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Dissertations / Theses on the topic 'Evaluation and quality control of medical care'
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Brindley, David. "Optimising the quality and effectiveness of risk : benefit appraisal methodologies utilised in randomised control trials." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:3a3f837c-1180-4609-80e5-c9d3d6ee1844.
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Al-Awa, Bahjat. "Impact of hospital accreditation on patients' safety and quality indicators." Doctoral thesis, Universite Libre de Bruxelles, 2011. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209917.
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Ecole de Santé Publique Université Libre de Bruxelles
Academic Year 2010-2011
Al-Awa, Bahjat
Impact of Hospital Accreditation on Patients' Safety and Quality Indicators
Dissertation Summary
I.\
Doctorat en Sciences
info:eu-repo/semantics/nonPublished
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Eckermann, Simon Economics Australian School of Business UNSW. "Hospital performance including quality: creating economic incentives consistent with evidence-based medicine." Awarded by:University of New South Wales. School of Economics, 2004. http://handle.unsw.edu.au/1959.4/22011.
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This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.
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Mpuntsha, Loyiso F. "Continuing professional development in medicine : the inherent values of the system for quality assurance in health care." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52173.
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Thesis (MPhil)--Stellenbosch University, 2001.ENGLISH ABSTRACT: The practice of medicine has always been a big area of interest as a profession. The focus ranges depending on issues at hand - it may be on the educational, training, humanistic, economic, professional ethics and legal aspects. One area of medicine that is under the spotlight around the world is that of the maintenance of clinical competency, followed very closely and almost linked to professional ethics. This study follows the introduction of a system of Continuing Professional Development (hereinafter also referred to as CPD), in South Africa and an overview of how it has been introduced in a few other countries. The main areas of focus being the extrication of inherent values of CPD, relating this aspect to quality improvement in medical health care. The medical profession as well as most of the interested parties, has different perspectives regarding the fact that the system is regulated through legislation. There is also the doubt whether the CPD system will be effective in achieving the goals that it has been set to achieve. Although a system of Continuing Medical Education has been a tradition in all countries, which implies that the CPD system is not totally new as far as the educational principles are concerned, the values accruable need to be exploited. It is the possible success of this kind of evaluations that may foster more understanding of the inherent values in this CPD system.
AFRIKAANSE OPSOMMING: Beroepsgewys het die praktyk van geneeskunde nog altyd groot belangstelling gelok. Die fokus verskuif na gelang van die onderwerpe ter sprake. Dit wissel van opvoedkunde, opleiding, humanisme, ekonomie, en professionele etiek tot regsaspekte. Dwarsoor die wêreld word daar gefokus op die handhawing van kliniese vaardighede, gevolg deur professionele etiek wat ook daarin verweef is. Hierdie studie bespreek die instelling van 'n stelsel van Voortgesette Professionele Ontwikkeling (hierna verwys na as VPO) in Suid-Afrika asook oorsig oor die wyse waarop dit in 'n paar ander lande ingestel is. Die klem lê op die inherente waardes met betrekking tot die verbetering gehalte in mediese gesondheidsorg. Die mediese beroep, asook meeste van die belangegroepe het verskillende opvattings oor die feit dat die stelsel deur wetgewing gereguleer word. Daar is ook twyfel of die VPO-stelsel in sy vooropgestelde doelwitte sal slaag. Wat die opvoedkundige beginsels betref, is die VPO-stelsel nie totaal en al nuut nie. Alhoewel VPO in ander lande tradisie is, is dit nodig om die totstandkoming van waardes te ontgin. Die moontlike sukses van hierdie tipe van evaluasies mag dalk beter begrip ten opsigte van die inherente waardes in die VPO-stelsel bevorder.
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Sugarman, Philip A. "A model of integrated healthcare governance." Thesis, University of Northampton, 2009. http://nectar.northampton.ac.uk/2716/.
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The history of psychiatry is littered with serious failures of governance, to the detriment of mentally disordered people, especially those resident in psychiatric hospitals. Current mental health providers, increasingly focussed on community care, have also struggled to develop effective internal governance systems. Nine peer-reviewed research papers, published by the author (mostly with others) and the wider literature, reveal deficits in mental health governance at a jurisdictional, professional, and corporate level. In this thesis new governance solutions are developed against this background, built on contemporary principles in mental health and healthcare management. A new model of mental health governance is presented, based on the key demands of the strategic and regulatory environment, articulated as rights, risks and recovery. This integrated healthcare governance approach, covering provider policy, staff training and service audit, can monitor and ensure the protection of patients’ rights, as well as those of others; it also promotes the management of clinical risks, and of patients’ recovery outcomes. Rights-based risk-reduction training is the core interventional element of the model, whilst the monitoring element can be formalised as part of a Balanced Scorecard reporting system. This thesis makes a contribution to research methodology, theory and practice in mental health, human rights, healthcare management and governance. The model generates specific propositions for testing in mental health governance, with the potential for application in wider settings of service provision.
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Court, Alex J. "They're NICE and neat, but are they useful? : a grounded theory of clinical psychologists' beliefs about, and use of, NICE guidelines." Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/12832/.
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There is a growing research interest into investigating why NICE (National Institute for Health and Care Excellence) guidelines are not consistently followed in UK mental health services. The current study utilised grounded theory methodology to investigate clinical psychologists’ use of NICE guidelines. Eleven clinical psychologists working in routine practice in the NHS were interviewed. A theoretical framework was produced conceptualising the participants’ beliefs, decision making processes and clinical practices. The overall emerging theme was “considering NICE guidelines to have benefits but to be fraught with dangers”. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, as a result of pressure, and also the rewards that follow from being seen to comply with NICE guidelines, they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. This is the first theoretical framework that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. Attention is drawn to the proposed benefits and limitations of guidelines and how these are managed. This study highlights the importance of clinical psychologists articulating and advertising their specialist skills. The findings are integrated with existing theory and research, and clinical and research implications are presented.
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Fickel, Jacqueline Jean. "Quality of care assessment : state Medicaid administrators' use of quality information." Full text (PDF) from UMI/Dissertation Abstracts International Access restricted to users with UT Austin EID, 2002. http://wwwlib.umi.com/cr/utexas/fullcit?p3077639.
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Javed, Sumbal. "Reconfiguration of vascular services to enhance quality of care." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206915.
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Hong Kong's aging population has, increased demand for vascular services. Currently, vascular surgery is subsumed under general surgery. The workload on both general surgery and vascular surgery is demanding and hence, not conductive to the development of vascular surgery. The volume of surgery, particularly emergency surgery provided by the Hospital Authority units varies significantly. The collaboration and differentiation of labor at present is not well defined in many centers. This may lead to unnecessary competition and duplication of resources in the long run.
This project examined if there is room for improvement in the present situation and provides evidence for relevant service reconfiguration and discusses how Hong Kong can learn from some overseas examples to enhance quality of services delivered to patients.published_or_final_version
Public Health
Master
Master of Public Health
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Driesen, Kevin E. "Statistical process control as quantitative method to monitor and improve medical quality." Diss., The University of Arizona, 2004. http://hdl.handle.net/10150/280602.
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Statistical Process Control (SPC) methods, developed in industrial settings, are increasingly being generalized to medical service environments. Of special interest is the control chart, a graphic and statistical procedure used to monitor and control variation. This dissertation evaluates the validity of the control chart model to improve medical quality. The research design combines descriptive and causal comparative (ex-post facto) methods to address the principal research question, How is the control chart model related to medical quality? Hospital data were used for patients diagnosed with Community Acquired Pneumonia (CAP). During the initial research phase, five medical quality "events" assumed to affect CAP medical quality indicators were pre-specified by hospital staff. The impact of each event was then evaluated using control charts constructed for CAP quality indicators. Descriptive analysis was undertaken to determine whether data violated the statistical assumptions underlying the control chart model. Then, variable and attribute control charts were constructed to determine whether special cause signals occurred in association with the pre-specified events. Alternative methods were used to calibrate charts to different conditions. Sensitivity was computed as the proportion of event-sensitive signals. The descriptive analysis of CAP indicators uncovered "messy," and somewhat complex, data structure. The CAP indicators were marginally stable showing trend, seasonal cycles, skew, sampling variation and autocorrelation. Study results need to be interpreted with the knowledge that few events were evaluated, and that the effect sizes associated with events were small. The charts applied to the CAP indicators showed limited sensitivity; for three chart-types (i.e. XmR, Xbar, and P-charts), there were more false alarms than event-associated signals. Conforming to expectation, larger sample size increased chart sensitivity. The application of Jaehn Decision Rules led to increases in both sensitivity and false alarm. Increasing subgroup frequency from month, to week samples, increased chart sensitivity, but also increased data instability and autocorrelation. Contrary to expectation, the application of hybrid charting techniques (EWMA and CUSUM) did not increase chart sensitivity. Study findings support the conclusion that control charts provide valuable insight into medical variation. However, design issues, data character, and causal logic provide conditions to the interpretation of control charts.
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Chu, Yim-kwong, and 朱琰光. "A study of the quality improvement of Hong Kong's health care system." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31966159.
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Patterson, Jan. "Consumers and complaints systems in health care /." Title page, contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09php3174.pdf.
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Lai, Tai-yee Barbara, and 黎德怡. "Pay for patient satisfaction: what is the evidence for quality of improvement?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B4299486X.
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Wong, Nga-man, and 黃雅敏. "Quality evaluation of geriatric health information on Yahoo! Answers : a cross-cultural comparative study." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193007.
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Given the increases on global ageing population, popularity of social Q&A sites and the level of geriatric health concerns from family caregivers, it raises the uncertainty about the quality of health information on social Q&A sites for family caregivers of elderly. The purposes of this study are to evaluate the quality of geriatric health information on social Questions and Answers (Q&A) sites: Yahoo! Answers from registered nurses’ perspective, to identify the structural patterns of questions and answers vary in quality and to discover the cultural aspects in relation to the findings. A total of 60 question-answers set is retrieved from regional Yahoo! Answers sites, including Australia, Canada, UK & Ireland, US, Hong Kong, Mainland China and Taiwan. 126 English answers and 112 Chinese answers are examined.
