Assignment Sample on Strong System That Can Detect Issues Within The Healthcare System
Introduction and context of the Proposal
In the global context there are different forms of medications that are provided to the patients from the necessary drugs. However, taking proper medications can assist in preventing hospitalizations that are avoidable by further helping patients to manage their own illness. In this aspect, if the routine of medication is increasingly complicated, healthcare facilities that involve pharmacists or doctors assist in simplifying the process (Chen et al. 2019). This further involves a diverse range of health supplements along with medicines that are required to be regularly provided to the patients over their treatment courses. Accordingly the health supplements are provided to the patients due to the health issue diversity for which an individual patient visits hospitals. Therefore, with such a large number of medical substances within the market critical mistakes are made by the healthcare practitioners during prescribing and dispensing medicines.
The number of deaths that are increasing rapidly has been specifically considered due to unsafe healthcare and medication worldwide. In this context, the total global medication error has been reported to increase its market revenue by 326 million during the year 2018. Furthermore, it is projected that this specific revenue can increase up to nearly 790 million dollars by 2026 (STATISTA, 2023). In addition, as per the world health organisation the number of deaths due to unsafe medication in the global context has been contributed to 2.6 million deaths within a year specifically within million and low income countries (WHO, 2023). Accordingly the specific number does not account for the difference and the other issues that are related within the patients such as complications due to the medications that they are provided with.
It can be significantly considered that the medication issues specifically arise due to patients. However, as a significant factor related to medication issues involves the deeply rooted critical challenges within health care systems for its rectification (Neresini et al. 2021). In this aspect, different other factors have been contributing to inadequate issues within medication such as improper doses of drugs, cardiovascular diseases or wrong drugs. Apart from this in this context in the government hospital within Palakkad, Kerala a major cause of harm to patient’s safety involves missed medication. Accordingly, this paper involves focusing on the issues of missed medication along with its impact within the government fund and hospital in Palakkad, Kerala. Furthermore, the study involves an evaluation of a strong medication reminder system that can assist in detection of the issues within the health care system by decreasing the incidence of missed medication specifically within the government hospital in Palakkad, Kerala in India.
The PEST analysis specifically involves the studying of key external factors which are political, economic, social and legal that can influence the government hospital of Palakkad Kerala India. This kind father assists in different scenarios that can guide the organisation along with the senior managers in a proper strategic decision making. This is regarding the implementation of a strong reminder system for the patients in the mitigation of issues related with missed medication. In addition to this, a proper management of funding is required for the implementation of a robust system in mitigation of the issues related with missed medication (Raoofi et al. 2020). Accordingly the proposed solution is technically possible and is also ethical as the medication reminder products and services can add simplicity within medication regimes.
Background Literature review
Issues within health care system specifically missed medication along with its impact
An error within medication can be defined as an event that is preventable but also leading or causing medication error that is inappropriate. However, providing complete medication can cause patient harm even if the medication is in the control of the professionals belonging within the healthcare facility (Isaacs et al. 2021). This involves a significant issue related to miss medication for which medication errors have been considered as one of the leading causes of avoidable harm and injury within the health care system in the global context. As per view of Alrabadi et al. (2021), the level of medication errors can vary widely within the settings facilities for different factors of defining and recognising the medication error status along with its documentation. Therefore, specific error medication can occur throughout the medication use system such as while prescribing for a drug. This is further related to medication error due to missed medication.
There have been a massive number of prescriptions and medicines along with different drugs provided for specific health issues. However, significant responsibility of healthcare practitioners can be complicated for this reason which is an availability of different medicines and prescriptions specifically during providing patient care. As per view of Poudel et al. (2019), there has been difficulty pertaining due to a lack of health information technology within the healthcare system due to lack of shared patient record. This has been further leading to an inconsistent communication between doctors, pharmacists and any primary care providers. Therefore, taking all the factors into consideration medication risk along with issues within the healthcare facilities is increasingly high.
Among all other risks within medication, missed medication has been considered as one of the significant categories. As per view of Norman et al. (2021) the consequences of missed medication involves serious negative impact specifically within older individuals. Therefore, in healthcare facilities it is an important factor in making the elderly patients understands why it is necessary to take their medications as prescribed.
