Six Sigma Concepts in OPD: Process Mapping and Waiting Time

Six Sigma Concepts in OPD: Process Mapping and Waiting Time Study on Process mapping, Waiting Time Based on  Six Sigma Concepts in OPD Dr Geetika Verma Dr Geetika Verma, Management Trainee, Department of Patient Care Services, Fortis Memorial Research Institute, Gurgaon. Abstract This study focuses on to identify the various procedures at the outpatient clinic as well as to investigate the possible operational problems that may lead to excessive patients’ waiting time. A patients’ experience in waiting time will radically influence his / her perceptions on quality of the service. The study was carried out in Fortis Memorial Research Institute, Gurgaon (Haryana) for three months. The subjects were outpatients who came to the outpatient clinic in FMRI. Data was analysed using the six sigma approach.Significant reduction in waiting time was achieved in the outpatient services of department by using the six sigma approach. Doctors were on time in OPD to reduce the delay in the OPD. Patients were coordinated well to the doctors. Keywords: ‘Lean Six Sigma’, ‘Waiting time’, ‘Process mapping’ Introduction Patients’ waiting time has been defined as â€Å"the length of time from when the patient entered the outpatient clinic to the time the patient actually received his or her perception†. Process mapping is a workflow diagram to bring forth a clearer understanding of a process or series of parallel processes. It views the system from the patient perspective following their journey across organisational boundaries. It helps staff understand how complex and confusing processes appear to the patient. It is organisation specific. It is diagnostic and used as a basis for redesign, actively involving frontline staff in the process. (Shows how things actually are). Fig. 1: Patient Process Aim Of the Study The two main objectives of the study were: To study the patients’ waiting time in the outpatient clinic, with a view to identify the factors that affect waiting time and recommend ways of minimising the delay To use the six sigma technique to identify the delay and improve management capabilities. Research Scope This research was done at the outpatient clinic in FMRI. The research methods chosen were to: Directly observe the patients. Interview the patients. Interview the people involved in managing the work process. Literature Research WAITING TIME Defined as the total time from registration until consultation with a doctor. REGISTERATION TIME Defined as waiting time from the moment patients submit a clinic card or referral letters at the counter until getting a call from the counter. During this time the payment process and record classification are made. Registration time is part of patient’s waiting time. SIX SIGMA First introduced by Motorola in 1986, Six sigma is a method to measure the quality of a process to fulfil customers’ needs which approaches perfection. Data and statistical analysis were used to identify defects in processes and reduce variation. With Six sigma, defects in a process can be measured by identifying the best method to eliminate defects and approach ‘zero defect’. Customers’ satisfaction is the main factor. A new and more effective method has to be adopted to ensure customers’ satisfaction. Six Sigma specifies a very high standard of quality achievement. It utilizes a variety of existing project management, statistical and analytical tools. Several toolkits of the six sigma were applied during this study: Descriptive statistics Statistical image shows characteristics of collected data. At this level, data will be presented using the best presentation tools such as histogram, pie charts or others. Flow chart Chart shows description and sequence of the process done. Cause and effect diagram Diagram shows the relationship of a cause that gives rise to a certain problem. Methodology MEASURABLES 1.Total waiting time for the consultation. 2.Time taken for Investigations. SAMPLE SIZE This study conducted at the outpatient clinic, FMRI, was an exploratory and evaluation study. Respondents of this study were selected patients, staffs and doctors at the outpatient clinic. Table 1: Sample Size Retrospective data of 4500 patients was analysed for waiting time during the period August- October 2013. Voice Of Patients was obtained from 150 patients. TYPE OF DATA AND COLLECTION METHODS Several variables monitored in this study were data on patients’ waiting time work process, number of doctors available and number of staffs at the registration counter. Three major collection methods were used in the study: The first method was observation. Data were collected through direct observation on the subjects involved in the various working processes in FMRI. Measurements of time spent from registration until consultation by a doctor were made using a stopwatch. The second method is through interview. In carrying out this research, some of the management staff and doctors were interviewed to obtain information on the working process in the hospital. Voice of patients (VOP) was obtained using standardized questionnaire. DMAIC METHOD (DEFINE-MEASURE-ANALYSIS-IMPROVE-CONTROL) The Six Sigma method which consists of the five steps of: Define Measure Analysis Improve Control (DMAIC) is the roadmap to achieve the objectives of this study. DMAIC STEPS Fig. 2: DMAIC Steps PROCESS FLOW IN FMRI OPD: Fig 3: Outpatient Flow Study was carried out in the GENERAL OPD FMRI Outpatients of 50 per day. Simple Random sampling was followed. Period of Study – AUGUST 2013 TO NOVEMBER 2013. STATISTICAL TOOLS 1. Process Map-Flow Chart that shows description and sequence of the process done. 2. Cause and Effect Diagram Diagram that shows the relationship of a cause that gives rise to a certain problem. 