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1
McKnight, Jacob. "Constructing reform in the Ethiopian healthcare system : unintended consequences for hospitals and patients." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:e844b6c5-2830-49ad-a411-2b3c0cb849ad.
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In the last decade, the reach of New Public Management (NPM) has stretched well beyond its Western origins as modernising African governments and their global health partners have sought to import new approaches. Public health systems in Africa are entirely different to those of the West however, and this sort of application introduces a number of contextually-specific questions that are not considered by the majority of the NPM literature. The few studies that do investigate NPM in Africa are evaluative in content, seeking to understand whether reforms work and to identify barriers to success. Invariably, whether they find in favour of public management reform or not, the same issues are highlighted: lack of capacity, weak institutions, and improper implementation. This thesis will build a theory of NPM reform that is particular to the African context. I develop this theoretical extension through an intensive ethnographic case study of one of the most important on-going public health reform efforts in Africa—the transformation of the entire Ethiopian hospital system to an NPM-style administrative regime. I develop a constructionist theory of African NPM through thick description of the hospitals under reform. I detail the various ways in which the reforms are indigenised as they meet up with local understandings, institutions, and market contexts, and the inevitable unintended consequences as managers seek to ‘make do’ in environments radically different to those of NPM’s origins. I then conduct a detailed consumer analysis to describe the strategies employed by patients seeking care. Patients from different class positions use very different strategies to get health services and I demonstrate that the reform has very different consequences for Ethiopians across classes. Many patients are not recognisable as the ‘customers’ described in the reform documents, and so the hospitals do not organise their reform efforts to serve them.
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Hedvall, Alexander, and Emil Svensson. "Teaching Maternal Healthcare and Nutrition in Rural Ethiopia through a Serious Game." Thesis, Malmö högskola, Fakulteten för teknik och samhälle (TS), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-20939.
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Ethiopia has one of the highest maternal and child mortality rates in the world. The main reason for this isthe low accessibility of educational content regarding healthcare in the rural regions. In this thesis weinvestigate the possibility to address this issue through a serious game, something that has proven efficientas a tool for learning in many situations. By designing and creating a game for rural Ethiopians, we aim tointerest them in learning about healthcare and nutrition by playing a game that reflects their culture andlife. In order to validate our solution we conducted a field study in Ethiopia, where we organized andcarried out a usability test with Ethiopian mothers. Our findings suggest that educational games has apotential in developing countries.
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Libasie, M. "Implementation of women's right to reproductive health in Ethiopia : policy and healthcare perspectives." Thesis, University of Surrey, 2017. http://epubs.surrey.ac.uk/813209/.
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Issues related to reproductive health are being increasingly recognised by the international community to contributing greatly towards eliminating gender-based health disparity. And in recent years, normative developments have proliferated both in the international and domestic arena. This thesis showcases the level of implementation of women’s right to reproductive health in Ethiopia. In so doing, it questions the international legal footings of this specific right. Implementation in this context is grappled with various obstacles such as balancing low economic resource setting with fulfilling economically demanding obligations; and/or eliminating entrenched harmful cultural traditions while enhancing acceptability of services. The research adopts a set contextual human rights indicators to sift the legal framework and health system of Ethiopia with a view to assessing the level of implementation. It identifies existing gaps and seeks to forward recommendations.
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Dineley, Louise. "Risk management systems in healthcare." Thesis, University of Kent, 2016. https://kar.kent.ac.uk/68659/.
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Healthcare is recognised as a complex high risk industry that demands effective management of the risks presented. A total of 260 NHS Trusts were surveyed to identify the risk management arrangements in place. The results were analysed alongside three different sources of nationally published data (CQC, Monitor and NHSLA) to determine if certain organisational or system characteristics existed that would either predetermine risk performance or predispose the Trust to a higher or lower level of performance. The results successfully dispelled a number of preconceptions relating to the size and status of the Trust in determining the performance achieved. However what was evident was the influence that the Trust’s culture and commitment to risk has on the safety and quality of services delivered. A second finding was the significant influence of central policy in the arrangements that organisations had in place from the presentation and content of risk strategy documents, criteria considered and executive leadership. The constraints of a national policy applied locally potentially limits the effectiveness of the processes in managing risk. It was concluded that whilst central policy may help in standardising how risk is managed current arrangements focus arrangements to narrowly. As a result the role of central policy makers should be to set principles that draw on and translate best practice from other high risk industries and encourage local health leaders to flex the approach to reflect local needs and priorities. This local flex should aim to integrate with other corporate programmes to ensure that risk is embedded in all decision making and the risk of the safety and quality of patients is considered alongside risks that may be perceived to be a higher priority such as operational targets and financial balance.
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Au-Yeung, Susanna Wau Men. "Response times in healthcare systems." Thesis, Imperial College London, 2008. http://hdl.handle.net/10044/1/1297.
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It is a goal universally acknowledged that a healthcare system should treat its patients – and especially those in need of critical care – in a timely manner. However, this is often not achieved in practice, particularly in state-run public healthcare systems that suffer from high patient demand and limited resources. In particular, Accident and Emergency (A&E) departments in England have been placed under increasing pressure, with attendances rising year on year, and a national government target whereby 98% of patients should spend 4 hours or less in an A&E department from arrival to admission, transfer or discharge. This thesis presents techniques and tools to characterise and forecast patient arrivals, to model patient flow and to assess the response-time impact of different resource allocations, patient treatment schemes and workload scenarios. Having obtained ethical approval to access five years of pseudonymised patient timing data from a large case study A&E department, we present a number of time series models that characterise and forecast daily A&E patient arrivals. Patient arrivals are classified as one of two arrival streams (walk-in and ambulance) by mode of arrival. Using power spectrum analysis, we find the two arrival streams exhibit different statistical properties and hence require separate time series models. We find that structural time series models best characterise and forecast walk-in arrivals, but that time series analysis may not be appropriate for ambulance arrivals; this prompts us to investigate characterisation by a non-homogeneous Poisson process. Next we present a hierarchical multiclass queueing network model of patient flow in our case study A&E department. We investigate via a discrete-event simulation the impact of class and time-based priority treatment of patients, and compare the resulting service-time densities and moments with actual data. Then, by performing bottleneck analysis and investigating various workload and resource scenarios, we pinpoint the resources that have the greatest impact on mean service times. Finally we describe an approximate generating function analysis technique which efficiently approximates the first two moments of customer response time in class-dependent priority queueing networks with population constraints. This technique is applied to the model of A&E and the results compared with those from simulation. We find good agreement for mean service times especially when minors patients are given priority.
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Kilic, Ozgur. "Achieving Electronic Healthcare Record (ehr) Interoperability Across Healthcare Information Systems." Phd thesis, METU, 2008. http://etd.lib.metu.edu.tr/upload/12609665/index.pdf.
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Providing an interoperability infrastructure for Electronic Healthcare Records (EHRs) is on the agenda of many national and regional eHealth initiatives. Two important integration profiles have been specified for this purpose: the "IHE Cross-enterprise Document Sharing (XDS)"
and the "
IHE Cross Community Access (XCA)"
. XDS describes how to share EHRs in a community of healthcare enterprises and XCA describes how EHRs are shared across communities. However, currently no solution addresses some of the important challenges of cross community exchange environments. The first challenge is scalability. If every community joining the network needs to connect to every other community, this solution will not scale. Furthermore, each community may use a different coding vocabulary for the same metadata attribute in which case the target community cannot interpret the query involving such an attribute. Another important challenge is that each community has a different patient identifier domain. Querying for the patient identifiers in another community using patient demographic data may create patient privacy concerns. Yet another challenge in cross community EHR access is the EHR interoperability since the communities may be using different EHR content standards.
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Røstad, Lillian. "Access Control in Healthcare Information Systems." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for datateknikk og informasjonsvitenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-5130.
