Dissertations / Theses: '4203 Health services and systems'

1

Kollberg, Beata. "Performance Measurement Systems in Swedish Health Care Services." Doctoral thesis, Linköping : Department of Management and Engineering, Linköpings universitet, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-9302.

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2

Catchpole, C. P. "Information systems design for the community health services." Thesis, Aston University, 1987. http://publications.aston.ac.uk/10620/.

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This system is concerned with the design and implementation of a community health information system which fulfils some of the local needs of fourteen nursing and para-medical professions in a district health authority, whilst satisfying the statutory requirements of the NHS Korner steering group for those professions. A national survey of community health computer applications, documented in the form of an applications register, shows the need for such a system. A series of general requirements for an informations systems design methodology are identified, together with specific requirements for this problem situation. A number of existing methodologies are reviewed, but none of these were appropriate for this application. Some existing approaches, tools and techniques are used to define a more suitable methodology. It is unreasonable to rely on one single general methodology for all types of application development. There is a need for pragmatism, adaptation and flexibility. In this research, participation in the development stages by those who will eventually use the system was thought desirable. This was achieved by forming a representative design group. Results would seem to show a highly favourable response from users to this participation which contributed to the overall success of the system implemented. A prototype was developed for the chiropody and school nursing staff groups of Darlington health authority, and evaluations show that a significant number of the problems and objectives of those groups have been successfully addressed; the value of community health information has been increased; and information has been successfully fed back to staff and better utilised.

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3

Atueyi, Kene Chukwu. "Implementing management information systems in the National Health Service." Thesis, Sheffield Hallam University, 1991. http://shura.shu.ac.uk/4990/.

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As a discipline Management Information System (MIS) is relatively new. Its short history has been characterised with epistemological dialectism. The current conflict and debate about MIS inquiry is broadly between the advocates of the social systems and technical systems perspectives. Few authors have made positive contributions toward clarifying the meaning and nature of MIS, and the appropriate design framework for MIS development. This thesis adds to their effort by using a MIS designed and implemented through action research at the North Western Regional Health Authority. There are seven Chapters in this thesis. Chapters One and Two examine the nature of the problem addressed by this research; the project history, ontological assumptions and research strategy. Chapter Three examines the debate, nature and conflicting views about MIS. It defines the theoretical problem addressed by this thesis and proposes a new concept of MIS. The theoretical problems are dealt with in Chapter Four. In Chapter Five the application of the theoretical concepts developed in Chapter Four is demonstrated in the design of MIS. Chapter Six relates some of the findings of this thesis to the work of other authors. It also examines the problem of human inquiry and the suitability of action research for MIS research. The main findings of this research summarised in Chapter Seven provide a new perspective of MIS as a purposeful system; the taxonomy of purposeful systems; primary context and secondary context of MIS; context analysis and context evaluation of MIS.

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4

Wolfe, Ingrid. "Child Health, Health Services and Systems in UK and other European countries." Doctoral thesis, Karlstads universitet, Institutionen för hälsovetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-35856.

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Background This work in child population medicine describes child health problems, increases knowledge of health services, systems, and wider determinants, and makes recommendations for improvements. Aims To explore trends in UK child health and health service quality and highlight policy lessons from the UK and other European countries To study child health and health services in western Europe and derive lessons from different approaches to common challenges To enhance knowledge on child to adult transition care To describe trends in UK and EU15+ child and adolescent mortality and seek explanations for deteriorating UK health system performance, and make recommendations for improving survival Methods Population level measures of health status and system performance; primary and secondary research on policies and practice for health system assessments. Quantitative: mortality rate trends, excess deaths, DALYs, healthcare processes Qualitative: case reports, system descriptions, analyses Results European child survival has improved, but variably between countries. The UK has not matched recent EU mortality gains. There are 6,000 excess deaths annually in children under 15 years in EU14 countries. There are child survival inequities; countries investing in social protection have lower mortality. Children in the UK, compared with other EU countries, are more likely to be poor than adults. Non-communicable diseases are now dominant causes of child death, disease, and disability. Mortality, processes, and outcomes of healthcare amenable conditions varies between countries. Better outcomes seem to be associated with flexible health care models promoting cooperation, team working, and transition. Conclusions Child health in Europe is improving, but unevenly. Child health systems are not adapting sufficiently to meet needs. Recommendations are made for improving health systems and services.
How do European countries compare when it comes to child health statistics? How do different child health services, systems, and wider determinants impact long term influences for good or harm? Why do some countries seem to do better than others in safeguarding their children’s and young people’s health and wellbeing? And what can we do to make things better for children? This thesis explores some of these difficult but important issues, and despite describing some serious signals of concern about child health, offers recommendations and clear ways forward for countries to ensure healthier futures for children.

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Irozuru, E. C. "Information systems in district health authorities : a strategy for management." Thesis, University of Salford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299129.

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Simmons, Robert Earl. "African therapeutic systems : their place in health care in Liberia." Thesis, University of Liverpool, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387349.

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Domapielle, Maximillian K. "Extending health services to rural residents in Jirapa District : analyses of national health insurance enrolment and access to health care services." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14803.

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This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit.

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Warner, Lora Hanson. "Control of Hospital Strategy in Small Multihospital Systems." VCU Scholars Compass, 1987. https://scholarscompass.vcu.edu/etd/5086.

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Hospitals are joining multihospital systems (MHSs) with growing frequency. About 80% of MHSs are small, composed of 2-7 hospitals. An important management issue in MHSs is the extent to which member hospitals retain control over their own strategic directions. Using a contingency framework, this study uses both system and hospital—level determinants to explain the extent to which hospital members of MHSs control their own strategies. Survey and secondary data from 272 member hospitals of 62 small multi hospital systems (size 2-7 hospitals) are analyzed. System dispersion, size, ownership, strategic type, and age along with hospital occupancy, size, relationship to the MRS, and market factors are determinants of hospital control of strategy. Two types of hospital strategic decisions were revealed by factor analysis: tactical and periodic. For tactical decisions, such as those relating to hospital budgets, service additions, and formulation of strategies, Catholic system ownership is a significant predictor of greater hospital control. Prospector system strategy and older system age are significant predictors of reduced hospital control. For periodic decisions, such as appointment of hospital board members, sale of hospital assets, and changes in bylaws, older system age is negatively associated with hospital control, and a hospital which is owned by the system has significantly less control. The results are analyzed using the framework of the Hickson, Butler, Cray, Mallory, & Wilson (1986) typology of strategic decisions. Thus the results of this work can be useful to managers in identifying the nature of a decision and understanding its associated decision process.

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9

Al-Haque, Shahed. "Responding to traveling patients' seasonal demands for health care services in the Veterans Health Administration." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/81112.

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Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, 2013.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 60-62).
The Veterans Health Administration (VHA) provides care to over eight million Veterans and operates over 1,700 sites of care distributed across twenty-one regional networks in the United States. Health care providers within VHA report large seasonal variation in the demand for services, especially in healthcare systems located in the southern U.S. that experience a large influx of "snowbirds" during the winter. Since the majority of resource allocation activities are carried out through a single annual budgeting process at the start of the fiscal year, the seasonal load imposed by "traveling Veterans," defined as Veterans that seek care at VHA sites outside of their home network, make providing high quality services more difficult. This work constitutes the first major effort within VHA to understand the impact of traveling Veterans. We found a significant traveling Veteran population (6.6% of the total number of appointments), distributed disproportionately across the VHA networks. Strong seasonal fluctuations in demand were also discovered, particularly for the VA Bay Pines Healthcare System, in Bay Pines, Florida. Our analysis further indicated that traveling Veterans imposed a large seasonal load (up to 46%) on the Module A clinic at Bay Pines. We developed seasonal autoregressive integrated moving average (SARIMA) models to help the clinic better forecast demand for its services by traveling Veterans. Our models were able to project demand, in terms of encounters and unique patients, with significantly less error than the traditional historical average methods. The SARIMA model for uniques was then used in a Monte Carlo simulation to understand how clinic resources are utilized over time. The simulation revealed that physicians at Module A are over-utilized, ranging from a minimum of 92.6% (June 2013) to maximum 207.4% (January 2013). These results evince the need to reevaluate how the clinic is currently staffed. More broadly, this research presents an example of how simple operations management methods can be deployed to aid operational decision-making at other clinics, facilities, and medical centers both within and outside VHA.
by Shahed Al-Haque.
S.M.in Technology and Policy

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10

Wilson, Nicola Ann. "Modelling intermediate care services as part of an integrated care pathway." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20290.