3. Affinity Diagram- Business tool used to organize ideas and data. 4. Descriptive statistics- Analysis of data that helps describe, show or summarize data in a meaningful way. Results And Conclusion DEFINE This is the first step that refers to defining the goals of the project. Process improvement goals may be aimed at increasing market share, the output of a particular department, bringing about improved employee satisfaction as well as customer satisfaction and so on. The goal has to align the patient demands and the strategic goals of the organization. Data mining methods can be used to find prospective ideas for project implementation. In other words, businesses are designing a road map for achieving the targets and goals of the organization. Problem Statement: Three months retrospective data from the department indicates that in August 2013 only 66.64% of patients were seen within 15 minutes by the physician. In September 2013 this decreased marginally to 59.68% and in October 2013 this was found to be 61.68%. OPD WAITING TIME PERCEPTION OF PATIENTS For understanding perception of patients on OPD waiting time, VOC was collected from 150 patients in the OPD. Questionnaire for OPD Patients: 1. Did you take an appointment for OPD visit? a) Yesb) No 2. How did you get the appointment? Through telephone or direct? 3. Are you satisfied with the way your phone call was handled? a)Yesb)No 4. What instruction was given by the counter staff at the time of appointment/arrival? 5. How did you feel at the reception? a) Very good b)Goodc)Badd)Very bad 6. How much time it took at the reception, to attend you? a)0-10 minsb)10-20 minsc)20-30 minsd)>30 mins 7. At what time you were asked to report at the counter and when did you reach the OPD reception? 8. Did any staff brief you regarding the workflow in OPD? a)Yesb)No 9. How long you have been waiting in OPD? a)0-10 minsb)10-20 minsc)20-30 minsd)>30 mins 10. Did any information regarding waiting time in OPD was given to you, at the time of appointment? a)Yesb)No 11. How much time it took for you to interact with doctor after your arrival? a)0-10 minsb)10-20 minsc)20-30 minsd)>30 mins 12. Are you aware of the existing appointment system in FMRI? a)Yesb)No 13. What is your perception on waiting time in the hospital? 14. What would you suggest to reduce waiting time in OPD? 15. Any other suggestions? How long have you been waiting in the OPD for Consultation (Observations): It was observed that 20% patients take prior appointment to consult the doctor whereas 80% patients come Walk- in to consult the doctor. Fig 4: Appointment for OPD Visit 67% patients who come to consult the doctor take prior appointment on the telephone whereas 33% comes directly to get the appointment. Fig 5: Appointment System It was found that 75% of the patients were satisfied with the telephonic call handled whereas 25% patients weren’t satisfied. Fig 6: Satisfaction Level As per as the behavior of the reception of the staff is concerned, it was found that out of 150 patients, 20 patients felt very good behavior; 90 patients felt good, 25 patients felt bad and 15 patients felt very bad behavior from the side of reception staff. Fig 7: Reception Staff’s behavior When process flow was observed to capture the waiting time, it was found that out of 150 patients, 50 patients were attended within 10 minutes; 70 patients were attended within 10-20 minutes; 25 patients were attended within 20-30 minutes and 5 patients were attended more than 30 minutes. Fig. 8: Time taken to attend the patients 75% patients felt that they were briefed regarding workflow in OPD whereas 25% patients felt that they weren’t. Fig.9: Briefing Regarding Workflow in OPD Regarding waiting time it was that out of 150 patients, 60 patients had to wait up to 10 minutes; 5 patients had to wait within 10-20 minutes, 15 patients had to wait within 20-30 minutes and 30 patients had to wait more than 30 minutes. Fig. 10: Waiting Time in OPD 93% patients felt that they were well informed regarding waiting time in OPD whereas 7% patients felt that they weren’t informed well. Fig. 11: Information regarding Waiting Time As per as interaction with doctor after arrival is concerned, out of 150 patients 98 patients interacted within 10 minutes, 12 patients interacted within 10-20 minutes, 26 patients interacted within 20-30 minutes and 14 patients interacted more than 30 minutes. Fig. 12: Time taken for consultation to doctor 51% patients were found aware regarding existing appointment system in FMRI whereas 