's warm hand on her bare back as they danced. Now, she felt something much icier, just a draft of cold air perhaps. But it drew her mind to the feeling of her own blood running down her sides. Suddenly Bonnie and Meredith were there beside her, forming a barricade between her and the increasingly curious and excited crowd. â€Å"Elena, what's happened? They said a barbarian human girl was to be whipped – † began Meredith. â€Å"And you just knew it had to be me,† completed Elena. â€Å"Well, it's true. I don't see how I can get out of it.† â€Å"But what have you done?† Bonnie asked frantically. â€Å"Been an idiot. Let some fraternity-type vampire boys think that it was a sort of magic act,† Damon put in. His face was still grim. â€Å"That's a little unfair, isn't it?† Meredith asked. â€Å"Elena told us about the first time. It sounded as if they jumped to the conclusion that it was an act all by themselves.† â€Å"We should have denied it then. Now, we're stuck with it,† Damon said flatly. Then, as if he were making an effort, â€Å"Oh, well, maybe we'll get what we came for, anyway.† â€Å"That was how we found out – some idiot came running down the steps yelling about an amulet with two green stones.† â€Å"It was all we could think of,† Elena explained wearily. â€Å"It's worth it for Damon and I to do this if only we can find the other half of the key.† â€Å"You don't have to do it,† Meredith said. â€Å"We can just leave.† Bonnie stared at her. â€Å"Without the fox key?† Elena shook her head. â€Å"We've already been through all that. The unanimous decision was to do it this way. She looked around. â€Å"Now where are the guys that wanted to see it so much?† â€Å"Looking in the field – that used to be a ballroom,† Bonnie replied. â€Å"Or getting shovels – lots of 'em – from Bloddeuwedd's gardening compound. Ow! Why'd you pinch me, Meredith?† â€Å"Oh, my, did that pinch? I meant to do this – â€Å" But Elena was already striding away, as eager now as Damon was to get it over with. Half over with. I just hope he remembers to change into his leather jacket and black jeans, she thought. In white tie – the blood – I won't let there be any blood. The thought was sudden and Elena didn't know where it came from. But in the deepest reaches of her being, she thought: he's been punished enough. He was trembling in the litter. He thought about another person's well-being from minute to minute. It's enough now. Stefan wouldn't want him to be hurt any more. She glanced up to see one of the Dark Dimension's small, misshapen moons moving visibly above her. This time the surrender she made to it was bright red, a feather shining in sullen crimson light. But she gave herself up to it unreservedly, body and soul, and it rested on the hallowed spring of eternal blood that was her womanhood. And then she knew what she had to do. â€Å"Bonnie, Meredith, look: we're a triumvirate. We have to try to share this with Damon.† No one looked enthusiastic. Elena, whose pride had been entirely broken from the moment she first saw Stefan in his cell, knelt down in front of them on the hard marble step. â€Å"I'm begging you – â€Å" â€Å"Elena! Stop that!† Meredith gasped. â€Å"Please get up! Oh, Elena – † Bonnie was a breath away from tears. And so, it was small, softhearted Bonnie who turned the tide. â€Å"I'll try to teach Meredith how. But anyway, we'll at least share it between the three of us.† Hug. Kiss. A murmur into strawberry hair, â€Å"I know what you see in the dark. You're the bravest person I know.† And then, leaving a stunned Bonnie behind, Elena went to collect spectators for her own whipping.