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This study explores the implications of implementing enhanced or redesigned intermediate care initiatives in the Western Cape of South Africa from the 2014/15 financial year onwards. Using a dynamic modelling methodology, we developed an empirical model of an integrated care system to explain the linkages, relationships and interactions among service components and analyse the implications of one of the proposed Healthcare 2030 policy interventions - intermediate care - on hospital admissions, waiting times and length of stay of all patients. We tested and compared a number of alternative intervention points using a simulation model parameterised with service component data from the Department of Health Information Systems. The findings from the study show the inconsistencies between the perceived structure and the available data from the respective service components that describe the resultant behavioural effects on an integrated care system, especially when care pathways cross organisational boundaries. The main managerial learning was around the existence and nature of organisational boundaries that require joint working and sharing of information. We conclude from the simulation results for the alternative scenarios tested that the implementation of enhanced or redesigned intermediate care initiatives can moderate the rate of growth in the demand for hospital services by reducing a percentage of hospital readmissions.

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11

Holloway, Jacqueline Anne. "Performance evaluation in the National Health Service : a systems approach." Thesis, Open University, 1990. http://oro.open.ac.uk/57302/.

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This research explores the contribution which systems theories, methodologies and models can make in the design and application of effective performance-evaluation processes. Approaches to performance assessment of organisations are reviewed, and the history and structure of the NHS, its objectives, and dimensions for evaluation are described. Drawing on questionnaire and interview data from health service and civil service staff, and secondary data, current performance evaluation and planning processes in the NHS are described and some problems identified. To test the hypothesis that attention to systemic factors could improve performance evaluation, eight topics are analysed by the application of systems methodologies or models. Four of the topic and methodology or model combinations have received detailed analysis: 1. Making and implementing strategic plans; the Open University's Hard Systems Methodology. 2. Controlling NHS performance through structure and process, e. g. the use of annual reviews, performance indicators; double-loop learning and cybernetic control model. 3. Improving the quality of NHS care; Stafford Beer's Viable System Model. 4. Assessing performance through the outcomes of care; Peter Checkland's Soft Systems Methodology. The areas studied in less detail are: 5. Planning for uncertainty and complexity; 6. Issues related to the politics of health; 7. Reducing the length of waiting lists and times; 8. Planning for health (health promotion and the prevention of ill health).

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12

Li, Jun. "The use of child health computing systems in primary preventive care : an evaluation." Thesis, University College London (University of London), 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274686.

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13

Frascina, Anthony Cosimo. "The integration of hospital information systems through user centred design." Thesis, Sheffield Hallam University, 1994. http://shura.shu.ac.uk/3185/.

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The development of computer systems in UK hospitals has in recent years been focused on the provision of hospital-wide information systems, known as Hospital Information Support Systems (HISS). This development has been motivated by National Health Service reforms and a realisation that earlier fragmented systems were not meeting the requirements of clinical and nursing staff in the most effective way. Such systems were often developed by external, centralised agencies using systems analysis techniques appropriate to the development of information systems in product orientated organisations. However, the hospital ward, an environment existing at the 'sharp end' of health care, in which many diverse and non-computer related activities take place, presents the system designer with many of the classic problems with which the discipline of Human Computer Interaction (HCI) is concerned. Although a HISS has the potential to improve both the work conditions of clinical staff and the delivery of health care, this may be impeded by many of the common obstacles associated with the introduction of a large and complex computer system into a work environment where tasks are ill defined. This thesis reports on a project that is based upon the application of HCI methods to the health care environment and their contribution to the solution of the problems that such an environment presents. Requirements for the users' interface to the potential HISS are derived using a task analytic approach, involving Task Analysis for Knowledge Descriptions (TAKD). A prototype system has been designed and subsequently evaluated in a hospital ward. The contribution of TAKD to the design and its further applicability to the environment are assessed. The research represents an original application of a formal task analysis method to the design of ward based computer systems, and as such makes a valuable contribution to the areas of medical informatics and HCI. It shows that TAKD has real but limited applicability in this sphere, in that its use can lead to the design of more usable interfaces, while there is a need to combine it with methods aimed at broader systems design if these benefits are to accrue in the development of a HISS. The potential for the integration of task analysis with Design Rationale methods is also demonstrated.

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Keen, Justin Robert. "A systems approach to modelling services for people with dementia." Thesis, City University London, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.245863.

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15

Lee, Fock Choy. "A quantitative performace measurement framework for health care systems." Diss., Columbia, Mo. : University of Missouri-Columbia, 2006. http://hdl.handle.net/10355/4583.

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Thesis (M.S.) University of Missouri-Columbia, 2006.
The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file viewed on (June 26, 2007) Includes bibliographical references.

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Timmons, Stephen. "Resistance to computerised care planning systems by nurses in the NHS." Thesis, Anglia Ruskin University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368274.

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Chadwick, Lionel Kevin. "Incentives influencing general practitioners in selected Western European health systems : a 1985 comparative study." Thesis, London School of Economics and Political Science (University of London), 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364370.

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18

Friedman, Nicole Lisa. "Impactful Care: Addressing Social Determinants of Health Across Health Systems." PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/5073.

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There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse. The goal of this applied research project is to examine Kaiser Permanente Northwest's patient navigator program as a case study for how health systems can transform into organizations that bridge clinical, social and behavioral health and redefine what it means to be a prevention-oriented delivery system. Kaiser Permanente Northwest (KPNW) provides high quality, patient-centered care to over 550,000 medical members and 240,000 dental members in Oregon and Southwest Washington. In conjunction with the Care Management Institute, KPNW created a patient navigator administered, social needs screening tool called "Your Current Life Situation" (YCLS). This thesis focuses on the data collected from this screening tool with an emphasis on operations management, workflows, and the technical tools that have been supported to do this work. The analysis also uses semi-structured qualitative interviews from patient navigators, physicians, social workers, community organizations and members to better understand the experience of social needs screening in clinical practice and its impact on members and community partners as they receive referrals for services outside the health care delivery system. Through using anthropological theory and methods, I seek to help health systems think and act differently by elevating the voice and experience of the community and translating vulnerable populations' needs into a language that can be integrated into multiple systems of care.

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Collin, Anne (Anne Claire). "Improving access through stochastic modeling in Veterans Affairs Mental Health Services." Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104817.

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Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society, Technology and Policy Program, 2016.
This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 85-88).
In this thesis, I created a tool for a particular VA clinic to simulate the delays veterans face in a network of mental health programs. Based on queueing theory, including blocking and reneging, different operations management strategies are compared using this discrete event simulation tool. To simulate wait times, users input arrival rates, service times, patience, probabilities of relapses and probabilities to go from one program to another. We determine that blocking is one of the main drivers of the delays. This model is not only useful for direct decision making, such as increasing capacity in one of the programs, but also to enable systems thinking in the VA. Indeed, if more quantitative methods were used at different levels of the organization, managers could take more informed decisions faster. This also prompts for rigorous data collection, which is something the VA needs, especially wait times for mental health clinics.
by Anne Collin.
S.M. in Technology and Policy

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20

Mitchell, Penelope Fay. "Mental health care roles and capacities of non-medical primary health and social care services : an organisational systems analysis /." Connect to thesis, 2007. http://eprints.unimelb.edu.au/archive/00003854.