49% patients were found unaware. Fig. 13: Awareness regarding appointment system in FMRI MEASURE This phase refers to the analysis of the existing system with various measurement techniques for the defects and levels of perfection that exist. In this step, accurate metrics have to be used to define a baseline for further improvements. This helps in understanding whether any progress has been achieved when process improvements are implemented. To identify High level process map the SIPOC has been done. Table 2: SIPOC The various processes involved in the particular project have been described in detail in flow chart: Fig.14: Process Flow Chart NO YES Revisit New Visit Value Analysis: A value analysis was done based on the flow chart and the processes were categorized into Value added, Operational Value Added Activity and Non Value Added Activities. Table.3: Value Analysis ANALYZE The analyze phase was undertaken to determine any disparity that may exist in the goals set and the current performance levels achieved. The understanding of the relationship between cause and effect is necessary to bring about any improvements, if needed. Brainstorming session was carried out and all the causes were listed in the affinity diagram. The Fish Bone Diagram was prepared. The causes which got from the brain storming session have been segregated into non controllable causes, direct improvement causes and controllable and likely causes. Its fish bone diagram for controllable causes only. Table.4: Analysis Phase CAUSE AND EFFECT DIAGRAM: Fig.15: Cause and effect diagram Causes were then ranked on the basis of severity and occurrence as per criteria given. Table.5: Ranking of causes on the basis of severity and occurrence A modified Failure Mode and Effects Analysis (FMEA) were carried out for Occurrence and Severity only. The top Risk Priority Number was considered for further analysis, using 5WHY. Single Registration counter Time taken to process blood test only Time taken to process blood test and other Investigations. DATA ANALYSIS As per analysis of data, following observations were made: Month August- As per observations, Average Time = 13 minutes. No. of patients seen >15 minutes = approx. 13 % of no. of patients seen > 15 minutes = 25.48% Fig. 16: Observation in Month August Month September- It was observed, Average Time = 17 minutes. No. of patients seen >15 minutes = approx. 17 % of no. of patients seen > 15 minutes = 32.70% Fig. 17: Observation in Month September It was noticed that there was slight increase in the average time, no. of patients seen more than 15 minutes and %age of no. of patients seen more than 15 minutes. The main reasons behind it are: Delay in Doctors’ in time( e.g. Doctor in OT/ On Rounds) Delay in Investigations. Long consultation time. Month October- It was observed, Average Time = 15 minutes. No. of patients seen >15 minutes = approx. 16 % of no. of patients seen > 15 minutes = 30.19%. Fig. 18: Observation in Month October In this month slight improvement was observed as the average time, no. of patients seen more than 15 minutes and its %age decreased slightly. This was due to: Doctors requested to be on time so that patients can’t feel inconvenient. Complete consultation on time. COMPARISON AMONG MONTHS AUGUST, SEPTEMBER OCTOBER: Table.5: Comparison among Months August, September October It was observed when compared the data of three months that: Average waiting time was decreased followed by slight increase. Maximum time for the consultation has decreased within three months. Minimum time was approximately zero in these three months. Fig. 19: Comparison among months August, September October IMPROVE Improvements in existing systems are necessary to bring the organization towards achievement of the organization goals. Creative development of processes and tools brings about a new lease on life for the organizations processes and takes them nearer to organizational objectives. Various project management and planning tools can be used to implement these new techniques and processes. Appropriate usage of statistical tools is important to measure the data, which is necessary to understand improvements done and any shortcomings that may exist. The solutions with their respective Causes are shown below: Table.6: Causes Solutions CONTROL Control phase is the last step in the DMAIC method. This phase is about sustaining the changes made in the Improve phase to guarantee lasting results. The best controls are MONITORING, appropriate CHECKS and balance the quality system for the long run. Recommendations Segregated OPD counters for billing. Separated nursing station for the departments to reduce waiting time. OPD schedule to be blocked for the time duration when the doctors are in procedure or on rounds. Time slot for appointments to be increased from 10 to 20 minutes per doctor. Conclusion: Significant reduction in waiting time was achieved in the outpatient services of the department. Doctors were on time in OPD to reduce the delay in the OPD. Patients were coordinated well to the doctors. Further data analysis will help to monitor and control the waiting time and process flow in the OPD.

