Prompt: Journal Article on Strategic Management and Innovation in Healthcare Administration: Write an article for the Journal of Advanced Strategic Management and Innovation in Healthcare Administration (JASMIHC).
o Requirements: Create a journal submission for the JASMIHC based on their Writer’s Guidelines. Create a journal submission for the JASMIHC based on their Writer’s Guidelines. The Journal of Advanced Strategic Management and Innovation in Healthcare Administration is a fictitious journal for students to gain experience writing for a Journal in a Journal type of format. The Journal of AdvancedStrategic Management and Innovation in Healthcare Administration covers all areas of Healthcare Strategic Management that have been covered in this course. Please select a topic of interest that we have addressed in this course and write a journal article based on this topic and provide a practical solution to that topic of interest. For example, we have covered Patient-Centered Care. You might discuss the importanceof Patient-Centered Care within the current healthcare landscape and provide practical strategic management solutions for how a healthcare administrator might support this healthcare delivery model within their strategy. How might Figure 2-1, “Conceptual drawing of a four-level health care system” from the article, A Framework for a Systems Approach to Health Care Delivery by Reid et al. fit into your journal? Usually, Journal articles are focused on a specific solution that solves a specific problem and provide evidence that tie them together. Review the Journals we have read as well as the ones you have gathered in this course for more guidelines on what content you should expect within a Journal article. A Framework for a Systems Approach to Health Care
Delivery
To consider how information/communications technologies and systems-engineering tools can be
used to help realize the IOM vision of a patient-centered health care system, we must first
understand the challenges facing the U.S. health care system (IOM, 2001). The committee has
adapted a four-level model by Ferlie and Shortell (2001) to clarify the structure and dynamics of the
health care system, the rough divisions of labor and interdependencies among major elements of
the system, and the levers for change. A brief description of the model follows. The remainder of
this chapter provides a “systems view” of health care and a brief description of the potential role of
information/ communications systems.
The Individual Patient
We begin appropriately with the individual patient, whose needs and preferences should be the
defining factors in a patient-centered health care system. Recent changes in health care policy
reflect an emphasis on “consumer-driven” health care. The availability of information, the
establishment of private health care spending accounts, and other measures reflect an increasing
expectation that patients will drive changes in the system for improved quality, efficiency, and
effectiveness. Overall, the role of the patient has changed from a passive recipient of care to a more
active participant in care delivery.
At the same time, the fragmented delivery system, combined with the growing burden of chronic
disease and the need for continuous care, have all but forced many patients to assume an active role
in the design, coordination, “production,” and implementation of their care, whether they want to
or not. Unfortunately, most people do not have access to the information, tools, and other resources
they need to play this new role effectively. Considering the roles, needs, and objectives of first-level
actors—individual patients—and their interdependencies with actors at other levels of the system,
opportunities abound for using information/ communications technologies and systemsengineering tools to improve the overall performance of the health care system.
A starting point for increasing the “patient-centeredness” of health care delivery is changing the
perspective of clinicians to consider patients and their families as “partners” and to incorporate
their values and wishes into care processes. The level of responsibility patients and their families
assume differs from patient to patient. Some prefer to delegate some, if not most, of the decision
making to a trusted clinician/counselor in the care system; others want to be full partners in
decision making. In either case, however, patients need a free exchange of information and
communication with physician(s) and other members of the care team, as well as with the
organizations that provide the supporting infrastructure for the care teams.
For patients to communicate “informed” needs and preferences, participate effectively in decision
making, and coordinate, or at least monitor the coordination, of their care, they must have access to
the same information streams—in “patient-accessible” form—as their physician(s) and care team.
Information that supports evidence-based, effective, efficient care encompasses the patient’s
medical record, including real-time physiological data; the most up-to-date medical evidence base;
and orders in process concerning the patient’s care. The patient and/or his or her
clinician/counselor or family member must also have access to educational, decision-support,
information-management, and communication tools that can help them integrate critical
information from different sources.