In addition to this, there are several other factors that have been making a contribution to missed medication such as the patient complexity along with the administered drug. As per view of Elliott et al. (2021) demographics of patients has been considered as a critical factor for which medical errors take place. Furthermore, this has been creating several of the challenges within healthcare facilities such as improper communication within the individuals involved in drug administration. In addition, this also involves incomplete checking of orders that does not include patients’ medical history. This has been providing inaccurate information through patients with an incomplete knowledge about drug administration.
Challenges within healthcare facilities and the consequences of missed medication that can take place in the government hospital of Palakkad, Kerala
The challenges within hair care facilities involve broad categories of Health Management problems. However, in taking medication management of information communication in health facilities can cause severe difficulties. In this aspect lack of communication or poor communication between the providers’ patients and care give us the health care facility has been aligned with missed medication (Trivedi et al. 2019). Along with this, severe Health Management problems leading to missed medication involve scarcity of medical employees along with registered nurses, doctors and pharmacists. Therefore, significant factors by which missed medication can be caused involve issues with availability and supply of medication along with an inclusion of drug shortages (Cortes et al. 2020). This also keeps an inclusion of medications that are expired along with inadequate storage conditions of medicines that can further interfere with the process of receiving medication by patients on time (Abu Zwaida et al. 2021). In addition to this several factors that are related to patients can also create challenges within an ability to follow the prescribed schedules of medication. This further involves challenges in understanding the information provided by healthcare along with remembering doses and routines of complicated medication.
The unprecedented changes after the industrial revolution have been creating challenges within the health care facilities. However, one significant challenge for the executives and professionals present within the system of health care along with decision makers involves financial limitations (Oleribe et al. 2019). In this context, budgetary constants and funding are related factors in achieving the innovation of an organisation within the healthcare system along with its transformation goals. In addition to this, various factors that involve an ageing population and an increase in chronic disease have been considered as fundamental factors that led to an increased demand for health care. Furthermore, in India an increased cost of healthcare is also a significant related challenge that involves financial limitations (Sarwal et al. 2021). In this aspect, the cost of advanced technology and special medical equipment that are used for treatments has been leading a rise to the medical inflation rate in India.
Among all other medical errors creating challenges within healthcare facilities involves missed medication specifically among older patients. The impact of missed medication can be adverse if a patient does not take pills at the prescribed normal time. As per view of Zhang et al. (2022), in care homes specifically for elderly people missed medication can take place if a patient has forgotten to be given meditation. However, the dose of medication can be doubled at the time of next medication among patients. Therefore, this can further cause problems and increase the risk of side effects among the patients belonging specifically from the government hospital of Palakkad, Kerala. Furthermore, the specific consequences of medication error can lead to a lack of satisfaction among patients with the lack of trust within the system of health care.
In minimising the errors of missed medication the Palakkad government hospital in Kerala requires implementation of a proper system of minimising the occurrences of missed medication. However, this requires an organisation in the healthcare sector to make significant investment in new technology in mitigation of errors (Lee & Yoon, 2021). Therefore, this involves providing proper training regarding the system of medication reminder that is required to be implemented within the hospital. In this aspect, implementation of new technology can be a critical process.
There are also different solutions and options that can be competing with each other in the market. However, these numerous solutions in the market can be further difficult to assess regarding which option can be the best and suitable within the organisation as per the specific means (Kretschmer et al. 2022). Accordingly, there are various professionals and executives in the health care sector that find the practical factors and implementation of new technology very hard. Therefore, these critical challenges are possibly due to not having a proper basic IT infrastructure.
Implementation of technology can be challenging within the health care system due to not being increasingly compatible with the new technology that can run within the organisation. However, the healthcare transformation is increasingly dependent upon the availability of talented and skilled workforce (Oliinyk et al. 2021). Therefore, the government hospital in Palakkad Kerala India can face critical challenges in attracting new talent. This specifically for transformation and innovation purposes within its health care facility for missed meditation.
Implementation of proper medication reminders system as a significant strategy in mitigation of the identified challenges of missed medication
The advantages of modern medical healthcare involve a wide variety of medications that has been helping in the enhancement of both quality and length of a patient’s life. However, in this aspect today’s modern medicine is specifically used for controlling insulin, blood pressure, cholesterol and even heart rates (Vishvakarma et al. 2023). Therefore, this involves the management of the prescribed medicine in an appropriate manner making it increasingly effective. In comparison, if medications are not properly managed among patients then it can result in hospitalisation or even death (Chioncel et al. 2020). This included the government hospital in Palakkad, Kerala in India in the implementation of a medication reminders system that can produce efficient results for a patient’s health. It is also significant within the providing of medications in the given time period considerably as an efficient management process of medication.
