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Questions Chapter 1
The Nature of Strategic Management
True/False Questions
Difficulty
Question 1 Easy
Question stem Choice Reference Topic
title 2 Medium
3 Hard
TF01.01 The implementation of Medicare’s prospective payment system in 1983 T 1 Managing a Change
initiated dramatic changes in the health care industry. Dynamic
Environment
TF01.02 Management rather than leadership is required to deal with rapid, complex, F 1 Managing a Leadership
and discontinuous change. Dynamic
Environment
TF01.03 The objective of long-range planning is to predict for some specified time in T 2 Long-Range Long-range
the future the size of demand for an organization’s products and services Planning to planning
and to determine where demand will occur. Strategic
Planning
TF01.04 Strategies are long range in nature and thus, the time span is the principal F 1 Long-Range Strategy,
focus of strategic planning. Planning to strategic
Strategic planning
Planning
TF01.05 Many of the management methods adopted by health care organizations T 1 Strategic Management
originated in the business sector. Management in techniques
the Health Care
Industry
TF01.06 “Strategic thinking maps” are designed to initiate strategic thinking and T 1 Combining the Strategic
strategic planning. Analytical and thinking
Emergent
Views
TF01.07 In order to effectively deal with a complex situation, the leader must redouble F 3 Strategic Leadership
efforts to become involved with every detail of the situation. Thinking
TF01.08 Strategic thinking is an individual intellectual process, a mindset, or method T 1 Strategic Strategic
of intellectual analysis that asks people to position themselves as leaders Thinking thinking
and see the “big picture.”
TF01.09 Strategic thinkers examine assumptions, understand systems and their T 1 Strategic Strategic
interrelationships, and develop alternative scenarios of the future. Thinking thinking
TF01.10 Strategic planning is the periodic process of developing a set of steps for an T 1 Strategic Strategic
organization to accomplish its mission and vision using strategic thinking. Planning planning
Difficulty
Question 1 Easy
Question stem Choice Reference Topic
title 2 Medium
3 Hard
TF01.22 The use of the systems approach requires strategic managers to define the T 2 A Systems Systems
organization in broad terms and to identify the important variables and Perspective approach,
interrelationships that will affect decisions. systems
thinking
TF01.23 Unit operational strategies may be developed within departments of an T 2 The Level and Unit-level
organization such as clinical operations, marketing, finance, information Orientation of strategy
systems, human resources, and so on. the Strategy
TF01.24 Corporate-level strategies address the question: “What business(es) should T 2 The Level and Corporate-level
we be in?” Such strategies consider multiple, sometimes unrelated, markets Orientation of strategy
and typically are based on return on investment, market share or potential the Strategy
market share, and system integration.
TF01.25 Strategy development has never been primarily a staff activity. F 1 Leadership Strategy
Roles development,
throughout the leadership
Organization
Multiple Choice Questions
SE01.01 Describe strategic Strategic management concepts have been employed within 2 Strategic Strategic
management in the health care organizations only in the past 25 to 30 years. Prior Management management
health care to this time, individual health care organizations had few in the Health
industry. incentives to employ strategic management because typically Care Industry
they were independent, freestanding, not-for-profit institutions,
and health services reimbursement was on a cost-plus basis.
In many respects health care has become a complex business
using many of the same processes and much of the same
language as the most sophisticated business corporations.
Certainly, in the late 1980s and 1990s many health care
organizations had much to learn from strategically managed
businesses. As a result, many of the management methods
adopted by health care organizations, both public and private,
initially were developed in the business sector.
SE01.02 Define the major The major activities of strategic management are: (1) strategic 2 The Strategic
activities of thinking, (2) strategic planning, and (3) strategic management. Dimensions thinking,
strategic Strategic thinking is an individual intellectual process, a of Strategic strategic
management. mindset, or method of intellectual analysis that asks people to Management planning,
position themselves as leaders and see the “big picture.” strategic
Strategic planning is the periodic process of developing a set of management
steps for an organization to accomplish its mission and vision
using strategic thinking. Strategic management is the actual
work to accomplish specific objectives.