From the patient’s perspective, improving the timeliness, convenience, effectiveness, and efficiency
of care will require that the patient be interconnected to the health care system. Synchronous
communication between patient and physician could improve the quality of care in a number of
ways. For example, continuous, real-time communication of a patient’s physiological data to care
providers could accelerate the pace of diagnosis and treatment, thereby reducing complications and
injuries that might result from delays. Remote (e.g., in-the-home, on-the-go) monitoring, diagnosis,
and treatment would make care much more convenient for patients, save them time, and
conceivably improve compliance with care regimes (see paper by Budinger in this volume).
Communication technologies also have the potential to change the nature of the relationship
between patient and provider, making it easier for patients to develop and maintain trusting
relationships with their clinicians.
Asynchronous communication also has the potential to significantly improve quality of care. The
easy accessibility of the Internet and the World Wide Web should enable all but continuous
inquiries and feedback between patients and the rest of the health care system (IOM, 2001). The
World Wide Web has already changed patients’ ability to interact with the system and to selfmanage aspects of their care. One of the fastest growing uses of the these communication
technologies is as a source of medical information from third parties, which has made the consumer
(i.e., the patient) both more informed, and, unfortunately, sometimes misinformed.
Some of the improvements just described are available today, some are under study, and some are
as much as a decade away from realization. Thus, research is still an essential component in
transforming the current system.
The Care Team
The care team, the second level of the health care system, consists of the individual physician and a
group of care providers, including health professionals, patients’ family members, and others,
whose collective efforts result in the delivery of care to a patient or population of patients. The care
team is the basic building block of a “clinical microsystem,” defined as “the smallest replicable unit
within an organization [or across multiple organizations] that is replicable in the sense that it
contains within itself the necessary human, financial, and technological resources to do its work”
(Quinn, 1992).
In addition to the care team, a clinical microsystem includes a defined patient population; an
information environment that supports the work of professional and family caregivers and patients;
and support staff, equipment, and facilities (Nelson et al., 1998). Ideally, the role of the
microsystem is to “standardize care where possible, based on best current evidence; to stratify
patients based on medical need and provide the best evidence-based care within each stratum; and
to customize care to meet individual needs for patients with complex health problems” (Ferlie and
Shortell, 2001). Most health and medical services today, however, are not delivered by groups or
teams.
The role and needs of individual physicians have undergone changes parallel to those of individual
patients. The exponential increase in medical knowledge, the proliferation of medical specialties,
and the rising burden of providing chronic care have radically undercut the autonomy of individual
physicians and required that they learn to work as part of care teams, either in a single
institution/organization or across institutional settings. The slow adaptation of individual clinicians
to team-based health care has been influenced by several factors, including a lack of formal training
in teamwork techniques, a persistent culture of professional autonomy in medicine, and the
absence of tools, infrastructure, and incentives to facilitate the change.
To participate in, let alone lead and orchestrate, the work of a care team and maintain the trust of
the patient, the physician must have on-demand access to critical clinical and administrative
information, as well as information-management, communication, decision-support, and
educational tools to synthesize, analyze, and make the best use of that information. Moreover, to
deliver patient-centered care (i.e., care based on the patient’s needs and preferences), the physician
must be equipped and educated to serve as trusted advisor, educator, and counselor, as well as
medical expert, and must know how to encourage the patient’s participation in the design and
delivery of care.
At the present time, precious few care teams or clinical microsystems are the primary agents of
patient-centered clinical care. Unwarranted variations in medical practice are common, even for
conditions and patient populations for which there are standard, evidence-based, patient-stratified
“best practice” protocols (McGlynn et al., 2003; Wennberg et al., 1989). Even though many
clinicians now accept the value of “evidence-based medicine” and recognize that they cannot deliver
evidence-based care on their own, they are many barriers to their changing accordingly: the guild
structure of the health care professions; the absence of training in teamwork; the strong focus on
the needs of individual patients as opposed to the needs of patient populations; and the lack of
supporting information tools and infrastructure. All of these can, and do, prevent systems thinking
by clinicians, the diffusion of evidence-based medicine, and the clinical microsystems approach to
care delivery. Thus, tailoring evidence-based care to meet the needs and preferences of individual
patients with complex health problems remains an elusive goal.
