NR 562: LEADERSHIP AND MANAGEMENT WITHIN COMPLEX HEALTHCARE SYSTEMS
Module 6 Assignment:
Data-driven Decision-making
in Complex Systems
Guideline and Rubric
DUE 02/19/2023
PURPOSE
Across healthcare settings, a vast amount of information is collected and analyzed to assess organizational
outcomes regarding quality, safety, and efficiency. The analysis of this data is used to measure
organizational performance and to drive strategic decision-making within the system. The purpose of this
assignment is to examine one specific data point and how it contributes to the assessment of quality, safety,
and/or efficiency within the healthcare system. The importance of the selected data point, how it shapes
decision-making, and implications for healthcare systems will be discussed.
COURSE LEARNING OUTCOMES
Through this assignment, the student will address the following course learning outcomes:
•
•
CO 3: Determine strategies to support efficiency and the responsible use of healthcare resources.
(PO 2)
CO 4: Develop problem-solution strategies for a selected issues within the healthcare environment.
(PO 5)
SUGGESTED DUE DATE
This assignment has a suggested due date of Sunday 11:59 pm MT at the end of Module 6.
Final due date is Sunday 11:59 pm MT at the end of Module 7.
TOTAL POINTS POSSIBLE: 200 POINTS
ASSIGNMENT OVERVIEW
Consider how data analysis contributes to safe, high quality, efficient delivery of healthcare. Investigate the
role of information management in the evaluation of outcome achievement and provision of data to drive
strategic decision-making. Identify one specific data point for which information is collected within a
healthcare system. Develop a 4 – 6 page paper to address the rubric expectations; use a minimum of 5
scholarly sources to support your work.
1. Provide an introduction to the paper.
2. Explain one selected data point and the purpose for the collection of this data within the healthcare
system. Describe how this data point measures quality, safety, and/or efficiency within the system.
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NR 562: LEADERSHIP AND MANAGEMENT WITHIN COMPLEX HEALTHCARE SYSTEMS
Discuss one internal or external benchmark surrounding this data point that serves as a measure or
indicator of success.
3. Describe a case scenario where outcomes regarding this data point fall short of meeting the required
benchmark. Identify the stakeholders impacted by the poor outcome, and the consequences
realized by each stakeholder. Discuss the potential impact on organizational quality, safety, and/or
efficiency that results.
4. Describe how outcomes surrounding this data point reflect organizational performance regarding
quality, safety, or efficiency. Explain how the data in the case scenario can inform strategic decisionmaking to improve organizational outcomes. Create an action plan to correct the poor outcomes
noted in the case scenario. Explain the action steps, stakeholder involvement, influencing factors
that will impact the plan.
5. Provide a conclusion to the paper.
ASSIGNMENT INSTRUCTIONS
1. Abide by the Chamberlain College of Nursing Academic Integrity Policy.
2. Sources older than five years may not be used without the permission of the class professor.
3. Title page, pagination, subheadings, body of paper, citation of sources, and reference page must
follow APA guidelines as found in the current edition of the manual.
4. Rules of grammar, spelling, word usage, punctuation, sentence and paragraph structure are
followed and consistent with formal, scholarly writing as noted in the APA Manual (current edition).