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Access control is a key feature of healthcare information systems. Access control is about enforcing rules to ensure that only authorized users get access to resources in a system. In healthcare systems this means protecting patient privacy. However, the top priority is always to provide the best possible care for a patient. This depends on the clinicians having access to the information they need to make the best, most informed, care decisions. Care processes are often unpredictable and hard to map to strict access control rules. As a result, in emergency or otherwise unexpected situations, clinicians need to be able to bypass access control. In a crisis, availability of information takes precedence over privacy concerns. This duality of concerns is what makes access control in healthcare systems so challenging and interesting as a research subject. To create access control models for healthcare we need to understand how healthcare works. Before creating a model we need to understand the requirements the model should fulfill. Though many access control models have been proposed and argued to be suitable for healthcare, little work has been published on access control requirements for healthcare. This PhD project has focused on bridging the gap between formalized models and real world requirements for access control in healthcare by targeting the following research goals:RG1 To collect knowledge that forms a foundation for access control requirements in healthcare systems.RG2 To create improved access control models for healthcare systems based on real requirements.This PhD project has consisted of a number of smaller, distinct, but relatedprojects to reach the research goals. The main contributions can be summarized as:C1 Requirements for access control in healthcare: Studies performed onaudit data, in workshops, by observation and interviews have helped discoverrequirements. Results from this work include methods for access controlrequirements elicitation in addition to the actual requirements discovered.C2 Process-based access control: The main conclusion from the requirementswork is that access control should be tailored to care processes. Care processesare highly dynamic and often unpredictable, and access control needs to adaptto this. This thesis suggests how existing sources of process information, bothexplicit and implicit, may be used for this purpose.C3 Personally controlled health records (PCHR): This thesis explores theconsequences of making the patient the administrator of access control andproposes a model based on these initial requirements. From a performedusability study it is clear that the main challenge is how to keep the patientinformed about the consequences of sharing.
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Sassoon, Richard. "Security in SOA-Based Healthcare Systems." Thesis, Norwegian University of Science and Technology, Department of Telematics, 2009. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-9884.
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Healthcare organizations need to handle many kinds of information and integrate different support systems, which may be accessed from external corporations. Service Oriented Architecture (SOA) provides the means to achieve a common platform to deploy services that can be used across the organization and its boundaries, but introduces new security concerns that need to be evaluated in order to implement a secure system, while still suffering from standard threats. Web Services are the common way to implement SOA applications, having several standards related to security (such as XML Encryption, XML Signature and WS-Security). Still, other security mechanisms such as input validation and SSL/TLS need to be thought of as well. A penetration test based on recognized methodologies and guidelines, such as the NIST Technical Guide to Information Security Testing and Assessment, OWASP Testing Guide and SIFT Web Services Security Testing Framework, was performed on a case study system. A proof of concept application making use of a set of middleware (web) services, the MPOWER platform, was audited in order to expose vulnerabilities. After conducting the penetration test on the system, 10 out of 15 scenarios presented security issues. The vulnerabilities found were described, demonstrating several risks from misusing, or not implementing at all, security mechanisms. As a consequence, countermeasures and recommendations were proposed in an attempt to improve the overall security of SOA-based (healthcare) systems. The results of the assessment show us how important is to validate the security of a system before putting it into production environment. We also come to the conclusion that security testing should be an inherent part of a secure software development life cycle. Moreover, not only healthcare systems may benefit from this study, and also not only SOA-based ones.
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Gebrezghi, Solomon Ghebre-Ghiorghis. "Dysfunctional polities, mediated information systems and modernisation in Ethiopia." Thesis, University of Liverpool, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367074.
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Furnell, Steven Marcus. "Data security in European healthcare information systems." Thesis, University of Plymouth, 1995. http://hdl.handle.net/10026.1/411.
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This thesis considers the current requirements for data security in European healthcare systems and establishments. Information technology is being increasingly used in all areas of healthcare operation, from administration to direct care delivery, with a resulting dependence upon it by healthcare staff. Systems routinely store and communicate a wide variety of potentially sensitive data, much of which may also be critical to patient safety. There is consequently a significant requirement for protection in many cases. The thesis presents an assessment of healthcare security requirements at the European level, with a critical examination of how the issue has been addressed to date in operational systems. It is recognised that many systems were originally implemented without security needs being properly addressed, with a consequence that protection is often weak and inconsistent between establishments. The overall aim of the research has been to determine appropriate means by which security may be added or enhanced in these cases. The realisation of this objective has included the development of a common baseline standard for security in healthcare systems and environments. The underlying guidelines in this approach cover all of the principal protection issues, from physical and environmental measures to logical system access controls. Further to this, the work has encompassed the development of a new protection methodology by which establishments may determine their additional security requirements (by classifying aspects of their systems, environments and data). Both the guidelines and the methodology represent work submitted to the Commission of European Communities SEISMED (Secure Environment for Information Systems in MEDicine) project, with which the research programme was closely linked. The thesis also establishes that healthcare systems can present significant targets for both internal and external abuse, highlighting a requirement for improved logical controls. However, it is also shown that the issues of easy integration and convenience are of paramount importance if security is to be accepted and viable in practice. Unfortunately, many traditional methods do not offer these advantages, necessitating the need for a different approach. To this end, the conceptual design for a new intrusion monitoring system was developed, combining the key aspects of authentication and auditing into an advanced framework for real-time user supervision. A principal feature of the approach is the use of behaviour profiles, against which user activities may be continuously compared to determine potential system intrusions and anomalous events. The effectiveness of real-time monitoring was evaluated in an experimental study of keystroke analysis -a behavioural biometric technique that allows an assessment of user identity from their typing style. This technique was found to have significant potential for discriminating between impostors and legitimate users and was subsequently incorporated into a fully functional security system, which demonstrated further aspects of the conceptual design and showed how transparent supervision could be realised in practice. The thesis also examines how the intrusion monitoring concept may be integrated into a wider security architecture, allowing more comprehensive protection within both the local healthcare establishment and between remote domains.
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Chung, Kristie (Kristie J. ). "Applying systems thinking to healthcare data cybersecurity." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/105307.
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Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, 2015.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 85-90).
Since the HITECH Act of 2009, adoption of Electronic Health Record (EHR) systems in US healthcare organizations has increased significantly. Along with the rapid increase in usage of EHR, cybercrimes are on the rise as well. Two recent cybercrime cases from early 2015, the Anthem and Premera breaches, are examples of the alarming increase of cybercrimes in this domain. Although modem Information Technology (IT) systems have evolved to become very complex and dynamic, cybersecurity strategies have remained static. Cyber attackers are now adopting more adaptive, sophisticated tactics, yet the cybersecurity counter tactics have proven to be inadequate and ineffective. The objective of this thesis is to analyze the recent Anthem security breach to assess the vulnerabilities of Anthem's data systems using current cybersecurity frameworks and guidelines and the Systems-Theoretic Accident Model and Process (STAMP) method. The STAMP analysis revealed Anthem's cybersecurity strategy needs to be reassessed and redesigned from a systems perspective using a holistic approach. Unless our society and government understand cybersecurity from a sociotechnical perspective, we will never be equipped to protect valuable information and will always lose this battle.
by Kristie Chung.
S.M. in Engineering and Management
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Mucheleka, M. (Martin). "Enterprise Resource Planning systems in healthcare sector." Master's thesis, University of Oulu, 2015. http://urn.fi/URN:NBN:fi:oulu-201504021292.
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The purpose of this thesis work was to find out how Enterprise Resource Planning systems (ERP) have been used in the healthcare sector and how ERP systems could be used to improve the healthcare services. Some findings were discussed and recommendations were made about how ERP systems could be used in the healthcare sector.
The thesis was written using literature review research method. Literature is the study that involves gathering and studying earlier knowledge about a specific topic of interest. Various documents were studied regarding the use of ERP in healthcare institutions. Literature review was used to show how ERP systems have been used previously in some healthcare institutions and organisations.
Based on the literature used in this study, ERP systems have not been widely reported to have been used in the healthcare sector. On the other hand, other findings showed that ERP systems could be used in the healthcare sector to improve their quality of services.