Bowlby’s research Essay

The maternal deprivation hypothesis was developed in post second world wartime and Bowlby’s research was based on children that were extremely traumatized, having possibly lost both parents at war. As a result a lot of children ended up in institutions which more than likely had substandard conditions and numerous untrained carers. It is very important to bear in mind the context of that time as there was a national need for family life to be recreated and stabilised after the war. Thus, Bowlby’s maternal deprivation hypothesis was interpreted as an opposition to the employment of women with young children and therefore the use of day-care facilities. It is important to acknowledge that Bowlby was primarily concerned with the welfare of children and that his theory of maternal deprivation played a huge role in reforming child care practices by pointing out the damaging effect of been cared for by numerous staff. In the years since however, the maternal deprivation hypothesis has been largely discredited in light of subsequent research which suggests that some separation, for example some time in a high quality day-care, may not necessarily have long-term effects on future relationships. Bowlbys monotropic model of attachment has also been highly criticised as recent evidence is revealing that children do form attachments with more than one adult, in particular with fathers, siblings and other adult carers with whom they have developed a stable relationship. Research has shown that children generally favour their father’s company to the company of a stranger. According to Lewis (1986) the attachment bond between a father and child is dependant on the quality of their relationship, that is, a child with a sensitive father that is focused on their needs will develop a stronger attachment bond with them. Nonetheless, in times of distress infants are more likely to seek out the comfort of their mother over their father (Lamb, 1981). Given the changing times and the steady increase in the proportion of working mothers, it is necessary to focus more on the effects of multiple attachments and specifically to the child’s relationship with adult caregivers other than parents and relatives. Studies however, carried out by Tizard and Rees (1975) and Tizard and Hodges (1978) caution that while children can be cared for and attached to more than one adult, having a large number of caregivers may have an adverse effect on their ability to develop close relationships. Bowlby’s maternal deprivation hypothesis was further developed by the work of Mary Ainsworth (1969), who devised a method for observing and assessing the attachment behaviour babies’ display towards their mothers/caregivers. This is known as the Strange Situation (ED209 TV4 programme) and is essentially a method for measuring a one year-old’s attachment to its mother and assessing how the child reacts to separation and more importantly to reunion with its mother when placed in a slightly stressful situation. Briefly, the experiment involves taking mother and child to a strange room and observing the child’s responses to the introduction of a stranger, the mother’s departure, reunion with the mother, leaving the child alone for a few minutes in the room (most stressful event), and leaving the child alone with the stranger. Researchers classify the maternal-child attachment relationship based on the child’s behaviour during reunion with the mot her. Ainsworth suggests that attachment relations fall into three categories: securely attached, insecure-avoidant and insecure-ambivalent infants. Sometimes an additional category (disorganised) has been used. According to Ainsworth securely attached infants explore freely when their mother is present and use her as a secure base when a stranger appears. They greet her warmly on reunion and show a clear preference for her over the stranger. Children who do not behave this way, for example by clinging (insecure-ambivalent) or been more detached (insecure-avoidant) during reunion with their mother, are described as insecurely attached. Ainsworth et al (1978) believed that children who are separated from their mother, for example children who attend day-care, are likely to form insecure attachments. This is supported by Belsky (1988) who, it is interesting to note, revised his conclusions regarding the consequences of placing children in non-maternal day-care. Initially, he believed that day care did not effect a child’s attachment to his/her mother, however subsequently in his review of a number of US studies, he concluded that children who are subjected to more than twenty hours a week of non-maternal day-care in their first year of life are at risk of developing insecure attachments. It is important to note that although the strange situation technique has been widely used by Belsky and others to assess the quality of a child’s attachment to its caregiver, it may not however be the best method for comparing children who experience day care with those who do not. Belsky’s conclusions regarding day-care have been disputed by Clark-Stewart (1988) who argues that the differences in attachment styles between infants attending non-maternal day-care for less than twenty hours a week and more than 20 hours a week are not large enough to conclude that working mothers put their children at risk of suffering from psychological problems. Furthermore, she points out that children who attend day care are used to separation and therefore react differently on reunion with their mothers than children who are with their mothers all day. Thus, children may appear detached not because they are insecure but because they are more independent and more accustomed to been separated from their mother (Clark-Stewart, 1988) . Like Bowlby, Ainsworth believed in a universal model of attachment however, evidence from cross-cultural research on secure and insecure attachments carried out by Van Ijzendoorn and Kroonenberg (1988) revealed cultural differences in the mother-child relationship. This evidence questions the validity of using the strange situation method to measure and compare attachment in different cultures. For example, children from Japan showed intense distress in the strange situation when separated from their mother, as in their culture children are never left alone at twelve months. These cultural differences highlight the importance of moving away from a universal model of attachment towards a more cultural perspective. Bowlby’s ethnocentric perspective, which sees the biological mother as the all-important person for the infants first attachment, has received a lot of criticism and has been branded as a Western cultural construction by some psychologists. It is interesting to note that out of 186 non-industrial societies Weisner and Gallimore (1977) found that, in only five of these societies was the child (almost) solely looked after by the mother! Moreover, research carried out in different countries showed the grandmother as having a special and unique attachment to the child due to her long life experience and wisdom (Tyszowka, 1991) thereby lending support to a more polyadic model of attachment.