The Stupidest Angel Chapter 22

Chapter 22 A PERFECT LONESOME CHRISTMAS The archangel Raziel hovered outside the Santa Rosa Chapel's big cathedral window, looking through a small pane of pink glass that formed Saint Rosa's cheek. He smiled at his handiwork, then beat his great wings and flew off to find some chocolate to sustain him on his trip home. Life is messy. Would that every puzzle piece fell into place, every word was kind, every accident happy, but such is not the case. Life is messy. People, generally, suck. This year, however, the Lonesome Christmas party in Pine Cove was coming off with clarified joy, an infectious goodwill, and a general harmony of spirit that shone in the guests with a smooth, high polish – a no-mess affair. â€Å"Theo,† Molly said, â€Å"can you grab the other lasagna pans out of the back.† She was carrying two of the long stainless-steel pans herself, and she was careful to bend at the knees as she set them down on the buffet table to keep the back of her short cocktail dress in the realm of decency. It was a plunging neckline LBD (little black dress) she'd borrowed from Lena just for the party – the first low-cut thing she'd worn in years. â€Å"We could have barbecued after all,† Theo said. â€Å"I told you fucksticks that the storm would turn south,† Mavis Sand growled as she sawed the end off a baguette like the moyl at a titanic bris. (Some people's goodwill shines differently than others'.) Molly set down her lasagna and turned around into the arms of her praying mantis of a husband. â€Å"Whoa, sailor, Warrior Babe's got work to do.† â€Å"I just wanted to tell you,† Theo said, â€Å"before everyone gets here, that you look absolutely stunning.† Molly brushed her hand across her neckline. â€Å"Scars don't do that, do they? They don't just disappear overnight like that, right?† â€Å"Doesn't matter to me,† Theo said. â€Å"Never mattered. Wait until you see what I got you for Christmas.† Molly kissed him on the chin. â€Å"I love you, even if you have mutant tendencies; now free me, Lena needs help with the salad.† â€Å"No, I don't,† said Lena, coming out of the back room carrying a huge salad bowl. Tucker Case followed close behind with a stainless caddie of dressings. â€Å"Oh, Theo,† Lena said, â€Å"I hope you don't mind, but Dale is going to come by in his Santa suit tonight.† â€Å"I thought you guys were in combat,† Theo said. â€Å"We were, but he surprised me a couple of nights ago when I was stealing some of his Christmas trees, and was just losing his temper when Tucker happened along and popped him in the nose.† Tucker Case grinned. â€Å"I'm a pilot, we're used to handling tense situations.† â€Å"Anyway,† Lena continued, â€Å"Dale was drunk. He started crying, getting maudlin, talking about how he was having trouble with his new girlfriend, saying how he hated that everyone saw him as the evil developer, so I invited him here. Thought maybe if he could do something nice for the kids, it would make him feel better.† â€Å"No problem,† Theo said. â€Å"I'm glad you two are getting along.† â€Å"Hey, Theo!† yelled Joshua Barker as he ran across the chapel floor toward them. â€Å"Mom says Santa will be at the party.† â€Å"A quick appearance, Josh, then he has to get on his route,† Theo said. He looked up to see Emily Barker and her boyfriend/husband/whatever Brian Henderson coming across the room. Brian was wearing a red Star Fleet Command shirt. â€Å"Merry Christmas, Theo,† Emily said. Theo hugged Emily and shook Brian's hand. â€Å"Theo, have you seen Gabe Fenton?† Brian asked. â€Å"I wanted to show him the shirt, I think he'll get a kick out of it. You know, nerd solidarity.† â€Å"He was here a little bit ago, Brian, but then Val Riordan arrived and they were talking. I haven't seen them for a while.† â€Å"Maybe they went for a walk. Beautiful evening, isn't it?† â€Å"Isn't it,† said Molly, coming to Theo's side. â€Å"He said he was good with weather,† said the Narrator. â€Å"Shhhhhhh,† said Molly. â€Å"Pardon?† Brian said. Out behind the chapel, the dead were feeling festive as well. â€Å"He's going to do her right here in the graveyard,† said Marty in the Morning. â€Å"Who would have thought a shrink could moan like that. A little carnal scream therapy, huh, doc?† â€Å"No way,† said Bess Leander. â€Å"She's wearing Armani, she's not going to mess up that outfit.† â€Å"You're right,† said Jimmy Antalvo. â€Å"They'll just suck face and take the party home for makeup sex. But how do you know she's wearing Armani?† â€Å"You know what?† said Bess. â€Å"I have no idea. Just a feeling, I guess.† â€Å"I do hope they sing ‘Good King Wenceslas, † said Esther, the schoolteacher. â€Å"I just love that song.† â€Å"Has anyone seen the biologist's dreadful dog?† asked Malcolm Cowley, the dead book dealer. â€Å"Last year the beast urinated on my headstone three times.† â€Å"He was sniffing around a minute ago,† said Marty in the Morning, â€Å"but he went inside when they started to bring the food out.† Inside, Skinner was sitting under the Christmas tree, looking at the strangest creature he'd ever seen. It was hanging from the lower branches, but it didn't look like a squirrel, or smell like food; in fact, it had a face that looked like another dog. Skinner whimpered and sniffed the air. If it was a dog, where was its butt? How could he say hello if he couldn't sniff its butt? He took a tentative step back to study the thing. â€Å"What are you looking at?† said Roberto.