Through a mixed method approach, results show that the overall information quality provided in Chinese group is relatively poorer than those of English. About 40% of questioners form both groups are not capable of judging the best answer among choices. In terms of structural patterns, questioners from both language groups are less capable of asking questions with clear focuses. 4 structural patterns, including Chinese and English answers with good and poor quality, are identified. Furthermore, cultural differences are found to have a significant impact on the level of information quality in social Q&A site. Finally, recommendations to corresponding social sectors are made for improving the current information quality of social Q&A sites in future.published_or_final_version
Library and Information Management
Master
Master of Science in Library and Information Management
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Cheung, Yuk-fai, and 張煜暉. "Clinical and health-related quality of life evaluation of acute strokeunit care versus conventional medical care for minor stroke patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48422800.
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The efficacy of stroke units has been extensively investigated in clinical trials. However, little information is available to the health care providers and policy makers on the benefits of stroke unit care in Hong Kong. The quality of life of our local stroke patients is largely unknown.
The objective of this study was to compare the 2-month outcomes after stroke admitted to either a stroke unit or a non-stroke unit. Outcomes included mortality, dependency, institutional care and quality of life. This was a prospective observational study conducted in a regional, tertiary hospital in Hong Kong. Baseline demographic and clinical data were collected from the subjects. The 36-Item Short-Form health survey (SF-36) questionnaire was administered to them. Follow up assessment at two months were made for mortality, dependency, institutionalisation, length of hospital stay and SF-36.
Eligible subjects were Cantonese-speaking Chinese aged 18 years or over. They should provide written informed consent, and verbally and cognitively competent in completing the SF-36 questionnaire
162 patients with acute stroke were included in the analysis. 106 patients were solely managed in the stroke unit. 41 patients were managed in other wards (as the control group). There were no statistically significant differences found between the two groups for death alone, death or dependency, and death or institutionalisation.
Multivariate logistic regression analyses showed similar findings. Mean lengths of acute and total hospital stay were similar between the two groups. Quality of life was impaired during the acute phase of stroke as reflected by low Physical Functioning (PF) and Social Functioning (SF) dimensions of the SF-36. At two months, significant improvement was observed in five out of eight dimensions of the SF-36 as well as its two summary scores, Physical Component Summary (PCS) and Mental Component Summary (MCS). There were several limitations in our study, namely small number of patients, minor stroke severity and tertiary hospital setting.
In conclusion, no significant differences in the clinical outcomes were found between the stroke unit group and the control group. These findings were inconclusive in view of limitations in this study. Stroke affected quality of life. Future researches with larger sample size are warranted.published_or_final_version
Public Health
Master
Master of Public Health
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He, Xinju. "Three essays on treatment quality : theory, measures and application in the hospital sector in China." HKBU Institutional Repository, 2019. https://repository.hkbu.edu.hk/etd_oa/698.
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This thesis investigates the treatment quality of medical services in the hospital sector from different angles: theory, measures and application in China. This thesis includes three essays. The first essay (Chapter 2) is a critical review about the quality assessment. It shows that the environmental performance index is suitable for measuring treatment quality. The second essay (Chapter 3) introduces alternative approaches to environmental performance indices to solve the infeasibility problem of current measures. Environmental performance indices are measures to evaluate the production of undesirable outputs relative to desirable outputs. My new measures are more accurate using the sequential frontier and various reference vectors. The last essay (Chapter 4) is an empirical case study in the Chinese hospital sector that examines how the degree of government involvement and the degree of market competition affect the performance of treatment quality. Using the environmental performance indices of Essay 2 to evaluate treatment quality, I find that the performance of treatment quality of Chinese hospitals improved during the 2009-2014 period. Therefore, the marketisation of hospitals and government subsidies contribute to this sustained improvement
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Sist, Martha. "Implementing quality in the healthcare industry." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/302.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Engineering
Industrial Engineering and Management Systems
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Petersson, Håkan. "On information quality in primary health care registries /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/tek805s.pdf.
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Ramos, Vanessa Mesquita. "Evaluation of the quality of care provided to women for prevention and control of cervical cancer in primary care in Sobral-CE." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12469.
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nÃo hÃApesar de esforÃos contÃnuos que vem sendo aplicados na prevenÃÃo e no controle do cÃncer do colo do Ãtero nas Ãltimas dÃcadas, este permanece um importante desafio para a saÃde no nosso paÃs. Isto porque, requer aÃÃes de variados graus de complexidade e de recursos humanos de diversas Ãreas de conhecimento. A AtenÃÃo PrimÃria à SaÃde desempenha importante papel nas vÃrias dimensÃes do cuidado para o cÃncer do colo do Ãtero, pois possui um papel estratÃgico para desenvolver aÃÃes de planejamento, implementaÃÃo e acompanhamento relacionadas à prevenÃÃo, detecÃÃo, tratamento e reabilitaÃÃo das mulheres com cÃncer cervical. Esta pesquisa tem o objetivo principal de avaliar a qualidade da assistÃncia prestada Ãs mulheres para prevenÃÃo e controle do CÃncer de Colo do Ãtero na AtenÃÃo PrimÃria à SaÃde em Sobral-CE. Trata-se de um estudo do tipo avaliativo com abordagem quantiqualitativa sob o enfoque de Donabedian no qual foram avaliados estrutura, processo e resultados em 15 unidades bÃsicas de saÃde na sede do municÃpio. Participaram da pesquisa 15 gerentes (estrutura), 14 mÃdicos e 15 enfermeiras (processo) e 58 usuÃrias (resultado). Os dados quantitativos foram processados no programa Microsoft Office Excel 2007 e os qualitativos foram submetidos à anÃlise de conteÃdo do tipo anÃlise temÃtica proposta por Minayo. Esta pesquisa respeitou os princÃpios bioÃticos descritos na ResoluÃÃo n 466/12 do Conselho Nacional de SaÃde e foi aprovada pelo Comità de Ãtica em pesquisa sob protocolo de nÃmero 245.512. Na investigaÃÃo sobre a estrutura identificamos que a disponibilidade de recursos fÃsicos e materiais à adequado para a maioria das unidades, que a coleta do exame citopatolÃgico Ã, em sua maioria, realizado pelas enfermeiras e as consultas ginecolÃgicas realizadas tanto por mÃdicos quanto por enfermeiros. A anÃlise do processo revelou que as unidades nÃo dispÃem de mecanismos de registro para identificaÃÃo e busca ativa das mulheres com exame em atraso, a captaÃÃo destas à dependente da procura pelo serviÃo de saÃde, as condutas e encaminhamentos dependem diretamente da alteraÃÃo encontrada, existe uma boa interaÃÃo ente os nÃveis de atenÃÃo, porÃm com dÃficits na comunicaÃÃo, falta de momentos de capacitaÃÃo profissional em serviÃo, assim como, fatores facilitadores como o livre acesso e a oferta semanal com dias fixos e restritivos como acomodaÃÃo profissional, falta das mulheres ao exame e demora nos resultados. No terceiro e Ãltimo elemento, o resultado, encontramos como principal motivador para a procura pelo atendimento a necessidade de conhecimento sobre seu estado de saÃde atribuindo ao exame a importÃncia de prevenir doenÃas, referÃncias sobre a facilidade no agendamento e atendimento nas unidades e satisfaÃÃo das usuÃrias em relaÃÃo ao acesso, gratuidade, rapidez e qualidade do serviÃo oferecido. ConcluÃmos que, de forma geral, a estrutura identificada mostrou-se adequada para a maioria das unidades investigadas, o processo de trabalho dos profissionais diretamente envolvidos revelou-se frÃgil frente Ãs atividades desenvolvidas e o resultado expÃs a opiniÃo e a satisfaÃÃo das usuÃrias decorrentes das aÃÃes oferecidas. O contato com todos estes dados permitiu a avaliaÃÃo dos fatores envolvidos na prestaÃÃo do cuidado que poderÃo subsidiar a anÃlise e planejamento das aÃÃes voltadas para a saÃde da mulher e o amadurecimento dos serviÃos do SUS no nosso paÃs.
Despite ongoing efforts that are being applied in the prevention and control of cervical cancer over the past decades, it remains a major challenge for health in our country. This is because actions require varying degrees of complexity and human resources from different areas of knowledge. The primary health care plays an important role in the various dimensions of care for cancer of the cervix, it has a strategic role to develop actions in planning, implementation and related to the prevention, detection, treatment and rehabilitation of women with cervical cancer monitoring. This research has the main objective to assess the quality of care provided to women for prevention and control of Cervical Cancer in Primary Health Care in Sobral-CE. This is an assessment study with quantitative-qualitative approach from the standpoint of Donabedian that assessed the structure, process and outcomes in 15 basic health units in the town. 15 managers participated in the survey (structure), 14 doctors and 15 nurses (case) and 58 users (result). The quantitative data were processed in Microsoft Office Excel 2007 and underwent qualitative content analysis of the type proposed by Minayo thematic analysis. This study followed the bioethical principles outlined in Resolution No. 466/12 of the National Board of Health and was approved by the Research Ethics Committee under protocol number 245 512. Research into the structure identified that the availability of physical and material resources is suitable for most units, the collection of Pap smear testing is mostly performed by nurses and gynecological consultations by doctors and by nurses. The process analysis revealed that the units do not have mechanisms for identification and registration of active search of women with late examination, the capture of these is dependent on demand for health services, pipes and referrals depend directly on changes found, there is a good interaction entity levels of care, but with deficits in communication, lack of time for professional in-service training as well as facilitating factors such as free access and weekly offering with fixed and restrictive days as a professional accommodation, lack of women to take and delay in results. In the third and final element, the result, we found the main motivator for seeking care by the need for knowledge about their health status examination attributing to the importance of preventing disease, results for the ease in scheduling and attendance units and satisfaction of users regarding access, gratuity, speed and quality of service offered. We conclude that, in general, the identified structure was adequate for most units investigated, the process of working professionals directly involved proved fragile in the face of activities carried out and the result exposed the opinion and satisfaction of users resulting from shares offered. Contact with all these data allowed the evaluation of the factors involved in the provision of care that can support the analysis and planning of actions for women's health and the ripening of NHS services in our country.