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21

Casino, Cembellin Francisco Jose. "Privacy-Preserving Crowdsourcing-Based Recommender Systems for E-Commerce & Health Services." Doctoral thesis, Universitat Rovira i Virgili, 2017. http://hdl.handle.net/10803/456380.

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En l’actualitat, els sistemes de recomanació han esdevingut un mecanisme fonamental per proporcionar als usuaris informació útil i filtrada, amb l’objectiu d’optimitzar la presa de decisions, com per exemple, en el camp del comerç electrònic. La quantitat de dades existent a Internet és tan extensa que els usuaris necessiten sistemes automàtics per ajudar-los a distingir entre informació valuosa i soroll. No obstant, sistemes de recomanació com el Filtratge Col·laboratiu tenen diverses limitacions, com ara la manca de resposta i la privadesa. Una part important d'aquesta tesi es dedica al desenvolupament de metodologies per fer front a aquestes limitacions. A més de les aportacions anteriors, en aquesta tesi també ens centrem en el procés d'urbanització que s'està produint a tot el món i en la necessitat de crear ciutats més sostenibles i habitables. En aquest context, ens proposem solucions de salut intel·ligent (s-health) i metodologies eficients de caracterització de canals sense fils, per tal de proporcionar assistència sanitària sostenible en el context de les ciutats intel·ligents.
En la actualidad, los sistemas de recomendación se han convertido en una herramienta indispensable para proporcionar a los usuarios información útil y filtrada, con el objetivo de optimizar la toma de decisiones en una gran variedad de contextos. La cantidad de datos existente en Internet es tan extensa que los usuarios necesitan sistemas automáticos para ayudarles a distinguir entre información valiosa y ruido. Sin embargo, sistemas de recomendación como el Filtrado Colaborativo tienen varias limitaciones, tales como la falta de respuesta y la privacidad. Una parte importante de esta tesis se dedica al desarrollo de metodologías para hacer frente a esas limitaciones. Además de las aportaciones anteriores, en esta tesis también nos centramos en el proceso de urbanización que está teniendo lugar en todo el mundo y en la necesidad de crear ciudades más sostenibles y habitables. En este contexto, proponemos soluciones de salud inteligente (s-health) y metodologías eficientes de caracterización de canales inalámbricos, con el fin de proporcionar asistencia sanitaria sostenible en el contexto de las ciudades inteligentes.
Our society lives an age where the eagerness for information has resulted in problems such as infobesity, especially after the arrival of Web 2.0. In this context, automatic systems such as recommenders are increasing their relevance, since they help to distinguish noise from useful information. However, recommender systems such as Collaborative Filtering have several limitations such as non-response and privacy. An important part of this thesis is devoted to the development of methodologies to cope with these limitations. In addition to the previously stated research topics, in this dissertation we also focus in the worldwide process of urbanisation that is taking place and the need for more sustainable and liveable cities. In this context, we focus on smart health solutions and efficient wireless channel characterisation methodologies, in order to provide sustainable healthcare in the context of smart cities.

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Al-umaran, Saleh. "Culture dimensions of information systems security in Saudi Arabia national health services." Thesis, De Montfort University, 2015. http://hdl.handle.net/2086/11393.

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The study of organisations’ information security cultures has attracted scholars as well as healthcare services industry to research the topic and find appropriate tools and approaches to develop a positive culture. The vast majority of studies in Saudi national health services are on the use of technology to protect and secure health services information. On the other hand, there is a lack of research on the role and impact of an organisation’s cultural dimensions on information security. This research investigated and analysed the role and impact of cultural dimensions on information security in Saudi Arabia health service. Hypotheses were tested and two surveys were carried out in order to collect data and information from three major hospitals in Saudi Arabia (SA). The first survey identified the main cultural-dimension problems in SA health services and developed an initial information security culture framework model. The second survey evaluated and tested the developed framework model to test its usefulness, reliability and applicability. The model is based on human behaviour theory, where the individual’s attitude is the key element of the individual’s intention to behave as well as of his or her actual behaviour. The research identified a set of cultural and sub-cultural dimensions in SA health information security and services.

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Nolan, Michael Robert. "Timeshare beds : a pluralistic evaluation of rota bed systems in continuing care hospitals." Thesis, Bangor University, 1991. https://research.bangor.ac.uk/portal/en/theses/timeshare-beds--a-pluralistic-evaluation-of-rota-bed-systems-in-continuing-care-hospitals(5cbe7718-983f-4e5d-a6f6-ced07a4d4a36).html.

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This thesis reports the results of a pluralistic evaluation of rota bed systems providing respite care to carers of the dependent elderly. Using a multi-method triangulated design the study examines: the sources and determinants of carers' stresses and rewards; the subjective views of the main stakeholder groups as to the benefits and problems of the rota bed system; the rota bed experience as indicated by the environment and regime of care and the activity levels of rota bed users at two contrasting continuing care hospital wards. Using data from a national sample survey of members of the Association of Carers, convincing empirical support is provided for the transactional approach to the understanding of carer stress. In addition the results extend the conceptualisation of caring to include sources of satisfaction. The benefits and problems of the rota bed system are explicated and, on the basis of these suggestions are made as to how both respite care and related services to carers might be improved. Within the context of recent policy initiatives consideration is given to the nature of professional responses to carers and their dependants with particular reference to the role of the nursing profession.

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24

Schira, Norma. "A Survey of Health Promotion Activities of Health Systems Agencies." TopSCHOLAR®, 1986. http://digitalcommons.wku.edu/theses/1980.

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The National Health Planning and Resources Development Act. Public Law 93-641, the last major step in the regulation of the health care system, created a network of health system agencies and state level health planning agencies. Subsequent legislation, the Health Planning and Resources Development Amendment 1929, Public Law 96-79, amended 1974 Law and changed the role and function of health systems agencies to include more regulatory activities. By 1981, the activities of Health System Agencies were being curtained by the action of the Reagan administration. The Health promotion/wellness movement which seeks to improve health has been developing as a compliment to medical medicine for several years. Previous research has determined that health systems agencies were active in health promotion and identified several planning and implementation activities related to this involvement. This is a survey of health systems agencies to determine their efforts in healthy promotions. Resources allocated to these activities, and opinions of the director relevant to agency involvement in health promotion. All active healthy system agencies listed in the 1980. Directory of Health System Agencies (DHSH) were surveyed by a mailed questionnaire. Reponses were receive from 112 agencies (57%) and the respondents were found to be representative of the population. The results revealed health systems agencies to be involved in health promotion. More than 90 percent of the responders listed some type of health promotion activity in their Healthy System Plans for the 1979-1980 planning year. Approximately half of the responders reported some community activity in health promotion. The majority of executive directors saw health systems agencies as being only moderately effective in controlling health care costs: considered healthy promotion as a viable means of controlling health care cost: and believed that modifications of individual life-styles had the greatest potential for improving health status. The survey revealed that Healthy System Agencies did not restrict the wellness/health promotion activities to traditional health facilities, but were defining health broadly and working with a variety of agencies to develop services.

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Scott, Shane P. (Shane Paul). "Network governance for the provision of behavioral health services to the US Army." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/79535.