Therefore, if ERP systems were successfully implemented in a healthcare organisations, it was suggested that it would bring about significant change especially in finance, human resources, and capacity, revenue and admission resource functions. ERP systems could also improve profitability and services in the healthcare organisations.
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Jin, Huan. "Workforce planning in manufacturing and healthcare systems." Diss., University of Iowa, 2016. https://ir.uiowa.edu/etd/5784.
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This dissertation explores workforce planning in manufacturing and healthcare systems. In manufacturing systems, the existing workforce planning models often lack fidelity with respect to the mechanism of learning. Learning refers to that employees’ productivity increases as they gain more experience. Workforce scheduling in the short term has a longer term impact on organizations’ capacity. The mathematical representations of learning are usually nonlinear. This nonlinearity complicates the planning models and provides opportunities to develop solution methodologies for realistically-sized instances. This research formulates the workforce planning problem as a mixed-integer nonlinear program (MINLP) and overcomes the limitations of cur- rent solution methods. Specifically, this research develops a reformulation technique that converts the MINLP to a mixed integer linear program (MILP) and proposes several techniques to speed up the solution time of solving the MILP.
In organizations that use group work, workers learn not only by individual learning but also from knowledge transferred from team members. Managers face the decision of how to pair or team workers such that organizations benefit from this transfer of learning. Using a mathematical representation that incorporates both in- dividual learning and knowledge transfer between workers, this research considers the problem of grouping workers to teams and assigning teams to sets of jobs based on workers’ learning and knowledge transfer characteristics. This study builds a Mixed- integer nonlinear programs (MINP) for parallel systems with the objective of maximizing the system throughput and propose exact and heuristic solution approaches for solving the MINLP.
In healthcare systems, we focus on managing medical technicians in medical laboratories, in particular, the phlebotomists. Phlebotomists draw specimens from patients based on doctors’ orders, which arrive randomly in a day. According to the literature, optimizing scheduling and routing in hospital laboratories has not been regarded as a necessity for laboratory management. This study is motivated by a real case at University of Iowa Hospital and Clinics, where there is a team of phlebotomists that cannot fulfill doctors requests in the morning shift. The goal of this research is routing these phlebotomists to patient units such that as many orders as possible are fulfilled during the shift. The problem is a team orienteering problem with stochastic rewards and service times. This research develops an a priori approach which applies a variable neighborhood search heuristic algorithm that improves the daily performance compared to the hospital practice.
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Timoney, Ringström Miriam, and Elin Johansen. "HIV POSITIVE WOMEN’S EXPERIENCE OF STIGMA FROM HEALTHCARE PROFESSIONALS DURING PREGNANCY AND CHILDBIRTH : Addis Ababa, Ethiopia." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-244699.
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Introduktion: 1,2 miljoner människor lever med HIV/AIDS i Etiopien, men med rätt åtgärder kan en gravid, HIV-positiv kvinna minska risken för att smitta sitt barn till under 5 %. Trots detta upplever en majoritet av HIV-positiva patienter stigma från sjukvårdspersonal som kan leda till en minskad livskvalitet. Vårdpersonalens förståelse av stigma och kunskap om HIV är nödvändig för att utveckla strategier för att minska denna stigmatisering. Syfte: Syftet med studien var att undersöka HIV-positiva kvinnors upplevelser av stigmatisering från vårdpersonal under graviditet och förlossning i Addis Ababa, Etiopien. Metod: En deskriptiv studie med kvalitativ ansats användes. Sju HIV-positiva kvinnor som har mottagit mödravård i Addis Ababa, Etiopien, deltog med hjälp av bekvämlighet urval. Travelbees omvårdnadteori och en kognitiv modell av AIDS-relaterad stigma användes som teoretisk ram. Strukturerade intervjufrågor användes och data analyserades med en kvalitativ innehållsanalys. Resultat: Studien har tre kategorier; Negativa reaktioner från vårdpersonal, Ingen känsla av stigma och Utbildning från vårdpersonal till kvinnorna. Majoriteten av deltagarna hade upplevt en händelse av HIV-relaterat stigma från vårdpersonal. Detta genom att bland annat känna sig annorlunda bemött på grund av sin diagnos eller genom att ha upplevt hur vårdpersonalen var överdrivet rädda för att bli smittade. Resultatet visar också att det finns vårdpersonal som utövar en vård utan stigmatisering samt att utbildning gavs till samtliga kvinnor från vårdpersonalen angående hur HIV smittas och dess medicinering. Slutsats: Stigmatisering från vårdpersonal förekommer bland HIV-positiva kvinnor. Sjuksköterskan har ett ansvar för att minska stigmatisering genom att utöva en omvårdnad där kvinnorna känner sig lika behandlad och respekterad. Förbättring behövs där vårdpersonal utvecklar sin förståelse av stigmatisering och av hur ett stigmatiserande beteende inom vården kan undvikas.Introduction: 1.2 million people live with HIV/AIDS in Ethiopia, but with correct interventions a HIV positive pregnant woman can reduce the risk of infecting her baby to below 5 %. Nevertheless, a majority of HIV positive patients experience stigma from healthcare professionals, which can lead to a reduced life quality. Healthcare professionals’ understanding of stigma and knowledge about HIV is necessary in order to develop strategies to reduce this stigma. Purpose: The purpose of the study was to investigate HIV positive women's experience of stigma from healthcare professionals during pregnancy and childbirth in Addis Ababa, Ethiopia. Method: A descriptive study with a qualitative method was used. Seven HIV positive women who had received maternity care in Addis Ababa, Ethiopia participated and were chosen through a convenience sample. Structured interview questions were used and data were analyzed by using qualitative content analysis. Travelbeés theory of care and cognitive model of AIDS-related stigmatization were used as theoretical framework. Results: Three categories were identified in this study: Negative reactions from health care professionals, Non-presence of stigma and Education from healthcare professionals. The majority of the participants had experienced an event of HIV- related stigma from healthcare professionals. These HIV positive women felt as if they were treated differently because of their diagnosis and they experienced the professionals’ fear of becoming infected. However some of the HIV positive women who were interviewed felt they had also experienced situations where no stigmatization was shown by healthcare professionals. All the woman who were interviewed had received information about the HIV virus, how it´s spread and what medication is used as treatment. Conclusion: Stigma from healthcare professionals among HIV positive woman exists. Health care professionals have a responsibility to reduce stigma by providing care that gives women the sense of being equally treated and respected. Improvements are needed in the education of healthcare professionals so that they can develop an understanding of stigma as well as an understanding of how their own stigmatizing behavior can be reduced when caring for HIV positive women.
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Tegene, Rebekah. "Empowering Innovation and Entrepreneurship in Ethiopia." Thesis, Linnéuniversitetet, Institutionen för samhällsstudier (SS), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-54442.
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ABSTRACT This thesis investigates innovative entrepreneurship in Addis Ababa, Ethiopia. The thesis is guided by the National Innovation Systems theory, where innovation is seen as result of interactions and learning between different institutions or actors. The objective was to investigate how conducive is the national system of innovation of Ethiopia in the perception of entrepreneurs and how relevant is the innovation policy of Ethiopia is to innovative entrepreneurship. A field study was conducted in order to collect empirical data through semi-structured interviews, observations and participation. Most of the interviews took place in the innovation hub iceAddis with most of the sample focusing on entrepreneurs that were members there. The results of the field study show that the national system of innovation of Ethiopia is not particularly conducive nor developed to empower to innovative entrepreneurs. Moreover, the policy although very ambitious does not explicably aim to empower entrepreneur. Other goals of the policy could have had spillover effects on entrepreneurs but they were not yet attained in the perception of innovative entrepreneurs. Keywords: Ethiopia, Innovation, Entrepreneurship, ICT, National Systems of Innovation
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Nagpure, Prashant. "Homebased healthcare : issues and challenges." Thesis, Massachusetts Institute of Technology, 2008. http://hdl.handle.net/1721.1/45232.