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Qin, Hong. "Links among perceived service quality, patient satisfaction and behavioral intentions in the urgent care industry: Empirical evidence from college students." Thesis, University of North Texas, 2009. https://digital.library.unt.edu/ark:/67531/metadc11014/.
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Patient perceptions of health care quality are critical to a health care service provider's long-term success because of the significant influence perceptions have on customer satisfaction and consequently organization financial performance. Patient satisfaction affects not only the outcome of the health care process such as patient compliance with physician advice and treatment, but also patient retention and favorable word-of-mouth. Accordingly, it is a critical strategy for health care organizations to provide quality service and address patient satisfaction. The urgent care (UC) industry is an integral part of the health care system in the United States that has been experiencing a rapid growth. UC provides a wide range of medical services for a large group of patients and now serves an increasing population. UC is becoming popular because of the convenient locations, extended hours, walk-in policy, short waiting times, and accessibility. A closer examination of the current health care research, however, indicates that there is a paucity of research on urgent care providers. Confronted with the emergence of the urgent care industry and the increasing demand for urgent care, it is necessary to understand how patients perceive urgent care providers and what influences patient satisfaction and retention. This dissertation addresses four areas relevant to the above mentioned issues: (1) development of an instrument to measure perceived service quality in the urgent care industry; (2) identification of the determinants of patient satisfaction and behavioral intentions; (3) empirical examination of the relationships among perceived service quality, patient satisfaction and behavioral intentions; and (4) comparison of the perceived service quality across several primary urgent care providers, such as urgent care centers, hospital emergency departments, and primary care physicians' offices. To validate this new instrument and examine the hypothesized relationships proposed in this study, an electronic web based survey was designed and administered to college students. Both exploratory and confirmatory factor analysis were employed to assess the reliability and validity of the developed instrument. The contextualized relationships were evaluated using structural equation modeling. The results of this research could potentially contribute to urgent care management and quality improvement.
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Gill, Peter John. "Developing paediatric quality indicators for UK general practice." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:1837f24f-e501-4e56-906d-6080191f09cb.
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The overall aim of this thesis is to define a candidate set of quality indicators that are evidence-based, feasible to implement, and have the potential to improve the quality of care provided for children in UK general practice. The indicators were developed using a three-stage process. First, the areas and aspects of care of highest priority for quality indicator development were identified. This was achieved by seeking the views of primary care clinicians and by undertaking a formal analysis of unplanned hospital admissions for ambulatory care sensitive conditions. Then, the evidence-base to underpin indicator development was identified through an overview of Cochrane systematic reviews of interventions relevant to the primary care of children. A search of SIGN and NICE national guidelines was also conducted to inform the evidence-base. Lastly, an expert panel determined the formulation and selection of indicators by applying the RAND appropriateness methodology. This process created a final set of 26 quality indicators in six priority areas: early recognition of potentially serious illness (n=7); child protection and safeguarding (n=4); mental health (n=4); health promotion (n=1); routinely managed conditions (n=6); and general practice management (n=4). The main strength of these indicators is that they reflect a strong professional consensus on their validity and feasibility. The main weakness is that the indicators are underpinned by evidence mainly derived from expert opinion rather than formal research; the requirement for professional consensus means that they do not challenge existing models of care delivery.
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Smith, Michael William. "Utilizing Control in Emergency Medical Services: Expertise in Paramedics." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1291139651.
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Xu, Jun. "Quality evaluation of Dendrobium species based on the analysis of multiple components." Thesis, University of Macau, 2010. http://umaclib3.umac.mo/record=b2454978.
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Barlow, Hilary Joan. "An evaluation of neonatal nursing care in selected hospitals in the Western Cape." Thesis, Stellenbosch : University of Stellenbosch, 2003. http://hdl.handle.net/10019.1/16253.
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Thesis (MCUR)--University of Stellenbosch, 2003.ENGLISH ABSTRACT: South Africa has a proud history of a high standard of health care delivery in State funded hospitals. This implies that high standards of education and care in both medical and nursing training have been achieved. The care of sick and premature newborn infants by nurses is a speciality that has evolved worldwide over the last forty years as a result of various technological developments. In order to ensure the standard of care delivered, protocols of care should be available for nurses to refer to and to measure their work against. There were no protocols of care available in the two Neonatal Units (NICUs) used in this study. Using a non-experimental, exploratory descriptive design, the researcher set about measuring the quality of nursing care in the NICUs. Standards (structure, process and outcome) were written by the researcher, and validated. The results showed that the standards were not met at an acceptable level in various areas. One of the areas of great concern was the lack of effective hand washing. Outcome standards which reflect the consequences of care indicated serious shortages of staff in some cases and insufficient staff training. Recommendations are that a Quality Assurance Program should be introduced with training and education of the nurses working in the NICUs and the introduction of evidencebased practice. Future research should aim at showing the way to improve the service delivered.
AFRIKAANSE OPSOMMING: Suid-Afrika het ‘n trotse geskiedenis van ‘n hoë standard van gesondheidsorgdienslewering in Staatsbefondsde hospitale. Dit impliseer dat hoë standaarde in mediese en verpleegopleiding bereik is. Die versorging van siek en premature pasgebore babas deur verpleegkundiges is ‘n spesialiteit wat oor die afgelope veertig jaar wêreldwyd ontwikkel het as gevolg van verskeie tegnologiese ontwikkelings. Ten einde te verseker dat ‘n hoë standard van sorg gelewer word, moet protokolle beskikbaar wees vir verpleegkundiges om te gebruik en hulle werkverrigting teen te meet. Daar was geen protokolle beskikbaar in die twee neonatale eenhede wat in hierdie studie gebruik is nie. ‘n Nie-eksperimentele, verkennende, beskrywende ontwerp is deur die navorser gebruik om die gehalte van verpleegsorg in die neonatale eenhede te evalueer. Standaarde (struktuur, proses en uitkoms) is deur die navorser opgestel en gevalideer. Die resultate toon aan dat die standaarde in verskeie areas nie aanvaarbaar nagekom word nie. ‘n Kommerwekkende bevinding was die afwesigheid van effektiewe was van hande. Uitkomsstandaarde wat die resultaat van sorg weerspieël, het aangedui dat daar ernstige tekorte aan personeel in sommige gevalle bestaan het asook onvoldoende opleiding van personeel. Aanbevelings is dat ‘n Gehalteversekeringsprogram ingestel behoort te word en met die opleiding van verpleegkundiges werksaam in die neonatale eenhede en evidence-based practice aangespreek moet word. Toekomstige navorsing behoort aan te dui hoe om die diens wat gelewer word, te verbeter.
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Daniel, Gregory Wayne. "An Evaluation of a Payer-Based Electronic Health Record in an Emergency Department on Quality, Efficiency, and Cost of Care." Diss., The University of Arizona, 2008. http://hdl.handle.net/10150/195598.
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Background: Health information exchange technologies are currently being implemented in many practice settings with the promise to improve quality, efficiency, and costs of care. The benefits are likely highest in settings where entry into the healthcare system is gained; however, in no setting is the need for timely, accurate, and pertinent information more critical than in the emergency department (ED). This study evaluated the use of a payer-based electronic health record (EHR) in an ED on quality, efficiency, and costs of care among a commercially insured population.Methods: Data came from a large health plan and the ED of a large urban ED. Visits with the use of a payer-based EHR were identified from claims between 9/1/05 and 2/17/06. A historical comparison sample of visits was identified from 11/1/04 to 3/31/05. Outcomes included return visits, ED duration, use of laboratory and diagnostic imaging, total costs during and in the four weeks after, and prescription drug utilization.Results: A total of 2,288 ED visits were analyzed (779 EHR visits and 1,509 comparison visits). Discharged visits were associated with an 18 minute shorter duration (95% CI: 5-33); whereas, the EHR among admitted visits was associated with a 77 minute reduction (95% CI: 28-126). The EHR was also associated with $1,560 (95% CI: $43-$2,910) savings in total plan paid for the visit among admitted visits. No significant differences were observed on return visits, laboratory or diagnostic imaging services and total costs over the four week follow-up. Exploratory analyses suggested that the EHR may be associated with a reduction in the number of prescription drugs used among chronic medication users.Conclusion: The EHR studied was associated with a significant reduction in ED duration. Technologies that can reduce ED lengths of stay can have a substantial impact on the care provided to patients and their satisfaction. The data suggests that the EHR may be associated with lower health plan paid amounts among admitted visits and a reduction in the number of pharmacy claims after the visit among chronic users of prescription drugs. Additional research should be conducted to confirm these findings.
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Yao, Wei-yen Rosa. "An evaluation of the reform and quality of pharmacy service in Hospital Authority : a case study at Princess Margaret Hospital /." Hong Kong : University of Hong Kong, 1995. http://sunzi.lib.hku.hk/hkuto/record.jsp?B14035534.
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Li, Cong. "A study on healthcare quality management in Guangzhou." Thesis, University of Macau, 2001. http://umaclib3.umac.mo/record=b1636657.
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Zullig, Keith J., Laura Lander, Rebecca J. White, Carl Sullivan, Clara Shockley, Lili Dong, Robert P. Pack, and Tara Surber Fedis. "Preliminary Evaluation of the WV Prescription Drug Abuse Quitline." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/6335.