There are significant benefits of medication reminders that can be increasingly effective for the government hospital in Palakkad, Kerala. However, one such significant benefit of medication reminder systems involves preventing life straightening mistakes due to mist medication (Baxi et al. 2022). Therefore, the medication reminders are considered as a significant aspect within the health care facilities that prevents the elderly patients from skipping the doses or even taking wrong medicines.
Implementation of medication reminder as a significant process within the government hospital of Palakkad, Kerala request organisation in providing proper training to the employees. As per view of Pinzone et al. (2019), providing appropriate training to the employees within the health care facilities cannot only assist in increasing employee’s skills but also makes them available part within the organisation. Furthermore, due to the advancements of technology the employees in modern health care facilities are required to be trained properly (Tzenios, 2019). This is so that they can get highly adapted with the skills related in handling the technology of medication reminders system to mitigate the negative impact of mist medication within the government hospital of Palakkad, Kerala.
Ethical considerations of the study
Ethical consideration within a research involves protecting the rights of the participants along with their well being by maintaining the integrity within the study (Brown et al. 2020). Accordingly the ethical consideration involves the set of principles that can guide research practices and designs. These principles involve “voluntary participation”, “informed consent”, and “confidentiality”, “potential for harm”, “results communication and anonymity. Among all other significant factors of ethical consideration within a research the study involves obtaining informed consent as a significant factor as it is a desk based research (Shlobin et al. 2020). This is because it is critically challenging in safeguarding the confidentiality and privacy of any utilised data within the study. In addition to this, the research includes implementation of the “data protection act 2018” that has been allowed to protect information. Furthermore, it is also required in maintaining the genuineness of the exploitation within the studies for which the authenticity and trustworthiness of the used resources has been maintained.
Implementation Plan – Aim, objectives/ Success criteria
Aims
The aim of the project is to build a strong system that can detect issues within the healthcare system by decreasing incidence of missed medication within a government hospital in Palakkad, Kerala.
Objectives (SMART)
Output
| Objectives | Specific | Measurable | Achievable | Relevant | Time |
| To analyse the challenges of missed medication within the healthcare system within a government hospital in Palakkad, Kerala. | Analysis of healthcare challenges is to mitigate adverse health impacts that can also lead to death among patients. | By introducing a robust system of surveillance within the healthcare system, specifically within a government hospital in Palakkad, Kerala can help in the identification of medication errors. | A proper system of “medication system” can effectively handle errors within medication. | An effective system of surveillance can identify the areas of improvement thereby gaining a wide insight of the errors within medication in the government hospital of Palakkad, Kerala. | 2 months |
| To implement a proper medication reminder system | Implementation of a proper medication reminder system
Can assist in an effective medical administration. |
Medication reminder systems can assist in spreading a high healthcare awareness (Le An et al. 2019).
|
Medication reminder systems can help elderly people with a proper user interface that further configures schedules of medication. | Medication reminder systems can further assist in reducing missed medication. | 3 months |
Table 1: SMART objectives
(Source: Created by learner)
Implementation Plan/ Project Milestones
Team building
A specific team includes team members with different levels of knowledge that further involves sharing a common goal. The teams within a healthcare system specifically include the professional that makes a high contribution within the treatment process of a patient. However, as opined by Yazdinejad et al. (2020), typical members present within a healthcare team includes a registered nurse and a doctor. Therefore, in the case of implementing a robust system to prevent errors of missed medication in the government hospital of Palakkad, Kerala the members of the team includes doctors, occupational therapists, registered nurses, and organisation management. Additionally, the team members within the healthcare system work collaboratively in promoting better health within a community.