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Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, 2012.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 230-234).
Under a charter from the Chairman of the Joint Chiefs of Staff, the author participated in a study of the military's behavioral health system for the purpose of determining the means and effectiveness of that system for the treatment of PTSD and related conditions. This work focuses on the architecture and means of control over the existing arrangement of semi-independent enterprises, organized into functional work groups that necessarily collaborate to provide a full spectrum of behavioral health services to service members and their families. The author suggests a rearrangement of the system architecture to enable integrated work across organizational boundaries in order to reduce waste generated through structural inefficiencies. Implementation of network architecture and control relies heavily on the development of shared strategic objectives that direct network processes in supporting overall organizational goals. Further, performance measurement systems and stakeholder behavior change through use of incentives are used as the drivers of inter-enterprise process development. Finally, a governance structure, focused on development of integrative processes and outcomes is established to foster inter-organizational relationships, direct process improvement, and resolve system conflicts.
by Shane P. Scott.
S.M.

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26

Maguire, Stuart. "The development of a methodology for the introduction of information systems within the National Health Service." Thesis, Lancaster University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287250.

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This thesis represents over five years of research focusing on the development and implementation of information systems within the National Health SefV1ce. It aims to contribute towards a better understanding of the information systems development process from inception through to system evaluation and review. Five long-term interventions have been undertaken in a range of National Health Service sites, examining different aspects of information provision. The length of the interventions ranged from nine months to almost two years. The five sites were all at different stages of system development. The research has been carried out using a combination of participant observation and action research. This has meant working with National Health Service staff on a series of system projects. The aim of the research is to try and help National Health Service (NHS) organisations deal more successfully with their information provision. The research question asks, "how can NHS organisations think about, and hence go about their information provision in such a way that successful information systems are introduced'!". Information systems development has generally been regarded as a technical discipline. This has led to a narrow view being taken of a number of areas that may affect the success or otherwise of system projects. Historically, the system development process has been concentrated in the hands of a small number of experts even though the implementation of systems can have far-reaching consequences for the organIsation. The output of the research is a set of issues that should be addressed when introducing information systems within the NHS. These have been translated into the OASES materials which form the appendices. OASES is not a prescriptive methodology but a set of principles and guidelines to try and improve the way that information systems are developed within the NHS. It IS hoped that the outcome of the research will be a situation in which effective information systems are developed that take account of the behavioural, cultural, and organisational issues that are important within complex organisations.

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Winkelmann, Regina Anette. "Evaluation of cancer surveillance systems in the New Independent States of the former Soviet Union." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299377.

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Jones, R. T. "The development of the medical laboratory scientific officer profession : Qualifying systems, professional politics and technical change." Thesis, University of Sussex, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.373914.

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29

Gomes, Mafalda Cristina Almeida. "The impact of the economic crisis on the quality of health services." Master's thesis, NSBE - UNL, 2014. http://hdl.handle.net/10362/11761.

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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics
purpose of this project is to analyze the impact of the crisis on the quality of health care provided, as well as the extent in which the levels of quality were affected by the decrease in resources and increase in patients’ health problems. By using patient level data from the DRG database, the effects will be estimated taking into account the demand and supply side factors, individual and illness’ episode characteristics. Results convey a deterioration of the quality indicators from 2009 to 2010. However, unemployment, a variable characterizing the crisis due to its magnitude, showed to have no significance statistically. Finally, the results also suggest that, the effects of the crisis created pressure in the financial situation of the hospitals, which led to inferior quality health services.

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30

Khan, Jahanzeb, and Muzammal Shahzad Arif. "Investigating the behaviour intention to use e-health services by Swedish Immigrants." Thesis, Örebro universitet, Handelshögskolan vid Örebro Universitet, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-39574.

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31

Harris, Jenine K., Kate E. Beatty, J. P. Leider, Alana Knudson, Britta L. Anderson, and Michael Meit. "The Double Disparity Facing Rural Local Health Departments." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6825.

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Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.

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32

Gray, C. J. "Electronic health record systems in a centralized computing services environment| critical success factors for implementation." Thesis, Robert Morris University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3628910.

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In 2009 the American Recovery and Reinvestment Act (ARRA) was signed into law. As part of ARRA, the HITECH Act set aside $29 billion in Medicare and Medicaid incentives for healthcare organizations. To collect these incentives, healthcare organizations must install an electronic health record (EHR) system and achieve meaningful use. Implementation of an EHR must be completed by 2015 in order to acquire any of the incentives available. Small medical practices consisting of one to five physicians are finding it easier to implement a cloud-based EHR system due to minimal upfront costs and no need for technical capabilities within the medical practice. This study was done using a modified Delphi technique developed by Roy Schmidt to find critical success factors for the implementation of electronic health record systems within a centralized computing services structure. For purposes of this study a centralized computing services structure was considered a cloud or cloud-based environment.

This study found that the top five critical success factors for the implementation were the following: (1) EHR Training – implementing a strong training / education process for EHR users; (2) Usability – practical application of EHR features in a real medical office setting; (3) Reliability – Specifically high levels of redundancy and system availability. If the system is down, patient safety is a risk, and that is an unacceptable norm; (4) Strong clinical representation in the project to ensure workflows, processes and education needs are met; (5) Support services such as deployment / implementation services, help desk, and online support. Of these five factors, four are actually related to usability of the system, and not necessarily strictly based on implementation. This leads us to believe that the success of an implementation is reliant upon user perception based on system usage.

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33

Bennett, Cudjoe A. "Urban Health Systems Strengthening| The Community Defined Health System for HIV/AIDS and Diabetes Services in Korogocho, Kenya." Thesis, The George Washington University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10146927.

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Background: Low- and middle-income countries have been experiencing unprecedented rates of urbanization. Rapid urbanization has attributed to an upsurge in non-communicable diseases, such as diabetes, cardiovascular diseases, and cancers in these countries. Most low- and middle-income countries are also still struggling to control communicable diseases such as HIV/AIDS, tuberculosis, and malaria. This phenomenon, described as the double burden of disease, places greater strains on urban health systems and vulnerable urban populations, such as slum dwellers, who are likely to bear the brunt of any negative health outcomes. Given the potential impacts of urbanization and quality of health services on poverty and disease in the urban poor, there is urgent need to study urban health systems and the ways in which services can be made more available, accessible, and acceptable to socioeconomically disadvantaged and culturally/ethnically diverse populations.

Objectives: This dissertation is a case study that investigated the community-defined health system for Korogocho slum residents in Nairobi, Kenya. Specifically, the purpose of the research study was to (1) determine the readiness of health workers to provide HIV- and diabetes-related services, (2) define the components of the health system as perceived by Korogocho residents; that is, determine the community-defined health system, (3) assess the factors that affect health service utilization with respect to HIV/AIDS and diabetes prevention, care, and treatment, and (4) make recommendations for improving the availability, accessibility, and acceptability of health services for Korogocho residents.

Methods: The case study research employed both quantitative and qualitative methods. Three complementary peer-review quality manuscripts were developed. Manuscript 1 presents results from one of the first assessments of health provider readiness to provide HIV/AIDS- and diabetes-related services using data from the Demographic and Health Survey’s Kenya Service Provision Assessment. A cross-sectional quantitative study was conducted. Readiness was defined as health workers having the training to provide the minimum HIV/AIDS services as prescribed by key government policies. Data analysis was conducted using STATA version 13 to assess the readiness of health workers in terms of a weighted proportion of providers from facility levels 2-4 who were trained in essential HIV/AIDS- and diabetes-related services according to Kenya’s national guidelines. Manuscript 2 details the results of a qualitative inquiry to understand the community-defined health system and identify factors that influence Korogocho residents’ health utilization behavior, especially in relation to HIV/AIDS and diabetes services. Manuscript 3 utilized a qualitative assessment to determine the role of informal health providers (those who have not received a Western biomedical model of medical training) in health service delivery to the Korogocho community. In both Manuscripts 2 and 3, semi-structured interviews were conducted with community members and informal health providers, respectively. Qualitative sampling was conducted with the purpose of generating a conceptual model of the urban health system for slum residents. Analysis of semi-structured qualitative interviews with community members and informal health providers in Manuscripts 2 and 3 was completed through an iterative process using NVivo 11 for Mac.