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Purpose: To evaluate the effectiveness of the West Virginia Prescription Drug Abuse Quitline (WVPDAQ). Methods: Descriptive data and inferential analyses are provided for the period of operations from 9/11/2008 to 3/1/2010. Chi-square tests for Independence compared differences between callers completing at least one follow-up survey against callers completing only the baseline intake survey were observed. A Wilcoxon signed rank sum test tested differences between the scores of intake callers and follow-up callers at the one-week (n=177) and one-month (n=89) intervals. Results: A total of 1,056 calls were received, including 670 intakes, 177 1st follow-ups, 89 2nd follow-ups, and 36 3rd follow ups, and 84 caller satisfaction surveys. Chi-square analyses determined that callers who only completed the intake survey tended to have initiated drug use at a younger age ([less than or equal to] 39 years of age, [chi square]=7.63, p=.02). Longitudinal findings indicated significant self-reported declines in daily drug use (p<.0001), increased intentions to quit in the next 30 days (p<.0001), and declines in requesting a referral for treatment (p<.0001) at the one-month follow-up. Finally, approximately 19% (n=17) of callers reported obtaining a counseling/ treatment appointment as a result of calling the WVPDAQ at the one-month follow up. Conclusions: Preliminary results suggest the WVPDAQ has established itself as a meaningful resource to combat prescription drug abuse in West Virginia. Sustainable funding and greater integration of the WVPDAQ into existing and developing treatment infrastructure could provide more affordable options for the state of West Virginia and its citizens.
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Behkami, Nima A. "Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home." PDXScholar, 2012. https://pdxscholar.library.pdx.edu/open_access_etds/237.
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It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to provide information about their payer mix, implementation barriers, registry implementation, registry use, and clinic satisfaction. The survey instrument was validated by an expert panel which included practitioners and researchers. Statistical methods including Structural Equation Modeling were used for analysis and to test the research hypotheses. The majority of medical home practices that responded used some type of computerized registry, either with basic patient information or integrated with detailed clinical information. And on average, they somewhat used registries for population management, individual health management, proactive care and planned care visits. All practices encountered some combination of barriers when implementing a medical home program. Most practices reported clinic satisfaction at least improved after becoming a medical home. The results of the analysis show that indeed payer mix, in particular Medicare and private insurance, has a significant relationship with level of registry implementation. There were no significant relationships between barriers and registry implementation or use. More sophisticated registry implementation led to greater registry use. And registry use is associated with increased clinic satisfaction. This research fills an important gap in understanding Health IT use, registries in particular, among Patient-Centered Medical Homes. The findings suggest that: 1) Implementation barriers may not be influencing use of computerized registries in medical home practices; 2) Using more sophisticated computerized registries facilitates registry use, which can help improve clinic satisfaction; 3) Payer mix may influence use of more sophisticated Health IT in medical home practices.
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McCall, MacBain Marcy C. "Yoga as a complex intervention and its development for health-related quality of life in adult cancer." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:c7259cbe-b6c0-42f8-b893-79306cdccdfa.
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The aim of this thesis was to develop yoga as a complex intervention in health care for the improvement of health-related quality of life (HRQoL) in adult cancer. As the Indian tradition of practising yoga increases in popularity worldwide, populations in the West are beginning to see yoga as an opportunity to prevent and treat health conditions. The Medical Research Council’s framework has provided a methodology to address a paucity of coherent evidence for the myriad of unsupported health claims made by yoga enthusiasts. The thesis structure included a step-by-step approach to investigate biomedical theories of how yoga might work to improve health, to synthesise evidence of yoga interventions, to model their process and outcomes, and to test evaluation procedures in the context of a randomised controlled trial (RCT). The results of a bibliometric analysis indicated an overall increase in the publication rate of yoga research in health care, and in 2005 this research began to focus on cancer. A component analysis, semi-structured patient interviews (n=10) and oncologist surveys (n=29) were successively designed, implemented and analysed to advance a model of yoga intervention specific to adult cancer. The cumulative results were applied to design three yoga interventions randomly allocated to men and women receiving treatment for cancer (n=15). Outcomes of the feasibility study demonstrated that yoga intervention is appropriate for adult patients and can be administered safely in a clinical setting. In its conclusion, this thesis produces evidence-based support for the optimisation of yoga intervention in the context of a large-scale RCT for HRQoL in adult cancer, and it provides recommendations to improve research methodology and reporting of complex interventions in health care.
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Rojas-Candio, Piero, Arturo Villantoy-Pasapera, Jimmy Armas-Aguirre, and Santiago Aguirre-Mayorga. "Evaluation Method of Variables and Indicators for Surgery Block Process Using Process Mining and Data Visualization." Repositorio Academico - UPC, 2021. http://hdl.handle.net/10757/653799.
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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.In this paper, we proposed a method that allows us to formulate and evaluate process mining indicators through questions related to the process traceability, and to bring about a clear understanding of the process variables through data visualization techniques. This proposal identifies bottlenecks and violations of policies that arise due to the difficulty of carrying out measurements and analysis for the improvement of process quality assurance and process transformation. The proposal validation was carried out in a health clinic in Lima (Peru) with data obtained from an information system that supports the surgery block process. Finally, the results contribute to the optimization of decision-making by the medical staff involved in the surgery block process.
Revisión por pares
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O'Connor, Patricia. "Looking for harm in healthcare : can Patient Safety Leadership Walk Rounds help to detect and prevent harm in NHS hospitals? : a case study of NHS Tayside." Thesis, University of St Andrews, 2012. http://hdl.handle.net/10023/2804.
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Today, in 21st century healthcare at least 10% of hospitalised patients are subjected to some degree of unintended harm as a result of the treatment they receive. Despite the growing patient safety agenda there is little empirical evidence to demonstrate that patient safety is improving. Patient Safety Leadership Walk Rounds (PSLWR) were introduced to the UK, in March 2005, as a component of the Safer Patients Initiative (SPI), the first dedicated, hospital wide programme to reduce harm in hospital care. PSLWR are designed, to create a dedicated ‘conversation’ about patient safety, between frontline staff, middle level managers and senior executives. This thesis, explored the use of PSLWR, as a proactive mechanism to engage staff in patient safety discussion and detect patient harm within a Scottish healthcare system- NHS Tayside. From May 2005 to June 2006, PSLWR were held on a weekly basis within the hospital departments. A purposive sample, (n=38) of PSLWR discussions were analysed to determine: staff engagement in the process, patient safety issues disclosed; recognition of unsafe systems (latent conditions) and actions agreed for improvement. As a follow-up, 42 semi-structured interviews were undertaken to determine staff perceptions of the PSLWR system. A wide range of clinical and non-clinical staff took part (n=218) including medical staff, staff in training, porters and cleaners, nurses, ward assistants and pharmacists. Participants shared new information, not formally recorded within the hospital incident system. From the participants perspectives, PSLWR, were non threatening; were easy to take part in; demonstrated a team commitment, from the Board to the ward for patient safety and action was taken quickly as a result of the ‘conversations’. Although detecting all patient harm remains a challenge, this study demonstrates PSLWR can be a useful tool in the patient safety arsenal for NHS healthcare organisations.
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Luke, Gary Joseph. "An assessment of the service quality expectations and perceptions of the patients of Awali Hospital in the Kingdom of Bahrain." Thesis, Rhodes University, 2008. http://hdl.handle.net/10962/d1003850.
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The quality of service from a hospital is the number one factor that will either turn a customer/patient away or make one for life. More and more hospitals are competing for greater shares in the market and customer-driven quality management is becoming the preferred method for improving their performance. Awali hospital is a private hospital in the Kingdom of Bahrain. It is a small 35-bed hospital that offers private medical services to the public. The hospital was originally built to serve the Bahrain Petroleum Company (Bapco) refinery workers but later opened its doors to the public. With the introduction of private patients came higher expectations of quality and higher demands on the overall services. A number of service quality shortfalls were identified over the years but never identified quantitatively by a patient evaluation survey. An English and Arabic version of the questionnaire based on SERVQUAL (Zeithaml, Parasuraman and Berry, 1988) was developed and placed in Awali hospital to test these service quality shortfalls. This study intends to evaluate these areas by answering questions about the relevant areas of service provided by the hospital. It measured patient satisfaction by looking at human aspects of service (responsiveness, reliability, empathy and assurance) with only one factor of the instrument being devoted to the non-human aspect of care rendered (tangibles). The SERVQUAL instrument has five dimensions that were measured by 21 pairs of item statements. One statement from each pair reflects perceptions, the other expectations. Measurement was accomplished by subtracting expectation from perceptions resulting in a service quality score. Positive or zero scores would reflect ideal or adequate service quality offered by the hospital. A negative score would be indicative of a service experience that did not meet customer expectations. Using the SERVQUAL questionnaire provided, quantifiable reasoning to the research questions in each dimension could be obtained so that precision, objectivity and rigour replaced hunches, experience and intuition as a means of investigating problem areas. Customers were first asked to supply some additional demographic information, for example gender, number of hospital visits, nationality, patient type (Bapco worker, general practitioner referred or private) and type of visit (inpatient, outpatient or both). They werethen asked to rate the hospital service on a 7-point Likert scale ranging from Strongly Agree (7) to Strongly Disagree (1). At the end of the questionnaire was space to write open comments. In total 600 paper questionnaires were distributed in the hospital, 300 English and 300 Arabic. Another 150 electronic questionnaires via emails were sent to refinery workers. Of the total 750 questionnaires distributed 162 were returned of which 156 (or 21.6%) could be statistically analysed. The empirical data results showed that the perception scores were significantly different at the p < 0.05 level from expectation scores. All the service quality differences (SQ=P-E) were negatively scored. This indicated that patients were not satisfied in all five dimensions of services offered by the hospital. Of the five dimensions responsiveness had the largest difference with assurance and reliability following with no significant differences between them. The demographic information revealed some interesting differences between the groups. Of all the demographic groups the most significant differences were between groups, “patient types” and “types of visit”, which showed differences between private patients and refinery workers and patients who used the hospital only as an outpatient and patients who used both services, outpatient and inpatient. In terms of the managerial implications, it was recommended that Awali hospital look to closing Gaps 1-4 of the SERVQUAL gap model which would result in closing the consumer gap, Gap 5. A process model for continuous measurement and improvement of service quality was recommended that looks at asking questions about how the hospital is performing. By adopting some of the recommendations identified in the research questions, Awali hospital could improve their quality of service, and as a consequence, their customer satisfaction and loyalty.