Stakeholder analysis
| Stakeholders involved | Type | Role | Impact |
| Patient | External | As patients are increasingly diligent within their care facilities and treatments making a decision that is informed with a physician’s information their experience is significant an s “external stakeholders”. | High |
| Hospital staffs or attendants | Internal | The attendants or hospital staffs knows the innermost functionality of a healthcare facility that further puts them in a proper position to offer a much wider insight within a healthcare project. | High |
| Government | External | The government is a key external stakeholder that involves collection of taxes from a healthcare project for economic development. | High |
| Doctors | Internal | Doctors include a regular intervention of treatment of patients with their skills and knowledge they are also considered as internal stakeholders. This is within a specific healthcare project in the case of implementing a proper system to avoid missed medication in the government hospital of Palakkad, Kerala. | High |
| Registered Nurses | Internal | Registered nurses within the healthcare system include providing advocacy within patient treatment. | High |
| Pharmacists | External and internal both | Significant role of pharmacist within a healthcare system involves high storage and distribution practices of medicine along with management practices providing effective pharmaceutical care (Bragazzi et al. 2020). | High |
Table 2: Stakeholder analysis of the government hospital in Palakkad, Kerala
(Source: Created by learner)
Stakeholders are considered as groups or individuals that have a high interest within a project and can further impact its outcome. However, significant stakeholders within the healthcare system involve the patient, hospital, government, charitable organisations, physicians, nurses and pharmacists. As per view of Panda & Mohapatra, (2021), in India an attending has a highly significant role in the decision making process during a treatment of a patient. In addition to this, the nurses in the Indian healthcare system also play a key role as they are an integral part of the patient treatment process. Therefore, both a nurse and an attendant are highly significant as key stakeholders within the Indian healthcare system as they establish a high quality and a productive care environment.
“Beneficence”, “non-maleficence”, “fairness” and “autonomy” are considered as significant principles of ethics within a healthcare facility. However, the first two principles “Beneficence” and “nonmaleficence” are considered as “to help and do no harm” (Varkey, 2021). On the other hand the other two principles “fairness” and “autonomy” have been later evolved within healthcare ethics. Therefore, as per “Beneficence” within the government hospital in Pakkaland, Kerala, the project of implementation of a robust medication reminder system involves the physician’s application to enact for the patient’s benefit.
In addition to this, “Beneficence” as a principle within the healthcare system involves the physician in supporting various moral rules in terms of protecting and defending others by removing any specific condition causing harm to patients. This can be further effective in a proper management of missed medication within the government hospital at Pakkaland, India. However, on the other hand as per the principle of “nonmaleficence” the obligation of a physician involves causing no harm to patients (Safaei & Abbasi, 2021). Therefore, “nonmaleficence” involves choosing the best possible treatment procedures by a physician within the healthcare system.
As per one of the key pillars of medical ethics “autonomy” involves respect for the right of a patient in “self -determination”. However, key laws that are involved within “autonomy” include “ consent”, “confidentiality” and “access to patient records” (Dong et al. 2023). Therefore, “autonomy” a key principle within medical ethics if implicated within government hospitals in Palakkad, Kerala can assist in prevention of medical errors due to missed medication within patients. This is because “autonomy” involves “a proper access to patient’s records” that can further allowing in the identification of those patients going through a miss medication. Along with this “justice” as a key principle within medical ethics involves providing equal care to all patients (Gillon, 2020). Thus, “justice” as a key principle within the government hospital in Palakkad, Kerala in its implementation of a proper system can allow the patients in gaining equal treatment that can further allow in avoiding missed medication.
11. Breakdown of Financial Costs / Rationale for funding requirements
Funding
| Key activities | Costs |
| Salaries for proposed staff | Rs 20,000 each |
| Cost of training to employees regarding new implementation system | Rs 25,000 |
| Cost involved in equipments | Rs 50,000 |
| Cost involved in maintenance | Rs 30, 000 |
| Costs involved in paying doctors, nurses and attendants | Rs 3, 45, 000 |
| Costs in implementing new reporting system | Rs 95,000 |
Table 3: Funding for the healthcare project
(Source: Created by learner)
The services provided by the healthcare system in India are specifically Private or public driven keeping a focus in reducing the rates of morbidity and mortality. However, there are various challenges that are associated within the Indian healthcare system as in comparison geographically within India the affordable healthcare services in the country often get a high exposure. Thus in the year 2021, the “NITI Ayog” has been launching a plan known as “Investment opportunities in India’s Healthcare sector” (Aayog, 2022). This specific programme involves different opportunities of investment in different sectors of the Indian healthcare system including medical devices and equipment, home care, health insurance and medical value travel. Therefore, the new project in implementation of a robust medication reminder system in avoiding missed medication can take assistance from this specific program that involves funding for different healthcare projects within India.
