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  • Stopping Employee Theft in Your Coffee Business

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    Regardless to how good of an employer you are, and even if you treat your employees well, understand that employee theft is a reality, and you need to control it. While it may only be a very small percentage of your staff that might steal from you, it can have a significant financial impact on your coffee business. If it goes unnoticed, employees will usually become even more brazen in their activities.

    When it comes to theft, your employees are likely to fall into one of the following four categories:

    Mr./Ms. honest – these are people who would never think of taking anything if it doesn’t belong to them. If they happen to go home with one of your ballpoint pens, they’ll bring it back the next day, and feel guilty that they took it home, even though it was unintentional.

    Incidental theft – these are people that will take home your pen by accident, and will keep it. And, they may scarf a piece of cheesecake occasionally when you aren’t looking, even though they know they shouldn’t. Because these items have minimal value, they have no great sense of guilt related to their activities.

    Theft because of need and opportunity – this is when you have an employee who is perhaps living on the edge financially, and because they have the need, and because your security may be lax, they’ll take advantage of an opportune situation to take something.

    Compulsive theft – this is the person who is always looking for something to steal, and they have absolutely no conscience about it. They typically rationalize the theft in their own mind. They consider you to be the rich, fat cat, and feel that they are over worked and under paid, so stealing from you is justified.

    Employee theft probably exists to some extent within your operation, whether you are aware of it or not. You can most likely live with incidental theft, provided it doesn’t get out of control. Theft related to need and opportunity is, in reality, your fault. These people would probably not steal from you normally, but a lack of security procedures has created the temptation and means for them to do so. Compulsive theft must be discovered, stopped, and you must eliminate the person(s) responsible.

    Losing product due to theft:

    Your employees may have no desire or need for a sleeve of 12oz. paper cups, Java Jackets, or a roll of toilet paper… but they might like a frozen cake, gallon of chocolate sauce, 6-pack of beer, or a bottle of wine.

    There are some simple things you can do to greatly reduce the chance of being ripped-off. First, don’t allow your employees to store their jackets, backpacks, and purses near where you store products. This makes it incredibly simple for someone to slide something into their bag or jacket pocket when no one is watching. I always had my employees store their personal belongings in the cabinet under the cash register (where someone would always be watching), or in my office, under lock & and key.

    Second, keep the back door of your store locked with a key at all times (you or your supervisor being the only ones having a key). If customers regularly enter through your back door, this may not be an option. If your back door is an emergency fire exit (and it probably is), you’ll need to install an alarmed breaker-bar. The whole point is that you don’t want your employees to be able to flow in and out of the back door without you knowing about it. Carrying product out the back door to their car, a hiding place for later pick-up, or an awaiting friend, is one of the most common ways products will exit your store.

    Once you have made it more difficult to stash things in their personal belongings, or carry them out the back door, employees may resort to hiding items in the trashcan. Of course you will unlock the back door to let them take out the trash. If they have hidden something in the trashcan, a dumpster-diving expedition will certainly be planned for after-hours to recover their treasure.

    Periodic trashcan checks should eliminate this problem, or make it a far less appealing option to anyone considering this method to smuggle things out of your store. Buy a long handle 3-prong garden rake. When employees ask to take out the trash, accompany them, and have them hold the can up on the edge of the dumpster while you rake out the trashcan contents. What you are looking for are things that might have been hidden in the trash, but you can tell your employees that you are merely making sure that small wares aren’t being accidentally thrown away. During the 15-years I owned and managed restaurants, I discovered everything from six-packs of beer, bottles of wine, and packages of steaks hidden in the trash!

    Another situation that will create an ideal opportunity for employees to steal from you is having only one person working in your store. If your baker comes in each morning a hour before you or the next employee, or if one person is left to clean and lock-up the place at the end of the day, opportunities for theft abound. As the old saying goes: when the cat’s away…

    Always try to have at least two people in your store at all times. If there is not justification for having a second employee on the clock, then you will need to be that second person. If this requires you going from a 60-hour workweek to 80-hours, then this may not be a tolerable option. If this is the case, then at least invest a couple of hours more each day for a week or two to do some detective work.

    During those times of day when only one employee is working, park at the far end of the parking lot, or across the street, so that you will reduce the chance of being noticed by your employee. If they are familiar with your vehicle, use your spouse’s or friend’s vehicle for a few days. Watch carefully (with binoculars if necessary). I know this all sounds a little CSI – like, but better to rest-easy, feeling fairly assured that your employee isn’t carrying away your store when you’re not watching. If I had the time, I could tell you countless stories of my experiences in catching employees red handed, loading the trunks of their cars.

    If you suspect that theft of product might be occurring, but you’ve seen no direct evidence of it, then conducting a daily key item inventory may shed some light on the situation. Write down a list of 15 to 20 products that you think would be most appealing for someone to steal. In your coffee business, this might include items such as coffee, syrups and sauces, smoothie puree, biscotti, cookies, and desserts, sandwich meats & cheeses, and of course beer & wine (if you serve those from your operation). Then take an inventory of these items every day. Your employees don’t need to know what you are doing, and if they ask, simply tell them you are taking an inventory for ordering purposes.

    What you are looking for are anomalies in usage. For example, let’s say that from your daily inventories you assess that you use about half a gallon of chocolate sauce per day. Then, one day you notice you used 1 1/2 gallons of chocolate the previous day. This should send up a red flag! Why did you go through an extra gallon of chocolate? Were you significantly busier yesterday, or did you featuring several drink specials which contained chocolate sauce? A quick review of individual item sales from yesterday’s cash register report should provide you with the answer. If you average one ounce of chocolate per beverage, then using 1 1/2 gallons means you should have sold approximately 192 beverages containing chocolate (128 oz. per gal. x 1.5 = 192). If this was the case, no problem. But, if you discover that you only sold 64 beverages containing chocolate, then 128 oz. (or 1 gallon) is unaccounted for and missing! A good indication that it probably walked out the door. If this happens, keep track of who was working on the day of the shortage. If this happens continually, eventually you will discover that the same person or persons were working every time.