History of Communication Essay

The history of communication dates back to prehistory, with significant changes in communication technologies (media and appropriate inscription tools) evolving in tandem with shifts in political and economic systems, and by extension, systems of power. Communication can range from very subtle processes of exchange, to full conversations and mass communication. Human communication was revolutionized with speech approximately 100,000 years ago. Symbols were developed about 30,000 years ago, and writing in the past few centuries. Petro glyphs The next step in the history of communications is petroglyphs, carvings into a rock surface. It took about 20,000 years for homo sapiens to move from the first cave paintings to the first petroglyphs, which are dated to around 10,000BC. It is possible that the humans of that time used some other forms of communication, often for mnemonic purposes – specially arranged stones, symbols carved in wood or earth, quipu-like ropes, tattoos, but little other than the most durable carved stones has survived to modern times and we can only speculate about their existence based on our observation of still existing ‘hunter-gatherer’ cultures such as those of Africa or Oceania. Pictograms A pictogram (pictograph) is a symbol representing a concept, object, activity, place or event by illustration. Pictography is a form of proto-writing whereby ideas are transmitted through drawing. Pictographs were the next step in the evolution of communication: the most important difference between petroglyphs and pictograms is that petroglyphs are simply showing an event, but pictograms are telling a story about the event, thus they can for example be ordered in chronological order. Pictograms were used by various ancient cultures all over the world since around 9000 BC, when tokens marked with simple pictures began to be used to label basic farm produce, and become increasingly popular around 6000-5000 BC. They were the basis of cuneiform and hieroglyphs, and began to develop into logographic writing systems around 5000 BC. Ideograms Pictograms, in turn, evolved into ideograms, graphical symbols that represent an idea. Their ancestors, the pictograms, could represent only something resembling their form: therefore a pictogram of a circle could represent a sun, but not concepts like ‘heat’, ‘light’, ‘day’ or ‘Great God of the Sun’. Ideograms, on the other hand, could convey more abstract concepts, so that for example an ideogram of two sticks can mean not only ‘legs’ but also a verb ‘to walk’. Because some ideas are universal, many different cultures developed similar ideograms. For example an eye with a tear means ‘sadness’ in Native Americanideograms in California, as it does for the Aztecs, the early Chinese and the Egyptians. Ideograms were precursors of logographic writing systems such as Egyptian hieroglyphs and Chinese characters. Examples of ideographical proto-writing systems, thought not to contain language-specific information, include the Vinca script (see also TÄÆ'rtÄÆ'ria tablets) and the early Indus script. In both cases there are claims of decipherment of linguistic content, without wide acceptance.

Intention to create legal relations - Free Essay Example

Sample details Pages: 9 Words: 2650 Downloads: 5 Date added: 2017/06/26 Category Law Essay Type Analytical essay Did you like this example? 1.The concept of intention to create legal relations is used by the courts as a device to enable them to deny enforceability to those agreements which they consider should not be legally enforced (Jill Poole, Contract Law). Discuss. 1500 words In order for a legally binding contract to come into existence, there are certain requirements which must be met. Don’t waste time! Our writers will create an original "Intention to create legal relations" essay for you Create order Briefly, these requirements include a clear offer and acceptance, consideration moving from the promisee, and an intention on the part of the contracting parties to create legal relations. Why has this concept been included in the prerequisites of a contract? Poole states that it is in order for the courts to deny enforceability to contracts which they do not consider should be legally enforced. How effective is the imposition of this doctrine is policing the suitability of contracts? What is the basis of the doctrine? The basic doctrine, then, is that in order for a valid and binding contract to exist, the parties to the contract must have had an intention to create legal relations. In the vast majority of commercial transactions, this is relatively straightforward, and rarely gives rise to any controversy. It is presumed, in law, that parties to any commercial transaction intend, from the outset, to be legally bound by their agreement. This legal binding offers them security and the possibility of redress if the other party fails to perform their