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Fielden, Jennifer E. "An Evaluation of the Quality Assurance Plan at East Tennessee State University’s Dental Hygiene Program." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etd/2298.
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Quality assurance in healthcare is fundamental in ensuring the achievement of desired outcomes for patients. In 2011 a quality assurance plan was created at the East Tennessee State University (ETSU) dental hygiene program in order to meet accreditation standards. The purpose of this study was to evaluate this plan in order to determine its effectiveness in improving the quality of patient care indicators. One hundred fifty patient charts were selected and audited. Deficiencies were counted in the categories of assessment, treatment, documentation, referral, caries management, perio management, patient education, and follow-up. Research findings were varied; however, external variables with the potential to affect the study’s results were identified. Furthermore, statistical process control procedures indicated that the quality assurance program was effective or had the potential to be effective. Although further research is warranted, this study could be used to improve quality assurance practices at the ETSU dental hygiene program.
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Nompozolo, Nikiwe Nomapelo. "The value of shared corporate services in improving patient care." Thesis, Rhodes University, 2009. http://hdl.handle.net/10962/d1003844.
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This case study was undertaken from mid 2003 to December 2005. It investigates the influence of the Corporate Services Centre (CSC) on customer (patient) service quality in the East London Hospital Complex (ELHC). This approach was justified on the basis that even though most patients do not have enough knowledge of clinical practices in order to make an accurate assessment on their quality, the same patients would readily appreciate factors such as faster turnaround times, drug availability and cleanliness. The study focuses on both service providers and end users for a quality health service delivery by looking at the potential of the shared corporate services centre. This was done by identifying important areas for improvements, such as response times, waiting periods and other aspects of the various services. The ELHC was formed from the merger of Frere and Cecilia Makiwane Hospitals, with a distance of 26km between the two institutions. The complex itself was in its infancy stages, having had to go through a process of re-engineering, rationalisation and standardisation of the two hospitals. The study seeks to answer the following key question: What has been the contribution of the corporate service centres in relation to health care service quality? The study examines the impediments to the realization of full potential of the Corporate Services Centre (CSC) through expedited decision-making and improved turnaround times. The main functions of the CSC were Procurement and Asset Management; General Administration (including but not limited to Transport, Office equipment, Patient Administration, Office Support, and Professional Secretariat Support); Financial Management and Administration; and Human Resource Management and Human Resources Administration. The study recommends that the CSC, to justify its existence, needs to consult with the clinicians and the patients to better understand what their needs and aspirations are. The study also emphasizes that the CSC is there purely to remove the administrative load and ease the processes and the biggest mistake is to make it an authority over the hospital, instead of being a support. Finally, it was realized that a lot of structural changes, business processes and organisational cultural changes are essential if one wants to create an impact through shared corporate services.
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Johnson, Laverne Michelle. "Measurement of service quality and customer satisfaction at a children’s hospital in the Western Cape." Thesis, Cape Peninsula University of Technology, 2017. http://hdl.handle.net/20.500.11838/2658.
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Thesis (MTech (Office Management and Technology))--Cape Peninsula University of Technology, 2017.Healthcare facilities across South Africa are increasingly facing a myriad of societal, fiscal, political and cultural challenges associated with demands for greater quality in the provision of healthcare services. This study measures service quality and customer satisfaction at a Cape Town hospital (hereinafter referred to as Hospital X), with the aim of providing its management with information to enable them to enhance service quality and thus improve customer satisfaction. It is essential to note that the respondents in this study were the parents or guardians of patients. The views of the patients were not obtained directly from them as it would have been unethical for minors to have participated in the survey. Their parents or guardians were surveyed in order to obtain the requisite data. The problem investigated was that management at public hospitals does not regularly research what customers need from a service quality point of view, Therefore, Hospital X may be failing to provide a quality service to its customers, namely, parents and guardians. Against this background, the researcher set out to measure customer perceptions and expectations of service quality by making use of the SERVQUAL model. “Customer expectation” is what the customer can reasonably expect given the available resources and is likely to be influenced by personal needs and past experience. “Customer perceptions” are totally subjective and based on the customer’s interaction with the service provided at Hospital X. The SERVQUAL model (reliability, assurance, tangibles, empathy and responsiveness), is commonly known as the RATER model, RATER being an acronym formed from the first letter of each of the five dimensions of SERVQUAL. The study incorporates the SERVQUAL dimensions within a survey comprising a number of questions structured on a six-point Likert scale. The results of applying the SERVQUAL model will indicate whether or not Hospital X provides a quality service to their customers. The study seeks to demonstrate the importance of service quality and customer satisfaction to hospital management, as well as the impact that effective service quality can have on customers’ evaluation of their overall hospital experience. (The term customer will be used interchangeably with parent and/or guardian in this study.)
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Yao, Wei-yen Rosa, and 姚惠穎. "An evaluation of the reform and quality of pharmacy service in Hospital Authority: a case study at PrincessMargaret Hospital." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1995. http://hub.hku.hk/bib/B31964874.
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Gray, Beverley Ann. "The influence of service quality perceptions and customer satisfaction on patients' behavioural intentions in the healthcare industry." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/514.
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Healthcare today has become a competitive industry, not only locally, but on a global level as well. In the South African economy the healthcare sector presently offers healthcare seekers two options to satisfy their healthcare needs – either through private business enterprises in the private sector or public enterprises in the public sector. Likewise, in the healthcare sector's hospital environment, patients can receive treatment from either private or public hospitals. As private business enterprises offering a relatively 'pure', but generally unsought-after service, private hospitals compete aggressively to attract patients. Patients are a hospital's lifeblood and they rightfully expect a high standard of customer service throughout the stay. With today's consumers being better informed, more sophisticated and more demanding than in the past, experts agree that the key to survival in the service industry today, almost without exception, is the quality of the service. The cornerstone of the service industry is without doubt the ability to deliver superior service quality that results in customer satisfaction. And the healthcare industry is no exception. Most consumers will experience a need for healthcare services at some time in their lives, but in South Africa, escalating medical costs in general and private hospitals in particular, have made private healthcare increasingly more expensive for the majority of the country's healthcare seekers. This situation raises the question of customer service in the private hospital industry and how patients' perceive service quality and evaluate customer satisfaction after a hospital stay. There is a growing body of empirical evidence from United States studies to show that service quality and customer (patient) satisfaction positively influence patients' behavioural intentions to reuse the hospital or recommend it to others (word-of-mouth endorsements). However, in South Africa, empirical studies to investigate these relationships have not been adequately addressed. This study was therefore an attempt to address the lack of scientific evidence and debate in the area of patient satisfaction. Against this background, the primary objective of this study was to measure patients' perceptions of service quality and customer satisfaction with a private hospital experience and to estimate the effect that each of these constructs will have on future behavioural intentions. More specifically, the present study was an attempt to assess empirically the most important dimensions of service quality and transaction-specific customer satisfaction dimensions that drive both patient loyalty and ‘overall’ or cumulative satisfaction in the South African private hospital industry. For the purpose of this study, buying intentions was used as a surrogate measure of loyalty as measured by willingness to reuse the hospital and/or willingness to recommend it to others (word-of-mouth endorsements). Initial exploratory research was conducted with the aim of assessing the views of three private hospital stakeholder groups, namely former patients, doctors and management about what the quality of service and customer satisfaction meant to each individual interviewed. A service enterprise that specialises in patient satisfaction surveys in the US provided particularly useful information during this phase of the study. Several case studies of patient satisfaction programmes, mostly at US hospitals, provided additional insights in this area. The study was conducted nationally at private hospitals owned by one of South Africa's three major hospital groups. Five private hospitals in four major centres were selected on a non-probability convenience basis to participate in the study. The hospital group's senior management and the management at each selected hospital gave their full commitment to ensure that the survey was successfully conducted in their hospital wards. Data were collected by means of a quantitative study using a selfadministered, structured questionnaire. Patients had to meet certain qualifying criteria which included being of adult age, in the hospital for an operation and at least one overnight stay. A total of 3 800 questionnaires was distributed to patients on a random basis in selected wards at the five hospitals by senior hospital staff designated for this task. From this distribution, 425 questionnaires were returned of which a final sample of 323 could be statistically analysed. To confirm the internal reliability of the measuring instrument, Cronbach alpha coefficients were calculated for each of the factors identified by the exploratory factor analysis. In order to assess the discriminant validity of the measuring instrument used to measure both service quality and customer satisfaction, the items were subjected to an exploratory factor analysis. The factors that emerged after the exploratory factor analysis were then used as independent variables in the four subsequent multiple regression analyses to assess the study's four hypothesised relationships. The findings revealed that the service quality dimensions that impact positively on both loyalty and cumulative satisfaction are Empathy of nursing staff and Assurance. The customer satisfaction dimensions to impact positively on both loyalty and cumulative satisfaction are Satisfaction with the nursing staff, Satisfaction with meals, and Satisfaction with fees charged.
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Bedal, Kyle W. "Systems Process Engineering for Renal Transplants at The University of Toledo Medical Center Utilizing the Six Sigma Approach." Connect to full text in OhioLINK ETD Center, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=toledo1229621313.
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Thesis (M.S.)--University of Toledo, 2008.Typescript. "Submitted as partial fulfillments of the requirements for The Master of Science in Industrial Engineering." "A thesis entitled"--at head of title. Bibliography: leaves 69-70.
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Irochu-Omare, Margaret Helen. "Parent/caregiver satisfaction with physiotherapy services for children with cerebral palsy: an explorative qualitative study at the cerebral palsy clinic in Mulago Hospital, Kampala, Uganda." Thesis, University of the Western Cape, 2004. http://hdl.handle.net/11394/1527.