The War I And World War II - 1930 Words

INTRO SUMMARY OF WARS Humanity was forever changed after the wars of the 20th century. World War I and World War II are known for the millions of military and civilian lives they took away. Horrific words such as concentration camps, slave labor and genocide are linked to the wars. They are also credited to causing nations to rapidly come up and develop brilliant new inventions, warfare tactics and revolutionary ideas that are still playing intricate roles in modern day societies. Both of these wars were accredited to the implementation of new technology and weapons. Many treaties and agreements were drafted, written and implemented in the aftermath of the war and reconstruction plans were carefully put together. The world famous war†¦show more content†¦The Great Depression, World War II, the Holocaust, the Cold War, and the collapse of several empires can all be linked back to it. WWI was triggered by the assassination of Archduke Franz Ferdinand, who was the heir to the throne of the Austro-Hu ngarian Empire. It officially began when Germany started invading Belgium and France. The sinking of the Lusitania, a British passenger liner; unrestricted German submarine warfare; and several other events, all led up to the United States feeling the need to become an intervention. Millions of American men were then drafted, and the War Industries Board was introduced by Congress to coordinate material production while the National War Labor Board was formed to unify labor policy. Additionally, there were independent republics formed after WWI that today are known as Austria, Czechoslovakia, Estonia, Hungary, Latvia, Lithuania, and Turkey. I can best summarize this war by using words written by author John Keegan. He wrote the following words in his book titled The First World War â€Å": The First World War was a tragic and an unnecessary conflict. Unnecessary because the train of events that led to its outbreak might have been broken at any point during the five weeks of crisis that preceded the first clash of arms, had prudence or common goodwill found a voice; tragic because the consequences of the first clash ended the lives of ten million human beings, tortured the

Analysis Of The Scarlet Letter - 1412 Words

In a novel that revolves almost solely around sin, the consequences of said sin, and redemption, there is no greater sin than that of revenge. No character in The Scarlet Letter is free of sin, but all gain some sort of redemption, save one Roger Chillingworth, who is arguably the greatest sinner of them all. Hester Prynne may have committed adultery, and Arthur Dimmesdale may have also committed adultery with Hester (as a priest, no less), but sins of passion are not the same as sins of vengeance and anger. These sins of revenge and madness are what Chillingworth is guilty of, ultimately making him the worst sinner in the entire book. Chillingworth is, honestly, just a very creepy character, for starters. He reunites with his wife, whom†¦show more content†¦He wants the people he will be tormenting to be alive and able to feel the full wrath of his revenge, which is just outright vindictive and evil. He is also manipulative, as shown in another part of Chapter Four: â€Å"‘It was my folly! I have said it. But, up to that epoch of my life, I had lived in vain. The world had been so cheerless! My heart was a habitation large enough for many guests, but lonely and chill, and without a household fire. I longed to kindle one! It seemed not so wild a dream,--old as I was, and sombre as I was, and misshapen as I was,--that the simple bliss, which is scattered far and wide, for all mankind to gather up, might yet be mine. And so, Hester, I drew thee into my heart, into its innermost chamber, and sought to warm thee by the warmth which thy presence made there!’† (Chapter Four) It is in this part of the chapter that Hester says she has wronged him, and Chillingworth goes on to say that it was he who had wronged her first, having taken away her youth to lie with his decaying, old self. This is all to make Hester feel guiltier about having done what she did, and this guilt-trip is only the beginning of Chillingworth’s revenge. Chillingworth’s plot for vengeance continues when Arthur Dimmesdale falls ill and the doctor takes up residence with the priest. He has his suspicions of the true nature of Dimmesdale

Capitalism Is An Economic And Political System - 1684 Words