For care teams to become truly patient-centered, the rules of engagement between care teams and
patients must be changed. Like individual care providers, the care team must become more
responsive to the needs and preferences of patients and involve them and their families (to the
extent they desire) in the design and implementation of care. Care teams must provide patients
with continuous, convenient, timely access to quality care. One member of the care team must be
responsible for ensuring effective communication and coordination between the patient and other
members of the care team.
The Organization
The third level of the health care system is the organization (e.g., hospital, clinic, nursing home)
that provides infrastructure and other complementary resources to support the work and
development of care teams and microsystems. The organization is a critical lever of change in the
health care system because it can “provide an overall climate and culture for change through its
various decision-making systems, operating systems, and human resource practices” (Ferlie and
Shortell, 2001). The organization encompasses the decision-making systems, information systems,
operating systems, and processes (financial, administrative, human-resource, and clinical) to
coordinate the activities of multiple care teams and supporting units and manage the allocation and
flow of human, material, and financial resources and information in support of care teams. The
organization is the business level, the level at which most investments are made in information
systems and infrastructure, process-management systems, and systems tools.
Health care organizations face many challenges. In response to the escalating cost of health care,
government and industry—the third-party payers for most people—have shifted a growing share of
the cost burden back to care providers and patients in recent years. As a result, hospitals and
ambulatory care facilities are under great pressure to accomplish more work with fewer people to
keep revenues ahead of rising costs.
In certain respects, management of health care organizations is not well positioned to respond to
mounting cost and quality crises. Compared to other industries, health care has evolved with little
shaping by the visible hands of management. Historically, most leaders of health care organizations
were initially trained in medicine or public health. Moreover, except in the relatively few integrated,
corporate provider organizations (e.g., Kaiser-Permanente, Mayo Clinic, et al.), the management of
most hospitals faces the challenge of “managing” clinicians, the majority of whom function as
“independent agents.”
Less than 40 percent of all hospital-based physicians are employed as full-time staff by the
hospitals where they practice, a reflection of the deeply ingrained culture of professional autonomy
in medicine and the deeply held belief of care professionals that their ultimate responsibility is to
individual patients. These circumstances have posed significant challenges to the authority of
health care management in many organizations, often creating discord and mistrust between health
care professionals and health care management. Other challenges to management include the
hierarchical nature of the health professions and inherent resistance to team-based care, significant
regulatory and administrative requirements (e.g., controlled substances, biohazardous waste
disposal, patient privacy, safety, etc.), and health care payment/reimbursement regimes that
provide little, if any, incentives for health care organizations to invest in non-revenue-generating
assets, such as information/ communications technologies and process-management tools.
To support patient-centered care delivery by well functioning clinical care teams or microsystems,
health organizations must find ways to bridge the health care professional/ delivery system
management divide and invest in information/ communications technologies, systems-engineering
tools, and associated knowledge. Integrated, patient-centered, team-based care requires material,
managerial, logistical, and technical support that can cross organizational/institutional boundaries
—support that is very difficult to provide in a highly fragmented, distributed-care delivery system.
Financial investments in information/communications technologies and systems-engineering tools
alone will not be enough, however. These investments must be accompanied by an organizational
culture that encourages the development of care teams working with semiautonomous agents/
physicians (see paper by Bohmer in this volume). “Developing a culture that emphasizes learning,
teamwork, and customer focus may be a ‘core property’ that health care organizations …will need to
adopt if significant progress in quality improvement is to be made” (Ferlie and Shortell, 2001).
Finally, health care institutions must become “learning organizations” that are “skilled at creating,
acquiring, and transferring knowledge, and at modifying [their] behavior to reflect new knowledge
and insights” (Garvin, 1993).
The Political and Economic Environment
The fourth and final level of the health care system is the political, economic (or market)
environment, which includes regulatory, financial, and payment regimes and entities that influence
the structure and performance of health care organizations directly and, through them, all other
levels of the system. Many actors influence the political and economic environment for health care.