SE01.03 Why is managing Managing strategic momentum: is the actual work to 2 Managing Strategic
strategic accomplish specific objectives, concerns decision-making Strategic management,
momentum processes and their consequences, provides the style and Momentum strategic
important? culture, evaluates strategy performance, is a learning process, planning
and relies on and initiates new strategic thinking and new
periodic strategic planning.
Question Question stem Rationale Difficulty
title 1 Easy
Reference Topic
2 Medium
3 Hard
SE01.04 Explain the role of Strategic decision making for health care organizations is the 2 The Leadership,
leadership in responsibility of top management. The CEO is a strategic Importance of decision
strategy manager with the pre-eminent responsibility for positioning the Leadership making,
development. organization for the future. The leader must be able to inspire, strategic
organize, and implement effective pursuit of a vision and management
maintain it even when sacrifices are required. As a result, the
leader must have an ability to identify what needs to be done
today and what can wait. They prioritize constantly; aware that
wars are lost by fighting on too many fronts. They know the key
messages to communicate from day to day, from audience to
audience. If the CEO does not fully understand or faithfully
support strategic management, it will not happen.
Exploring the Variety of Random
Documents with Different Content
they also returned to the atmosphere in the form of harmful gas?
Just think of the amount of carbonic acid gas vomited into the
atmosphere by a factory furnace into which coal is poured by the
carload! Think also of the volcanoes, gigantic natural chimneys
which in a single eruption throw up such quantities of gas that
furnaces offer no comparison. It is very clear: the atmosphere is
constantly receiving carbonic acid gas in torrents that defy
computation. And yet animal life has nothing to fear for the present
or for the future, since the atmosphere, though continually being
poisoned with carbonic acid gas, is at the same time always being
purged of it.
“When, on the other hand, the plant receives the sun’s rays without
hindrance, the carbonic acid gas is decomposed in no time, the
carbon and the air separate, and each resumes its original
properties. Freed of its carbon, the air becomes what it was before
this admixture: it becomes pure air, fit to maintain [46]both fire and
life. In this state it is restored to the atmosphere by the stomata to
be used again in combustion and respiration. It entered the plant as
a fatal gas, it leaves it as a vivifying gas. It will return some day with
a new charge of carbon, which it will deposit in the plant, and then,
restored to purity once more, it will recommence its atmospheric
round. A swarm of bees goes and comes, from the hive to the fields
and from the fields to the hives, on one trip lightened and eager for
booty and on the other heavily laden with honey and returning to
the comb on wearied wing. In the same way air on coming to the
leaves is charged with carbon from an animal’s body, a burning fire-
brand, or decaying matter; it gives it to the plant and departs for a
fresh supply.
“It is thus that the atmosphere preserves its salubrity despite the
immense torrents of carbonic acid that are cast into it. The plant
lives on deadly gas. Under the action of the sun’s light it
decomposes the gas into carbon, which it keeps for building up its
own substance, and breathable air, which it returns to the
atmosphere. From this carbon combined with other substances come
wood, sugar, starch, flour, gum, resin, oil, in fact every kind of
vegetable product. Animal and plant are of mutual assistance, the
animal producing carbonic acid gas, which nourishes the plant, and
the plant changing this deadly gas into air fit to breathe and into
food. Thus our dependence on plants is twofold: they purify the
atmosphere and they give us food.” [47]
[Contents]
CHAPTER IX
LIME
To make mortar with which masonry is held in place it is customary
to use lime. In a sort of trough lined with sand are placed lumps of
stone having a calcined appearance, and on these stones water is
poured. In a few moments the pile becomes heated to high
temperature, cracks and splits and finally crumbles into dust, at the
same time absorbing the water, which disappears little by little as it
is taken up by the solid matter or vaporized by the heat. More water
is added to reduce it all to paste, which is finally mixed with sand.
The product of the mixture is mortar. Such is the process often
witnessed by Emile and Jules, who are always surprised, that stone,
by having water poured on to it, should become hot and turn the
water into jets of steam. “Lime,” Uncle Paul explained to them, “is
obtained from a widely diffused stone called limestone or, in more
learned language, carbonate of lime. The process is of the simplest
sort. It consists of heating the stone in kilns built in the open air in
the vicinity of both limestone and fuel, so as to avoid the expense of
transportation in the manufacture of a product that it is desirable to
furnish at a low price. [48]
“Then all that the fire does,” queried Jules, “is just to break apart the
limestone and drive out the carbonic acid gas that it contained?”