part of the contract. It is in the context of domestic and social agreements that the doctrine plays its most significant role. In this context, the courts make a presumption in the opposite direction; namely that the parties do not intend to be bound by their agreement. This is based on the policy that the courts should, as a rule, stay out of regulating domestic and social agreements. There are, then, two presumptions used by the courts in the context of the doctrine of intention to create legal relations, both of which are, however, rebuttable. The earliest case in which the doctrine was expounded was that of Balfour v Balfour. The fact that the doctrine first appeared as late as 1919 shows that it was a very late development in the law of contract. Briefly, the case involved a husband and wife, who went abroad to live. When the plaintiff wife decided to stay in England rather than return abroad with her hus band, she alleged they made an oral agreement for him to pay her some money each month. The first instance judge said the defendant owed it to his wife to look after her, while the Court of Appeal held that he was not liable to make the payments to his wife. In the context of Pooleà ¢Ã¢â€š ¬Ã¢â€ž ¢s statement, then, the Court of Appeal used the doctrine of intention to create legal relations to enable them to deny enforceability to an agreement which they felt should not be enforced. Domestic affairs, it was thought, should be dealt with privately, or else there would be a à ¢Ã¢â€š ¬Ã‹Å"flood of litigationà ¢Ã¢â€š ¬Ã¢â€ž ¢. Atkins LJà ¢Ã¢â€š ¬Ã¢â€ž ¢s judgement in this case clearly recognises the doctrine of intention to create legal relations. What is the basis for this presumption? According to McKendrick, Atkins LJà ¢Ã¢â€š ¬Ã¢â€ž ¢s judgement suggests that the initial presumption is derived from the law (or public policy) rather than the intention of the parties.[1] In th is particular case, Atkins LJ put forward the floodgates argument; that if they afforded binding status to this type of arrangement, the lower courts would be overwhelmed with similar cases. The presumption that domestic agreements are not intended to be binding was first established, then, in Balfour v Balfour in 1919. The later case of Merritt v Merritt, however, added a new aspect to this doctrine. The presumption in domestic agreements can be rebutted (that is, it can be found that there was an intention to create legal relations) where the parties have separated, or are about to separate, at the time of the arrangement. The Court of Appeal found the plaintiff wife was able to enforce her defendant husbandà ¢Ã¢â€š ¬Ã¢â€ž ¢s promise, as they were not happily married at the time of the agreement. Again, this shows the courtsà ¢Ã¢â€š ¬Ã¢â€ž ¢ willingness to use the doctrine of intention to create legal relations to deny or affirm enforceability to those agreements which they c onsider worthy. Here they were keen to afford a measure of protection to the plaintiff wife, and the presumption was therefore said to have been rebutted for this purpose. This same motivation was evident in the subsequent case of Tanner v Tanner. This case established that where a party gives up their legal rights in reliance upon a domestic arrangement, that arrangement is legally binding. Again this shows the courtsà ¢Ã¢â€š ¬Ã¢â€ž ¢ willingness to afford the protection of contractual certainty in some domestic arrangements. A similar presumption to the one established in Balfour v Balfour was evident in the case of Jones v Padavatton. Here it was established that in family arrangements, there is a presumption that the parties do not intend to create legal relations. Briefly, the plaintiff offered her daughter (the defendant) an allowance if the daughter gave up her job in the USA and studied for the Bar in London. The mother subsequently bought her daughter a house to rent ou t to provide an income for the daughter. Three years later the mother claimed possession as the daughter had still not passed her Bar exams. The Court of Appeal held that as the parties were close when the arrangement was made, and because the arrangement was vague and uncertain, there was no intention to be bound. This case would seem rather to contradict Pooleà ¢Ã¢â€š ¬Ã¢â€ž ¢s statement, as following Tanner v Tanner, one might have expected the courts to afford some degree of protection to the plaintiff mother who was seeking to rely on the agreement being contractually binding. The case shows that the courts will not simply use the doctrine to arrive at a just solution at the expense of other relevant doctrines. The presumption established in Jones v Padavatton can also, however, be rebutted. According to Simpkins v Pays, an arrangement between members of the same household can rebut the presumption. The case involved a domestic arrangement between three ladies (two of whom were related) who lived in the same house to pool their