5. Sources older than five years may not be used without the permission of the class professor.
6. No direct quotes are to be used in this assignment.
7. Please note: If you do not receive a proficient rating in any major content category, you can resubmit your assignment with revisions in those content categories to receive a better grade. You
have one additional opportunity to revise after the initial submission in order to make
improvements. The initial submission must be a complete paper, rough drafts will not be graded. All
revisions must be submitted no later than Sunday of Week 7 at 11:59pm. (You cannot revise your
graduate level writing style for a higher grade in that category)
ASSIGNMENT CRITERIA
Assessment Criteria
Introduction
Points
20
%
10%
Description
This section includes:
•
•
•
•
NR 562 3/20/19
Importance of information management to
determine outcomes healthcare systems
Role of data to inform decision-making to
promote quality, safety, and efficiency
Identification of the sections of the paper
Sufficient integration of scholarly sources to
support information presented
NR 562: LEADERSHIP AND MANAGEMENT WITHIN COMPLEX HEALTHCARE SYSTEMS
Data Collection to
Measure Outcomes
40
20%
This section includes:
•
•
•
•
Case Application
40
20%
This section includes
•
•
•
Data-driven
Decision-making
50
25%
•
•
•
20
10%
Explanation of how data in the case scenario
can be used to inform strategic decisionmaking to improve outcomes regarding
quality, safety, or efficiency
Create an action plan to correct the poor
outcomes noted in the case scenario
Explain the action steps, stakeholder
involvement, and influencing factors that will
impact the plan
Sufficient integration of scholarly sources to
support information presented
This section includes:
•
NR 562 3/20/19
Description of a case scenario where
outcomes regarding this data point fall short
of meeting the identified benchmark
Discussion of the potential impact on
organizational quality, safety, and/or
efficiency that results
Identification of stakeholders impacted by the
poor outcome and the consequences realized
by each stakeholder
This section includes:
•
Conclusion
Description of one identified data point and
purpose for collection within the healthcare
system
Explanation of how outcomes surrounding
this data point contribute to assessment of
organizational performance regarding quality,
safety, and/or efficiency
Description of one example of an internal or
external benchmark regarding this data point
to serve as an indicator of success
Sufficient integration of scholarly sources to
support information presented
Concluding points regarding the role of
information management and outcome
NR 562: LEADERSHIP AND MANAGEMENT WITHIN COMPLEX HEALTHCARE SYSTEMS
•
Graduate-level
Writing Style
30
15%
•
•
•
•
•
Quality of
Literature Support
assessment to inform decision-making
within healthcare systems
Importance of outcome assessment to
sustain or improve quality, safety, and/or
efficiency within healthcare systems
Correct use of spelling, grammar, punctuation,
sentence and paragraph structure
Clarity, organization, and logical flow of ideas
within writing
Scholarly, professional writing tone with no use of
first person
Synthesis of information is present with no direct
quotes used in this assignment
Correct APA format for the following:
o Page numbering
o Font style and size
o Margins and spacing
o Headings; subheadings
o Citation and referencing sources
o Mechanics of style (abbreviations,
capitalization, italics, numbers)
It is an expectation that a minimum of 5 scholarly sources, current within five
years, are integrated within the assignment.
If the above expectation is not met, 5 points shall be deducted.
Assignment Length
Criteria
It is an expectation that the paper is a minimum of 4 pages in length, and a
maximum of 6 pages (not including the title or reference pages).
If the above expectation is not met, 5 points shall be deducted.
Total
NR 562 3/20/19
200
100%
A quality assignment will meet or exceed the above
requirements.
NR 562: LEADERSHIP AND
MANAGEMENT WITHIN COMPLEX
HEALTHCARE SYSTEMS
GRADING RUBRIC
Assessment
Criteria
Introduction
Distinguished
Exceeds
Proficient
Needs Improvement
(100%)
(92%)
(84%)
(0)
20 Points
18 Points
16 Points
0 Points
Proficient presentation of
information evidenced by
content covered in a limited
or superficial manner in two
or more of the content areas:
Presentation of information
needs improvement as
evidenced by content that is
missing or unsatisfactory in one
or more of the content areas:
Distinguished presentation of
information evidenced by all of
the following content areas
covered in a comprehensive
and concise manner:
•
•
•
•
Importance of
information
management to
determine outcomes
healthcare systems
Role of data to inform
decision-making to
promote quality,
safety, and efficiency
Identification of the
sections of the paper
Sufficient integration
of scholarly sources to
support information
presented
Presentation of
information exceeds
expectations evidenced