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Magister Scientiae (Physiotherapy) - MSc(Physio)The extent to which customers are satified with the care they receive from the health professionals has been an important area of interest for researchers, managers and health care workers. The physiotherapy cerebral palsy clinic at Mulago Hospital in Kampala Uganda provides physiotherapy services for parents caregivers of children with cerebral palsy. The parents caregivers visit the clinic seeking physiotherapy services that will address their problems and those of the child. The purpose of this study was to explore the satisfaction that the parents caregivers of children with cerebral palsy get from utilising the physiotherapy services at the clinic and to identify the barriers problems that they encounter that might affect their attendance.
South Africa
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Montague, Diane M. "Medication errors in hospitals : to ERR is human, to report is divine." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/235.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Legal Studies
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Santos, Adriana de Cassia Paiva dos 1971. "Promoção da qualidade, controle de infecção e avaliação de indicadores de resultados no Hospital Central de Maputo em Moçambique = Quality promotion, infection control and endpoint result evaluation in the Hospital Central de Maputo in Mozambique." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308769.
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Orientadores: Luis Otávio Zanatta Sarian, Aarão Mendes Pinto NetoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: As condições econômicas e sociais encontradas na maior parte da África sub-Saariana são refletidas na qualidade da assistência à saúde. A melhora das condições de assistência ambulatorial e médico-hospitalar, neste contexto, envolve a capacitação do capital humano, isto é, treinamento e formação de profissionais, e alocação de recursos para insumos e infraestrutura. Dadas às limitações econômicas e técnicas do continente, essas ações costumam ser viabilizadas por ações cooperativas entre governos e instituições locais e estrangeiras. No Hospital Central de Maputo (HCM), em cooperação com o Ministério da Saúde de Moçambique (MSM), a Unicamp desenvolveu um projeto de pesquisa visando à identificação de necessidades de infraestrutura hospitalar e capacitação profissional com vistas a melhorar as taxas de infecção hospitalar e a qualidade à assistência em geral. Objetivo: 1) avaliar as ações executadas desde 2008 pelo MSM, junto com outros organismos multinacionais, na Enfermaria de Cirurgia (EC) do HCM, com vistas à humanização e correção de deficiências primárias de infraestrutura e capacitação profissional; e 2) avaliar fatores relacionados às taxas de infecção hospitalar em pacientes internados na EC e elaborar um plano de controle de infecção hospitalar aplicável e exequível segundo as condições locais. Métodos: Na primeira parte do estudo (referente ao objetivo 1), relatamos o processo de melhorias implementadas na EC a partir da aplicação de um Instrumento de Avaliação de Desempenho (IAD), desenvolvido em colaboração com o MSM, cujas funções eram determinar as necessidades de recursos humanos, organização em serviço, segurança do paciente e satisfação da equipe profissional. O IAD também determinava 83 metas, relacionadas aqueles aspectos mencionados. Este instrumento foi inicialmente utilizado em 2009, e a partir dos resultados obtidos foram delineadas e implantadas intervenções voltadas à correção das limitações do serviço. A partir de então, o IAD permaneceu em uso contínuo pelos profissionais da EC e os resultados obtidos subsequentemente são relatados e comentados nesta tese. A segunda parte do estudo (referente ao objetivo 2) trata das duas primeiras de três fases de um estudo de intervenção, desenhado para 1) determinar a taxa de infecção hospitalar (IH) e suas características na Enfermaria de Cirurgia; 2) propor um plano de controle de IH (PCIH) baseado nos achados de 1). A fase 3, que visa a implantação do PCIH e a avaliação de seus resultados, será realizada posteriormente. Resultados: Em janeiro de 2009, na primeira aplicação do IAD, 49% das metas preconizadas já eram atingidas pela EC; após ações baseadas nos resultados da primeira aplicação do IAD, em junho e setembro de 2009, 88% e 90% das metas haviam sido atingidas, respectivamente. Foram detectadas melhoras substanciais nas práticas de enfermagem, níveis de satisfação de pacientes e estudantes, higienização do ambiente hospitalar e organização do serviço. Em 2011, teve início a segunda parte do estudo, referente à infecção hospitalar na EC. A taxa de IH foi estabelecida em 16.6% e esteve associada ao maior tempo de internação dos pacientes e à menor utilização de artigos hospitalares críticos (agulhas, sondas, bisturis, entre outros). Foi desenvolvido um plano de controle de infecção hospitalar que aborda a melhoria do treinamento de profissionais médicos e não médicos para os fatores associados à IH. Conclusões: A intervenção baseada na elaboração e aplicação o IAD permitiu a melhoria de indicadores de qualidade e satisfação em uma Enfermaria de Cirurgia de um hospital moçambicano, e a taxa de infecção na Enfermaria de Cirurgia do HCM pode ser reduzida com intervenções voltadas a redução do tempo de hospitalização e maior investimento em artigos hospitalares críticos
Abstract: Introduction: The economic and social conditions found in most of sub- Saharan Africa are reflected in the quality of health care. The improvement of the conditions of outpatient care and healthcare in this context involves the training of human capital, ie, education and training of professionals, and resource allocation to inputs and infrastructure. Given the economic and technical limitations of the continent, these actions are often made possible by cooperative actions between governments, local and foreign intuitions. In Maputo Central Hospital (HCM), in cooperation with the Ministry of Health of Mozambique (MSM), Unicamp developed a research project aimed at identifying basic needs of hospital infrastructure and professional training in order to decrease hospital infection rates and quality of care in general. Objective: 1) to evaluate actions taken since 2008 by the MSM, along with other international organizations in surgery ward (EC) HCM, to improve humanization and correction of deficiencies related to infrastructure and job training, and 2) to evaluate essential aspects related to hospital infection rates in patients hospitalized at EC and develop a plan for hospital infection control applicable and enforceable according to local conditions. Methods: In the first part of the study (for the purpose of 1), we report the improvement process implemented in EC from the application of a Performance Assessment (PA), developed in collaboration with the MSM, whose duties were to determine the needs of human resources, service organization, patient safety and satisfaction of professional staff. The PA also determined 83 goals, related to those aspects. This instrument was first used in 2009, and from the results obtained was outlined and implemented interventions that aimed at correcting the limitations of the service. Since then, the PA remained in continuous use by professional EC and results are reported and discussed in this thesis. The second part of the study (related to objective 2) addresses the first two of three phases of an intervention study designed to 1) investigate the rate of nosocomial infection (NI) and their characteristics in MS, 2) propose a control plan IH (HICP) based on the findings of 1) Phase 3, which aims to set the HICP and the evaluation of its results, will be held later. Results: In January 2009, the first application of the IAD, 49% of the recommended goals were already stricken ECII; following actions based on the results of the first application of the IAD in June and September 2009, 88% and 90% of the targets had been reached, respectively. We detected substantial improvements in nursing practice, levels of satisfaction of patients and students, hygienic cleaning and service organization. In 2011 began the second part of the study, referring to nosocomial infection in EC. The rate of NI was established in 16.6% and was associated with longer hospital patients staying and less use of hospital critical items (needles, probes, scalpels, etc.). A plan was developed for hospital infection control that addresses the improvement of the training of medical professionals and decrease of nonmedical factors associated with IH. Conclusions: The intervention based on development and implementation PA allowed the improvement of quality indicators and satisfaction in a general ward of a hospital Mozambique, and the rate of infection in the General Infirmary HCM, can be reduced with interventions aimed at reducing the time hospitalization and greater investment in hospital critical articles
Doutorado
Oncologia Ginecológica e Mamária
Doutora em Ciências da Saúde
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Andersson, Agneta. "Health economic studies on advanced home care." Doctoral thesis, Linköping : Univ, 2002. http://www.ep.liu.se/diss/health_society/2002/002/index.html.
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Myhre, Teri Ann, and University of Lethbridge Faculty of Arts and Science. "Medication safety practices : a patient's perspective." Thesis, Lethbridge, Alta. : University of Lethbridge, School of Health Sciences, 2007, 2007. http://hdl.handle.net/10133/626.
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Medication administration constitutes a key element of acute care delivery, while errors in the process threaten patient safety. The purpose of the study is to explore patients’ perceptions, attitudes and beliefs about the safety practices utilized by nurses when administering medications. Specifically, the study addresses patients’ perceptions of nurse behaviours regarding safe medicine administration, patient behaviours, patients’ perceptions and nurse behaviours regarding pain medicine, patients’ perceptions of nursing care, and patients’ perceptions of their participation/accountability in care. The results identify key safety issues from a patients’ perspective to focus change strategies that will improve patient care.x, 125 leaves ; 29 cm
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Bimray, Portia Benita. "Die bepaling van standaarde vir 'n omvattende opvolgdiens aan onkologiepasiente op die Wes-Kaapse platteland." Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51693.
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Thesis (MCur)--Stellenbosch University, 2000.ENGLISH ABSTRACT: Against the background of the approach to make the follow up care to oncology patients more accessible and with the emphasis on quality care, it was indicated that this service needs to be evaluated. A study based on a combination of qualitative and quantitative methods (also called triangulation) was conducted to formulate structure, process and outcome standards for a comprehensive follow up care for the oncology patients and to evaluate this service according these standards. The most important results are: • The quality of care relating to the structure standards was optimal regarding the organization of the patient's visits, follow up treatment and referrals. A suboptimal standard was found regarding the general management system. • In the process standards focusing on the physical and psychosocial needs of the patient, a suboptimal standard was found regarding all aspects. Nursing practice leading to subobtimal care of patients is a major cause for concern. • With the outcome standards reflecting in patient satisfaction, positive as well as negative opinions and perceptions were found. Recommendations include: • Upgrading of management systems • Empowerment of the nurses with knowledge and scientific competencies • Attention to the opinions and perceptions of the patients to completely involve the patient in the service and treatment process. Keywords: Oncology follow up service I formulation of structure, process and outcome standards.