    Theft of money by employees:

    Hopefully, none of your employees will have the desire to steal products from you, but some will be tempted by the lure of cold, hard, cash. Everyone could use an extra $20 a day. Employees who steal money from you will definitely hurt your bottom line, and must be eliminated.

    The first way to reduce cash theft is to have a cash handling policy in place that will discourage theft. If multiple employees are using the cash register, and no one person is responsible, then I can almost guarantee that your cash drawer will keep coming up short on a regular basis. The fact that no one person can be held responsible for the shortages, will make grabbing a bill or two easy and appealing.

    Implement a policy that one, and only one person is responsible for the cash register for the entire shift. They should count the drawer at the beginning of their shift to verify that they are starting with the designated change bank. Then, they should be the only person to ring up sales and make change. Even you, the owner/manger, should keep your hands out of their cash drawer. Finally, at the end of their shift, they should set aside the amount they started with in the change drawer, and total all the remaining cash, checks, and charges, and balance against what was rung up on the register. If they started with the right amount of money in the cash drawer, rang everything up, took all the money, counted back all the change, and they end up short… who’s fault is it? It can only be theirs. By implementing this simple policy, I once took an operation that was coming up $100 a day ($3,000 a month) cash short, and reduced it to $3 a day, in just 30 days! That’s over a $2,900 bottom line improvement, (in case you didn’t do the math)!

    The other common method that a cashier might use to steal money from you is by using a method called, building a bank. This is the process of not ringing up items on the cash register, while still taking money from the customers, and then pocketing that money. Typically, they will obscure the view of the cash register display on the customer’s side with something like a flower, retail merchandise, or by turning the display so that it cannot be easily seen. Then, they will pretend to ring up an item, but will hit the no sale key instead, popping the drawer open so they can take the cash and make change, but in reality, they haven’t rung up anything. The other thing they might do when it is busy is to just not shut the drawer between transactions. They simply convey verbally the cost of items ordered by customers and take the cash, but once again, nothing has been rung up.

    A cash register that prints out the order on a remote receipt printer to the person who will be preparing the item, can eliminate this problem. Quite simply, if the item isn’t rung-up, it won’t print out. If your barista or cook won’t prepare anything without a receipt (and they shouldn’t!), it will force your cashier to ring everything up.

    If you observe that the cash register’s display has been blocked from the customer’s view, or there are an excessive number of no sale indications on your cash register’s detail tape, or notice that your cashier is not shutting the drawer between transactions, beware! While these may not be indisputable proof that your cashier is stealing from you, they should certainly heighten your vigilance to find out if something is going on.

    If your coffee business only warrants having one employee working at a time, perhaps because you own a cart, kiosk, or low volume drive-through operation, then how do you go about keeping your employee from building a bank and stealing from you? The best solution I’ve seen is to turn your customers in to watchdogs. Affix a sign to the front of your cash register, in plain sight of the customer, that reads: If you don’t receive a receipt with your order, it’s FREE! This will force your cashier to hand each customer a receipt for their purchase. If they are building a bank, this means they will have to hand the customer a receipt that says – NO SALE; something they probably won’t fell comfortable doing!

    The financial impact of theft of money can be extremely damaging, for example: Let’s say you have a cashier who is skimming off $20 a day by not ringing things up, and then pocketing the money. Not only did you loose the stolen $20, but the $7 of ingredients that were probably used to produce the ordered products; ($20 x 35% ingredient cost = $7.00). So in reality, you lost $27, and it will take an additional $41.54 in sales, to recover this loss; ($41.54 x 65% gross profit = $27). $27 a day lost to theft, X 21 days worked by the employee = $567 lost cash & product per month; $872 extra sales required to offset this loss. (Annual loss, $6,804; $10,468 in additional income required to offset loss.) You must stop theft of money!

    Theft of money management:

    If you have a manger running your operation for you, this can really create an opportunity for cash theft. Just about anyone who has ever run a food service operation (self included), probably felt that they were over-worked and under-paid. Some are tempted to grant themselves an unapproved raise. Your manger has the control key to the cash register, which means they have the ability to back off items that were sold. You would be wise to check your cash register detail tapes on a regular basis. If you see multiple items backed off in groups, or more worrisome yet, all backed off at the very end of the shift, beware!

    A good way to keep this from happening is to establish a policy that no over-rings are to be backed off of sales on the cash register with the management control key. Instead, when the cashier makes an over-ring, they should take the receipt, write over-ring on it, sign it, and put it in the cash drawer. At the end of the shift, the total of all over-rings should be manually backed off of the sales total indicated on the cash register report.

    Many years ago I had a manager that was stealing money from me in another creative way. This manager, who opened the store each day, would reset the cash register by Z-ing it out after the first half hour of business. He would then pocket the proceeds earned during that first half hour. Because additional sales were generated during the second half hour, the cash register hourly sales report would always show sales for the first hour of operation, thus eliminating any suspicion that something might be going on.

    It wasn’t until I was doing a routine audit of cash register Z tapes that I noticed something wasn’t right. When you run a Z report, which resets the cash register at the end of each day, a multi-digit number will usually be printed somewhere on that tape. The next time you Z the register, that number will advance by one digit. I noticed that even though the tapes were sequential in date, every other number was missing. This tipped me off that the register was being Z-ed twice a day! When I confronted my manager with the tapes, his look of panic spoke volumes.

    If you are doubting the honesty of any of your employees or managers, one way you can verify or eliminate your suspicion is by baiting the cash drawer. Slip an extra $20 bill in the drawer sometime during the day when they aren’t watching. If they don’t end up reporting at the end of their shift that they were $20 cash-over, I’ll do it a second time (just to make sure). If they don’t report it a second time, you should have no doubts that they are indeed, dishonest.