entries into a newspaper fashion competition and to share any prize money. The entry was sent in the defendantà ¢Ã¢â€š ¬Ã¢â€ž ¢s name. It was held that the plaintiff could recover a third of the prize money from the defendant, and that there had been an intention to be legally bound. In commercial agreements, the opposite presumption applies. This is because of the need for certainty in commercial transactions. Parties to any commercial agreement, then, intend to be legally bound, whether it is a corporate contract, or simply a contract to purchase goods in a shop. Although it is more difficult than in the domestic context, it is not impossible to rebut this presumption. The case of Rose and Frank Co v JR Crompton established that the presumption can be rebutted by the inclusion of an à ¢Ã¢â€š ¬Ã‹Å"honourà ¢Ã¢â€š ¬Ã¢â€ž ¢ clause in the contract. In this case, a contract clause provided à ¢Ã¢â€š ¬Ã…“This arrangement is not entered into, nor is this memorandum written, as a formal or legal agreement, and shall not be subject to legal jurisdiction in the law courts.à ¢Ã¢â€š ¬Ã‚  Where the presumption is sought to be rebutted in the commercial context, the onus of doing so rests with the party claiming it does not apply (Edwards v Skyways Ltd). If there is any doubt as to whether the presumption should apply, following Esso Petroleum Ltd v Commissioners of Customs and Excise, the court should use an objective test to decide the issue. Finally, in deciding whether the presumption has been rebutted, the courts should look at the totality of the evidence (J Evans, etc v Andrea Merzario Ltd). The courts, then, throughout the last century, have developed the doctrine of intention to create legal relations in order to differentiate between arrangements which they consider should be enforced, and those which should not. This has been done by establishing various presumptions which will apply, depend ing on whether the agreement is a domestic, social, or commercial one, unless they can be rebutted. __________________________________________ 2. Problem question There are a number of contractual issues arising in this scenario. Firstly, what is included in the contract which Jack makes with the travel agent? The initial advert promises à ¢Ã¢â€š ¬Ã‹Å"great deals on your weekend breaks or your money backà ¢Ã¢â€š ¬Ã¢â€ž ¢. If this is found to be a term incorporated into the contract, Jack and Vera will have redress at the end of their disappointing holiday. Following the case of Bannerman v White, a statement which is merely an incident in preliminary negotiations is not a term of the contract. It must be understood and intended by both parties to be a term of the contract. It seems that the offer of a money back guarantee would be intended to be a term by Great Escapes. The advert, however, would probably not be considered the offer in the contract. Following Partridge v Crittenden, an advertisement is usually considered an invitation to treat as opposed to an offer. This is because it is clear that in an advert, the advertiser does not intend to be bound. The situation might have been different had Jack noticed the advert displayed prominently in a window (of the tour operatorà ¢Ã¢â€š ¬Ã¢â€ž ¢s office). In this situation, following Bowerman v Association of British Travel Agents Ltd, such an advertisement would have been considered an offer to the world. This is significant as it determines what was involved in the contract. If the contract was formed at a later time than Jack à ¢Ã¢â€š ¬Ã‹Å"acceptingà ¢Ã¢â€š ¬Ã¢â€ž ¢ the offer in the newspaper, the money back statement would more likely be considered a representation than a term of the contract. It seems likely in this scenario that the offer was made, not by the tour operators in their advert, but by Jack when he telephoned the travel agent. The upshot of this is that he will not be able to rely on the money back guarantee as a term of the contract, but he may be able to bring a misrepresentation claim if the tour operator refuses to pay back their money. Jillà ¢Ã¢â€š ¬Ã¢â€ž ¢s statement that the Raffles Hotel is an à ¢Ã¢â€š ¬Ã‹Å"exclusive hotel that meets all of his requirementsà ¢Ã¢â€š ¬Ã¢â€ž ¢ is made over the telephone. It is important to establish at what exact point in the call Jill made her statement. It is significant as it could give Jack another possible cause of action for misrepresentation. It is unclear from the scenario whether Jack relied on Jillà ¢Ã¢â€š ¬Ã¢â€ž ¢s statement during negotiations to enter into the contract. If the contract was made and Jill subsequently made the statement, Jack will have no redress on this count (the representee must have relied on the statement following JEB Fasteners Ltd v Marks Bloom Co). Even if the statement was made prior to concluding the agreement, Jack may have some trouble relying on it. According to Edgin gton v Fitzmaurice, an actionable misrepresentation is a false