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Thesis (M. Eng. in Logistics)--Massachusetts Institute of Technology, Engineering Systems Division, 2008.Includes bibliographical references (leaves 75-80).
Healthcare costs in United States are projected to rise to 20% of GDP by 2015. This is a cause of major concern and current political debate. The largest contributor to this cost is the hospital cost accounting for 30 % to the healthcare expenditure. Segmenting healthcare through new delivery mechanisms may be an answer to the rising cost. Disruptive innovations like Retail clinic's is a prime example of this segmentation providing patients increased convenience at a reduced cost. This thesis presents the case of evolving Homebased healthcare as an alternative segment for healthcare with the objective that it would reduce the costs of healthcare by early monitoring, diagnosis and treatment of disease, a paradigm on which preventive healthcare is based. Synthesizing the information and research available this thesis proposes key elements of Homebased healthcare using which a model for Homebased healthcare is derived. Technology is discussed as a key enabler and a discussion is made regarding some of the current trends in evolving technology. Applying some lessons learned from other industry in high technology sector, this thesis then comment on the supply chain challenges arising due to homebased healthcare model.
by Prashant Nagpure.
M.Eng.in Logistics
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Derakhshani, Nava. ""God has locked the sky" : exploring traditional farming systems in Tigray, Ethiopia." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/97123.
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Thesis (MPhil)--Stellenbosch University, 2015.ENGLISH ABSTRACT: The Tigray region in northern Ethiopia is a historic centre of agricultural production and home to many subsistence farmers that still use traditional farming systems and practise rain-fed agriculture. The region has been affected adversely by famines and periodic droughts for centuries and is vulnerable to climate change. Farmers are producing on small plots of often degraded land and through their own actions have depleted the natural resources they rely on, in particular soil, water and trees. This study sought to explore the environmental degradation of Tigray through both a literature review of its agricultural socio-political history and a lived experience in the village of Abraha We Atsebaha among farmers of the region. It uses a variety of methodologies and methods, including a literature review, grounded theory, narrative inquiry and ethnography, to expand on the factors that have contributed to the current degradation, the implications for traditional farming and the potential for land regeneration. The first journal article seeks to explore how Ethiopians have shaped their natural environment. In particular, it focuses on deforestation, soil degradation, the role of changing governance and land-ownership patterns, and the effects of climate change. The article demonstrates that traditional farming systems do not operate in isolation from their socio-political and environmental context. The second journal article provides an in-depth narrative inquiry conducted in Abraha We Atsebaha over a three-month period in 2014. This village is known for its indigenous farming knowledge, commitment to regeneration and innovation in conservation practices. Interviews were conducted with selected farmers and local leaders and informal discussions were carried out with government extension representatives using the ethno-ecological cosmos-corpus-praxis guidelines to enable an integrated exploration of the nature of traditional farming, the causative factors of environmental deterioration and the resultant communal response. In addition to written interview notes, observations and field notes were recorded daily. Photographs are used to give a real sense of the community and their work. It emerged during this process that underlying belief systems were exceptionally important in a context of traditional conservation. Both articles discuss the development work undertaken by government in the rural farming sector and the successes and challenges faced. They also show that elements of traditional farming, sustainability measures and environmental care were suspended in favour of short-term survival as a consequence of social, political and population stressors. This study provides learning points, gained from insights gleaned from the literature review and the lived experience, for improving development interventions in this region. This study did not explicitly explore the role of religion in conservation or the potential long-term effects of current government policies and initiatives. However, it contributes to the small pool of literature on the region focused on traditional farming systems by providing a comprehensive overview of the drivers of degradation (historical and current) and offers a unique, “soft” experiential narration of a village in northern Ethiopia that allows insight into farmer experiences, pressures and adaptation efforts.
AFRIKAANSE OPSOMMING: Die Tigray-streek in die noorde van Ethiopië is ’n historiese sentrum van landbouproduksie en die tuiste van menige bestaansboer wat nog op tradisionele boerderystelsels en reënbesproeiing staatmaak. Die streek het eeue lank onder hongersnood en periodieke droogtes gebuk gegaan en is kwesbaar vir klimaatsverandering. Boere bewerk klein stukke, dikwels afgetakelde, grond en het deur hul eie optrede die natuurlike hulpbronne waarop hulle staatmaak – veral die grond, water en bome – uitgeput. Hierdie studie was daarop toegespits om ’n beter begrip te vorm van die omgewingsaftakeling in Tigray. Vir hierdie doel is ’n literatuurstudie van die sosiopolitieke landbougeskiedenis van die gebied onderneem, en is die lewe in die dorp Abraha We Atsebaha tussen boere van die streek ervaar. Die navorsing het van ’n verskeidenheid metodologieë en metodes, waaronder ’n literatuuroorsig, gegronde teorie, narratiewe ondersoek en etnografie, gebruik gemaak om lig te werp op die faktore wat tot die huidige aftakeling bygedra het, die implikasies vir tradisionele boerdery, en die potensiaal vir grondvernuwing. Die eerste tydskrifartikel verken hoe Ethiopiërs hul natuurlike omgewing gevorm het. Dit konsentreer veral op ontbossing, grondaftakeling, die rol van veranderende staatsbestuurs- en grondbesitpatrone, en die uitwerking van klimaatsverandering. Die artikel toon dat tradisionele boerderystelsels nie afsonderlik van hul sosiopolitieke en omgewingskonteks funksioneer nie. Die tweede tydskrifartikel beskryf ’n narratiewe diepte-ondersoek wat oor ’n drie maande lange tydperk in 2014 in Abraha We Atsebaha onderneem is. Hierdie dorp is bekend vir sy inheemse landboukennis, toewyding aan vernuwing, en innoverende bewaringspraktyke. Onderhoude is met ’n uitgesoekte groep boere en plaaslike leiers gevoer, en voorligtingsbeamptes van die staat is by informele gesprekke betrek. Die etno-ekologiese cosmos-corpus-praxis-riglyne is gebruik om ’n geïntegreerde studie te onderneem van die aard van tradisionele boerdery, die oorsaaklike faktore van omgewingsaftakeling, en die gevolglike gemeenskapsreaksie. Benewens skriftelike aantekeninge gedurende die onderhoude, is waarnemings en veldnotas ook daagliks opgeteken. Foto’s word gebruik om die gemeenskap en hul werk getrou uit te beeld. Gedurende hierdie proses het aan die lig gekom dat onderliggende oortuigingstelsels besonder belangrik is in ’n tradisionele bewaringskonteks. Albei artikels bespreek die ontwikkelingswerk wat die regering in die landelike boerderysektor onderneem, sowel as die suksesse en uitdagings daarvan. Dit toon ook dat elemente van tradisionele boerdery, volhoubaarheidsmaatreëls en omgewingsorg as gevolg van maatskaplike, politieke en bevolkingsfaktore laat vaar is ten gunste van korttermynoorlewing. Die insigte wat uit die literatuuroorsig sowel as die lewenservaring in die bestudeerde gemeenskap spruit, bied lesse vir die verbetering van ontwikkelingsintervensies in die streek. Die studie het nie uitdruklik die rol van godsdiens in bewaring of die potensiële langtermynuitwerking van huidige staatsbeleide en -inisiatiewe ondersoek nie. Tog dra dit by tot die klein hoeveelheid beskikbare literatuur oor tradisionele boerderystelsels in die streek deur ’n omvattende oorsig te bied van die (historiese en huidige) snellers van aftakeling, en vertel dit ’n unieke, ‘sagte’ ervaringsverhaal oor ’n dorp in die noorde van Ethiopië om sodoende insig in landbou-ervarings, -druk en -aanpassingspogings te bied.
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Richardson, Sandra. "HEALTHCARE INFORMATION SYSTEMS:DESIGN THEORY, PRINCIPLES AND APPLICATION." Doctoral diss., University of Central Florida, 2006. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/3182.