    NEVER accuse an employee or manger of stealing unless you catch them red-handed (actually stuffing money into their pockets). Even though the circumstantial evidence may be overwhelming, unless you actually catch them in the act, they are likely to deny your accusations, and will probably file a complaint against you with the department of labor! The brief moment of satisfaction you will gain from letting them know you are aware of what they’ve been doing, will be quickly overwhelmed by the legal predicament you will find yourself in. You will be far better off to not make accusations. Simply terminate their employment. In many states, you do not need to provide a reason as to why you are letting them go. When they ask for an explanation as to why you are firing them, simply say: I don’t need to give you a reason, I’m just letting you go, goodbye!

    Finally, don’t over look technology to help you with security. Surveillance cameras linked to a DVR (digital video recorder) can provide you with peace of mind, or evidence of theft. These systems have become very affordable, and many are easy to install. The value of these cameras go beyond having a video record of operations. The mere fact that employees understand that their activities are being video recorded, will usually discourage them from doing things that they might not think twice about, if no one was watching.

    I think it’s important to not be paranoid about employee theft. Certainly, you don’t want to be constantly obsessed with the suspicion that everyone is stealing from you. In reality, the majority of your employees are probably honest people. But, you would be wise to establish some simple safeguards, and maintain a watchful eye.

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    Source by Ed Arvidson

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  • Caribbean Medical School: Fastest Way to Be a Doctor?

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    Caribbean medical schools have long been the butt of jokes but their graduates are the ones having the last laugh. There are thousands of licensed physicians from Caribbean schools practicing all across the country. Over 25% of all doctors in the US are from international schools. Do you know where your primary care physician went to medical school? This is the field where Caribbean graduates are expected to dominate with a large percentage of graduates training in Internal and Family Medicine. They are expected to fill a nationwide shortage that is currently occupied by Physicians Assistants and Nurse Practitioners.

    Picture this. A 17 year old high school graduate enrolls in a pre-medical program at a Caribbean university. Schools will automatically accept students to their medical programs as long as they maintain a certain GPA in the pre-program. This means there is no need to take the MCAT so you can save yourself the headaches from preparing for that. The program is completed in 2 years and the student enrolls in the first year of the medical degree program at 19 years old.

    Numerous Caribbean schools offer an accelerated curriculum that divide the year into trimesters. Students attend school year round and are able to complete their M.D. in less than 36 months. Not to mention you only spend 18 months studying on the island. The clinical years are spent training alongside American medical student at hospitals in the US. St. George’s medical school has hospital affiliations that match any US school. Our fictional student graduates with his Doctorate in Medicine at the ripe age of 22 (going on 23).

    Our new graduate is eligible to practice in any state in the country as long as he attended one of the “Big 4” Caribbean medical schools (St. George’s University, Saba University, Ross University and American University of the Caribbean). Internal Medicine residencies last 3 years so we have a residency trained physician ready for board exams, licenses and employment at a mere 25 years old. Not quite Doogie Howser but it’s impressive to say the least.

    This accelerated path also benefits those seeking a new career or chasing their dream of being a doctor. Time is of the essence and wasting summers off in the traditional semester system is not time well spent. Caribbean medical schools are littered with nurses, pharmacists, dentists, chiropractors and many other health care practitioners. Many schools offer several different entrance times during the year giving flexibility for students who want to begin their medical education immediately.

    There is risk involved in attending a medical school overseas but there have been thousands who have blazed the trail before you and set the precedent. Caribbean medical schools produce capable physicians and fill an integral need in the health care system of the US.

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    Source by Greg Andrew Park

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  • What You Need To Know About Drug And Alcohol Addiction Treatment Programs

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    A drug and alcohol addiction treatment program is one of the most successful ways to wean yourself from drugs, alcohol and all other addicting processes. If you are at the stage where you are considering drug and alcohol addiction recovery, the good news is that you are on the road to recovery. The bad news is that this is a long and very difficult journey that you will have to take. A drug rehab clinic is often one of the best ways for you to detox from alcohol and drug use. But, you need to do so with the necessary knowledge about the drug and alcohol addiction treatment program you plan to attend.

    Here are some fundamental things to consider about the drug and alcohol addiction treatment program you are considering.

    · Your drug rehab clinic should provide help for all areas of the infected person. That includes their psychological, medical, and legal problems.

    It can also address their needs for finding a way to work and overall restart their life.

    · Realize that not all treatment programs are the same for everyone. You should work with the clinic to determine the most appropriate treatment program for your specific circumstances.

    · The program should allow for continuous change to it, as the individual grows through it. As they begin to repair the damage done to them by drugs, the effective treatment program should change to accommodate these needs.

    · Time is needed. It is necessary for a person to stay in treatment for as long as possible. On average, this is about three full months. Only with enough time will the treatment be successful.

    · The drug and alcohol addiction treatment program also needs to focus on the medicinal needs of the patient. That would mean careful consideration for their specific medical concerns. Things like withdrawal medications are almost always necessary in severely addicted individuals.

    · You should realize that detoxifying the individual is not enough to stop the behavior. The drug rehab clinic needs to handle more than just this process. It needs to look for the long term rehabilitation of the individual. Detoxing is just not enough.

    · Also, you should take note that voluntary drug treatment is not always necessary. If a person is motivated to detox because of family, employment or legal problems, this can be enough to push them through it.

    Additionally, this force to go in can help them to become more successful at their program as well.

    Drug and alcohol addiction recovery does and can happen through a high quality drug and alcohol addiction treatment program. Once the alcohol and drug detox has happened, the next step is to correct the behavioral, emotional, physical and long term effects of the drugs. This can be the mark of healing when the program addresses the full scope of what is happening.

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    Source by Sandy Sizemore

    Views: 1

  • 12 Benefits and 12 Challenges of Being an Entrepreneur

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    All over the world, people are breaking free from the traditional employment model and choosing to achieve business success as entrepreneurs. Will you be the next?