The federal government influences care through the reimbursement practices of Medicare/
Medicaid, through regulation of private-payer and provider organizations, and through its support
for the development and use of selected diagnostic and therapeutic interventions (e.g., drugs,
devices, equipment, and procedures). State governments, which play a major role in the
administration of Medicaid, also influence care systems. Private-sector purchasers of health care,
particularly large corporations that contract directly with health care provider organizations and
third-party payers (e.g., health plans and insurance companies), are also important environmentlevel actors, in some cases reimbursing providers for services not covered by the federal
government.
Federal regulations influence the structure, level, and nature of competition among providers and
insurers. They can also affect the transparency of the health care system by setting requirements
related to patient safety and other aspects of the quality of care. By exercising its responsibility to
monitor, protect, and improve public health, the federal government shapes the market
environment for health care. Federal agencies, the primary sources of funding for biomedical
research, influence the research and technological trajectories of health care, and, with them, the
education of health care professionals and professionals in other areas invested in the health care
enterprise.
At present, many factors and forces at the environmental level, including reimbursement schemes
for health care services and some regulatory policies, do not support the goals and objectives of
patient-centered, high-performance health care organizations or the health care delivery system as
a whole. Although the federal government, the single largest purchaser of health care services,
principal regulator, and major research patron, is, in many ways, best positioned to drive changes
in the health care delivery system, some private-sector payer organizations and state governments
are better positioned to experiment with new mechanisms and incentives for improving the quality
of care and making health care more affordable (see papers by De Parle and Milstein in this
volume).
A SYSTEMS VIEW OF HEALTH CARE
In Chapter 1, the health care delivery system was described as a “cottage industry.” The main
characteristic of a cottage industry is that it comprises many units operating independently, each
focused on its own performance. Each unit has considerable freedom to set standards of
performance and measure itself against metrics of its own choosing. In addition, cottage industries
do not generally attempt to standardize or coordinate the processes or performance of Unit A with
those of Units B, C, and so on.
Indeed, this is an apt characterization of the current health care delivery system. Even in many
hospitals, individual departments operate more or less autonomously, creating so-called “silos.”
Many physicians practice independently or in small groups, and ambulatory clinics, pharmacies,
laboratories, rehabilitation clinics, and other organizations—although part of the delivery system
—often act as independent entities. We often call this arrangement a “health care system,” even
though it was not created as a system and has never performed as a system.
Moving from the current conglomeration of independent entities toward a “system” will require
that every participating unit recognize its dependence and influence on all other units. Each unit
must not only achieve high performance but must also recognize the imperative of joining with
other units to optimize the performance of the system as a whole. Moreover, each individual care
provider must recognize his or her dependence and influence on other care team members (e.g.,
specialists in different fields, pharmacists, nurses, social workers, psychologists, physical therapists,
etc.) (IOM, 2003). These are the underlying attitudes that support a systems approach to solving
problems.
Changing attitudes to embrace teamwork and systems “thinking” can be extremely difficult and
may encounter resistance. Nevertheless, a concerted, visible commitment by management will be
necessary to achieve this new way of thinking as a giant step toward the improvements identified in
Crossing the Quality Chasm (IOM, 2001).
Optimization
It is easy to show mathematically that the optimization of individual units rarely, and only under
highly improbable circumstances, results in optimization of the whole. Optimization is determined
by a variety of metrics, including the productivity of a unit, the quality of service, the use of physical
resources, or a combination of all of these. Optimization of the whole requires a clear
understanding of the goal of the overall system, as well of interactions among the subsystems. The
whole must be recognized as being greater than the sum of its parts (Box 2-1).
A handful of health care organizations have embraced the systems view (e.g., the Veterans
Administration and Kaiser-Permanente Health Care). These significant exceptions to the general
rule demonstrate that the systems view is applicable to health care and could be a model for other
health care organizations. The goal of this report is to identify existing tools that can be used to
address problems and to suggest areas for further exploration.