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Flint, M ichigan was the home of eleven successful General Motors factories that employed a lot of the city and made the city a lot of money. While the factory was thriving Roger Smith, the CEO of GM at the time decided to close all eleven of the Flint factories in order to open up new factories south of the border in Mexico. When the factories went on to close it resulted in a loss of eleven-thousand jobs, and the morale of the city. Considering General Motors employed the majority of Flint withShow MoreRelatedCapitalism Is The Most Influential Economic And Political System Essay2012 Words   |  9 PagesCapitalism is the most influential economic and political system in the world today as it has had a large effect on some of the defining aspects of the world, from abolishing feudal rule as â€Å"feudal rulers were continually forced to turn for loans to their resident burghers†¦ by the way the leaders stood this was completely incompatible with feudal rule†. 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Forecasting Emergency Department Overcrowding †MyAssignmenthelp

Question: Discuss about the Forecasting Emergency Department Overcrowding. Answer: Introduction The success of organizations is determined by the operational efficiency of the organization in service delivery. Organizations strive to deliver quality services and products to their consumers in the most cost-effective way but keeping in mind the need to maintain the quality of the products or services. An organization can, therefore, be said to be operating at their maximum operational efficiency when it receives maximum output from the resources employed or the inputs. For operational efficiency to be achieved there is a need to ensure that there are adequate material and information flow in various organizational departments (Narasimhan, 2014, P. 216). Lack of operational efficiency in an organization contributes to increased costs, inability to meet the consumer demands as well as the overall decrease in the organization's revenues or profitability. This report, therefore, seeks to provide an understanding of how we can improve the operational efficiency and effectiveness of N SW Health Emergency Department and improve the quality of patient care. It will provide the techniques, principles, practices as well as Information technology solutions which can facilitate the improved process and information flow in the emergency department. Operation management in any organization or business is involved with the science of understanding business processes and identifying effective strategies to improve the processes. In this case, we refer operations management to the science of understanding the emergency department operations in NSW health Emergency Department and developing the methods to improve hospital efficiency in service delivery and quality health care (Matthias Buckle, 2015, P. 114). The hospital had experienced concerns over the continued demand from customers for the provision of quality services and at the lowest cost. The introduction of modern information systems led to the development of challenges in operational processes. The hospital has a burden of reducing medical errors and increasing patients safety in the emergency department through improved operational procedures and general information flow. Due to the overcrowding effect in the emergency department, there is a great need to develop effecti ve strategies and techniques to facilitate information flow Different emergency departments have embraced the use of different operation management practices in solving the problems facing them or in improving service delivery to their customers. One of the standard methods used in most emergency departments is the lean management practice or principle. The training seeks to improve the operational efficiency of the emergency departments by attempting to provide or meet the demands of the customers in a more efficient manner with little wastes (Amaral Costa, 2014, P. 4). The lean management practice emphasizes the creation of value to their services and products and argues that the emergency services and products should be designed to meet customer demands and expectations and set the right prices. The further outline that every step of the operational process in the emergency department should produce value for the customers by eliminating the wastage of resources. The Lean management practice/principle Lean management practice is designed to ensure that the system flows efficiently or without other intermediate processes of storage. However, the flow of material and information affects the operational process and is determined by the content being delivered The lean practice emphasized that the data or the operational process in the emergency departments must be flexible and centered on meeting individual consumer demands. This means that the executive management process in these departments should produce or provide their services based on consumers needs and not based on what the hospitals consider to be good for the consumers (Saghafian et al. 2015, P. 109). The primary emphasis of the practice is to achieve perfection by creating a constant review strategy to the operational processes in different hospital emergency departments from the floor and learning from the past mistakes as these are critical