    Let’s start by covering 12 of the most commonly-mentioned benefits of being an entrepreneur to inspire you on your journey:

    1. You can choose your own schedule.

    2. You are free to travel.

    3. You can take sick days or vacation days whenever you need them.

    4. If there are necessary tasks you don’t enjoy or have time for, you can outsource them.

    5. You can select your own employees.

    6. Learning to be a better boss also teaches you to be a better employee.

    7. Your innovative ideas have a chance to shine unfettered.

    8. You do not have to wear a uniform or follow a company dress code.

    9. You enjoy better job security than most people.

    10. Entrepreneurship teaches you the benefits of hard work.

    11. You can always feed your curiosity by learning more about every aspect of your business.

    12. Your ambition can always drive you to greater heights and business success.

    As you can see, entrepreneurship is becoming popular because it comes with a whole new lifestyle for those who are willing to seize it.

    Of course, entrepreneurship isn’t all sunshine and freedom. According to the United States Small Business Association, a third of small businesses fail within the first two years, and more than half fail within the first five years.

    Not surprisingly, the challenges of entrepreneurship represent the flipside of the advantages we discussed above:

    1. Choosing your own schedule can result in wasted time without the proper time-management skills.

    2. Even while traveling, it may be necessary to handle work-related crises, because you are basically always “on call.”

    3. There are no paid sick days or vacation days, so you must decide how much each day off is worth to you.

    4. You are responsible for completing any tasks you can’t afford to outsource.

    5. Hiring employees means you must learn how to conduct interviews, uphold workers’ legal rights, and coordinate payroll.

    6. If you don’t yet have the leadership capabilities to direct others, you will be taking a crash course once you hire freelancers or employees.

    7. You must narrow all of your innovative ideas down to the ones that have the most potential to help you achieve business success.

    8. If you don’t maintain a professional appearance in person and online, it is sure to reflect poorly on your company.

    9. You are responsible for funding your business, even if you’re operating at a loss.

    10. Only results are profitable, not time clocked, so it’s possible you will work hard and still end up disappointed.

    11. You must be familiar with each aspect of how your business operates, including those which may not interest you, to ensure everything is running smoothly.

    12. Only you can motivate yourself to achieve business success.

    To sum it up, let’s say that with freedom comes responsibility. If you can’t handle one, you aren’t yet ready for the other.

    Of course, I don’t believe people should give up on their dreams. Just be sure to arm yourself with knowledge and understand what you are getting yourself into.

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    Source by Evelyn Gawlowska

    Views: 0

  • 3 Obscure APA Writing Style Rules You Should Know

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    Many students are required to submit essays, research papers, and other assignments written in APA writing style. Academic papers written in APA style of writing should strictly follow APA guidelines even those obscure ones to score good grades. Using APA Writing style requires more than just the form of references and citations. Some complex requirements may be unknown for those who are not familiar with APA writing style or have some experience using this style when preparing their academic papers. Below are the three obscure APA rules you should know:

    Prefixes in APA Writing Style

    A big part of using APA writing style is the proper use of prefixes. It is common to use hyphens after prefixes in casual English. However, this is against APA style of Writing. Words such as underdevelopment, hypertext, underscore should not be hyphenated when writing an academic paper using APA style of writing. There are certain circumstances that you will be allowed to use prefixes when writing an academic paper using APA style. When using the prefix self-, you should always add prefixes for example self-esteem, self-employment among others. On the same note, you are allowed to use a hyphen when the word after the prefix is a proper noun or number.

    Anthropomorphism in APA style of writing

    Anthropomorphism refers to a situation where a writer ascribes human traits or action to non-living things. Anthropomorphism is commonly used in all levels of study when writing an academic paper. Many tutors, professors, or reviewers may not bother to mention it; however, it should be avoided when writing an academic paper. Examples of most commonly used anthropomorphism include “This article examines… ” or “This paper discusses… ” Be as it may, it is not technically possible for a paper to discuss anything. Therefore, the best alternative is to say “The researcher discussed… ” or “… is discussed in this paper.”

    Numbers in APA Writing Style

    Many students and scholars are confused by the use of numbers when writing documents using APA style. Many students and scholars are familiar with numbering rules in APA style, but they end up misusing them. It is important to note that you should spell out numbers between one through ten when you include in a paper formatted in APA style of writing. For example, you should not write ” It took 7 years for me to understand how to cite a paper using APA.” Instead, write, “It took seven years for me to understand how to cite a paper using APA.”

    Tips for proper formatting and editing a document using APA

    It is important to obtain a copy of APA writing style guidelines and review it thoroughly before writing an academic writing paper. You obtain them from popular websites such as Purdue OWL and reputable universities writing centers. You can also get help from professional writers and editors that can help you format your academic paper or book in APA style of writing.

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    Source by Johny Evans

    Views: 0

  • Biotechnology and Social Entrepreneurship: The Perfect Symbiosis

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    This is the era of globalization where modernization in every sector is essential due to societal changes and the continuous demand for a quality life. It’s the duty and a moral obligation of every industry to assist in providing a better way of life to those who are less fortunate and require your help. In such conditions, one needs to be resourceful, altruistic, have qualities pertaining to that of a businessman, and have a scientific view. Biotechnology as such is a field that can contribute to various individuals in terms of money as well as its inventions. This industry has grown monumentally over the years and has helped people find hope and restore their belief in humanity with its applications in the field of genetics, agriculture, food, medicine, and healthcare.

    Biotechnology and social entrepreneurship can go hand in hand. For example, by providing better healthcare options at cheaper costs, consumers are motivated to opt for Biotech products. In this way, the Biotech organizations can help move low-income communities toward better health, and by purchasing their products, the consumers are indirectly promoting the company’s brand. Creating employment opportunities, intellectual wealth, and expanding industrial growth are a few of the absorbing factors that guarantee a focused approach for this sector, resulting in a general benefit to society.