statement of an existing fact. In this instance, there may be some doubt that Jillà ¢Ã¢â€š ¬Ã¢â€ž ¢s statement was of an existing fact as opposed to an opinion. Following Bissett v Wilkinson, a statement of opinion will not usually be considered a statement of fact. A statement made in this situation, however, must be full and frank, not partial and misleading (Curtis v Chemical Cleaning Dyeing Co). There is no doubt that Jillà ¢Ã¢â€š ¬Ã¢â€ž ¢s statement is misleading as to the facilities and standard of the Raffles Hotel. On the back of Jackà ¢Ã¢â€š ¬Ã¢â€ž ¢s receipt, there is a disclaimer by Great Escapes to the effect that à ¢Ã¢â€š ¬Ã‹Å"we cannot be held liable for any disappointment caused by lack of amenities in any of our partner hotelsà ¢Ã¢â€š ¬Ã¢â€ž ¢. It is possible that Great Escapes could rely on this clause to escape liability for the lack of an ensuite bathroom and poor views. It seems that Jack wou ld probably be able to defeat this defence, however. Following Parker v South Eastern Railway, an exclusion clause of this sort will be incorporated by giving reasonable notice that the document contained writing. Whether reasonable notice has been given will be a question of fact which is determined objectively. In Thompson v LM S Rly Co, it was held that the defendant had taken reasonable steps to bring the conditions to the publicà ¢Ã¢â€š ¬Ã¢â€ž ¢s notice. In this scenario, it will have to be determined objectively whether a condition which is displayed on the back of the receipt constituted reasonable notice. Even if it does, however, the disclaimer will probably not be considered a condition of the contract, as it was not brought to Jackà ¢Ã¢â€š ¬Ã¢â€ž ¢s attention prior to concluding the contract. Following Olley v Marlborough Court, the clause must be brought to the other partyà ¢Ã¢â€š ¬Ã¢â€ž ¢s attention before or at the time of contracting. Jack will probably be able to disregard this disclaimer as not being part of the contract. The fact that Jack contracts food poisoning, probably from the sea food platter in the hotel restaurant, has little bearing on the contract. It is possible they would have a claim for negligence on the part of the hotel chefs, but it would be difficult to prove. If they were successful in this, however, Jack and Vera would also be able to claim damages in the amount of the value of the tickets for the show they had to miss (300 Euros). With regard to the green algae in the hotel pool, it is again possible that Jack and Vera may have a claim in negligence against the hotel rather than the tour operators. The hotel owe a duty of care to their guests, and it would seem they have breached this duty by allowing the pool to become unclean. Again, however, this is a tort rather than a contract issue. Veraà ¢Ã¢â€š ¬Ã¢â€ž ¢s specific ailment resulting from her swim would probably not give the hapless couple a cause of actio n, as the hotel would probably be able to escape liability by relying upon the disclaimer notice displayed prominently above the pool. This notice states that à ¢Ã¢â€š ¬Ã‹Å"Residents swim at their own riskà ¢Ã¢â€š ¬Ã¢â€ž ¢. Again, whether this notice amounted to sufficient notice to escape liability would be an objective test. Such factors as the exact position of the notice (we are told only that it appears on the back wall), the size of the print, and whether it was obscured by anything would all need to be considered. It is likely that a higher degree of notice will be required than usual in this instance, as the term is, perhaps, more unexpected than usual. Following Thornton v Shoe Lane Parking Ltd, if a term is unusual or unexpected (as this particular one might be regarded), the degree of notice is correspondingly higher. There are, then, a number of possible causes of action available to Jack and Vera upon their return from this disappointing holiday. BIBLIOGAPHY Cases Balfour v Balfour [1919] 2 KB 571, CA Bannerman v White (1861) 4 LT 740 Bissett v Wilkinson [1926] All ER 343 Bowerman v Association of British Travel Agents Ltd (The Times, November 24, 1995) Curtis v Chemical Cleaning Dyeing Co [1951] 1 All ER 631 Edwards v Skyways Ltd [1964] 1 WLR 349 Edgington v Fitzmaurice [1881 1885] All ER Rep 59 Esso Petroleum Ltd v Commissioners of Customs and Excise [1976] 1 WLR 1 JEB Fasteners Ltd v Marks Bloom Co [1983] 1 All ER 583 J Evans, etc v Andrea Merzario Ltd [1976] 1 WLR 1078 Jones v Padavatton [1969] 1 WLR 328 Merritt v Merritt [1970] 1 WLR 1211 Olley v Marlborough Court [1949] 1 All ER 127 Parker v South Eastern Railway (1877) 2 CPD 416 Partirdge v Crittenden [1968] 1 WLR 1204 Rose and Frank Co v JR Compton [1925] 2 AC 445 Simpkins v Pays [1955] 1 WLR 975 Tanner v Tanner [1975] 1 WLR 1346 Thompson v LM S Rly Co [1929] All ER 474 Thornton v Shoe Lane Parking Ltd [1971] 2 WLR 585 Secondary sources McKendrick, E., Contract Law (Oxford, 2003) Footnotes [1] McKendrick, E., Contract Law (Oxford, 2003), p296