Results: The results of this research demonstrate the complexity of urban health systems. Korogocho residents utilize health services from a variety of facilities and providers from both the formal and informal sectors. Their health utilization behavior is primarily influenced by the availability, accessibility, and acceptability of health services, health facilities, and health providers. Informal health providers play a critical role in terms of expanding the availability and accessibility of health services to Korogocho residents. The results of this case study also reveal that training levels of health providers in Nairobi for the delivery of HIV- and diabetes-related services are low. On average, 12% of health workers interviewed in the 2010 Kenya service provision assessment reported having training in the previous 2 years in the full complement of essential HIV-related services as prescribed by Kenyan Government policies. There were similar low proportions of training for the provision of diabetes-related services among the three health worker cadres included in this analysis of the 2010 Kenya service provision assessment. Moreover, the community’s perceptions of the availability and accessibility of diabetes services lagged behind HIV services.

Conclusions: The results of this research reveal key information that can impact the health systems strengthening agenda, particularly for improving the availability and accessibility of health services to the urban poor. It is also clear from this research that there is an urgent need to scale up the training of health providers to handle the current double burden of disease. Further, among socioeconomically disadvantaged populations, such as urban slums, the intentional incorporation of informal providers into the health system is a key step towards ensuring that much needed health services reach the urban poor.

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34

MacDonald, Morag. "HIV and AIDS in prison : a comparative analysis of the Italian and English and Welsh prison systems." Thesis, Birmingham City University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272094.

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35

Sines, David Thomas. "Valuing the carers : an investigation of support systems required by mental handicap nurses working in residential services in the community." Thesis, University of Southampton, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.305651.

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36

Mazur, Lukasz Maciej. "The study of errors, expectations and skills for medication delivery systems improvement." Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/mazur/MazurL0508.pdf.

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Medication errors occurring in hospitals are a growing national concern. The enormous gaps in knowledge related to medication errors are often seen as major reasons for increased patient safety risks and increased waste in the hospital setting. However, little research effort in industrial and management engineering has been devoted specifically to medication delivery systems to improve or optimize their operations in terms of patient safety and systems efficiency and productivity. As a result, the current literature does not offer integrated solutions to overcome the workflow and management difficulties with medication delivery. Therefore, a better understanding of workflow and management sources of medication errors is needed to help support decisions about investing in strategies to reduce medication errors. Using qualitative and quantitative research methods the work reported in this dissertation makes several contributions to the existing body of knowledge. First, using healthcare professionals' perceptions of medication delivery system, a set of simple and logical workflow design rules are proposed. If properly implemented, the proposed rules are capable of eliminating the unnecessary variations in the process of medication delivery which cause medication errors and waste. Second, a theoretical model of 'expectations' for effective management of medication error reporting, analysis and improvement is provided. The practical implication of this theoretical model extends to effective management strategies that can increase feelings of competence and help create a culture that values improvement efforts. Third, eight propositions for effective use of a systems engineering method (in this research the "Map-to-Improve" (M2I) method) for medication delivery improvement are offered. Finally, a set of skills needed for future healthcare professionals to effectively use systems engineering methods is provided. The proposed insights into these areas can result in improved pedagogy for professional development of healthcare professionals. The practical implication extends to the development of better methods for healthcare systems analysis. In summary, the author of this research work hopes that the findings and discussions will help healthcare organizations to achieve satisfactory improvement in medication delivery.

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37

Weng, Chao. "A pilot evaluation study on benefits of a record linkage between a hospital diabetes database and the information systems within the NHS." Thesis, King's College London (University of London), 2000. https://kclpure.kcl.ac.uk/portal/en/theses/a-pilot-evaluation-study-on-benefits-of-a-record-linkage-between-a-hospital-diabetes-database-and-the-information-systems-within-the-nhs(065d944e-29fe-442e-a981-15012719d063).html.

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38

Field, Kenneth Spencer. "Modelling health care utilization : an applied Geographical Information Systems approach." Thesis, University of Northampton, 1998. http://nectar.northampton.ac.uk/2708/.

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This research has emanated from the geographical concerns raised by organisational change in the British National Health Service (NHS), namely the ongoing debate relating to health and health care inequalities. This thesis develops a flexible, portable and predictive model of health care utilization capable of assisting improved health care planning and analysis. In so doing it contributes to the current resurgence in medical geography. An applied approach to this research is identified which builds upon methods of modelling spatial patterns and processes in geography and the upsurge of interest in Geographical Information Systems (GIS) technology. In these terms, the use of GIS is central to the research; it supports construction and application of the model; facilitates a wide range of analyses; and provides a basis for visualisation and interpretation of model results. The value of modelling in analysing relationships between health inequalities and the location and allocation of health care is identified through a discussion of previous NHS policy initiatives and previous research. From this, a conceptual model of utilization is developed which incorporates components of need, accessibility and provision. A patient survey of asthmatics and diabetics informs the development of the model and validates the choice of indicators used to measure utilization. Indicators of need, accessibility and utilization are thus defined and subsequently measured using a signed chi-square scoring method. The model was developed and tested for primary care General Practitioner services in the Northampton District Health Authority area and outcome measures are proposed and evaluated. Rigorous testing of the model’s sensitivity and robustness is undertaken and potential for its simplification explored. Components are critically evaluated through a comparison with alternative methods of determining spatial inequalities in disadvantage. The potential of the model of utilization for health care planning and analysis is extensively demonstrated through the application of a variety of modelled scenarios. Emergent issues from the research are considered and potential for future geographical research in this area of study, and the impact upon research agendas more generally, is explored

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39

Carney, Philip Sheridan. "Managed healthcare and integrated delivery systems: A model for getting ahead of the change curve." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2103.

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Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.

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40

Shoopala, Anna-Liisa. "Design of a backend system to integrate health information systems – case study: ministry of health and social services (MoHSS)-Namibia." Master's thesis, Faculty of Engineering and the Built Environment, 2021. http://hdl.handle.net/11427/34011.

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Information systems are the key to institution organization and decision making. In the health care field, there is a lot of data flow, from the patient demographic information (through the electronic medical records), the patient's medication dispersal methods called pharmaceutical data, laboratory data to hospital organization information such bed allocation. Healthcare information system is a system that manages, store, transmit and display healthcare data. Most of the healthcare data in Namibia are unstructured, there is a heterogeneous environment in which different health information systems are distributed in different departments [1][2]. A lot of data is generated but never used in decision-making due to the fragmentation. The integration of these systems would create a flood of big data into a centralized database. With information technology and new generation networks becoming a called for innovations in every day's operations, the adaptations of accessing big data through information applications and systems in an integrated way will facilitate the performances of practical work in health care. The aim of this dissertation is to find a way in which these vertical Health Information System can be integrated into a unified system. A prototype of a back-end system is used to illustrate how the present healthcare systems that are in place with the Ministry of Health and Social Service facilities in Namibia, can be integrated to promote a more unified system usage. The system uses other prototypes of subsystems that represent the current systems to illustrate how they operate and, in the end, how the integration can improve service delivery in the ministry. The proposed system is expected to benefit the ministry in its daily operations as it enables instant authorized access to data without passing through middlemen. It will improve and preserve data integrity by eliminating multiple handling of data through a single data admission point. With one entry point to the systems, manual work will be reduced hence also reducing cost. Generally, it will ensure efficiency and then increase the quality of service provided.