    Scientific entrepreneurs often lack managerial competencies, industrial experience, and contacts, even if they integrate members with an administrative background; so therein lies a critical area that requires some work. Solutions to certain social problems, such as improving the quality of health, economic, political, and cultural problems in reference to poverty, often require fundamental transformations in the political, economic, and social systems. A Social Entrepreneur brings change to the social system by utilizing their work and business to address that cause. Such ingenious creativities represent social entrepreneurship. Hence, it can be stated that the approaches for network building observed by biotech companies regarding social entrepreneurship will combine behavioral features that are archetypal of biotechnology entrepreneurs, and include other characteristics that are a response to the conditions found in their particular environment.

    An excellent managerial team can provide the necessary skills for the management and coordination of scientific and commercial operations, and can also help maintain a good organization repute. One key area where social entrepreneurs play a vital role is in the commercialization of research results of the biotechnology industry thus, warranting sustainable growth. A working local innovation system with respect to the connections between companies and knowledge organizations can be the stimulus to this implementation.

    For example, Juan David and Alicia Carpio launched Q’omer Bioactive Ingredients, a technology-based social enterprise. They witnessed the condition of people regarding their farms and unfair labor deals in Peru, so they designed a sustainable and socially responsible way of working with resources in Latin America. They offer raw materials and ingredients to produce organic products and improve the well-being of people while promoting the economic and social sustainability of producers from Latin America. This is only one example, but with each passing year, more and more Biotech companies are taking the initiative to promote social entrepreneurship and contribute to various societies by providing scholarships, funding, and research options in the field of Science.

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    Source by Chris Bouchard

    Views: 0

  • Department Administrator Interference in the Doctor-Patient Relationship

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    I contacted a resident doctor in Internal Medicine at a teaching hospital and asked if he would be interested in becoming my primary care physician (PCP). My note briefly described my background in health outcomes research and two of my prescription drugs. He wrote back that he would be honored to be my PCP, and came across as professional, humble, and sincere. A new doctor-patient relationship was formed, and I contacted my existing doctor’s office to arrange for my medical records to be transferred, which immediately informed that office that I must be dissatisfied and going to a new doctor. I also shared with the resident doctor confidential information from my medical records and a copy of one of my professional presentations at a health care conference.

    A department administrator then contacted me to say the resident doctors are not available every day of the week for clinic and are not even here when they do their ICU rotation. Also, the Internal Medicine department protocol would not allow the resident doctor to write me a drug prescription for off label use. Finally, she was concerned that in the past I have ordered and correctly interpreted my own blood tests. The administrator’s attitude reflects one of the chief complaints Americans have with the health care system: the system is coming at them and requiring them to get health services in some predefined structure to which the facility is accustomed but which eliminate any potential for individualized treatment according to individual patients’ needs.

    Apparently the administrator did not spend enough “careful consideration” to get her facts straight. I do not need to see my PCP daily or even monthly. My track record shows I saw my existing doctor once in a calendar year, and the prior doctor before him I saw once in a 15-month period. So the administrator based her decision on her own ignorance of the facts.

    She also misstated facts concerning off-label prescriptions for drugs by resident doctors. One of the drugs we are talking about is Clomiphene. Both a resident doctor and an attending faculty physician at the teaching hospital advised me that they would be willing to write me (off-label) prescriptions for this drug, and the attending physician did indeed phone in a prescription for one of the drugs at my request. Similarly, the Dept. of Obstetrics and Gynecology (OB-GYN) advised me that their doctors, both resident and attending, have prescribed Clomiphene to patients. Therefore, residents in Family Medicine and OB-GYN (both primary care departments) can write prescriptions for Clomiphene, but “protocol” prevents residents in Internal Medicine (also primary care) from writing off-label prescriptions. What kind of a cockamamie rule is that? What, the residents in Internal Medicine are too dumb or too naive to understand off-label benefits of medicines?

    Finally, I had planned for my resident PCP to order and interpret blood tests each time I visited him. The administrator could have learned that fact if she had bothered to call or write me before jumping to conclusions and interfering in my doctor-patient relationship. I strongly reject the Director’s paternalistic view of medicine in which she feels she has to protect resident doctors from patients who order or interpret their own blood tests. These resident doctors are young professionals who have completed their medical degrees; they don’t need paternalistic oversight from a department administrator telling them who they can and cannot invite to be patients.

    Apparently, an overwhelming number of patients who visit this teaching hospital’s doctors want to be told what to do and how to feel. I am the exact opposite; I take personal responsibility for and manage my own health, which is strongly advocated under health care reform. Having a more equal, collaborative relationship with my PCP works for me, and that seems to be the true reason for the administrator’s interference. Studies show that medical malpractice rates drop with a non-paternalistic model of health care services. That fact of reducing litigation risks is pushing more health care systems across the country to migrate to a non-paternalistic model.

    LEGAL ANALYSIS

    I. Formation of Doctor-Patient Relationship

    The first question to address is whether, based on this fact pattern, a doctor-patient relationship was formed. When I gave the Internal Medicine resident doctor confidential information on two off-label drugs that I take, that act would be analogous to a prospective client approaching a lawyer with facts about his case to see if the lawyer will assist him. Contacting a lawyer this way does not create an attorney-client relationship. However, the lawyer is under an ethical duty to protect the confidentiality of the information shared by the prospective client. Similarly, the resident doctor was under an ethical duty to keep the information I shared with him confidential.

    When a lawyer responds to a prospective client, “I agree to take your case,” or “I will be your lawyer,” or words to that effect, then an attorney-client relationship is created, and the protection afforded to the client’s information rises to the level of constitutionally protected attorney-client privilege. In this case, when the resident doctor responded that he would be honored to be my PCP, we have offer and acceptance forming a contract. The offer-acceptance could be construed as my offering to be his patient, which he accepted, or his offer to be my PCP, which I accepted.