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Healthcare information systems (HISs), as a class of systems, are not currently addressed in the MIS literature. This is in spite of a sharp increase in use over the past few years, and the uniquely qualified role that MIS has in the development of, impact and general understanding of HISs. In this project the design science paradigm frames the development of a set of design principles derived from the synthesis of the design literature, ethics literature, and professional guidelines, from both the medical and computing professions. The resulting principles are offered to address the design of healthcare information systems. Action research, a widely accepted methodology for testing design principles derived from the design science paradigm, is employed to test the HIS principles and to implement change in a healthcare organization through the use of an HIS. The action research project was a collaborative effort between a Central Florida hospice and the researcher, the result of which was an advanced directives decision support system. The system was design to meet a number of organizational goals that ranged from tracking compliance with federal regulations to increasing the autonomy of the patients that used the system. The result is a set of tested design principles and lessons learned from both anticipated and unanticipated consequences of the action research project.Ph.D.
Department of Management Information Systems
Business Administration
Business Administration: Ph.D.
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Mazengia, Dawit Hailu. "Ethiopian Energy Systems : Potentials, Opportunities and Sustainable Utilization." Thesis, Uppsala universitet, Institutionen för geovetenskaper, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-150786.
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Ethiopia is a nation endowed with huge amount of water, wind, solar and geothermal energy potentials.However, regardless of its enormous potentials the energy system is highly dependent on traditional fossilfuels and biomass and only about 32% of the nation‟s population has access to electricity. Given this fact,the country has engaged itself in unprecedented multimillion dollar energy projects in recent years.However, some of the projects and the construction of huge dams have raised controversy oversustainability issues. In this thesis work, the potentials and opportunities of the Ethiopian energy systemsand the sustainability of the ongoing and planned energy projects are discussed. Their social,environmental and economic implications are also addressed based on an in depth literature review. Asurvey was also conducted through questionnaire to research people‟s opinion on the current projects andtheir implications and results were interpreted using Web HIPRE software. It is concluded that thesurveyed group, selected and contacted randomly, believe that the economy is the most important aspectfor the country to consider giving it a weight of 43% over the social (29%) and environmental (28%)aspects. The Web HIPRE analysis also showed that respondents support the current hydropower projectson the Gibe River. Different important stakeholder such as farmers, fishermen and other inhabitants of thearea who are directly affected (positively or negatively) by the projects and also people from EEPCo andother concerned bodies such as policy makers are not included in this survey due to communicationproblems to gather data. The inclusion of data from such key stakeholder could have potentially changedthe outcome of the survey. It is also concluded that while there are lots of rooms for improvements on theprojects (prior and post construction), some of the criticisms encircling the project seem to lack allrounded understanding of the social and economic needs of the country as well as the long term ecosystemimplications of the projects. It is also concluded that Ethiopia, if it uses its energy potentials properly,could not only meet its energy demands but also be a giant energy supplier to east African nations in a few years.
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Andersson, Anna. "Management information systems in process-oriented healthcare organisations." Licentiate thesis, Linköping : Univ, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5689.
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Zhang, Peng. "Multi-Agent Systems Supported Collaboration in Diabetic Healthcare." Doctoral thesis, Karlskrona : Department of Interaction and System Design, Blekinge Institute of Technology, 2008. http://www.bth.se/fou/Forskinfo.nsf/allfirst2/412a22709997af61c125745e003680a2?OpenDocument.
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Pouloudi, Athanasia. "Stakeholder analysis for interorganisational information systems in healthcare." Thesis, London School of Economics and Political Science (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298621.
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This thesis defines an interpretive stakeholder analysis approach for studying interorganisational systems and demonstrates its value in the healthcare domain. It is argued that the complex and political nature of these systems implies that the issues affecting their development and implementation go well beyond the primarily commercial concerns on which current research in interorganisational systems focuses. This thesis is based on the assumption that this broader range of issues can be better investigated and understood through a systematic and comprehensive study of their stakeholders. It is argued that this can be achieved by adopting an interpretive research epistemology, not least because of some common assumptions that stakeholder analysis approaches and interpretive research share. The thesis unveils these common assumptions and uses them to define an interpretive approach to the identification and analysis of stakeholder perceptions on interorganisational systems and their context. Using previous research in the stakeholder literature this work examines descriptive, instrumental and normative implications of the stakeholder approach in interorganisational systems use in healthcare, a domain where interorganisational systems development is less likely to be driven by commercial concerns. The descriptive aspect is made explicit with the study of interorganisational systems used in the drug use management domain whereas instrumental and normative aspects are investigated in the context of the NHSnet, a controversial system pertaining the electronic exchange of information in the healthcare domain in the United Kingdom. The thesis contributes to interpretive information systems research with the systematic study of the stakeholder concept in an interorganisational context and its grounding within the interpretive epistemology. It emphasises the importance and interrelation between the different aspects of stakeholder theory and demonstrates the value of each aspect in the healthcare domain thus also contributing to a rich insight in the particular empirical research context.
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Zhang, Yanan. "Understanding saving, consumption, and healthcare systems in China." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8497/.
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This thesis aims to explain the financial behavior of households and individuals in China, with a focus on the effects of the old-age dependency, household composition and healthcare systems. First, we investigate the association between old-age dependency ratio and household savings with 1995-2015 provincial-level panel data in China. The results show a negative association between the old-age dependency and the savings ratio, which is weaker in areas with higher level of government medical expenditure, financial development and insurance density. Second, we examine household composition and consumption with the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS). We provide evidence that the reallocation of resources freed up when an offspring moves out depends on the lever’s age. Finally, using the 2011, 2013 and 2015 waves of CHARLS, we evaluate and compare the Urban Employee Basic Medical Insurance (UEBMI) and resident health insurance (RHI) schemes. Estimations show that UEBMI is associated with a higher level of household consumption, the utilization of healthcare services, and medical expenditure (compared to RHI). Additionally, RHI fails to help poor people in purchasing sufficient healthcare, whilst UEBMI encourages rich people to overuse healthcare services.
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Ren, Haiying S. M. Massachusetts Institute of Technology. "Transition to cloud computing in healthcare information systems." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/76507.
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Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2012.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 60-63).
This thesis is a study on the adoption of cloud computing in healthcare information technology industry. It provides a guideline for people who are trying to bring cloud computing into healthcare information systems through the use of a framework of tools and processes to overcome both technical and business challenges.
by Haiying Ren.
S.M.in Engineering and Management
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Bravo, Plaza Maria Fernanda. "Cost and resource allocation in healthcare delivery systems." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/103217.
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Thesis: Ph. D., Massachusetts Institute of Technology, Sloan School of Management, 2015.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 145-152).