“What takes place in the lime-kiln,” replied his uncle, “is nothing but
the separation of the lime and the gas. Now let us turn our attention
to the mortar. When lime is watered, it gets very hot, swells, cracks
open, and crumbles into a fine powder like flour. The heat that is
generated comes from the violence with which the two substances
rush together. Before absorbing water lime is called quicklime; after
this absorption, which has reduced it to powder, it is called slaked
lime. This slaked lime is reduced to a paste with water, and then well
mixed and kneaded with sand. The result is the mortar used in
laying stone and brick in order to hold the courses firmly together
and give solidity to the building.
“There is one thing I advise you to note, if you have not already
done so, since it will explain to you [50]the part played by mortar in
masonry. Look at the water that for several days has covered a bed
of lime slaked by the masons. You will see floating on the surface
small transparent particles resembling ice. Well, these tiny fragments
of crust are nothing but stone like that from which the lime was
obtained; in a word, they are limestone or carbonate of lime. To
make stone of that kind two substances are necessary, as I have just
told you: lime and carbonic acid gas. The lime is furnished by the
water, in which it must be present in solution, since the water covers
a thick bed of this material; and as to the carbonic acid gas, it is
furnished by the air, where it is always to be found, though in small
quantities. Lime, then, has this peculiarity, that it slowly incorporates
the small amount of carbonic acid gas present in the atmosphere,
and so once more becomes the limestone that it was before.
“A similar process goes on in mortar: the lime takes back from the
atmosphere the gas that it had lost in the heat of the lime-kiln, and
little by little becomes stone again. The sand mixed with it serves to
disintegrate the lime, which thus more easily absorbs the air
necessary for its conversion into limestone. When the mortar has
fully resumed the form of limestone the courses of masonry are so
strongly bound one to another that the stones themselves
sometimes break rather than give way.
“What is known as fat lime is lime that develops great heat when
brought into contact with water, and also increases considerably in
volume, forming with [51]the water a thick, cohesive paste. On the
other hand, poor lime develops but little heat, disintegrates slowly,
and increases scarcely any in volume. The first kind comes from
nearly pure limestone and can be mixed with a large proportion of
sand, thus making a great quantity of mortar. The second kind is
obtained from limestone having various foreign substances and will
admit of but a small admixture of sand, thus yielding less mortar
than the other. Both have the property of hardening in the air by the
absorption of carbonic acid gas which converts them into limestone.
“There is a third variety of lime called hydraulic lime, which has the
peculiar merit of being able to harden under water. It is made from a
limestone containing a certain proportion of clay. Hydraulic mortar is
used for the masonry of bridges, canals, cisterns, foundations,
vaults, in fact for all stone and brick work under water or in damp
soil.” [52]
[Contents]
CHAPTER X
LIME IN AGRICULTURE
“To be fertile a soil must contain limestone, sand, and clay, besides
the organic substances coming from humus and fertilizers. Now it
may be that nature has not endowed the soil with a sufficient
quantity or with any of these three constituents. Then the character
of the soil must be corrected by giving it what it lacks. That is what
is called improving the land. Thus a soil that is too sandy is improved
by the addition of limestone and clay; one that is too compact, too
clayey, is improved by adding sand and, still more, by adding
limestone. Mineral substances thus added to the soil to correct it are
called correctives. These substances coöperate also in the nutrition
of plants, and from this point of view may be regarded as mineral
fertilizers.
“In the second place, lime corrects or neutralizes the acidity peculiar
to certain soils, as is proved by the following experiment. Let us mix
some vinegar, no matter how strong, with a little lime. In a short
time the smell and acid taste of the vinegar will have disappeared.