    But offer and acceptance are only two of the three required elements to form a contract. The third essential element is exchange of consideration, expressed in Latin as the quid pro quo. In this case, there were several separate exchanges of consideration that complete the formation of a contract and thereby render it enforceable in a court of law. Consideration is defined as some act or some transfer of an item from one party to the other, for which the receiving party had no legal right to otherwise obtain that consideration. There is no requirement that the consideration have intrisinc value. For example, the transfer of a scrap piece of paper can constitute valid consideration that renders a contract binding and enforceable.

    The initial disclosure of confidential information from my health history amounts to sufficient consideration. Second, the fact that both I and the doctor each began pursuing scheduling an appointment for me to see him is also consideration: neither of us had a prior legal right entitling us to that action by the other person. Third, when we continued to correspond after offer and acceptance, with additional information being shared back and forth, further consideration was exchanged. My sending the resident doctor a copy of one of my professional presentations was a fourth example of consideration. Finally, my request that my medical records be transferred to the resident doctor’s clinic constituted an obvious legal detriment based on reliance rendering the contract enforceable.

    If a lawsuit were filed for enforcement of this contract, I am confident that the plaintiff would overcome any attempt to dismiss the lawsuit by the teaching hospital’s attorneys based on the absence of a contract. Defendant might attempt to argue that no contract could be formed, because the resident doctor is not licensed. According to the website http://medical-dictionary.thefreedictionary.com/resident+physician, a “resident physician is a graduate and licensed physician receiving training in a specialty, usually in a hospital.” The resident’s licensing status would not prevent the formation of an enforceable contract, as we have in this fact pattern, for treatment in the supervised residents’ clinic.

    In court, we would pose a series of questions: 1) Is the resident a graduate of a medical school? Yes! 2) Was our conversation focused on health care treatment? Yes! 3) Does the resident see other patients (whether supervised or unsupervised) in the resident clinic? Yes! 4) Are the resident’s services billed to the U.S. government and to private insurers as the services of a doctor (not a student or a doctor’s aide)? Yes! 5) Did we both use the term PCP in describing our relationship? Yes. 6) Did the resident undertake to assist me in obtaining a medical appointment to see him? Yes! With these answers, any court of law is going to recognize if it looks like a duck, swims like a duck, and quacks like a duck, then it is a duck. Therefore, the defendant’s argument on licensing will be viewed as a red herring and will fail. In a similar vein, courts have noted “it is axiomatic that a doctor-patient relationship may arise from, briefly exist, and be limited by the unique circumstances presented in a transfer situation.” Sterling v. Johns Hopkins Hosp., 145 Md. App. 161 (Md. Ct. Spec. App. 2002). It does not matter how long the doctor has been seeing patients or how brief the contact with any given patient, a doctor-patient relationship can be formed.

    Selection of a PCP and other medical decisions are “core” private decisions. A fundamental tenet of privacy jurisprudence, as it has been applied to other types of personal matters, is that the individual most directly concerned is entitled to make and implement the protected decision autonomously and free from paternalistic government intrusion. See, e.g., Zablocki v. Redhail, 434 U.S. 374, 54 L. Ed. 2d 618, 98 S. Ct. 673 (1978) (decision to marry); Moore v. East Cleveland, 431 U.S. 494, 52 L. Ed. 2d 531, 97 S. Ct. 1932 (1977) (decision to live with extended family members); Griswold v. Connecticut, 381 U.S. 479, 14 L. Ed. 2d 510, 85 S. Ct. 1678 (1965)(reproductive choice). I would argue that the constitutional right to privacy also protects autonomy in selecting a PCP among a wide choice of available doctors, selecting which medications I want prescribed, and choosing what lab tests I want to order myself to monitor my health.

    In 2005, the Supreme Court of Arkansas provided the best statement in American jurisprudence on the elevated status of the doctor-patient relationship. The court noted the relationship of doctor-patient is unique. “The loss of this relationship, even temporarily, causes irreparable damage to the doctor and the patient. There is no adequate remedy at law because the loss is a loss of a one-time opportunity.” Baptist Health v. Murphy, 362 Ark. 506 (Ark. 2005)

    The court noted that the hospital had violated the Arkansas Department of Health rules and regulations for hospitals by failing to enforce policies that protected the doctor’s selection of patients and the patient’s choice of a physician. “We interpret this to mean that an otherwise qualified doctor must be granted access to his patient for the purpose of treating his patient, if that is what both the doctor and the patient want. Or, stated another way, a hospital cannot deny the services of a physician of the patient’s choice if the patient is already being seen by physicians at the hospital. Baptist Health v. Murphy, 362 Ark. 510-511 (Ark. 2005)

    Based on reading Baptist Health, I will now forward a copy of this article to the state Department of Health to determine whether the teaching hospital violated any of my state’s regulations requiring Tennessee-licensed medical centers to have policies or bylaws that respect the patient’s right to select his own physician. If so, then the teaching hospital is violating those regulations.

    II. Tennessee’s Tortious Interference Statute

    Tenn. Code Ann. § 47-50-109 is captioned, “Procurement of breach of contracts unlawful – Damages.” The administrator tortiously interfered in my doctor-patient relationship and prevented the resident doctor from performing his services under our contract. She therefore procured a breach of that contract. The administrator will argue that she was merely performing her duties, but that is no excuse for interfering in an existing doctor-patient relationship.

    Although Tennessee jurisprudence does not have a case on point, courts across the country have taken a dim view and expressed disapproval of employer interference in the doctor-patient relationship. For example, the U.S. Supreme Court stated, “The ethical objection has been that intervention by employer… makes a tripartite matter of the doctor-patient relation. Since the contract doctor owes his employment and looks for his pay to the employer… rather than to the patient, he serves two masters with conflicting interests.” United States v. Oregon State Medical Soc., 343 U.S. 326, 329 (U.S. 1952).