In any large system that has many subsystems, achieving high operating performance for each
subsystem while taking into account the mutual influence of subsystems on each other and on the
system as a whole can be a daunting task. A simple pictorial description of interacting elements in a
system may be helpful for understanding how the system works. However, a deeper understanding
invariably involves creating a mathematical description of subsystems, their performance, and their
interactions. This, in turn, requires a model, that is, an abstract representation of how the system
operates (a mathematical form that can be used to analyze the system) that includes parameters
that determine the performance of each sub-element of the system, as well as descriptions of
interactions. The model is a tool for simulating the performance of the actual system.
The principal objective of a simulation is to ask “what if” questions and assess the impact of
alternative actions on the performance of the system to determine which ones might improve
overall system performance. For example, if a change is planned in the layout of a facility, a model
can be used to determine if it will improve the flow of people and equipment through the facility. A
model might help determine how much inventory must be kept at Station A to ensure that it can
respond to an emergency in less than five minutes. A model might also reveal if a different
communication system might reduce the required inventory or the best way to assign a nursing
staff when 10 percent of the nurses are not available. As Alan Pritsker, the author of many treatises
on large-scale system modeling and simulation, writes, “The system approach is a methodology that
seeks to ensure that changes in any part of the system will result in significant improvements in
total system performance” (Pritsker, 1990).
Because the health care system involves a myriad of interacting elements, it is difficult, or even
impossible, for any individual to have a complete picture of the system without using special tools
to perform a systems analysis. A model of the health care system must include a description of
“processes,” including a wide variety of activities, from nurses administering medication on the
hospital floor to examinations by a doctor to laboratory tests to the filling of prescriptions by a
pharmacist to follow-on visits by a nurse. The model must include the role of each process in health
care delivery and its interactions with other processes in the system. But clinical elements are not
the only important elements in an analysis. The interaction between administrative elements (e.g.,
patient check-in and billing procedures) and other processes can also significantly influence the
overall performance of the system from the patient and organization’s point of view. All processes
must be quantitatively described to be included in the model.
Any attempt to optimize the performance of a system must take into account objectives that are
difficult to quantify and that may, in fact, conflict with each other. Quantifying the quality of care,
for example, can be difficult, largely because the meaning of quality varies depending on whether
the patient, the health care professional, or the clinic or hospital is assessing it. Improvements in
productivity may mean an increase in the number of patients that can be accommodated or a
decrease in waiting time for the average patient. IOM identified safety, effectiveness, patientcenteredness, timeliness, efficiency, and equity as proper quality objectives for the health care
delivery system. Systems analyses can be used to improve the overall performance of systems with
multiple objectives because they include possible trade-offs and/or synergies among these
objectives. In addition, potentially conflicting goals—for example, cost containment and patientcenteredness—can also be analyzed.
THE ROLE OF INFORMATION AND COMMUNICATIONS
TECHNOLOGY
Many industries have attempted to use information/ communications systems in place of manual
operations, such as record keeping. But information/communications systems can be used for
much more than electronic record keeping. With incredible advances in computational speed and
capacity and parallel advances in computer software, clinical information and communications
systems can provide immediate access to information, including patient-based information (e.g.,
past laboratory values and current diagnoses and medications), institution-based information (e.g.,
drug-resistance patterns of various bacteria to different antibiotics), profession-based information
(e.g., clinical-practice guidelines, including summaries of recommended best practices in various
situations), real-time decision support (e.g., alerts about potential drug interactions or dosing
patterns in a patient with a compromised drug-metabolism mechanism), practice-surveillance
support (e.g., reminders about upcoming screening tests recommended for a patient), and
population health data (e.g., for epidemiological research, disease and biohazard surveillance,
notification of post-introduction adverse drug events).