by most content covered
in a comprehensive and
concise manner, but with
one area where coverage
is superficial:
•
•
•
•
Importance of
information
management to
determine outcomes
healthcare systems
Role of data to inform
decision-making to
promote quality,
safety, and efficiency
Identification of the
sections of the paper
Sufficient integration
of scholarly sources to
•
•
•
•
Importance of
information
management to
determine outcomes
healthcare systems
Role of data to
inform decisionmaking to promote
quality, safety, and
efficiency
Identification of the
sections of the paper
Sufficient integration
of scholarly sources
to support
•
•
•
•
Importance of
information
management to
determine outcomes
healthcare systems
Role of data to inform
decision-making to
promote quality,
safety, and efficiency
Identification of the
sections of the paper
Sufficient integration
of scholarly sources to
support information
presented
5
NR 562: LEADERSHIP AND
MANAGEMENT WITHIN COMPLEX
HEALTHCARE SYSTEMS
support information
presented
Data
Collection to
Measure
Outcomes
40 Points
Distinguished presentation of
information evidenced by all of
the following content areas
covered in a comprehensive
and concise manner:
•
•
•
Description of one
identified data point
and purpose for
collection within the
healthcare system
Explanation of how
outcomes surrounding
this data point
contribute to
assessment of
organizational
performance regarding
quality, safety, and/or
efficiency
Description of one
example of an internal
or external benchmark
regarding this data
point to serve as an
indicator of success
information
presented
36 Points
Presentation of
information exceeds
expectations evidenced
by most content covered
in a comprehensive and
concise manner, but with
one area where coverage
is superficial:
•
•
•
Description of one
identified data point
and purpose for
collection within the
healthcare system
Explanation of how
outcomes surrounding
this data point
contribute to
assessment of
organizational
performance regarding
quality, safety, and/or
efficiency
Description of one
example of an internal
or external benchmark
regarding this data point
33 Points
0 Points
Proficient presentation of
information evidenced by
content covered in a limited
or superficial manner in two
or more of the content areas:
Presentation of information
needs improvement as
evidenced by content that is
missing or unsatisfactory in one
or more of the content areas:
•
•
•
Description of one
identified data point
and purpose for
collection within the
healthcare system
Explanation of how
outcomes surrounding
this data point
contribute to
assessment of
organizational
performance
regarding quality,
safety, and/or
efficiency
Description of one
example of an internal
or external benchmark
regarding this data
point to serve as an
indicator of success
•
•
•
Description of one
identified data point
and purpose for
collection within the
healthcare system
Explanation of how
outcomes surrounding
this data point
contribute to
assessment of
organizational
performance regarding
quality, safety, and/or
efficiency
Description of one
example of an internal
or external benchmark
regarding this data point
to serve as an indicator
of success
6
NR 562: LEADERSHIP AND
MANAGEMENT WITHIN COMPLEX
HEALTHCARE SYSTEMS
•
Case
Application
Sufficient integration of
scholarly sources to
support information
presented
•
40 Points
Distinguished presentation of
information evidenced by all of
the following content areas
covered in a comprehensive
and concise manner:
•
•
•
Description of a case
scenario where
outcomes regarding
this data point fall short
of meeting the
identified benchmark
Discussion of the
potential impact on
organizational quality,
safety, and/or
efficiency that results
Identification of
stakeholders impacted
by the poor outcome
and the consequences
realized by each
stakeholder
to serve as an indicator
of success
Sufficient integration of
scholarly sources to
support information
presented
•
36 Points
Presentation of
information exceeds
expectations evidenced
by most content covered
in a comprehensive and
concise manner, but with
one area where coverage
is superficial:
•
•
•
Description of a case
scenario where
outcomes regarding this
data point fall short of
meeting the identified
benchmark
Discussion of the
potential impact on
organizational quality,
safety, and/or efficiency
that results
Identification of
stakeholders impacted
by the poor outcome
Sufficient integration
of scholarly sources to
support information
presented
•
Sufficient integration of
scholarly sources to
support information
presented
33 Points
0 Points
Proficient presentation of
information evidenced by
content covered in a limited
or superficial manner in two
or more of the content areas:
Presentation of information
needs improvement as
evidenced by content that is
missing or unsatisfactory in one
or more of the content areas:
•
•
•
Description of a case
scenario where
outcomes regarding
this data point fall
short of meeting the
identified benchmark
Discussion of the