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    Source by Michael Guth

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  • Social Entrepreneurship – Now is the Time

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    Social entrepreneurship is a major area of interest in many social and civic organizations and has a significant impact on many areas of society. During the past decade economic resources have become more difficult to acquire and society has continued to exhibit economic and cultural decline. Concurrently, communities are in need of initiatives that will enhance their financial viability and programs that will enhance the overall viability of the population.

    Social entrepreneurship initiatives are ventures that can serve as a method of increasing the social value of a community, organization or cause while enhancing the financial viability of a not-for-profit organization. With this being stated, social entrepreneurship has been defined in different ways by many different theorists. Gary McPherson, Executive Administrator of the Canada Centre for Social Entrepreneurship, states that social entrepreneurship involves various individuals working toward meeting social and economic goals simultaneously; while Bill Drayton, CEO of Ashoka, defines social entrepreneurship as a term coined to describe “individuals who combine the pragmatic and results oriented methods of a business entrepreneur with the goals of social reform.”

    A more basic definition of social entrepreneurship states that it is “the process of using entrepreneurial and business skills to create innovative approaches to social problems.” Therefore, it is a methodology that is presently being used to resolve community and societal concerns globally. Social entrepreneurship as an area of specialized entrepreneurship is not defined by the same titling in every culture. For example, in Latin America countries social entrepreneurship initiatives are referred to as “Micro Enterprise.” In India the same program would be identified as a “Social Mission.” Though termed differently in various regions, social entrepreneurship initiatives are being implemented to solve specific societal and community concerns by focusing on the needs and resource availability within specific geographic regions.

    Social Entrepreneurship in Education Throughout the United States, many top tertiary level academic institutions are enhancing their business programs by including a curriculum that caters to the study of social entrepreneurship. In 2003, the Center for Responsible Business was launched on the University of California Berkley Campus. This subsidiary of the Haas School of Business was implemented with the intent of training students to be more principled and socially responsible members of society through attending “the preeminent educational institution in area of Corporate Social Responsibility.” Stanford University also has established a Center for Social Innovation as a part of its graduate school of business. This center was founded with the mission to “build and strengthen the capacity of individuals and organizations to develop innovative solutions to social problems for a more just, sustainable and healthy world.”

    In 1993, Harvard Business School started its social enterprise program with its mission of “generating and sharing knowledge to help individuals and organizations to create social value in the not-for-profit, private and public sectors,” and the University of Miami has refocused its business school curriculum to include coursework in the areas of ethical-decision making, social entrepreneurship and community engagement with the primary focus being to expose students to various areas of civic engagement while concurrently teaching them leadership and team building skills.

    Tertiary level institutions, including Duke, which has established a Center for the Advancement of Social Entrepreneurship as part of its Fuqua School of Business, and Columbia University where the research initiative on social entrepreneurship is embedded in its school of business, have also made strides to enhance the study and education of those seeking to venture into areas of social entrepreneurship and social venture implementation. The Association to Advance Collegiate Schools of Business-International (AACSB – International) has identified over twenty-four tertiary level institutions that have included social entrepreneurship as a part of their business college and or business curriculums.

    With social entrepreneurship being perceived by many as a new way of stimulating social change, Idee Winfield believes that the implementation of community-focused service learning projects is the first step in exposing youth to the various attributes associated with social entrepreneurship. Through community involvement, youth will begin to visualize and experience the various social issues within their community and envision ways to solve these problems. Winfield states that social entrepreneurship should be promoted in primary and secondary education, and coursework should be adjusted to allow students to “see how abstract socially focused concepts can have real world applicability.” Jeffrey Soderborg, a member of the Kauffman Center for Entrepreneurial Leadership Clearinghouse on Entrepreneurship Education, is also an ardent proponent of social venture education who believes that social entrepreneurship would be more readily accepted if youth were exposed to information expounding the laurels of these initiatives during their primary and secondary academic years.

    As youth expand their horizons through the establishment of entrepreneurial efforts, knowledge and exposure to information about the process involved in the establishment of entrepreneurial business effectively plays a major role in the rate at which business entities are established. A study focusing on entrepreneurial interests among black youth ages 14 to 19 identified that 75% of the youth surveyed had interest in becoming entrepreneur. The study also found that these minority youth believed that more information about entrepreneurship should be presented through their schools. They also believed that entrepreneurs have a responsibility to reinvest in their community.

    Corporate Social Responsibility

    Personal values often serve as the justification for entrepreneurs to focus organizational efforts on socially focused ventures. The organizational decision to forgo pursuing financial gain with the intent of using the corporations’ profit resources to enhance a community is often referred to corporate social entrepreneurship. Corporate Social Entrepreneur (CSE) is a term used to describe corporate initiatives whose primary focus is to enhance a social concern and whose secondary focus is financial gain. The corporate social entrepreneur differs from the financial profit seeking entrepreneur in the area of decisions made that affect the community and environment in which their organization functions. Research identified that in corporate social entrepreneurship business acumen serves as a factor in the success or failure of social venture initiative implementation. Research identifies that success factors associated with the implementation of social responsibility initiatives were linked to whether the entrepreneur exhibits behavior that is moral, amoral or immoral.

    The amoral entrepreneur would pursue initiatives only if they were deemed acceptable by the organization as a whole. The immoral entrepreneur implements initiatives based on what can be potentially gained for self as well as for the stakeholders, while the moral entrepreneur would pursue social responsibility initiatives based on what was in the best interest of the organization. Individuals identified as corporate social entrepreneurs are individuals who are more active in community activities and are actively involved in social responsibility efforts. Corporate social entrepreneurs also are more likely to implement social responsibility initiatives based on an organization’s long term objectives.

    While many corporations are looking for ways to increase their social responsibility efforts, in some regions corporate responsibility efforts are not progressing. A policy paper, “Corporate Social Responsibility in Latin America and the Caribbean,” documented that corporate social responsibility activity in this region has “stalled.” The reason for stagnation in this region is “minimal government involvement” and the lack of “private sector involvement.” It was also identified that initiatives to implement programs focusing on social responsibility are often initiated outside of the market, and then subsequently not embraced by stakeholders who reside within this geographic region.