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41

Mazza, Jessica. "Organizational culture in children's mental health systems of care." [Tampa, Fla] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002351.

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42

Cousins, Wendy Elaine. "Northern Ireland's Health and Social Services complaints systems : is the voice of the child being heard?" Thesis, Queen's University Belfast, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.501249.

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43

Bain, Christopher. "Developing effective hospital management information systems: A technology ecosystem perspective." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2014. https://ro.ecu.edu.au/theses/1410.

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This thesis presents the results of the program of research performed in the completion of a Doctor of Philosophy (Business) entitled: Developing Effective Hospital Management Information Systems: A Technology Ecosystem Perspective. The central contention of this thesis is that the current ecosystem models in the information technology (IT) and information systems (IS) literature can be extended and improved. In turn they can be better applied to the field of IS and the development and implementation of information systems. This research seeks to highlight an example of how these models can be extended, through an analysis of the specific context of the hospital management information system environment, using the technology ecosystems model (TEM) of Adomavicius et al (Adomavicius et al., 2005). The environment in which hospital managers operate is characterised by high demand pressures, strong public service expectations, and an ever diminishing income stream (in relative terms) with which to provide services. Even in private hospital care, many of these pressures still apply, as well as a pressure to maintain profit margins. The agenda context here is a complex one, particularly when one considers the role of hospitals in this context. Hospitals have multiple competing priorities when viewed from a management perspective. This is despite the fact that the core mission of the hospital is to provide timely, safe care within available human and financial resources, to patients who present for care. This care can be across multiple care settings inside the hospital including the inpatient space, the operating theatres, the intensive care unit, and the emergency department; and in outreach settings. Hospitals however, have been described as a series of cottage industries each loosely coupled with a common objective of supplying care to patients. All of these factors combine to mean that managing a hospital with the above-mentioned aim in mind, is a very difficult task. Nakagawa et al (Nakagawa et al., 2011) talk specifically to this difficulty. In this research I undertake this examination through 2 core exercises. Firstly I examine the literature – both the information related and health care literature, for insights into the questions at hand. Secondly I examine the lessons learned from five Case Studies (CSs). The first four of these are based in physical hospital facilities across three Australian states. The final one is a “virtual CS” in which the views of multiple parties, not centred on any given physical institution, are sought and examined in relation to these questions. Based on the data collected in both the literature review and the CS’, and through a process of triangulation and research model validation, I conclude that a hospital management technology ecosystem (a HOME) can be described. Its existence thus validates the core TEM, and in fact the findings support some meaningful extensions to the TEM. The HOME is predominantly characterised by the presence of strong drivers of change that arise from outside the immediate hospital environment. Examples include changes in the labour market, and the skill sets of workers; changes in the broader development and availability of technology (for example – think of the effects of the rise of smart phones), and changes in government policies and funding arrangements. In the majority of cases these broader influencing forces (Environment Shaping Forces – ESF’s) can be seen to act on the local management environment and the role of technology in that environment, through describable intermediaries. A very obvious example of this is the effect of a global financial downturn - eventually this wide reaching force could be expected to affect hospitals (be they private or public) through struggling performance of a parent company, or state government funding cutbacks. In turn this could easily lead to reduced spending on IT in a given hospital. These findings, along with those around services provided by the ecosystem, and the measurement of ecosystem success or failure, add substantially to the IS knowledge base in this area. This research thus acts as a sound basis for further research in this new direction, but also provides a usable conceptual and practical framework within which stakeholders – managers, clinicians, beauracrats and the software development community - can view the management of hospitals and the technologies in support of that management.

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44

Zangana, Goran Abdulla Sabir. "Understanding Iraq's basic health services package : examining the domestic and external politics of post-conflict health policy." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/25905.

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Background: Iraq is a higher middle-income country with a GDP of $223.5 billion (as of 2014). In the 1970s and 1980s, an extensive network of primary, secondary and tertiary health facilities was built, and the country recorded some of the best health indicators in the Middle East. However, two decades of conflict (both inter- and intra-state), sanctions and poor planning have reversed many of the previous gains. In the aftermath of the 2003 war, the government of Iraq introduced a Basic Health Services Package (BHSP) with a user fee component. International actors often advocate BHSPs as a means of rapidly scaling-up services in health systems that are devastated by conflict. User fees have also been promoted as a way of raising revenue to enhance the financial sustainability of healthcare systems in such contexts. While Iraq is a conflict-affected state, it has retained an extensive healthcare infrastructure and has a ministry of health with considerable financial and administrative capacity. In such a context, the introduction of a BHSP is a notable and distinctive feature of health policy in this setting, and the process through which this occurred have not yet been examined. Aim: To explore the processes through which the BHSP was conceived and designed in Iraq. It compares Iraq’s BHSP with similar policies in other post-conflict settings. It examines the roles of domestic and external actors and models in the policy’s conception and design. It explores the preferences of internal and external actors about the financing of service delivery through user fees. The study also examines the extent of policy transfer in the formulation of Iraq’s BHSP. Methodology: The thesis utilises a qualitative case study approach, incorporating analysis of semi-structured elite interviews and documents. Twenty Skype, phone, and face-to- face interviews were conducted between January 2013 and August 2014. Interviewees included former ministers of health, directors of departments of health, academics and officials at donor agencies, bilateral and multi-lateral bodies and consultancies. Documents included 47 official government publications, evaluations, reports, policy briefs and assessments. Literature review: A search of the literature on health policy making in post-conflict and fragile settings identified three key gaps in existing evidence; first, there is a dearth of published work examining health policy in post-conflict Iraq. Second, the literature focuses mainly on the impact of policy action in post-conflict contexts, largely neglecting the processes through which those policies are introduced. Third, while the literature concentrates on the roles of external actors, it pays limited attention to the role of domestic actors and politics. Results: Iraq’s BHSP shares commonalities with the other selected countries (Uganda, Afghanistan, and Liberia) in its primary aims, influential actors, interventions included or excluded, and financing principles. However, Iraq’s BHSP also aims at broader, and longer-term, structural reform, while the BHSP in other countries is often motivated by short-term objectives. The MoH in Iraq also appears to assume a prominent role in this case relative to others. Also, Iraq’s BHSP includes a greater number of interventions compared to the other countries. The Iraq war of 2003 offered the opportunity for wide-ranging structural change in the healthcare system. External actors, especially the WHO, were influential in advocating for a BHSP drawing on the recent experience of a similar initiative in what was in some ways the similar context of Afghanistan. However, the removal of former politicians and the emergence of internal policy actors with considerable technical and financial capacity allowed the domestic authorities to debate, dispute and challenge the recommendations of external actors. Relatedly, some of the internationally distinctive features of the BHSP in Iraq, including user fees, are similar to those that exist elsewhere in the health system. Most interviewees agreed that the BHSP was a means of enhancing financial sustainability and that it would help to enhance efficiency by targeting resources at population health need. The BHSP, according to some, represented the categories of healthcare that the government should finance, while allowing the private sector to meet demand for other services. However, many domestic actors supported the introduction of user fees as part of the BHSP. Several external actors either distanced themselves from this decision or declared no position, claiming that this was properly a matter for the government of Iraq. Discussion: While the BHSP’s ‘label’ is new in the context of Iraq, its substantive content is not. The BHSP can be seen as the outcome of the combination of old (existing) technologies and instruments presented in new (and introduced) ways. The existing health system offered ideas, techniques and processes that were maintained and reproduced even if these were packaged in new ways, to create a policy framework which is genuinely novel. External experts highlighted the idea of the BHSP and provided models (such as Afghanistan) on which the policy could be based. Internal decision-makers, however, were active players in policy formulation, not passive recipients who did not question or modify the policy during the process of transfer. On the contrary, it seems that the latter exerted considerable influence. User fees represent one aspect of that continuity. Ownership of policies by ministries of health in post-conflict is often advocated. However, such involvement introduces the potential for replicating old structures and policies, and may result in a degree of policy incoherence. Policy ideas are likely to change significantly where there is considerable local engagement in policy design and implementation.