Now wherever masses of vegetable refuse, such as leaves, mosses,
rushes, old stumps, are undergoing decay, there are produced
certain sour-tasting substances or, in other words, acids, which are
invariably harmful to agriculture. This generation of acid occurs
notably in turfy soils, which have an excessive acidity favorable to
the growth of coarse rushes and sedges that are valueless to us, and
at the same time this acid is highly injurious to all our cultivated
plants. Lime, therefore, which is sure to correct this acidity, works
wonders in marshy lands, damp meadows, and turfy soils. We are
warned of the need of lime by the appearance of ferns, heather,
sedge or reed-grass, rushes, mosses and sphagnei.
“Thirdly, when once mixed with the soil, lime speedily resumes the
form it wore before passing through the lime-kiln; that is to say, it
becomes limestone, but in the shape of fine powder. This return
[54]to the limestone condition is brought about by union with the
carbonic acid gas coming from the atmosphere or thrown off by the
substances decaying in the ground. Under this new form lime
continues to play a useful part by supplying the calcareous
ingredient to soil that lacked it, and also by preventing the clay from
becoming too cohesive, too impervious to air and water.
“The addition of lime to the soil should take place at the end of
summer, when the ground is dry. Little heaps of quicklime, each
containing about twenty kilograms, are placed at intervals of five
meters and covered with a few spadefuls of earth. In a short time
the moisture in the atmosphere reduces the lime to a fine powder,
which is then spread evenly with a shovel and covered with earth—
an operation involving no severe labor.
“Lime should never be applied with seed. Mere contact with it would
burn the young shoots. Neither should it be mixed with manure
before it is used, since the immediate result would be a total loss of
great quantities of ammonia, thrown off in gaseous form; and
ammonia, as I have explained, is one of the richest of fertilizers.
Lime and manure, therefore, should be used separately.
“Soils rich in turf, clay, or granite are the ones on which lime acts
most beneficially. Because of the important results attained by the
use of lime, its manufacture for purely agricultural purposes by
certain expeditious and effective methods is customary in many
places. Thus in Mayenne, where this application [55]of lime has
converted tracts of uncultivated clayey land into rich pastures or into
wheat fields of exceptional fertility, lime is made in enormous kilns a
dozen meters high and supported by the cliff that furnishes the
limestone and sometimes the fuel also.
“All animal matter makes excellent fertilizer. Of this class are old
woolen rags, stray bits of leather, fragments of horn, dried blood
from slaughter-houses, and flesh not fit for human consumption. All
these substances are rich in nitrogen and phosphates, and if mixed
with farm manure they add greatly to its value. Lime furnishes us
the means of utilizing one of these substances, flesh, in the best way
possible.
“Dead bodies of animals, heedlessly left for dogs and crows and
magpies to devour, should be cut up in pieces and then buried with
a mixture of earth and quicklime. This attacks the flesh and quickly
decomposes it, so that in a few months’ time there would be
available a deposit of the most powerful fertilizer instead of a
useless, disease-breeding carcass. As to the bones, resistant to the
action of lime, they are burned to render them more friable, and
then reduced to powder. This bone-dust, mixed with the fertilizer
furnished by the decayed flesh, will contribute to grain-field or
pasture a rich supply of phosphorus. To uses of this sort the farmer
should put all horses and mules that have had to be killed, as well as
all large farm animals that have died of disease.” [56]
[Contents]
CHAPTER XI
PLASTER OF PARIS
“Though less important than lime, plaster of Paris is nevertheless
much used in building, especially for ceilings, molded chimney-
pieces, and in the filling of cracks and cavities. It is a white powder
which is made into a paste by adding water, prepared a little at a
time and only as fast as needed.”
“I’ve seen them do it,” Emile interposed; “the workman takes a few
handfuls of that powder out of a bag, and then he mixes it with a
little water in his trough with a trowel. He scrapes the paste all
together in his hand and uses it immediately, before making any
more. Why don’t they mix all the plaster at once, as they do with
lime when they make mortar?”
“Plaster is not all prepared beforehand for the reason that it hardens
very quickly, turns to stone, and is then unfit for use. Accordingly, to
have it in a suitable state of softness, it must be prepared at the
moment of using.”
“And what do they make that powder of that turns to stone when it
is mixed with water?”