    Corporations are continually looking for ways to increase corporate advantage through their social responsibility efforts. While proponents of corporate social responsibility believe that corporations are obligated morally to engage in efforts to enhance social, community and environmental concerns, many stakeholders believe that social involvement should only be initiated if the efforts are going to strengthen the organization’s image, brand, moral or stock value. With this in mind, corporations have separated social issues into specific categories.

    These categories are social concerns that are general, social concerns that are value chain based and concerns that focus on social dimensions of competitive contrast. Generic social issues are identified as social concerns that do not directly affect the company’s operation and do not have an effect on a company’s competitive advantage. Corporations are least likely to get involved or invest in projects that focus in these areas because they will not receive a high value of return on their involvement. Value Chain Social Impact issues can significantly affect a company’s operation and can have an impact on the way a company conducts business. Corporations are more likely to be involved in value chain concerns, but only after conducting due diligence studies to ensure that a return on investment will be achieved over time.

    Social issues that affect a company’s financial profitability or serve to enhance or increase a company’s competitive edge are likely to be areas that a company will invest in because of the direct impact that these initiatives will have on the company’s overall viability and stability. An example of a social dimension projects is General Electric’s investment in under-performing high schools throughout the country. General Electric believes that through investing financial and professional resources in under-performing high schools in areas where they have substantial financial investment, they are investing in enhancing a community, as well as directly increasing their future employment prospects.

    Whole Foods Market is an organization that has taken control of its social value position through purchasing products from local farmers. Also, Whole Foods maintains strict controls over all of the products produced and sold in all of its locations. They even have extended their social and ecological efforts through offsetting the use of in-store electricity with the installation of wind conversion generators, converting their trucks to operate on bio-fuel and trucking spoiled produce to regionally located compost sites. Though the investments in these technologies may be costly at the onset, the long term financial, civic and market exposure benefits far exceed any initial costs incurred.

    In the area of corporate philanthropy many corporations are at a loss. They continue to be involved in the conflict between philanthropic giving and investor requests for increased profits. For this reason many corporations engage in context-giving programs. Context-giving programs are programs that are defined as allotting resources to specific projects that will enhance the community while simultaneously enhancing the corporation.

    Examples of context-giving initiatives include the Cisco System Networking Academy, which trains computer network administrators and provides job opportunities to those who complete the program; the DreamWorks SKG film production program that trains low-income individuals in occupations that are needed in the film and entertainment industry; and American Express Travel and Tourism Academy which trains high school youth for careers in the hospitality and tourism industry. Corporations that invest in corporate-giving social venture programs are concurrently gaining positive return on their social investment, improving the economic climate of the communities where they are located and gaining positive exposure for their organizations.

    At times social ventures do not have the intended impact on the community. A study focusing on the impact of community focused business ventures found that businesses started with the intent of enhancing a community often lose focus by becoming focused on profitability and competition. Competition and self-focused motivators were identified to be factors that played an additional role in the impact and economic role that entrepreneurial ventures have in community settings.

    While many foundations, trusts and philanthropic organizations, accumulate and distribute resources with the intent of providing services to enhance specific community or social causes, many of these organizations are looking for ways to gain public exposure for their efforts. Organizations also attempt to leverage their gifting efforts through seeking not-for-profit organizations that are willing match the funding received. The success of funded programs is evaluated through performance outcomes and indicators, and through promoting the organization’s work through success stories provided by program clients. These methods are viable ways for funding agencies to acquire value and exposure through their philanthropic efforts and simultaneously continue their efforts to enhance the communities in which they invest.

    With the social philanthropic efforts of Warren Buffet and Bill Gates gaining a high degree of attention, and many leaders engaging in activities to promote social advocacy, corporations are seeking ways to also gain exposure with social entrepreneurship. Social entrepreneurship from the corporate perspective can be defined as corporate social initiatives used by a corporate entity as vehicle to show support for social causes. In recent years, many Fortune 500 companies have implemented social ventures with the intent of enhancing their corporate image through providing funding for various social causes.

    McDonald’s is one such company that has funded social causes for many years. McDonald’s primary social venture is the Ronald McDonald House Charities. The Ronald McDonald House provides lodging for the families of adolescents, ranging in age from birth to 18, who are receiving critical care for illness in communities that are away from their community of residence. The Ronald McDonald House allows families to reside in these temporary living facilities throughout the child’s period of treatment at no charge.

    The Federal Express Corporation also funds programs focused on the implementation of socially responsible programs. FedEx is a supporter of St. Jude’s Children’s Hospital and has been acknowledged by Reader’s Digest as one of “Americas Best Charity Minded Corporation.” Federal Express has also been recognized for providing funding for numerous community and civic organizations, including March of Dimes, Heart to Heart organization, an organization that focuses on delivering food and health resources globally, the United Way and the National Civil Rights Museum. These are just a few of the charitable initiatives that allow Federal Express to present itself as a socially conscious organization.

    Virgin Mobile has partnered with Youth Noise, a not-for-profit organization that brings youth together for networking and brainstorming opportunities, and Stand Up for Kids, the largest all volunteer not-for-profit organizations in the United States, to implement an initiative to expand its corporate social responsibility activities. The project involves recording artists donating ring tones to Virgin Mobile and through partnership agreements, 5% of the proceeds received through ring tone sales are donated to various “Virgin Mobile Charity Partners.” This initiative, established in June 2006, is being positioned to raise over $250,000 annually.

    For social ventures to gain global acceptance, corporations need to become involved in ventures that allow employees and consumers to see the social, community and external benefit of these ventures. This process is identified in countries south of the United States, where the concept of social responsibility is one that has been embraced by many but implemented by few. Many government organizations expect non-government, or private organizations to take responsibility for ensuring the stability and longevity of the resources throughout this region while the private sector is looking toward government agencies for intervention.

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    Source by Paul Van Putten

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