AFRIKAANSE OPSOMMING: Teen die agtergrond van die benadering om opvolgdienste meer toegangklik te maak vir onkologiese pasiënte, met die beklemtoning van gehaltesorg, is dit aangedui dat hierdie diens geëvalueer moes word. 'n Studie gebaseer op 'n kombinasie van kwalitatiewe en kwantitatiewe metodes (genoem triangulasie) is uitgevoer om struktuur, proses en uitkomsstandaarde vir 'n omvattende opvolgdiens aan onkologiepasiënte te formuleer en die diens aan die hand daarvan te evalueer. Die belangrikste resultate is: • Die gehalte van sorg wat verband hou met die struktuurstandaarde was net optimaal ten opsigte van die organisasie van die pasiënt se besoeke, opvolgbehandeling en verwysings. 'n Suboptimale standaard is gevind ten opsigte van die algemene bestuurstelsel. • In die prosesstandaarde wat fokus op die fisiese en psigososiale behoeftes van die pasiënt, is 'n suboptimale standaard in alle aspekte gevind. Verpleegpraktyk wat lei tot suboptimale sorg van pasiënte is 'n groot bron van kommer. • Met die uitkomsstandaarde wat reflekteer in pasiënttevredenheid is positiewe maar ook negatiewe opinies en persepsies gevind. Aanbevelings sluit in: • Verbetering van bestuurstelsels • Bemagtiging van die verpleegkundige met kennis en wetenskaplike vaardighede • Aandag aan pasiënte se opinies en persepsies ten einde die pasiënt ten volle te betrek by die hele diens en behandelingsproses. Sleutelwoorde : Onkologiese opvolgdiens / formulering van struktuurproses en uitkomsstandaarde.
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Mindemark, Mirja. "The Use of Laboratory Analyses in Sweden : Quality and Cost-Effectiveness in Test Utilization." Doctoral thesis, Uppsala universitet, Klinisk kemi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-120554.
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Laboratory analyses, essential in screening, diagnosis, treatment, and monitoring of disease, are indispensable in health care, but appropriate utilization is intricate. The overall aim of this thesis was to study the use of laboratory tests in Sweden with the objective to evaluate and optimize test utilization. Considerable inter-county variations in test utilization in primary health care in Sweden were found; variations likely influenced by local traditions and habits of test ordering leading to over- as well as underutilization. Optimized test utilization was demonstrated to convey improved quality and substantial cost savings. It was further established that continuing medical education is a suitable means of optimizing test utilization, and consequently enhancing quality and cost-efficiency, as such education was demonstrated to achieve long-lasting improvements in the test ordering habits of primary health care physicians. Laboratory tests are closely associated with other, greater, health care costs, but their indirect effects on other areas of medicine are rarely evaluated or measured in monetary terms. In an illustrative example of the effects that optimal test utilization may have on associated health care costs it was demonstrated that F-calprotectin, a fecal marker of intestinal inflammation, has the potential to substantially reduce the number of invasive investigations necessary in, and the costs associated with, the diagnosis of Inflammatory Bowel Disease. Information on trends in test utilization is essential to optimal financial management of laboratories. A longitudinal evaluation revealed that test utilization had increased by 70% in 6 years, and even though the selection of tests more than doubled, a very small number of tests represented a stable, and disproportionally large, share of the total number of tests ordered. The study defines trends and thus has potential predictive values. In summary, appropriate utilization of laboratory analyses has both clinical and economical benefits on all levels of health care.
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Cavalcanti, Luciano Stuepp. "Proposta de um instrumento para avaliação de serviços hospitalares com base em critéios de assistência, infraestrutura e práticas de gestão." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2010. http://hdl.handle.net/10183/21590.
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Esta pesquisa propõe um instrumento para avaliação de serviços hospitalares com base em critérios de assistência, infraestrutura e práticas de gestão, como forma de contribuir para o gerenciamento dos negócios em saúde no Brasil. Desta forma, identificou-se que os planos/seguros de saúde e os hospitais brasileiros não possuem um instrumento abrangente e adequado para aferir a qualidade dos serviços hospitalares multiespecializados, disponibilizados aos seus clientes, nos três aspectos fundamentais citados acima. Consequentemente, não há diferenciação, nas tabelas de remuneração contratadas entre planos/seguros de saúde e hospitais, que seja fundamentada em critérios técnicos e que estimulem a concorrência entre os prestadores de serviços nos quesitos eficiência, qualidade e custos dos serviços prestados aos clientes/pacientes. Através da revisão bibliográfica, buscou-se compreender a dinâmica econômica do setor saúde no Brasil, o relacionamento comercial entre os participantes, os métodos de classificação hospitalar disponíveis no mercado brasileiro, os critérios legais e técnicos para avaliação da assistência médicohospitalar, da infraestrutura hospitalar e das práticas de administração hospitalar. Obteve-se, ao final desta pesquisa, uma ferramenta de diagnóstico precisa, do tipo check list, para mensurar as condições técnicas dos serviços hospitalares disponibilizados aos clientes das instituições avaliadas.This research proposes a tool for evaluation of hospital services on the basis of assistance, infrastructure and management practices as a way to contribute to the health care management in Brazil. Thus, we identified that Brazilians prepaid health plans/health insurance and hospitals do not have a comprehensive and appropriate instrument for measuring the quality of multi-specialist hospital services, available to their customers for the three aspects above mentioned of this hospital services. Consequently, there is no differentiation in price scales between contracted prepaid health plans/health insurance and hospitals that are based on technical criteria and to encourage competition among service providers regarding to efficiency, quality and cost of services to clients/patients. Through literature review we sought to understand the economic dynamics of the health care management field in Brazil, the commercial relationship between participants, the methods of hospital classification available in Brazil, legal and technical criteria for evaluation of medical assistance, the hospital infrastructure and practices of hospital administration. It was obtained at the end of this research a diagnostic tool, of the check list type, for measuring the technical conditions of hospital services provided to clients by the evaluated institutions.
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Mugerwa, Pumla Princess. "The relationship between clinical learning environmental factors and clinical competence of newly qualified registered nurses in public hospitals." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/19266.
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There is increasing concern that newly qualified registered nurses (RNs) find it difficult to make a smooth transition from completing their four-year nursing training to taking up their posts as first time RNs. In a constantly changing healthcare system, these newly qualified RNs are expected to work independently and be competent in applying the decision making and problem-solving skills gained during their training. While certain aspects of clinical incompetence may be ascribed to individual factors, the importance of the clinical learning environment and its influence on the development of clinical competence cannot be ignored. Nurses need support and guidance to effect a successful transition from being novice to competent nurse and the environment is regarded as important in developing technical competencies. The research study followed a positivistic, quantitative paradigm, where the hypothesized relationship between clinical learning environmental factors and clinical competence of newly qualified RNs were explored. Data was collected from the experienced RNs in the hospitals by means of a structured pre-existing questionnaire, namely the Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and inferential statistics were used to analyse data. The analysed data was used to describe the findings. Recommendations were made based on the findings. Results suggested that the development of clinical competence is dependent on both the individual and context. Positive relations were reported between clinical learning environmental factors and clinical competencies.
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Devreux, Isabelle. "Relationship between staff satisfaction, productivity and patient satisfaction: a study in physical rehabilitation services." Doctoral thesis, Universite Libre de Bruxelles, 2012. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209609.
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La satisfaction du patient et du personnel sont considérés comme des indicateurs importants afin de mesurer la qualité dans le secteur hospitalier.Dans les services de revalidation, les rencontres thérapeutes-patients présentent une valeur significative par le temps consacré, l'approche thérapeutique mais également la relation qui découle du processus de soin.
L'objectif de la recherche fut d'évaluer la satisfaction du personnel travaillant dans les services de revalidation physique (thérapeutes et techniciens ou assistants) et les différents variables démographiques ou liés à l'environnement du travail ainsi que la satisfaction des patients traités dans ces services.
Une analyse transversale par questionnaire a permis de mesurer la satisfaction au travail et les éléments de productivité dans les services de revalidation. Simultanément, une enquête concernant la satisfaction des patients a été réalisée dans ces mêmes départements. La recherche fut effectuée au sein de dix centres hospitaliers au moyen d'un questionnaire d'enquête commun basé sur le modèle " Effort- Reward Imbalance" ou “déséquilibre efforts-récompenses” et des informations complémentaires sur les conditions de travail ont étés collectées au moyen de questionnaires spécifiques. L’étude met en évidence des variables démographiques tells l'âge, la nationalité, le niveau d'éducation, ainsi que la charge travail et les types de cas traités comme facteurs significatifs influençant le stress au travail.
Les résultats confirment une corrélation positive entre le stress au travail par le déséquilibre Efforts-Récompenses et la performance quantitative (productivité) des thérapeutes en revalidation. Il est basé sur la satisfaction des thérapeutes en fonction des heures de travail, du nombre moyen de patients par jours ainsi que des mesures de productivité élevées du département. En ce qui concerne les récompenses perçues comme positives, le soutien du médecin et du superviseur apparaissent comme facteurs de motivation importants. Il a été également déterminé que les thérapeutes appréciaient la participation et l’expression de son opinion dans la gestion thérapeutique du patient. Bien qu’une corrélation entre la satisfaction des patients et le degré de stress au travail des thérapeutes n’ait pas été démontrée, ces deux mesures varient de manière significative en fonction des types d’hôpitaux et du degré de « Over-commitment » des thérapeutes dans leur travail.
Les déterminants essentiels de la satisfaction des patients en revalidation apparaissent toutefois liés à l’intervention du thérapeute tel que sa capacité à rassurer le patient ou la qualité de l’information liée au plan de traitement et doivent être considérés dans l’approche thérapeutique en revalidation.