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45

Byrne, Elaine. "A participatory approach to the design of a child-health community-based information system for the care of vulnerable children." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&amp.

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The existing District Health Information System in South Africa can be described as a facility based Information System, focusing on the clinics and hospitals and not on the community. Consequently, only those who access health services through these facilities are included in the system. Many children do not have access to basic health and social services and consequently, are denied their right to good health. Additionally, they are excluded from the routine Health Information System. Policy and resource decisions made by the District Managers, based on the current health facility information, reinforces the exclusion of these already marginalised children. The premise behind this research is that vulnerability of children can be tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an Information System for action
an Information System that can be used to advocate and influence decisions and policies for the rights of these children
an Information System that includes all children. An interpretive participatory action research approach, using a case study in a rural municipality in South Africa, was adopted for the study of a child-health Community-Based Information System. The context in which the community is placed, as well as the structures which are embedded in it, was examined using Structuration Theory. This theory also influenced the design of the Information System. As the aim of the research is to change the Information System to include vulnerable children, a Critical Social Theoretical and longitudinal perspective was adopted. In particular, concepts from Habermas, such as the creation of a public sphere and the &rsquo
Ideal Speech Situation&rsquo
, informed the methodology chosen and were used to analyse the research undertaken.

Based on the research conducted in this municipality, four main changes to the Health Information System were made. These were: &bull
determination of the community&rsquo
s own indicators
&bull
changes in data collection forms
&bull
creation of forums for analysis and reflection, and
&bull
changes in the information flows for improved feedback. Other practical contributions of the research are the development of local capacities in data collection and analysis, the development of practical guidelines on the design of a child-health Community-Based Information System, and the development of strategies for enabling participation and communication. In line with the action research approach adopted, and the desire to link theory and practice, the research also contributed on a theoretical level. These contributions include extending the use of Structuration Theory, in conjunction with Habermas&rsquo
Critical Social Theory, to the empirical context of South Africa
addressing the gap of Community-Based Information Systems in Information System design
extending the debate on participation and communication in Information Systems to &rsquo
developing&rsquo
countries, and developing generalisations from a qualitative case study.

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46

Mheta, Doreen. "Health systems factors that impact on access to maternal services for women with disabilities in sub-Saharan Africa: a systematic review." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16656.

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Includes bibliographical references
Maternal mortality is an enormous global challenge that is most prevalent in sub-Saharan Africa (SSA). Its prevalence in the SSA region has been attributed to inadequate access to maternal services (MHS) amongst the poor and rural women. In an attempt to improve access to maternal services, women with disabilities (WWDs) have generally been neglected. Little is known about the health systems factors that facilitate or hinder access to MHS for WWDs. However, available studies for women in general in SSA, examining health systems determinants of access to MHS, utilise the silo approach thereby providing fragmented and ineffective solutions to maternal mortality. Globally, taking a comprehensive health systems approach to understand the full range and interconnectedness of health factors is now recognised as crucial in understanding and planning complex health problems such as access to MHS. This paper presents findings from a qualitative systematic review of empirical studies providing evidence on the health systems factors that impact on access to MHS for WWDs in SSA. This dissertation comprises three sections, namely Part A, Part B and Part C. Part A reviews the Protocol; it presents the background and the qualitative systematic review methodology that is utilised in this study. A systematic search of five data bases is outlined and inclusion and exclusion criteria set out to select the suitable tool. A data extraction tool is designed to summarise the studies in a common format and to facilitate synthesis and coherent presentation of data. Part B is the review of existing empirical literature on access to MHS for both women in general SSA and for WWDs globally. Theoretical frameworks of access to health care services and health systems frameworks are also presented in this section. Furthermore, Part B provides the background on why access to MHS for WWDs is important. This section explores how health systems approach can be adopted to reveal the factors that impact on access to MHS; it links the complex systems framework to the availability, accessibility, acceptability and quality framework. Part C is a complete systematic review journal manuscript. The background of the study and methodology are described. This section also includes the findings from the systematic review of original journal articles published in English from 2000 to 2014 that report empirical findings on health systems factors that impact on access to MHS WWDs in SSA.

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47

Willis, Cameron David. "Measuring quality outcomes in patient care: the example of trauma services." Monash University. Faculty of Medicine, Nursing and Health Sciences. Department of Epidemiology and Preventive Medicine, 2008. http://arrow.monash.edu.au/hdl/1959.1/62206.

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As healthcare and health systems become increasingly complex, expectations of what constitutes high quality care continue to evolve. Stakeholders now require contemporary and meaningful measures of system performance. As such, valid healthcare quality metrics are rapidly becoming essential for those providing and receiving healthcare to assess performance and motivate change. This thesis investigates the utility of quality indicators in trauma care. Multiple in-hospital indicators have been promulgated by various bodies for assessing quality of trauma care. The properties of ideal indicators have been widely documented however few published data have reported these properties for many trauma measures. The emphasis on trauma process measures (eg. time to interventions) highlights the need for indicators with known links to patient outcomes. This process-outcome link may be viewed as a measure of an indicator’s construct validity. As this property is unknown for many trauma indicators, this thesis focuses on the construct validity of a number of routinely utilised trauma indicators. In this thesis, the available in-hospital indicators proposed by The American College of Surgeons Committee on Trauma and additional indicators used in the Victorian State Trauma System were investigated for their relationships with patient outcomes. A small number of indicators were found to have statistically significant relationships with patient outcomes, however many indicators demonstrated counter-intuitive relationships, whereby high quality care was linked with poorer patient outcomes. These results suggested that links between indicators and outcomes may not be best measured using individual indicators for individual patients. Rather, a strategy for measuring patient outcomes at the hospital level may be needed. To combine multiple indicators into a single measure of hospital level performance, a number of composite methods were explored using two trauma registries. Three composite weighting schemes were employed. As composite measures are often used for provider ranking or benchmarking, the stability of hospital ranks between providers and over time was investigated. The composites were found to have moderate to strong correlations (0.76-0.99) however variability in composite hospital rankings existed, particularly for middle ranking facilities. The construct validity of each available indicator and composite score was investigated through the relationship with hospital level risk-adjusted mortality using Poisson regression models, risk adjusting for expected deaths using the TRISS formulation. Each composite measure demonstrated a significant association with mortality, with the mortality decrease across the middle 50% of each composite score ranging from 12.06% – 16.13%. These findings suggest that complex measures such as trauma composite indices may be better able to measure the interactions between processes within complex systems that influence quality of care. This thesis adds valuable insight into the use of indicators for assessing quality of care in trauma systems. The combination of individual indicators into composite forms appears to strengthen the construct validity of these measures. By demonstrating the process-outcome link for trauma composite indices, this thesis has identified a means of utilising process measures to assess hospital level performance that may become important for future public reporting and hospital funding schemes.

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Kamugumya, Denice Cyprian. "Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15546.