potential impact on
organizational quality,
safety, and/or
efficiency that results
Identification of
stakeholders impacted
by the poor outcome
and the consequences
realized by each
stakeholder
•
•
•
Description of a case
scenario where
outcomes regarding this
data point fall short of
meeting the identified
benchmark
Discussion of the
potential impact on
organizational quality,
safety, and/or efficiency
that results
Identification of
stakeholders impacted
by the poor outcome
and the consequences
realized by each
stakeholder
7
NR 562: LEADERSHIP AND
MANAGEMENT WITHIN COMPLEX
HEALTHCARE SYSTEMS
and the consequences
realized by each
stakeholder
Data-driven
Decisionmaking
50 Points
Distinguished presentation of
information evidenced by all of
the following content areas
covered in a comprehensive
and concise manner:
•
•
•
•
Explanation of how
data in the case
scenario can be used to
inform strategic
decision-making to
improve outcomes
regarding quality,
safety, or efficiency
Create an action plan to
correct the poor
outcomes noted in the
case scenario
Explain the action
steps, stakeholder
involvement, and
influencing factors that
will impact the plan
Sufficient integration
of scholarly sources to
46 Points
Presentation of
information exceeds
expectations evidenced
by most content covered
in a comprehensive and
concise manner, but with
one area where coverage
is superficial:
•
•
•
Explanation of how data
in the case scenario can
be used to inform
strategic decisionmaking to improve
outcomes regarding
quality, safety, or
efficiency
Create an action plan to
correct the poor
outcomes noted in the
case scenario
Explain the action steps,
stakeholder
involvement, and
influencing factors that
will impact the plan
42 Points
0 Points
Proficient presentation of
information evidenced by
content covered in a limited
or superficial manner in two
or more of the content areas:
Presentation of information
needs improvement as
evidenced by content that is
missing or unsatisfactory in one
or more of the content areas:
•
•
•
•
Explanation of how
data in the case
scenario can be used
to inform strategic
decision-making to
improve outcomes
regarding quality,
safety, or efficiency
Create an action plan
to correct the poor
outcomes noted in the
case scenario
Explain the action
steps, stakeholder
involvement, and
influencing factors
that will impact the
plan
Sufficient integration
of scholarly sources
•
•
•
•
Explanation of how data
in the case scenario can
be used to inform
strategic decisionmaking to improve
outcomes regarding
quality, safety, or
efficiency
Create an action plan to
correct the poor
outcomes noted in the
case scenario
Explain the action steps,
stakeholder
involvement, and
influencing factors that
will impact the plan
Sufficient integration
of scholarly sources to
8
NR 562: LEADERSHIP AND
MANAGEMENT WITHIN COMPLEX
HEALTHCARE SYSTEMS
support information
presented
Conclusion
•
20 Points
Distinguished presentation of
information evidenced by all of
the following content areas
covered in a comprehensive
and concise manner:
•
•
Concluding points
regarding the role of
information
management and
outcome assessment
to inform decisionmaking within
healthcare systems
Importance of
outcome assessment
to sustain or improve
quality, safety,
and/or efficiency
within healthcare
systems
to support
information
presented
Sufficient integration
of scholarly sources to
support information
presented
18 Points
Presentation of
information exceeds
expectations evidenced
by most content covered
in a comprehensive and
concise manner, but with
one area where coverage
is superficial:
•
•
Concluding points
regarding the role of
information
management and
outcome assessment
to inform decisionmaking within
healthcare systems
Importance of
outcome assessment
to sustain or improve
quality, safety, and/or
efficiency within
healthcare systems
support information
presented
16 Points
0 Points
Proficient presentation of
information evidenced by
content covered in a limited
or superficial manner in two
or more of the content areas:
Presentation of information
needs improvement as
evidenced by content that is
missing or unsatisfactory in one
or more of the content areas:
•
•
Concluding points
regarding the role
of information
management and
outcome
assessment to
inform decisionmaking within
healthcare systems
Importance of
outcome
assessment to
sustain or improve
quality, safety,
and/or efficiency
within healthcare
systems
•
•
Concluding points
regarding the role of
information
management and
outcome assessment
to inform decisionmaking within
healthcare systems
Importance of
outcome assessment
to sustain or improve
quality, safety, and/or
efficiency within
healthcare systems
9
NR 562: LEADERSHIP AND
MANAGEMENT WITHIN COMPLEX
HEALTHCARE SYSTEMS
Graduatelevel Writing
Style
30 Points
27 Points
25 Points
0 Points
Distinguished graduate-level
writing style is evidenced by
meeting all of the following
criteria with 0-1 errors total:
• Correct use of spelling,
grammar, punctuation,
sentence and paragraph