Cost-benefit analysis
CBA or (cost benefit analysis) specifically involves evaluation of the involved costs within a specific project or a decision. However, as per view of Husereau et al. (2022) CBA involves effectiveness of “distributional costs” that includes an examination of both the cost along with its consequences. Therefore, the significant aim of CBA involves an assessment of the “economic feasibility” comparing the total cost of the decision or the project with its total benefits. Accordingly, once the benefits or costs have been identified along with the “assigned monetary value” the next step involves comparison of the total costs with the total benefits (Han et al. 2020). Thus, as per the CBA analysis in funding for implementation of robust systems to avoid missed medication in the government hospital in Palakkad, Kerala includes a specific formula which is “Cost Benefit Ratio= Sum of Present Value Benefits / Sum of Present Value Costs”.
Health- benefit analysis
In comparison inside a healthcare system evaluation of CBA includes an inclusion of different interventions along with their respective consequences in which both resulting benefits and costs involve expressing in monetary terms. However, health benefit analysis involves comparisons of different alternatives of treatment using the “summary metric of net monetary benefit” (Rognoni et al. 2020). In addition to this, the “monetary valuation” of benefits is obtained commonly through “willingness to pay” or WTP surveys or “discrete choice experiments” (DCEs). As implementation of a proper medication reminder system is considered as a new facility within the government hospital in Pakallam, Kerala the CBA involves its assessment with the large capital investments that further involves a successful healthcare outcome.
Evaluation Plan Monitoring Implementation and evaluating success
Clarification of the goals and objective of the new project
Any valuation and monitoring plan can be considered as a significant document that assists in tracking and analysing the intervention results throughout the program or a project life cycle. As per view of Ali et al. (2020), it is significant in the development of any valuation monitoring plan before starting any activities. This is for obtaining a clear pathway for what are the specific benefits the implementation system requires within the government hospital in Palakkad, Kerala. Therefore, as per the significant objective of this specific new project it involved analysis of the challenges due to missed medication will be a health care facility inside a government hospital of Palakkad, Kerala. Another significant objective building a strong system for detecting issues making a decrease in missed medication involves implementation of a proper medication reminder system. Adequately the specific program of the new project involves solving the problem with mist medication inside the government hospital of Palakkad, Kerala.
Specific indicators after defining the objectives and goal of the new project involves tracking of the project which involves process indicators that can further help in generating outcome indicators in achievement of the objectives. However, for this new project the process indicators include:
- The number of training provided to the health care providers.
- The number of activities that can be outreached within the hospital premises of government hospital in Palakkad, Kerala.
- Determining the percentage of patients involved within missed medication.
On the other hand the indicators that are related to the outcome of the project involve:
- The number of patients that have been facing proper healthcare interventions during missed medication.
- Specific percentage of patients that received proper medication.
In defining the methods of data collection there is a requirement of efficient communication among the staff, stakeholders and the involved employees in the implementation of proper medication reminder system in avoiding missed medication. Therefore, significant data that are required along with its relevant sources for implementation of the proper medication reminder system involves:
| Information that is required to be obtained | Relevant sources |
| Reaching towards small groups of audiences or communities for knowing the adverse impacts of missed medication | Small surveys within the audiences who are primary and are present near the hospital premises. |
| Service statistics | Referral cards |
| Data that are qualitative regarding intervention outcome | In Depth interviews, focus groups and case studies |
Table 4: Required information with its relevant sources
(Source: created by learner)
Development of evaluation plan:
| What? | How? | Why? |
| Funding in implementation of a robust system to mitigate issues due to missed medication. | By analysing different perspectives within the current market such as Price, functionality, customer reviews, features an idea of proper funding can be generated for a specific project (Schiavone et al. 2021). In this aspect, analysis of features in implementation of medication reminders involves looking for products that can serve different needs of a patient. Additionally, as per its features, the new project in the installation of a medication reminder involves fitting inside different budgets. | Proper management of funding is required for facilitation of “market trials” and trialling of the new product. |
| Collection of data from relevant sources | Data for this specific project has been gathered by coding surveys and focus groups. As per the view of Roche et al. (2021), a survey is considered as a key method in gathering information from a group of individuals. This further involves procedures that are identical for each individual within the process of survey. | Collection of data from relevant sources can assist in the formulation of mitigation strategies. This can further allow in a proper monitoring tracking of a patient’s health condition. |