in enhancing quality health care and improving the hospital emergency. Another common practice and principle in operation management is the waiting time formula. This practice is employed in almost every emergency department and consists of providing an understanding of how long it takes to complete an operational process in the emergency department, the overall activity time, utilization rate as well as the variations in the methods (Song et al. 2015, p. 3045). The practice provides to the management of the hospitals with parameters which can be used to in improving the efficiency of the operations by reducing the waiting time. The crowding effect in most emergency departments has resulted due to lack of time management and delays in service provision. This practice or operation management principle has played a vital role in reducing delays and minimizing the time taken to provide a particular service or activity time. The efficient Frontier Practice/Principle Lastly, many emergency departments have adopted the principle or practice of efficient frontier. The method provides a comparison of the performance of emergency departments in delivering quality healthcare concerning two practical dimensions (Liebler McConnell 2016, p. 8). The first dimension is the responsiveness of the emergency departments towards consumer health care needs while the second dimension is the utilization rate of the operational processes in the emergency departments. The practice advocates for two strategies for improving efficiencies in emergency departments (Haddow et al. 2014). The management of the hospitals can either choose to apply this practice by moving along the efficient frontier. Such a move will require the managements efforts to increase the emergency department capacity without improving their efficiency. The management can, therefore, achieve this by hiring new staff and building more treatment spaces. However, studies have shown that having more areas for treatment does not necessarily lead to reduced crowding in the emergency departments but having the right systems controlled to enhance efficiency (Batt Terwiesch 2015, p. 44). Secondly, the practice holds that the management of hospital can also choose to move towards the efficient frontier which means that, they will be required to increase the efficiency of the emergency departments. Increased efficiency leads to increased utilization rates as well as the increased responsiveness of the departments to consumer demands (Brown et al. 2015, p. 367). This can be achieved by eliminating general waste, reducing the variability of the emergency operations or activities and increasing their flexibility. Such an initiative will eventually lead to improved efficiency of the emergency departments and impact positively on the provision of quality healthcare. Impact of Operation management practice and principles on the process and information flow Successful implementation of these practices and policies should result in the definite improvement of the operations of the emergency department and improve the quality of healthcare provided by meeting consumer demands. The methods should give the management of the hospitals with an opportunity to impact the operations of the emergency departments (DAndreamatteo et al. 2015, p. 1202). The lean management practice helps in improving efficiency in the emergency department by ensuring that the management is determined in meeting consumer demands through the provision of services which create value for the consumers. The practice, therefore, provides the control with an opportunity to continually review its operational management activities and learning from their past mistakes. The waiting time formula has dramatically impacted and contributed to the reduced crowding effect in most emergency departments. Through designing systems to control the time taken for every activity in the emergency department, the management has to be able to reduce time wastage for the consumers as well as enhance their levels of efficiency regarding increased responsiveness to consumer demands (Fagel 2016, p. 12). The practice or principle provides the management with an opportunity to reduce the time and the length of stay at the emergency department by regulating various parameters such as the utilization rate or the activity time. Lastly, the efficient frontier practice or principle has enhanced the effectiveness of emergency services through improved efficiency and responsiveness to consumer demands (Hillman, 2014, p. 492). It provides the management with an opportunity to examine which approach best suits their goal and may decide on whether to use the strategy of moving alo ng the frontier or moving towards the efficient frontier. In this case, running towards the frontier is more useful as it leads to increased efficiency through increased utilization rates and responsiveness. The supply chain and