structure
• Clarity, organization, and
logical flow of ideas within
writing
• Scholarly, professional
writing tone with no use of
first person
• Synthesis of information is
present with no direct
quotes used in this
assignment
• Correct APA format for the
following:
o Page numbering
o Font style and size
o Margins and spacing
o Headings; subheadings
o Citation and referencing
sources
o Mechanics of style
(abbreviations,
Graduate-level writing style
exceeds expectations as
evidenced by meeting the
following criteria with 2-4
errors total:
• Correct use of spelling,
grammar, punctuation,
sentence and paragraph
structure
• Clarity, organization, and
logical flow of ideas within
writing
• Scholarly, professional
writing tone with no use of
first person
• Synthesis of information is
present with no direct
quotes used in this
assignment
• Correct APA format for the
following:
o Page numbering
o Font style and size
o Margins and spacing
o Headings; subheadings
o Citation and referencing
sources
o Mechanics of style
(abbreviations,
Proficient graduate-level
writing style is evidenced by
meeting the following
criteria with 5-7 errors,
total:
• Correct use of spelling,
grammar, punctuation,
sentence and paragraph
structure
• Clarity, organization, and
logical flow of ideas within
writing
• Scholarly, professional
writing tone with no use of
first person
• Synthesis of information is
present with no direct
quotes used in this
assignment
• Correct APA format for the
following:
o Page numbering
o Font style and size
o Margins and spacing
o Headings; subheadings
o Citation and
referencing sources
o Mechanics of style
(abbreviations,
Graduate-level writing style
needs improvement as
evidenced by meeting the
following criteria with 8 or
more errors, total:
• Correct use of spelling,
grammar, punctuation,
sentence and paragraph
structure
• Clarity, organization, and
logical flow of ideas within
writing
• Scholarly, professional
writing tone with no use of
first person
• Synthesis of information is
present with no direct
quotes used in this
assignment
• Correct APA format for the
following:
o Page numbering
o Font style and size
o Margins and spacing
o Headings; subheadings
o Citation and referencing
sources
o Mechanics of style
(abbreviations,
10
NR 562: LEADERSHIP AND
MANAGEMENT WITHIN COMPLEX
HEALTHCARE SYSTEMS
capitalization, italics,
numbers)
Quality of
Literature
Support
Assignment
Length
Expectations
0 Points Deducted
A minimum of 5 peerreviewed scholarly sources,
current within 5 years,
are integrated within the
assignment.
0 Points Deducted
The length of the assignment
meets the criteria:
capitalization, italics,
numbers)
capitalization, italics,
numbers)
capitalization, italics,
numbers)
5 Points Deducted
The assignment fails to meet
the requirement noted for
quality of literature support.
5 Points Deducted
The assignment fails to meet
the requirement for length.
Minimum of 4 pages in length;
Maximum of 6 pages in length.
(Not including title or reference
pages)
11
NR562 Reflection 2
Due 02/19/2023
Based on your response to Reflection: Part 1, state one insight that you gained regarding
the concepts in this module. Connect learning achieved to a minimum of one course
outcome addressed during this module.
Course Outcomes
CO 3: Determine strategies to support efficiency and the responsible use of
healthcare resources within a caring environment. (PO 2)
• CO 4: Develop problem-solution strategies for a selected issues within the
healthcare environment. (PO 5)
•
Module Objectives
Analyze the impact of information systems on the delivery of efficient, safe, highquality healthcare. (CO 3)
• Discuss strategies to promote health-related and organizational outcomes
through the application of information management systems. (COs 3 and 4)
•
This is what I put in part 1:
In this module, I hope to learn/do:
Be able to determine strategies to support efficiency and the responsible use of
healthcare resources within a caring environment.
• Be able to develop problem-solution strategies for a selected issues within the
healthcare environment.
•
Module Reflective Discussion Guidelines and Rubric
PURPOSE
The purpose of this reflective discussion is to encourage student reflection upon concepts learned
during the module and their contribution to professional growth. Students will reflect upon learning
within each module and connect insights gained with course-specific outcomes.
DUE DATE
•
•
Reflection 1 is due by 11:59 p.m. MT Wednesday during Modules 1–8 of the session.
Reflection 2 is due by 11:59 p.m. MT Sunday at the end of Modules 1–7 of the session
and due 11:59 p.m. MT Saturday at the end of Module 8 of the session.
TOTAL POINTS POSSIBLE: 15 POINTS
REFLECTION OVERVIEW
This course includes eight weekly modules of content. During each of the eight modules within this
course session, please respond to the following reflective questions, beginning with Module 1 (the first
week of the session) and continuing in consecutive order throughout the eight modules of the course
session.