This thesis studies contemporary challenges arising at the market, system, and organization levels in the healthcare industry, and develops novel frameworks that allow us to better understand cost and resource allocation for strategic decision making in healthcare settings. The U.S. healthcare industry is going through a massive transformation process due to the increasing industry consolidation, and the implementation of the recently enacted healthcare reform. These changes have completely transformed the incentives in the industry, and traditional practices have become outdated, or are, in general, inadequate to address the new challenges. Our frameworks combine real data and statistical analysis with novel optimization-driven approaches (e.g., linear programming, game theory) that capture the first order aspects of the dynamics of the corresponding markets, systems, and organizations. Overall, this work has relied on collaboration with industry partners in order to identify trade-offs, validate models, and pursue practical innovation and implementation of the proposed frameworks. In the first part, and motivated by real applications from the healthcare industry, we consider a setting, where one firm provides a service to a second firm that is facing stochastic demand for the service. The changes in the reimbursement system have created new opportunities for business-to-business interactions between healthcare systems and providers. Typical contracts in the healthcare industry are based on a transaction fee per unit of service that is negotiated between the two parties. Unlike traditional product-based 2-echelon supply chains, the two firms have opposing risks with respect to the demand volume. We leverage this insight to design a conceptually simple two-price volume based contract, and analyze it within a game theoretic setting. We show that a two-price contract can optimally ensure risk sharing. Moreover, although the resulting problem is non-convex, we are able to characterize the unique equilibrium contract in closed form for a family of utility functions that captures firms' different risk behaviors, and general demand distributions. Moreover, at equilibrium the new contract has two desirable properties: (1) it allows for better risk reduction (measured by CVaR) for the two firms, and (2) it reduces the uncertainty of the payment transaction. In the second part, we study the strategic cost and resource allocation in large healthcare delivery networks and how these networks can, efficiently, integrate their operations in order to attain network's welfare objectives. Strategic problems, such as resource allocation, capacity placement, and portfolio of services in multi-site networks, require the correct modeling of network costs, network's welfare objectives and trade-offs, and operational constraints. Traditional practices related to cost accounting, specifically, the allocation of overhead and labor cost to individual activities, as a way to account for the consumption of resources, are not suitable for addressing these challenges. These practices often confound resource allocation and network building capacity decisions. In this part, we develop a general methodological optimization-driven framework inspired by network revenue management models, specifically linear programming optimization, that allows us to better understand network costs and provide strategic solutions to the aforementioned problems. We report the application of this framework on a real case study to demonstrate its applicability and important insights derived from it. Finally, in the third part of this thesis, we study the nature and sources of variability in surgical activities in a large pediatric hospital. We use machine learning techniques to quantitatively show that surgery time variability is high among pediatric cases and, against common belief, this is poorly explained by surgeon effect or other commonly considered characteristics. Our studies suggest that pediatric surgery time has higher inherent variability making pediatric ORs necessarily more costly and harder to schedule than adult ORs. They must therefore be sourced accordingly. These findings are novel and will be useful in the management of busy pediatric operating theaters. For administrators and policymakers, it provides a basis for understanding some of the added costs inherent in caring for children.
by Maria Fernanda Bravo Plaza.
Ph. D.
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Smith, Arthur M. D. "A Study on Federated Learning Systems in Healthcare." Youngstown State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1629188090536169.
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Rodríguez, Lina María Garcés. "A reference architecture of healthcare supportive home systems from a systems-of-systems perspective." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/55/55134/tde-16102018-111654/.
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Population ageing has been taking place all over the world, being estimated that 2.1 billion people will be aged 60 or over in 2050. Healthcare Supportive Home (HSH) Systems have been proposed to overcome the high demand of remote home care for assisting an increasing number of elderly people living alone. Since a heterogeneous team of healthcare professionals need to collaborate to continually monitor health status of chronic patients, a cooperation of pre-existing e-Health systems, both outside and inside home, is required. However, current HSH solutions are proprietary, monolithic, high coupled, and expensive, and most of them do not consider their interoperation neither with distributed and external e-Health systems, nor with systems running inside the home (e.g., companion robots or activity monitors). These systems are sometimes designed based on local legislations, specific health system configurations (e.g., public, private or mixed), care plan protocols, and technological settings available; therefore, their reusability in other contexts is sometimes limited. As a consequence, these systems provide a limited view of patient health status, are difficult to evolve regarding the evolution of patients health profile, do not allow continuous patients monitoring, and present limitations to support the self-management of multiple chronic conditions. To contribute to solve the aforementioned challenges, this thesis establishes HomecARe, a reference architecture for supporting the development of quality HSH systems. HomecARe considers HSH systems as Systems-of-Systems (SoS) (i.e., large, complex systems composed of heterogeneous, distributed, and operational and managerial independent systems), which achieve their missions (e.g., improvement of patients quality of life) through the behavior that emerges as result of collaborations among their constituents. To establish HomecARe, a systematic process to engineer reference architectures was adopted. As a result, HomecARe presents domain knowledge and architectural solutions (i.e., architectural patterns and tactics) described using conceptual, mission, and quality architectural viewpoints. To assess HomecARe, a case study was performed by instantiating HomecARe to design the software architecture of DiaManT@Home, a HSH system to assist at home patients suffering of diabetes mellitus. Results evidenced HomecARe is a viable reference architecture to guide the development of reusable, interoperable, reliable, secure, and adaptive HSH systems, bringing important contributions for the areas of e-Health, software architecture, and reference architecture for SoS.O envelhecimento da população é um fenômeno mundial e estima-se que no ano 2050, 2,1 bilhões de pessoas terão 60 anos ou mais. Sistemas de casas inteligentes para o cuidado da saúde (em inglês Healthcare Supportive Home - HSH systems) têm sido propostos para atender a alta demanda de serviços de monitoramento contínuo do número cada vez maior de pacientes que vivem sozinhos em suas residências. Considerando que o monitoramento do estado de saúde de pacientes crônicos requer a colaboração de equipes formadas por profissionais de várias especialidades, é fundamental que haja cooperação entre sistemas eletrônicos de saúde (por exemplo, sistemas de prontuário eletrônico ou sistemas de atenção de emergência), sendo eles externos ou internos à residência. Entretanto, as soluções de HSH existentes são comerciais, monolíticas, altamente acopladas e de alto custo. A maioria delas não considera a interoperabilidade entre sistemas distribuídos e exteriores ou internos à residência dos pacientes, como é o caso de robôs de companhia e monitores de atividade. Além disso, os sistemas de HSH muitas vezes são projetados com base em legislações locais, na estrutura do sistema de saúde (por exemplo, público, privado ou misto), nos planos de cuidados nacionais e nos recursos tecnológicos disponíveis; portanto, a reusabilidade desses sistemas em outros contextos é não é uma tarefa trivial. Em consequência, os sistemas de HSH existentes oferecem uma visão restrita do estado de saúde do paciente, são difíceis de evoluir acompanhando as mudanças no perfil de saúde do paciente, impossibilitando assim seu monitoramento contínuo e limitando o suporte para o paciente na autogestão de suas múltiplas condições crônicas. Visando contribuir na resolução dos desafios apresentados, esta tese estabelece a HomecARe, uma arquitetura de referência para apoiar o desenvolvimento de sistemas de HSH de qualidade. A HomecARe considera os sistemas de HSH como Sistemas-de-Sistemas (do inglês Systems-of-Systems - SoS) (ou seja, sistemas grandes e complexos formados por outros sistemas heterogêneos, distribuídos e que apresentam independência em seu gerenciamento e operação), que cumprem suas missões (por exemplo, melhoria da qualidade de vida do paciente) mediante o comportamento que emerge resultante da colaborações entre seus sistemas constituintes. Para estabelecer a HomecARe, foi adotado um processo sistemático que apoia a engenharia de arquiteturas de referência. Como resultado, a HomecARe contém o conhecimento do domínio, bem como soluções arquiteturais (por exemplo, padrões arquiteturais e táticas) que são descritas usando os pontos de vista conceitual, de missão e de qualidade. A HomecARe foi avaliada por meio da condução de um estudo de caso em que a arquitetura de referência foi instanciada para projetar o DiaManT@Home, um sistema de HSH que visa apoiar pacientes diagnosticados com diabetes mellitus na autogestão de sua doença. Os resultados obtidos evidenciaram que a HomecARe é uma arquitetura de referência viável para guiar o desenvolvimento de sistemas de HSH reusáveis, interoperáveis, confiáveis, seguros e adaptativos, trazendo importantes contribuições nas áreas de saúde eletrônica, arquitetura de software e arquiteturas de referência para SoS.
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Woldetsadik, Lia. "Instituting Collaborative Planning: government systems, trust and collective action in Ethiopia." Doctoral thesis, Universite Libre de Bruxelles, 2020. https://dipot.ulb.ac.be/dspace/bitstream/2013/305111/3/doc.pdf.