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The role of the private sector in improving health systems performance in lower to middle income countries is increasingly gaining more recognition. Public-private partnership (PPP) has been suggested as a tool, to assist governments fulfil their responsibilities in the efficient delivery of health services. In Tanzania, although the idea of PPP has existed for many years in the health sector, there has been limited coordination, especially at a district level - which has contributed to limited health gains or systems strengthening obviously seen as a result of PPP. In 2009 a formal PPP policy was introduced in Tanzania, which directs the appropriate allocation of resources, and describes risk and rewards that can be achieved by building on the expertise of each partner. The Health Sector Strategic Plan III (2009-2015) further emphasises the need for service level agreements (SLAs), which are seen as an important indicator of improved PPP. This case study that draws on the decision-space framework, was conducted in the Bagamoyo district of Tanzania, and employed in-depth interviews, document reviews, and observations methods. The study findings reveal several forms of informal partnerships between the local government and non-state actors. The lack of SLAs for facilities that receive subsides from the government is argued to contribute to inappropriate distribution of risk and reward leading to moral hazards. This is evidenced by non-state actors who pursue their own interests, diverting from public social goals. Furthermore, findings highlight weak capacity of governing bodies to exercise oversights and sanctions, which is acerbated by weak accountability linkages and power differences. Moreover, restricted flexibility in spending is seen to deter prompt actions to address evolving population needs, given limited local fiscal space. It is concluded that effective PPP policy implementation at a local level depends on the capacity of local government officials to make choices that would embrace relational elements dynamics in strategic plans. Disempowered Council Health Services Board in relation to engaging non-state actors is shown to impede PPP initiatives that are conceptualized at local and national levels. This study highlights a need to consider initiatives that would foster new social contracts with non-state actors at the local level and in return build a people-centred district health system. This study is intended to improve knowledge on health systems policy interventions, strengthen future policy implementation at the sub-national level, and strengthen the district health systems as a result of PPP in a country with similar contextual elements.

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Kisaka, Lily. "Modelling payment systems for environmental services in the Mt Elgon ecosystem of Kenya." Thesis, University of Fort Hare, 2014. http://hdl.handle.net/10353/d1013123.

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Unsustainable patterns of consumption by humankind have increased the rate of change in the natural ecosystems and consequently the levels of stress experienced within the environment. Access to sufficient good quality water is essential and a requirement to meet a number of the Millennium Development Goals (MDGs). However, poor land management and untenable agricultural practices have become the main drivers of the declining watershed services. Upstream farmers often have little or no incentives to take these impacts into account in their decision-making process. Therefore, without investment in ensuring proper land management, the trend in watersheds degradation will continue. Payment for Environmental Services (PES) has emerged as an incentive–based tool that is expected to motivate farmers to improve their agricultural practices. PES is set up to facilitate the process whereby the beneficiaries of environmental services pay compensation to providers of environmental services for conserving the ecosystem. This tool has received increasing attention as a means of creating incentive measures for managing the ecosystem, addressing livelihood issues for the rural poor, and providing sustainable financing for protected areas. The Government of Kenya, as part of its efforts to improve water resource management, is considering use of economic incentive. However, there is insufficient information to guide policy making in that direction. Little is known about the farmers’ preferences for management schemes that will affect land use patterns, their willingness to accept compensation and the willingness of potential buyers to pay for the services. This study evaluates the willingness to accept and the willingness to pay for environmental services with a view to assessing the viability of a PES scheme for the Kuywa Watershed in particular, as well as the Mt. Elgon Ecosystem and other areas with similar conditions. The objectives of the study are threefold (i) to examine respondents preferences for management options for the provision of environmental services in the watershed of River Kuywa of Mt. Elgon Ecosystem; (ii) to evaluate households’ willingness to pay (WTP) and willingness to accept (WTA) payment for improved environmental services from the River Kuywa watershed; and (iii) to propose viable PES approaches for the management of the natural resource of the Kuywa watershed and the Mt. Elgon ecosystem in general. Using six land management attributes relevant to the local situation, the study applied the conjoint method to evaluate farmers’ preferences for management options for the provision of environmental service and assess farmers’ willingness to pay and willingness to accept payment for environmental services. To enable assessment of viability, an analysis was done of the institutional and legal framework within which the PES scheme would operate. Data were collected using literature review and document analysis, questionnaires, focus group discussions and key informant interviews. Results indicate that poor water quality was the most acute problem, followed by deforestation. Results from the conjoint models show that the length of commitment period and land size that is 40% or more of the total land holding influence the farmers’ rating of the management scenarios. The study found that a management contract that requires use of 20% of land holding for a period of 5 years, combined with a cash incentive, harvesting partially permitted, administered by a local NGO and requiring contribution of free labour for two days had the highest likelihood of being selected. The conjoint valuation exercise also came up with a WTA by farmers upstream of KSh. 7,080/= per year. The corresponding value downstream was KSh. 43/= per month over and above their regular water bill. In terms of the institutional and regulatory framework, Kenya has a wide range of policies, laws and regulation on water and other natural resources which provide an enabling environment for PES. With the decentralized institutional setup implemented in both the water sector and the agricultural sector, the institutional setting also provides an enabling environment for PES. With a positive WTA and WTP coupled with an enabling legal and institutional environment, the study concludes that PES is a viable environmental management tool for the Kuywa water shed and similar watersheds.

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Nickerson, Jason W. "A Field Evaluation of Tools to Assess the Availability of Essential Health Services in Disrupted Health Systems: Evidence from Haiti and Sudan." Thesis, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/30373.

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Background: This thesis presents three research papers that evaluate the current tools and methods used to assess the availability of health resources and services during humanitarian emergencies. Methods: A systematic review of peer-reviewed and grey literature was conducted to locate all known health facilities assessment tools currently in use in low- and middle-income countries. The results of this review were used to generate a framework of essential health facilities assessment domains, representative of seven health systems building blocks. Using this framework, a field-based evaluation of tools used to assess the availability of health resources and services in emergencies in Haiti and the Darfur states of Sudan was conducted. The collected assessment tools from these countries were compared against the framework from the systematic review, as well as the Minimum Standards for Health Action in the Sphere Humanitarian Charter and Minimum Standards in Humanitarian Response, and the Global Health Cluster’s Set of Core Indicators and Benchmarks by Category. A coding system was developed using all of these frameworks that enabled the comparison of the assessments collected in both countries. Field-based interviews were conducted with key informants using a convergent interviewing methodology, to gain perspectives on data collection and the use of evidence in formulating health systems interventions in emergencies. Results: 10 health facility assessments were located in the systematic review of the literature, generating an assessment framework comprised of 41 assessment domains. Of the included assessments, none contained assessment criteria corresponding to all 41 domains, suggesting a need to standardize these assessments based on a structured health systems framework. In Haiti and Sudan, a total of 9 (Haiti, n=8; Sudan, n=1) different assessment tools were located that corresponded to assessments of the availability of health resources and services. Of these, few collected data that could reasonably have corresponded to the different assessment domains of the health facilities assessment framework or the Sphere Standards, nor could many have provided the necessary inputs for calculating the Global Health Cluster’s indicators or benchmarks. The exception to this was the one tool located in Sudan, which fared reasonably well against these criteria. The interviews with participants revealed that while evidence was viewed as important, systematically-collected data were not routinely being integrated into program planning in emergency settings. This was, in part, due to the absence of reliable information or the perceived weaknesses of the data available, but also due uncertainty as to how to best integrate large amounts of health system data into programs. Conclusions: Greater emphasis is needed to ensure that data on the availability and functionality of health services during major emergencies is collected using methodologically-sound approaches, by field staff with expertise in health systems. There is a need to ensure that baseline data on the health system is available at the outside of emergency response, and that humanitarian health interventions are based on reliable evidence of needs and capacities from within the health system.

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Dissertations / Theses on the topic '4203 Health services and systems'

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