Information/communications systems can also provide important information to the patient for
self-treatment of diseases and enable ongoing asynchronous communication between patients and
care providers. In the future, with the advent of remote monitoring devices and wireless
communication systems, information/communications systems have the potential to support
continuous monitoring of a patient’s health status at home, rapid diagnosis by clinicians, and
timely, effective therapeutic interventions in the home by the patient or a family member, with
guidance by health professionals. Furthermore, by capturing process and system performance data
for systems analysis, control and design, information/communications technologies can facilitate
the use of systems-engineering tools by patient care teams, provider organizations, and
environmental actors at all levels of the health care delivery system.
Chapter 3 provides descriptions of a large portfolio of systems-engineering tools and concepts with
the potential to significantly improve the quality and cost performance of the health care system.
These tools have been widely and effectively used to design, analyze, and control complex processes
and systems in many major manufacturing and services industries. In Chapter 4 opportunities are
described for accelerating the development and widespread diffusion of clinical information and
communications systems for health care delivery that can support the use of systems tools and
improve the connectivity, continuity of care, and responsiveness of the health care system as a
whole.
Competing for the Future
by Gary Hamel and C.K. Prahalad
Will your company survive the changes that may strike your industry in the next five to ten years?
The answer depends on whose view of the future is driving your agenda: yours or your
competitors’.
Consider these questions:
• Which customers does your company serve today—and which will it serve in the future?
• Who are your competitors today—and who will they be in the future?
• Which capabilities make your firm unique today—and which will make it unique in the
future?
If you don’t have detailed answers to the “future” part of these questions, or if your “future” and
“today” answers are similar, your company can’t expect to remain a market leader.
Yet most senior managers devote less than 3% of their time to developing a corporate view of the
future that’s distinctive, well tested, and deeply shared by colleagues. Why? The task requires
enormous commitment and intellectual energy. Difficult questions about the future also challenge
the belief that top managers possess a clear, compelling view of the opportunities and risks awaiting
their company.
Results? The urgent drives out the truly important. Managers spend too much time catching up to
competitors by cutting costs and improving quality and productivity. Such actions are prerequisites
for survival, but they don’t provide enduring competitive advantages. To stay ahead of industry
change, managers must focus on creating a future in which their company will lead, not follow.
The Idea in Practice
Improving Efficiency and Productivity
Stagnant growth, declining margins, and failing market share often force executives to slash
payrolls, R&D budgets, and underperforming businesses—making their companies “lean and
mean.” But such moves have more to do with shoring up current businesses than building
tomorrow’s industries. They boost share price only temporarily and create a distorted picture of
productivity. For example, when an industry halves it workforce but increases output only
marginally, the resulting ROI ratio may look impressive—but it disguises the industry’s failure to
create new markets.
Creating the Future
Real organizational transformation stems from a shared point of view about your industry’s future.
It answers questions such as:
• How do we want our industry to be shaped in five to ten years?
• What capabilities must we start building now if we want to occupy the industry high ground
later?
• How should we organize for opportunities that may not fit within current business units’
boundaries?
Creative companies answer these questions by gathering insights from people at all levels in the
organization. Example:
Electronic Data Systems’ industry position seemed unassailable in 1992, but some executives
foresaw problems—new competitors and fewer new customers among leading IT users. One
hundred and fifty managers convened to create EDS’s future. They analyzed threats and
opportunities created by the digital revolution. They benchmarked their competencies against
competitors’ and considered how to build additional capabilities to develop new opportunities.
With the participation of 2,000+ people, managers formulated a new strategy centered on
globalizing (spanning geographical, cultural, and organizational boundaries), informationalizing
(helping customers convert data into information, knowledge, and action), and individualizing
(mass-customizing services and products).
Though this process consumed nearly 30,000 person hours, EDS now had a broader, more
prescient view of its industry and its role—and a view shared by every senior manager.
01230430105367849 1 0901281
70 27603 806 18120 3 28 0
90
386281 5
! ”
#623 2
$%! ! &% ’! ( !”! )!) *
’ +!%’) ( ) !) %*&% (% %&
( , !+ (- %./’ &*&”0 ”, !&+
% %& ) &% ( !0 * ! !*) ( !
!&+!! !( , % ! % % % %&
) 0+ ! % * ’ +!%’ % %& 0
!&1 ! % ’ + ) ( % ’ +
) ( ) ’& !! ’+& !1 ( , + &) !.