For each module, consider the course concepts and topics addressed during the respective module,
and respond to the following questions.
Reflection 1: Review the course outcomes and consider the module objectives. What do you
hope to learn during this module of study?
Reflection 2: Based on your response to Reflection 1, state one insight that you gained regarding
the concepts in this module. Connect learning achieved to a minimum of one course outcome
addressed during this module.
REFLECTION INSTRUCTIONS
1. Abide by the Chamberlain College of Nursing Academic Integrity Policy.
2. Read the two reflective questions and respond within the following timeframes noted above.
MSN-AT Reflection Guidelines and Rubric_January 2019
1
3. Follow the rules of grammar, spelling, word usage, punctuation, and sentence and paragraph
structures.
4. The use of first person tense is acceptable in the reflective discussions.
REFLECTION CRITERIA
Category
Points
%
Description
Reflection 1
6
40%
Reflective posting is submitted and describes what the student
hopes to learn during this module.
Reflection 2
6
40%
Reflective posting is submitted and
• describes one insight gained regarding the concepts in
this module; and
• connects learning achieved to a minimum of one course
outcome addressed in this module.
Timeliness of
Postings
3
20%
During Modules 1–8: Posting in response to Reflection 1 is made
before Wednesday 11:59 p.m. MT.
AND
During Modules 1–7: Posting in response to Reflection 2 is made
between Thursday 12:00 a.m. MT and Sunday 11:59 p.m. MT.
OR
During Module 8: Posting in response to Reflection 2 is made
between Thursday 12:00 a.m. MT and Saturday 11:59 p.m. MT.
Graduatelevel Writing
Style
It is an expectation that graduate-level writing style is used, evidenced by correct:
• Grammar
• Spelling
• Word usage
• Punctuation
• Sentence structure
• Paragraph structure
If the above expectation is not met, 3 points shall be deducted.
Total
15
100%
A quality reflective discussion will meet or exceed all the above
requirements.
MSN-AT Reflection Guidelines and Rubric_January 2019
2
GRADING RUBRIC
Reflection
Criteria
Met
Not Met
Reflection 1
6 Points
0 Points
Reflective posting is submitted and describes
what the student hopes to learn during this
module.
Reflective posting is submitted but fails to clearly
describe what the student hopes to learn during
this module.
OR
No posting is submitted in response to Reflection
1.
Reflection 2
6 Points
0 Points
Reflective posting is submitted and
• describes one insight gained regarding
the concepts in this module; and
• connects learning achieved to a
minimum of one course outcome
addressed in this module.
Reflective posting is submitted but fails to meet
one or both of the following criteria.
• Describes one insight gained regarding
the concepts in this module.
• Connects learning achieved to a minimum
of one course outcome addressed in this
module.
OR
No posting is submitted in response to Reflection
2.
Timeliness of
Postings
3 Points
0 Points
The following expectations for timely postings
are met:
One or more of the following expectations for
timely postings are not met:
During Modules 1–8: Posting in response to
Reflection 1 is made before Wednesday 11:59
p.m. MT.
During Modules 1–8: Posting in response to
Reflection 1 is made before Wednesday 11:59
p.m. MT.
AND
AND
During Modules 1–7: Posting in response to
Reflection 2 is made between Thursday 12:00
a.m. MT and Sunday 11:59 p.m. MT.
During Modules 1–7: Posting in response to
Reflection 2 is made between Thursday 12:00 a.m.
MT and Sunday 11:59 p.m. MT.
MSN-AT Reflection Guidelines and Rubric_January 2019
3
Graduatelevel Writing
Style
OR
OR
During Module 8: Posting in response to
Reflection 2 is made between Thursday 12:00
a.m. MT and Saturday 11:59 p.m. MT.
During Module 8: Posting in response to
Reflection 2 is made between Thursday 12:00 a.m.
MT and Saturday 11:59 p.m. MT.
0 Points Deducted
3 Points Deducted
Graduate-level writing style is used, evidenced
by correct:
• Grammar
• Spelling
• Word usage
• Punctuation
• Sentence structure
• Paragraph structure
MSN-AT Reflection Guidelines and Rubric_January 2019
One or more errors is present in any of the
following areas.
•
•
•
•
•
•
Grammar
Spelling
Word usage
Punctuation
Sentence structure
Paragraph structure
4
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