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More democratic planning processes are acknowledged to facilitate several positive outcomes including acceptance, support, better solutions and ownership, which are even more critical in developing countries where resource limitation is debilitating. But the paradox lies in needing to institute more democratic planning processes inside less democratic systems. In seeking explanations as to why collaboration in planning is lacking in urban Ethiopia, the research adopts a different analytical perspective that conceptualizes the state not only as a direct participant through its different agencies but also as the main architect of social structure. As the state in less democratic systems is stronger in shaping society, the contextualization of sense-making in the wider environment of the South requires focusing on the influence of government systems to discover associations and patterns that determine the structure of planning processes. Adopting flexible and pragmatic methodological procedures, methods and techniques that balance what is possible with epistemological interest, the research introduces a different lens to planning that links trust, collective action and cooperation with confidence in government by taking into consideration the embeddedness of actors within the framework of existing realities. Through the case of Amdework, the thesis presents implications on planning by the different attributes of the state and state-society relations. It shows how and to what extent partial and undemocratic government systems create power asymmetry, impede the development and the integrity of organized civil society, affect social capital such as trust, cooperative norms and the motivation to participate in collective action. These in turn penetrate planning processes by destroying the basic level of trust, balanced power of participants and democratic culture, and the we-intention for joint action. And through five more cases that focus on conceptions and cooperation at the micro-level (in the autonomous community of Awra Amba, the foreign NGO spearheaded joint action of the BuraNest initiative, and different projects in or related with Addis Ababa), it provides empirical evidence that planning, whether government entities are direct participants or not, also heed to pressures exerted by the overall of intuitional/political environment where the state rules rather than governs.Doctorat en Art de bâtir et urbanisme (Architecture)
info:eu-repo/semantics/nonPublished
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Olatinwo, Ismaila Gbenga. "Telehealth Implementation Strategies for Healthcare Providers." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7053.
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The shift in the landscape of healthcare services from inpatient care to outpatient care prompts healthcare leaders to re-evaluate their strategies to boost declining revenue. Telehealth offers potential for increasing efficiency and access to care, and the acceptance of its modal quality is essential for its diffusion and adoption. The purpose of this single case study was to explore strategies that healthcare providers used to implement telehealth to increase profitability. The conceptual framework was the technology acceptance model. Data were collected through semistructured interviews and review of organizational documents. The research population comprised 4 healthcare leaders in 1 organization in the midwestern region of the United States who had successfully implemented telehealth. Three main themes emerged from coding of phrases, word frequency searches, and data analysis: implementation strategies, obstacles in implementation, and user acceptance of telehealth. The findings from this study may contribute to the implementation of telehealth business practices by providing healthcare leaders with strategies to successfully implement telehealth to improve profitability. These strategies could help to provide suitable healthcare at lower costs and improve quality of life for patients.
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Neuhaus, Christian, Andreas Polze, and Mohammad M. R. Chowdhuryy. "Survey on healthcare IT systems : standards, regulations and security." Universität Potsdam, 2011. http://opus.kobv.de/ubp/volltexte/2011/5146/.
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IT systems for healthcare are a complex and exciting field. One the one hand, there is a vast number of improvements and work alleviations that computers can bring to everyday healthcare. Some ways of treatment, diagnoses and organisational tasks were even made possible by computer usage in the first place. On the other hand, there are many factors that encumber computer usage and make development of IT systems for healthcare a challenging, sometimes even frustrating task. These factors are not solely technology-related, but just as well social or economical conditions. This report describes some of the idiosyncrasies of IT systems in the healthcare domain, with a special focus on legal regulations, standards and security.IT Systeme für Medizin und Gesundheitswesen sind ein komplexes und spannendes Feld. Auf der einen Seite stehen eine Vielzahl an Verbesserungen und Arbeitserleichterungen, die Computer zum medizinischen Alltag beitragen können. Einige Behandlungen, Diagnoseverfahren und organisatorische Aufgaben wurden durch Computer überhaupt erst möglich. Auf der anderen Seite gibt es eine Vielzahl an Fakturen, die Computerbenutzung im Gesundheitswesen erschweren und ihre Entwicklung zu einer herausfordernden, sogar frustrierenden Aufgabe machen können. Diese Faktoren sind nicht ausschließlich technischer Natur, sondern auch auf soziale und ökonomische Gegebenheiten zurückzuführen. Dieser Report beschreibt einige Besondenderheiten von IT Systemen im Gesundheitswesen, mit speziellem Fokus auf gesetzliche Rahmenbedingungen, Standards und Sicherheit.
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al-Safadi, Yasser Haycam. "Distributed computing environment for standards based multimedia healthcare systems." Diss., The University of Arizona, 1995. http://hdl.handle.net/10150/187400.
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The Open Software Foundation (OSF) Distributed Computing Environment (DCE) is an integrated set of services that facilitates the construction, use and maintenance of distributed applications in a heterogeneous computing environment. The OSF DCE services include remote procedure calls, naming service, threads service, time service, and security service. Several OSF DCE toolkits are currently available from computer and software vendors. The Global Picture Archiving and Communication System (Global PACS) operates in a medical environment for managing digital images over a large geographical area. This dissertation presents an approach to developing a platform to support multimedia Global PACS applications using the OSF DCE services and toolkits. Dynamic sequences such as Ultrasound are retrieved from a scalable video service over a TCP/IP connection. The Comprehensive Chart and the Remote Consultation and Diagnosis system are multimedia Global PACS applications that demonstrate the utility of this approach. The Comprehensive Chart is a multimedia medical record browser that provides a comprehensive view of patient data. The user of the Comprehensive Chart is authenticated using DCE Security and can access the objects only allowed by the Access Control List. System resources locations are transparent to the user and are located using the DCE Directory Service. Patient data privacy is maintained during communication through the use of secure remote procedure calls. The Remote Consultation and Diagnosis system was developed under a National Science Foundation project headed by Dr. Ralph Martinez, University of Arizona. It allows medical experts at different geographical locations to view the same image and exchange synchronized voice and image annotation commands. The current version uses the DCE Directory Service to dynamically locate session participants. These participants are authenticated and they can access objects only allowed by access control lists. The DCE Time Service will hide time zone differences among participants, and support the timestamp mechanism for the synchronization of voice and image annotation commands. The use of the OSF DCE approach features an open architecture, heterogeneity, security, scalability, and technology independence. This approach can be used to develop general purpose multimedia delivery applications. Finally, this design and implementation provides the foundation for extending medical services to rural areas.
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Skilton, Alysia. "Supporting the information systems requirements of distributed healthcare teams." Thesis, Cardiff University, 2011. http://orca.cf.ac.uk/14573/.
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The adoption of a patient-centric approach to healthcare delivery in the National Health Service (NHS) in the UK has led to changing requirements for information systems supporting the work of health and care practitioners. In particular, the patient-centric approach emphasises teamwork and cross-boundary coordination and collaboration. Although a great deal of both time and money has been invested in modernising healthcare information systems, they do not yet meet the requirements of patient-centric work. Current proposals for meeting these needs focus on providing cross-boundary information access in the form of an integrated Electronic Patient Record (EPR). This research considers the requirements that are likely to remain unmet after an integrated EPR is in place and how to meet these. Because the patient-centric approach emphasises teamwork, a conceptual model which uses care team meta-data to track and manage team members and professional roles is proposed as a means to meet this broader range of requirements. The model is supported by a proof of concept prototype which leverages team information to provide tailored information access, targeted notifications and alerts, and patient and team management functionality. Although some concerns were raised regarding implementation, the proposal was met with enthusiasm by both clinicians and developers during evaluation. However, the area of need is broad and there is still a great deal of work to be done if this work is to be taken forward.
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Walley, Paul. "Demand and capacity management in healthcare : a systems perspective." Thesis, University of Warwick, 2011. http://wrap.warwick.ac.uk/51557/.
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The report as a whole presents a collection of academic papers that make a significant contribution to the field of demand and capacity management in healthcare. The report is divided into six main sections. In this section the context of the challenges faced by healthcare organisations is explained, the objectives of the research are outlined, and the research methodologies employed are described. Section 2 summarises the key contributions to theory contained within the submitted papers. Section 3 provides a justification and explanation of the theoretical perspectives employed in this research. Section 4 provides a summary of each of the submitted papers together with a commentary on the contribution that the paper makes. The work is presented in a sequence that best explains the conceptual logic rather than a chronological overview. Section 5 discusses and evaluates these papers with a critical perspective. The final section contains concluding comments and presents a framework of demand and capacity management in healthcare.