| Providing proper training regarding proper medication reminder system | If medication reminders are not managed effectively than it can lead to missed medication leading a patient towards severe injury or even death. Adequately, it requires providing proper training to the employees within the healthcare facility in the Indian government hospital in Palakkad, Kerala. | Providing proper training not only can help in increasing skills but also it makes them feel that they are a valuable part of a specific organisation (Kost et al. 2020). In addition, as there has been an emergence of different technological advancements, the employees are required to be properly trained that can further allow them to get adapted with the changing market demands and needs. |
Table 5: Project evaluation plan
(Source: created by learner)
Mainstreaming the project
The “project exit strategy” is considered as a plan of action that involves how an existing programme or a project can withdraw their support in terms of financial and personal resources. However, the “project exit strategy” does not involve making a compromise within the continuity and quality of the set objectives and goals for a project (Ndombi, 2021). Therefore, implementation of a project exit strategy does not leave a project unfinished. In this aspect, significant categorisation of “exit strategy” includes “phasing down”, “phasing out”, and “phasing over”. For the new project within a government hospital in Palakkad, Kerala the exit strategy “phasing down” involves making reduction in the project activities by sustaining its benefits. On the other hand, the “phasing out “includes withdrawing from the involvement of a stakeholder by making an elimination of other external outputs (Ndungutse, 2019). Lastly, within the government hospital in Palakkad, Kerala in implementation of a medication reminder system in reducing missed medication “phasing over ” involves the activities being transformed within local communities.
The plan of sustainability involves planning regarding how a project can be further sustained in the long term. However, the plan of sustainability for a project involves making sure that the resources spent within a project are not lost (Allam et al. 2022). Therefore, in implementation of a medication reminder system in reducing missed medication in Palakkad, Kerala involves listing of all the significant factors and resources that are further responsible for its successful outcomes. In this aspect, a significant resource for this specific project involves significant funding. For this factor future funding sources for the healthcare project can be considered which are “revenue raising”, “voluntary prepaid insurance schemes”, “direct out-of-pocket payments by users”, and “external aid”.
Reflexivity
Gibbs reflective cycle:
Description
I was provided with the teamwork assignment in which three other members were involved. However, in this aspect I decided to divide the work between different team members so that we are able to research one element separately each. In addition to this, when the team members started to write the assignment some of the sections were not written properly in the same style of writing. Therefore, the members of the team made the assignment of work to rewrite almost the whole assignment. In this approach the team members have been provided with enough time. As the planning was not properly conducted two team members have been dropping out their plans so that the task can be completed within the given time period.
Feelings
Before the team members sat together I was increasingly happy as I thought that I had been dividing the task between us in a proper manner. However, I was extremely anxious and frustrated when I realised that the assignment was not properly conducted. Along with this I also felt sad and guilty that two of the team members have to top out their own plans for the completion of the project.
Evaluation
Significant things that have been going well included each team member producing high quality work. In addition to this the specific things that did not work properly included our assumptions.
Analysis
As per my view point I have been conducting some research on teamwork and have been finding two things that have been further allowing me to understand the whole situation. In this aspect significant framework Belbin’s team role involves each team member with their own business in strength that can be included within teamwork. Along with this another theory included “group think” which I feel that it can have increasing advantages within team tasks in the future.
Conclusion
From the group task it has been provided to us I have been learning that it is necessary to plan ahead and that can help in completion of the task within the given deadline without any writing. I am also required to develop effective skills of communication that can ensure that I can act differently next time while doing teamwork. I am required to adapt different skills that can help me to develop myself more in handler specific situations like this in an effective manual. This can also become increasingly a positive situation for everyone who has been involved within the team task. Furthermore, this can help in improving the outcome in the near future.
Action plan
Specific reaction that I required to take includes working as an eyes breaker keeping a proper communication with all other team members during the division of work. I will further implement the framework of Belbin’s team role in future teamwork. Moreover I can also provide a suggestion that writing only one section each together before all the team members can conduct their own work can further make a proper review of the errors. Finally with proper communication I will speak my mind out when I am increasing the concern by making a reference that it can provide advantages within the outcome.
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