“And is it carbonic acid gas this time, too, that is driven out by the
heat, as in the manufacture of lime?” asked Jules. [58]
“No, my friend: gypsum does not contain any carbonic acid gas. It is
made of lime, as in limestone, but united with sulphuric acid, which
heat is powerless to drive out. Besides this it contains water, which
forms a fifth of the total weight of the stone. This water, and nothing
further, escapes under the action of heat. With this expelled the
gypsum is turned to plaster.
“But this latter has a strong tendency to take on again the moisture
parted with in the kiln, and thus to become once more what it was
in the beginning—primitive stone. It is this peculiarity that renders
gypsum suitable for plaster. Moistened in the trough, the powdery
matter quickly incorporates the water that is thus restored to it, and
the whole hardens into a block having the solidity of gypsum that
has not yet passed through the kiln. Lime turns to stone by being
permeated with carbonic acid gas, which restores it to its limestone
state. Plaster becomes stone by absorbing water, which brings it
back to the state of gypsum. The transformation of lime is slow, of
plaster very rapid.
“As soon as it comes from the kiln plaster is ground under vertical
millstones and then sifted. The powder must be kept in a very dry
place, since it contracts moisture easily and then will not harden or
set, as they say, when mixed with water. You will perceive clearly
enough that after being more or loss impregnated with moisture
plaster cannot have the same tendency to absorb the water
necessary to change it into a solid mass; the substance [59]being
already somewhat soaked will not show the same thirst when the
time comes for using it. All damp and, still more, all wet plaster is of
no further use.
“The doubters must have been convinced,” said Jules, “on seeing
those big green letters rising above the rest of the lucerne. Did not
Franklin do some other remarkable things? I remember the name; I
have seen it several times in books.”
“Yes,” replied his uncle, “Franklin became by his learning, one of the
most remarkable men of his time. Among other things, we owe to
him the invention of the lightning-conductor, that tall pointed iron
rod erected on the roofs of buildings to protect them from the
thunderbolt. It was he who first had the [62]superb audacity to evoke
the lightning from the midst of the thunder-clouds, to direct it
according to his wishes, and to bring it to his feet that he might
study its nature. One stormy day in 1752 he went out into the
country near Philadelphia in company with his young son who
carried a kite made out of a silk handkerchief tied at the four corners
to glass rods. A pointed piece of metal terminated the apparatus. A
long hemp cord, with a shorter cord of silk tied to the lower end,
was fastened to the kite, which was then sent up toward a black
thundercloud. At first nothing happened to confirm the previsions of
the American sage, and he was beginning to despair of success
when there came a shower of rain and with it a flash of lightning.
The wet cord proved a better conductor than when dry. Without
thinking of the danger he ran, and transported with joy at having
brought within his reach that which causes thunder, Franklin put his
finger near the cord and made little spurts of fire dart out, lighted
brandy from these sparks out of the sky, and only brought his
perilous experiment to an end when he had fully determined the
origin and nature of thunder and lightning. This was the way he
studied the mystery at close quarters, discovered its nature, and
finally succeeded in protecting buildings by means of a pointed iron
rod.
The author is not quite accurate here. Franklin was, as he tells us, “the
1
youngest son, and the youngest child but two.”—Translator. ↑
[Contents]
CHAPTER XIII
NATURAL FERTILIZERS—GUANO
“Plant-life finds a part of its sustenance provided by nature in the
atmosphere; it finds carbonic acid gas, whence it derives the carbon
it requires; but the care and ingenuity of man have to supplement
these natural resources by providing fertilizers.
“Nor is that the whole of the story. A slow combustion will soon
begin throughout the pile of manure; its mass will ferment and
become heated, and as a consequence the nitrogenous constituents
will decompose and will liberate ammonia, which will escape into the
air and be lost if the fermentation is excessive. It is to avoid too
rapid a heating that the manure-pile is placed in the shade and not
under the direct rays of the sun. Moreover, the liquid manure thrown
on to the heap from time to time also moderates the fermenting
process.
“Liquid manure being the richest part of the whole pile, care should
be taken not to let escape what the bedding does not absorb. It
should be first diluted with water and then applied to the growing
crops. When it is desired for use in non-liquid form, it should be
mixed with enough earth to absorb it, and the result is an excellent
fertilizer.