inventory management concepts can be instrumental in developing the process of health care or hospitals emergency departments. The ideas involve the efficient integration of some players in the industry or business such as the manufacturers, the suppliers, distribution agents, warehouses among others (Kadri et al. 2014, p. 107). The main aim of integrating these players is to ensure that good and services are produced and distributed in the right quantities, are delivered to the correct locations, the delivery is done in time in a manner that minimizes the operational costs and offers satisfactory services to the consumers. The concept is beneficial in the healthcare sector due to the number of players involved in providing health care to consumers. The healthcare supply chain can be designed to include product manufacturers, the purchasers of the products and the healthcare providers (Skinner 2016, P. 8). For the hospital emergency department to improve their ef ficiency in service delivery and in meeting consumer demands, there is a need to integrate these players by developing an effective healthcare supply chain and inventory management strategy. Inventory Management Concepts The central inventory concepts which can be used to improve the efficiency of the emergency department include; the adoption of the just in time or stockless inventory management systems to reduce waste, outsourcing the inventory management systems as well as the use of new models to improve patients scheduling decisions which help in lowering crowding effect. The management can also create better demand forecasts (Kang DeFlitch 2014, P. 3974). The primary goal however of the inventory management, as well as the supply chain concepts in health care, is to reduce the operational costs of the facility and general health care and still maintain the quality of service provided by improving service efficiency and increased the productivity of the system. For improved efficiency and effectiveness of NSW Health Emergency Department, there is need to adjust the operations of the department from registry or admission of patients in emergency treatment. The waiting time formula systems will help in enhancing the prioritized queue systems in the departments. The major problems experienced in achieving efficiency and effectiveness of emergency departments include increasing the flexibility of the emergency healthcare systems. Some hospitals still use the traditional emergency response systems and have been reluctant in adopting the new policies. The modern emergency centers have also faced a challenge in increasing the flexibility of these systems in meeting consumer demands. In responses to these issues, it is essential to for the operation management of the emergency department to design systems which are flexible or customized to meet consumer increasing demands. Flexibility will ensure that there are increased efficiency and utilization rates as well as the department responsiveness to consumer needs (Wylie et al. 2015, p. 98). With the increased technological advancements in the health sector, it is essential for the management also to adopt modern technologies and inventory as well as supply chain systems to help in improving their service delivery. The significant barriers expected in the implementation of these strategies can either result from resource capabilities of the hospital and especially in adopting or implementing the modern operation management systems. It is also expected that the hospitals may be resistant in embracing the changes due to organizational culture and structure since most hospitals have remained conservative to their practices and even their operational processes. Conclusion Operational efficiency and effectiveness in emergency departments can be achieved through the development of effective strategies. However, sound management of the operating processes in the emergency departments is very vital in the reduction of waste and inventory costs. It will also be able to improve the department operational efficiency and bring about a significant impact on the quality of patient care provided in the facility. List of references Amaral, T.M. and Costa, A.P., 2014. Improving decision-making and management of hospital resources: An application of the PROMETHEE II method in an Emergency Department. Operations Research for Health Care, 3(1), pp.1-6. Batt, R.J. and Terwiesch, C., 2015. Waiting patiently: An empirical study of queue abandonment in an emergency department. Management Science, 61(1), pp.39-59. Brown, C.A., Bair, A.E., Pallin, D.J. and Walls, R.M., 2015. Techniques, success, and adverse events of emergency department adult intubations. Annals of emergency medicine, 65(4), pp.363-370. DAndreamatteo, A., Ianni, L., Lega, F. and Sargiacomo, M., 2015. Lean in healthcare: A comprehensive review. Health policy, 119(9), pp.1197-1209. Fagel, M.J., 2016. Principles of emergency