Les résultats de l’étude ont permis de concevoir un modèle systémique de satisfaction et de stress au travail résumant les éléments liés de manière significative au déséquilibre des efforts et récompenses dans les services de revalidation physique et qui pourrait inspirer les directeurs ou gestionnaires hospitaliers a promouvoir une atmosphère de travail positive.
Patient and staff satisfaction are considered as important indicators to monitor quality in healthcare. In rehabilitation services the patient and therapist encounters are of significant value by the amount of time, the therapeutic approach but also the personal relations in the care process. The aim of the research was to evaluate the staff job satisfaction in physical rehabilitation services and the related variables as well as its correlations to patients’ satisfaction.
A cross sectional survey approach in the rehabilitation services has measured the job satisfaction and the related elements of productivity. Simultaneously a survey of the patients’ satisfaction was performed. As the research in the physical rehabilitation services was conducted in ten different health care facilities of the Jeddah region, a common assessment tool was utilized based on the Effort Reward Imbalance (ERI) model and complementary information were collected using specifically developed survey questionnaires. Socio-demographic variables such as age, nationality, work specialty, educational levels, as well as the caseload and workload appeared also as significantly influencing job satisfaction.
The findings confirmed a positive correlation between the Effort Reward Imbalance and the quantitative performance (productivity) of the rehabilitation staffs. It is supported by the level of job satisfaction of the therapists which is related to the number of patients per day, caseload, hours of work and high productivity measures. From the aspects of positive rewards, the role of the supervisor and doctors appear as important motivators. It was also found that therapists valued the fact of being given the opportunity to participate and discuss opinions in the patient management and quality improvement.
While no evidence confirmed a positive correlation between patients’ satisfaction about the rehabilitation treatments and the staff job satisfaction, both measured patients’ and staff satisfaction varied significantly according to the hospital type and the degree of Over-commitment.
Essential determinants of patients’ satisfaction appeared however related to the therapists' input, such as the ability to reassure or the quality of information given in the treatment plan and have to be taken into account when delivering the patients’ care.
All the results allowed the design of a systemic model of staff job satisfaction resuming the significant related elements of effort and reward in the rehabilitation services and could be utilized to inspire the hospital leaders, managers and executive directors to promote a healthy work life environment based on a valued human resources approach.
Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished
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Binefa, i. Rodríguez Gemma. "Avaluació de la qualitat del programa de cribratge de càncer colorectal de L’Hospitalet de Llobregat." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/575371.
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INTRODUCCIÓ: el càncer colorectal (CCR) constitueix un dels càncers més prevalents i incidents a nivell mundial. A Catalunya, el CCR és el càncer més freqüent, si considerem els casos conjuntament en homes i dones, amb 5.903 casos nous/any, i és el segon càncer que més morts produeix.
El CCR és també un dels que més es pot beneficiar de la prevenció. La prevenció secundària o detecció precoç de la malaltia o cribratge té com objectiu detectar la malaltia en estadis inicials i aplicar les mesures terapèutiques necessàries per tal d’impedir o retardar la seva evolució.
La millor manera de dur a terme la detecció precoç del CCR és en el marc de programes organitzats, on es defineixen les principals característiques que ha de tenir i complir el programa.
OBJECTIUS: aquesta tesi reuneix els resultats de l’avaluació dels principals indicadors de qualitat del Programa de cribratge de CCR de l’Hospitalet de Llobregat, el qual es va implementar a mode de prova pilot l’any 2000. S’han plantejat els següents objectius: 1) comparar els resultats de participació i les taxes de detecció de neoplàsia colorectal amb el test de sang oculta en femta de guaiac (gTSOF) i amb test de sang oculta en femta immunològic (FIT); 2) descriure l’associació entre el resultat quantitatiu del FIT i el tipus de lesió detectada en la colonoscòpia; 3) avaluar els indicadors de qualitat relacionats amb la colonoscòpia; 4) avaluar l’adequació de les colonoscòpies de seguiment segons les recomanacions de les guies; i 5) analitzar els principals indicadors de qualitat del Programa de les 5 primeres rondes.
METODOLOGIA: s’han realitzat diferents estudis, tots ells en el marc del programa de cribratge de CCR però amb períodes d’estudi diferents. La població diana han estat els homes i dones de 50 a 69 anys residents a l’Hospitalet de Llobregat, sense antecedents personals de CCR, adenomes colorectals o malaltia inflamatòria intestinal i sense antecedents familiars d’alt risc. S’han utilitzat dos test de cribratge, el gTSOF (bioquímic qualitatiu) i el FIT (immunològic quantitatiu). La prova confirmatòria ha estat la colonoscòpia.
RESULTATS: els resultats dels indicadors avaluats van ser millors pel FIT que pel gTSOF, destacant la clara diferència en les taxes de detecció, sobretot d’adenomes avançats.
Es va trobar una clara associació positiva entre la concentració d’hemoglobina fecal (Hb-f) i la gravetat de la lesió.
La taxa d'intubació cecal va ser del 95,6% i la neteja intestinal va ser adequada en el 93,6% dels casos. La taxa de recuperació de pòlips va ser del 86,7%. I la taxa global de complicacions va ser del 10,7 ‰.
Es va observar una manca d’adequació de les colonoscòpies de seguiment, de manera que només el 28,0% de les colonoscòpies que requerien seguiment es van dur a terme de manera adequada. Com més avançada era la lesió, major va ser el grau d’adequació.
En l’avaluació de les 5 rondes del programa, es va poder observar com la majoria d’indicadors obtenien resultats acceptables, excepte la participació.
CONCLUSIONS: el programa de cribratge de CCR ha assolit resultats satisfactoris en la majoria d’indicadors de qualitat. Malgrat la participació no ha arribat al 45% (valor establert en la Guia Europea), ha anat augmentant en cada ronda.
El FIT és un bon test de cribratge si el comparem amb el gTSOF. No obstant, encara hi ha marge de millora, sobretot en la sensibilitat. La concentració d’Hb fecal, s’associa amb la severitat de les lesions colorectal.
Els indicadors relacionats amb la colonoscòpia van obtenir molts bons resultats, assolint l’estàndard en tots ells. No obstant, es relació a les colonoscòpies de seguiment, es va observar una molt baixa adequació a les recomanacions.INTRODUCTION: Colorectal Cancer (CRC) is one of the most prevalent and incident cancer worldwide. In Catalonia, CRC is the most frequent cancer, if we consider the cases together in men and women. The best way to carry out early detection of CRC is in the framework of organized screening programs, which define the main characteristics that must fulfil the program. OBJECTIVES: This thesis summarized the results of the evaluation of the main quality indicators of the CRC Screening Program of Hospitalet de Llobregat, which was implemented as a pilot in 2000. METHODOLOGY: Different studies have been carried out, all of them within the framework of the CRC screening program but with different periods of study. The target population were men and women 50 to 69 years old residing in Hospitalet de Llobregat, without personal history of CRC, colorectal adenomas or inflammatory bowel disease and without a high risk family history. Two screening tests have been used: guaiac faecal occult blood test (gFOBT) and immunochemical test (FIT). The colonoscopy has been the confirmatory test. RESULTS: the results of the indicators evaluated were better for FIT than for gFOBT, highlighting the difference in detection rates, especially advanced adenomas. A clear positive association was found between the faecal hemoglobin concentration (Hb-f) and the severity of the lesion. Cecal intubation rate was 95.6% and intestinal cleansing was adequate in 93.6% of the cases. The polyp’s retrieval rate was 86.7%. And the overall complication rate was 10.7 ‰. Only 28.0% of the colonoscopies that required surveillance were performed appropriately, within the correct time interval. In the evaluation of the 5 rounds of the program, it was observed that most indicators obtained acceptable results, except participation. CONCLUSIONS: the CRC screening program has achieved satisfactory results in most quality indicators. Although participation has not reached 45%, it has increased in every round. The FIT is a good screening test if we compare with gFOBT. The concentration of fecal Hb is associated with the severity of the colorectal lesions. The indicators related to colonoscopy obtained good results. However, it was observed a very low adequacy in surveillance colonoscopies.
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Mebius, Alexander. "Philosophical controversies in the evaluation of medical treatments : With a focus on the evidential roles of randomization and mechanisms in Evidence-Based Medicine." Doctoral thesis, KTH, Filosofi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-161489.
Full textAbstract:
This thesis examines philosophical controversies surrounding the evaluation of medical treatments, with a focus on the evidential roles of randomised trials and mechanisms in Evidence-Based Medicine. Current 'best practice' usually involves excluding non-randomised trial evidence from systematic reviews in cases where randomised trials are available for inclusion in the reviews. The first paper challenges this practice and evaluates whether adding of evidence from non-randomised trials might improve the quality and precision of some systematic reviews. The second paper compares the alleged methodological benefits of randomised trials over observational studies for investigating treatment benefits. It suggests that claims about the superiority of well-conducted randomised controlled trials over well-conducted observational studies are justified, especially when results from the two methods are contradictory. The third paper argues that postulating the unpredictability paradox in systematic reviews when no detectable empirical differences can be found requires further justification. The fourth paper examines the problem of absence causation in the context of explaining causal mechanisms and argues that a recent solution (Barros 2013) is incomplete and requires further justification. Solving the problem by describing absences as causes of 'mechanism failure' fails to take into account the effects of absences that lead to vacillating levels of mechanism functionality (i.e. differences in effectiveness or efficiency). The fifth paper criticises literature that has emphasised functioning versus 'broken' or 'non-functioning' mechanisms emphasising that many diseases result from increased or decreased mechanism function, rather than complete loss of function. Mechanistic explanations must account for differences in the effectiveness of performed functions, yet current philosophical mechanistic explanations do not achieve this. The last paper argues that the standard of evidence embodied in the ICE theory of technological function (i.e. testimonial evidence and evidence of mechanisms) is too permissive for evaluating whether the proposed functions of medical technologies have been adequately assessed and correctly ascribed. It argues that high-quality evidence from clinical studies is necessary to justify functional ascriptions to health care technologies.QC 20150312