$% ! +”& &+ ! % !&+ % %& ) & + !
!%- ! &)’ 0 ’ +) ( ! !’ !1
*& ( !0) ( (&% ( 0 ! ( !+& !0
&( , (” + ! % ) & ! ( ,
1 ”.
81235281
$% ./.% % & ) %! 1
+ ( ( +)1 *!( *& &% ( !.23*& !
% % %& ) &+ ! (% %&
&! !0&)’ 0 % (- %*) ( & 0 4’ !
&% (“0( (* % ’’+ & ! &+ +
! ” 56 7% (0899:;/%
6+, ”0899:?6>@@6A(% 8
6
$ $ 6 %
7 #6 6
$ % 1 $
#&9B 8>>9( &B $ $ ?6# 44E
012
344565789 11
!”! #
$%& 11#'(6 )* * !
+ !!,)* *+ )
“ $- )*11#'(
5!! *-!./ +$#001’* ,** !
,! 2
!. ! *! + * ” )(3
!.* ” * ”+ ,*
“ ) !)+) )
“”.! * * .!.!* +
“”.! ) .””!+ **. !
“ ! !, * + ”*.
* ) *)!,! / (3+).
+) / !. )*. * * )
& !
. .* * !!, * *
$#001′(9 “ .! ) ” ,!
$4. *
5 ! )#001′(
9 **
” .(6 1 !! 6 !
! +”!+*(7.! +
“ *,. !* *
( 6 !
!! ) . )) / ! )!
)”! (6 ,!+. .! ) !.*
)* *! + + ”” !
!”! *”+ (8) / . .
” ”.”..!
) *” * ..
* *! ) ! *
) / !. .$9//! ! 11:5 +
#002:5 + *;”,!! 11′(3!) )*
! + ) !! )
. !! * 7438?/89B7?/86738 B/6547C9738
(#D F ’ G H
&)EE* ’ % %
D
D
H %
2 K %’
F
D#
L #D
I D ’” ” ”’’
&) J* D’
$ ’# %
’ 6
# ’
%D’
D H %
’ #
#D’ #
MN G#
G
OL3
#D
&) J*
2$D !$’ G
&) E*
%
’
%
’
%
P D
I% !
! D
&9 )*
#
%DD
QRS=TR2+;=U@V@W=Q
3 # %#
&!#’)JX*H ’
012
344565789 22
1!”#$ %& ‘(
)& *$
4) )’ ’( & *
+) ),&”*’
‘)’&-*,& 1!0!#$5(
-)’)& *)-
’’’ ).&)(
/’)(+’ ) $9
.’)) *0 &(.
1$4 ’ )’ *
(&’’,&$ 6* )’
*(’.’*( 1!2#$ 9
” 5. 1!3#’&* +
'()/”*’’),&
*) . ‘
&4 ’))4)$5 )
)).’’ *
‘.’&( *+(
’( ’)./ 1!3#$
& 1!36# ’’ ./
)$4 ’)*
7 1#)’*’
$% ’ ’ ’’
)8 #)
/ ”))$%
’ ) ‘)’/)8 6#
‘)/’ $
% ’ ‘&
’’$
6’ 1!””#’’)$6
0’1) /0
‘1$60*1).
/$601)’
’)* (
)) $ 9( 0))1
011232456789
!3”
# #” $
% !
& ’()*)+ # ,-.
%
#!3 % ,-.
“
$!3 ,-.
!3 #
# $! & ’/
,-.” $
“ 0” ())1+!6
& ’0”
% !
2%$# 3
$ %”
!6
$ !6
# %
$” #”
$$
/$ !6
’
!2
#
’” $
!
012
344565789 2
!”
#!
4()*+,-.1/0/0
$%& %’
1,)(23,425-525-63,347(8(9:;,0,;()
?8(9:;,
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Achiever Papers is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Dissertation Writing Service Works
First, you will need to complete an order form. It's not difficult but, if anything is unclear, you may always chat with us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download