management and emergency operations centers (EOC). CRC press.pp. 12 Haddow, G., Bullock, J. and Coppola, D.P., 2017. Introduction to emergency management. Butterworth-Heinemann. Hillman, A., 2014. Why must I wait?The performance of legitimacy in a hospital emergency department. Sociology of health illness, 36(4), pp.485-499. Kadri, F., Harrou, F., Chaabane, S. and Tahon, C., 2014. Time series modelling and forecasting of emergency department overcrowding. Journal of medical systems, 38(9), p.107. Kang, H. and DeFlitch, C., 2014, January. Identifying Emergency Department Efficiency Frontiers and the Factors Associated with their Efficiency Performance. In IIE Annual Conference. Proceedings (p. 3974). Institute of Industrial and Systems Engineers (IISE). Liebler, G. and McConnell, C.R., 2016. Management principles for health professionals. Jones Bartlett Publishers.pp. 8 Matthias, O. and Buckle, M., 2015. Accidental lean: performance improvement in an NHS hospital and reflections on the role of operations strategy.PP. 114 Narasimhan, R., 2014. Theory development in operations management: Extending the frontiers of a mature discipline via qualitative research. Decision Sciences, 45(2), pp.209-227. Saghafian, S., Austin, G. and Traub, S.J., 2015. Operations research/management contributions to emergency department patient flow optimization: Review and research prospects. IIE Transactions on Healthcare Systems Engineering, 5(2), pp.101-123. Skinner, J., 2016. Forecasting Emergency Department Overcrowding. SPNHA Review, 12(1), p.8. Song, H., Tucker, A.L. and Murrell, K.L., 2015. The diseconomies of queue pooling: An empirical investigation of emergency department length of stay. Management Science, 61(12), pp.3032-3053. Wylie, K., Crilly, J., Toloo, G.S., FitzGerald, G., Burke, J., Williams, G. and Bell, A., 2015. Emergency department models of care in the context of care quality and cost: A systematic review. Emergency Medicine Australasia, 27(2), pp.95-101.

Organizational Structure and Culture free essay sample

Organizational structure can be defined as the establishment of authority and responsibilities between different positions in the company. It can be either horizontal or vertical. Organization structure also facilitates transparency in the organization (Luthans, 1998). My organization is Saint Joseph’s Hospital, which is a leading magnet facility here in Atlanta Georgia. Saint Josephs was the first hospital in the Southeast to perform open heart surgery, the first to develop a cardiac cath lab and the first to perform balloon angioplasty. The hospital was also the first to open a pace maker clinic and the first in Georgia to implant an artificial heart. Saint Josephs is also regarded as one of Georgias early pioneers in vascular surgery. Saint Josephs is a true innovator and attracts some of the nations finest physicians, nurses and medical support personnel http://www. stjosephsatlanta. org. Patient ratings of Saint Josephs nurses are among the highest reported year after year. We will write a custom essay sample on Organizational Structure and Culture or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Therefore, organizational structure and culture is of utmost importance to our leadership. Executives, directors, managers and supervisors have the responsibility to promote a culture that supports compassion, honesty, respect, responsibility, integrity, teamwork and stewardship among employees and physicians. This requires the promotion of open communication; zero tolerance of fraud, abuse and waste; encouragement of educational and training sessions; and cooperation with requests for information on a timely basis. Each member of the management team is accountable for setting an example that supports the hospital’s culture and structure. Our facility is structured using a team-based type of structure to create an environment of ownership among the stakeholders. This structure supports our organizations plan because it relies strongly upon collaboration, shared goals, common assessments, and other aspects of cooperation to achieve its various plans and missions. It is also a structured system of tasks, workflows, reporting relationships, and communication channels that link the diverse parts of an organization. Team-based approaches benefit from the collective and shared decision-making, planning, goal setting, and overall collaborative nature. On the other hand, some negatives are that this approach is often arduous, time consuming, and even cumbersome since it takes a long time to reach consensuses. Any structure should both allocate tasks and provide for the coordination of performance results. Unfortunately, it is easier to talk about good structures than it is to actually create them. This is why you often read about restructuring, the process of changing an organization’s structure in an attempt to improve performance. Activities of an organization are the combination of some functions like planning, organizing, directing, controlling, etc. All these functions have an impact on the structure of the organization. Planning is a very important function for an organization. It is a determination of the future course of actions for the company. Planning includes determination of specific objectives, programs, policies and strategies. Structure is designed according to the plans of the organization. Any change in the plan causes a change in the structure of the organization. Organizing is the process of dividing the tasks and duties to different groups, and departments. Organizing function increases the efficiency of the organization. All authorities and responsibilities are divided in such a manner that goals of the organization can be achieved. Organizational structure is designed and changed according to the task divided among the employees. Directing is a process of communicating to the subordinates by the superiors. Each employee of the organization is directed by his superiors. Superiors give continuous guidance to the subordinates. Changes in the duties and responsibilities of the superiors and subordinates also affect the structure of the organization because directing process also includes communicating, leading and motivating process. Controlling is the process in which a manager compares the actual results from the predetermined objectives. If any variation is found, some corrective actions are taken by the manager. Corrective actions include changes in the policy, plans or any strategy of the organization. All these changes also affect the structure of the organization. Structure is changed according to new plans and policies of the organization (Prasad, 2008). During this project I discovered that the organizational chart at my facility has undergone significant change. We no longer have the traditional organizational chart which is best illustrated by the shape of a pyramid with board of trustees on top, CEO, CFO, COO then upper management, followed by middle management, then front line people and at the bottom with the argest area, the customers. It shows that top management has the power over those situated below it. Now we have a modern customer-oriented organizational chart, that is an inverted pyramid where the customers are on top occupying the largest area followed by the front line people, middle management and at the bottom, the top management with the smallest area. There are arrows pointing upwards showing that customers are now the primary focus of the organization hence, it is customer-oriented. I have learned that an organizational chart for our unit shows us the division of work via positions and titles which show how work responsibilities are assigned. Supervisory relations with levels of management, let staff members know who reports to whom. Communication channels direct the formal reporting process through the chain of command. Whenever someone speaks of the way we do things here, for example, they are talking about the organizational culture. Although culture is not the sole determinant of what happens in organizations, it is an importance influence on what the members accomplish and how. Therefore, internal and generational differences have the potential to shape attitudes, reinforce common beliefs, direct behavior, establish performance expectations, and create the motivation to fulfill them. In my facility the younger nurses have varied beliefs whereas the older generation pride themselves on their core beliefs about the right way to do things. They have different ways of looking at things based on their traditions and values. They dress differently and express themselves in different ways. I enjoy the cultural differences of my workplace environment but I’ve come to discover that I’m managing the diverse needs of our employees, not their cultural differences. Diverse, yet very common needs, such as child care, flextime, working at home, leave to take care of elderly parents, paternity leave as well as maternity leave. Those needs are in the workplace, and it has nothing to do with a persons cultural difference. Collectively these differences and similarities all influence the organizational culture of the workplace. In conclusion, the potential advantages of team structures begin with better ommunication across all disciplines. Teams are the building blocks of the new and more horizontal organizations. Our organizational structure formally designates and uses permanent and temporary teams extensively to accomplish tasks. References http://www. stjosephsatlanta. org/ Luthans, F. (1998). Organizational Behavior, (8th Ed. ). New York: Irwin McGraw-Hill. Pras ad, L. M (2008), Organizational Behavior (3rd Ed. ), New Delhi: Sultan Chand and Sons. Sullivan, E. J.. Decker, P. J. (2009). Effective Leadership and Management in Nursing (7th ed. ). Upper Saddle River, NJ: Pearson Prentice Hall.