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Dawson, Carolyn. "Future systems of measurement for hand hygiene in healthcare." Thesis, University of Warwick, 2014. http://wrap.warwick.ac.uk/63285/.
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Hand hygiene is considered a key infection prevention strategy against the challenge of healthcare associated infections, as it prevents cross-transmission of microorganisms which may cause harm. Despite this, compliance amongst healthcare professionals is often poor. Considerable attention has been placed on developing interventions to increase hand hygiene, however known problems with measurement make determining improvement from established baselines difficult. This thesis addresses measurement through three research themes: The importance of meaningful data (Study 1), the potential for technology (Study 2), and the influence of human behaviour (Study 3). These are considered in relation to guidelines developed by the World Health Organisation (WHO) (My 5 Moments for Hand Hygiene). The thesis output provides recommendations for the healthcare setting, technology industry and research community by forming a new conceptual and integrated way of considering the measurement of hand hygiene compliance. A mixed methods approach was applied using a single case study methodology comprising three studies (two qualitative, one quantitative), based at a UK acute National Health Service Trust. Healthcare professionals involved in the current hand hygiene measurement process participated in all three studies (N=47). Methods included structured literature reviews, participant observation, one-to-one and group interviews, nonparticipant observation and analysis of existing case study site data. In Study 1 healthcare professionals identified a lack of clarity regarding feedback, and a lack of synergy between hand hygiene training and measurement. Combined with data accuracy flaws, their view was that the current hand hygiene measurement process produced meaningless data. Study 2 investigated healthcare professional views regarding the potential of technology to measure hand hygiene. It found that whilst current innovations are unable to detect all the WHO 5 Moments, healthcare professionals are interested in their potential to aid measurement and compliance. However they raised concerns about Fit for Purpose, anonymity and resistance, and over-reliance on technology and habituation. Interestingly participants suggested that hand hygiene across all WHO 5 Moments is not equal, expecting higher levels of adherence to Moments 2 and 3 than Moments 1, 4 and 5. Study 3 explored this, investigating the theory of Inherent and Elective hand hygiene behaviour. Inherent can be linked to Moments 2 and 3, through activities likely to stimulate an automatic “disgust” reaction within humans. Hand hygiene was significantly lower when healthcare professionals performed Elective rather than Inherent activities. The research developed Inherent and Elective theory further by proposing it as a lens with which to view the WHO 5 Moments and develop strategies for improved compliance. Understanding that hand hygiene is less likely at Elective activities, linked to Moments 1, 4 and 5 suggests these as key areas of focus for technology development. Acknowledging that hand hygiene may be more instinctive at Moment 2 and 3 may be useful when planning education, leading to reduced healthcare professional apathy towards hand hygiene. Involvement of healthcare professionals in exploring measurement processes and developing technologies for hand hygiene is proposed as key to ensure data produced by future methods of measurement is meaningful, vital to ensure desired behaviour change.
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Ainsworth, John David. "Re-engineering healthcare systems to use evidence from practice." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/reengineering-healthcare-systems-to-use-evidence-from-practice(5fbb474d-ea68-42f4-883e-1a930868935c).html.
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Health and care services need to be optimised to meet the future demand that will be placed on them. This will require a closer coupling of service and research, whereby innovations in services can be rapidly tested and evaluated, and feed back into a continual process of service optimisation. The timely delivery of information from services into research is critical to this cycle. However, there are serious problems with the evidence on which healthcare and public health practice is based: it is expensive to produce; it takes a long time to produce; it takes a long time to influence professional practice; it is crude, relating to the average participant and simple treatment definitions under ideal conditions. In other words, it gives a low-resolution picture of how a patient might respond to treatment or a how a sub-group of the community might respond to a public health intervention. This work is an exploration of informatics solutions to these problems with an aim to re-engineer health care systems to make best use of the evidence available.
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Afrasiabi, Rad Amir. "Business process modeling in Web service-based healthcare systems." Thesis, University of Ottawa (Canada), 2009. http://hdl.handle.net/10393/28422.
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Web services composition is an emerging paradigm for enabling inter and intra organizational integration, and a landscape of languages and techniques for modeling business processes in web service based environments has emerged and is continuously being enriched. With the advent of modeling standards, different business sectors are investigating the options for modeling their workflows. In terms of business process modeling, healthcare is a rather complex sector of activity. Indeed, modeling healthcare processes presents special requirements dictated by the complicated and dynamic nature of these processes as well as by the specificity and diversity of the actors involved in these processes. Little effort has been dedicated to evaluating the capabilities and limitations of modeling languages based on healthcare requirements. This thesis presents a set of healthcare requirements and proposes an evaluation framework for process modeling languages based on these requirements. The suitability of three major process-based service composition languages, namely BPEL, BPMN and WS-CDL, is evaluated.
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Liu, Hailong, Wenhua Qi, Qishan Zhang, and Jinpei Wu. "PKI/PMI AND SMART TOKENS IN HEALTHCARE INFORMATION SYSTEMS." International Foundation for Telemetering, 2003. http://hdl.handle.net/10150/606668.
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International Telemetering Conference Proceedings / October 20-23, 2003 / Riviera Hotel and Convention Center, Las Vegas, NevadaWhile healthcare industry is striving to achieve e-health systems for improvements in healthcare quality, cost, and access, privacy and security about medical records should be considered carefully. This paper makes a deep study of Public Key Infrastructures (PKIs) and Privilege Management Infrastructures (PMIs) and how they can secure e-health systems. To access resources, e.g. patient records, both authentication and authorization are needed, so public key certificates and attribute certificates are both required to protect healthcare information. From a typical medical scenario, we see not only static but also dynamic permissions are required. Dynamic authorization maybe the most complex problem in e-health systems.
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Wakjira, Dereje Tadesse. "Governance of social-ecological systems in an Afromontane forest of southeast Ethiopia : exploring interactions between systems." Thesis, University of Aberdeen, 2013. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=205392.
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Adaptive governance is increasingly regarded as necessary to improve the resilience of social-ecological systems. However, empirical studies of social-ecological systems are scarce, especially in relation to multiple-use forest systems. This thesis draws on a study of an Afromontane forest in southeast Ethiopia that has been used by humans through history, and explores mechanisms of interactions between social and resource systems and their influences on the overall social-ecological system. The thesis analyses the role of local-level institutions in this social-ecological system, their changes over time, their function as channels of access to forest products for local people and their influence on the forest system resulting from people's patterns of forest use. I use an interdisciplinary approach, considering local governance institutions (Chapters 2 & 3), forest-based livelihoods (chapter 4) and forest system (Chapter 5) as components of social-ecological systems. Chapter 2 analyses institutional change over time in order to understand mechanisms by which local forest use has been coordinated in dynamic political and socio-economic contexts. Data were collected through in-depth and semi-structured interviews. The findings show that combining elements from both informal and formal institutions allowed traditional rules to persist for decades in the guise of more formal arrangements. However, large-scale governance changes constrained the adaptive capacity of local institutions by abolishing fora for collective decision-making. Chapter 3 builds on these findings. It examines the roles of elders, i.e., key actors in the communities, and the structure of their networks in order to understand mechanisms by which informal institutions were coordinated across study villages in the absence of fora for collective decision-making. Key informant in-depth interviews were used to explore the roles of elders in local governance. In addition, a questionnaire survey was conducted with elders to identify social networks. Findings suggest that prominent elders resident in different Kebeles were connected by layers of informal networks through which they exchanged opinions and knowledge. These networks were not centralised and were to some degree redundant, as the same roles were preformed by more than one elder in each community, which contributed to the persistence of informal institutions. These informal networks created a power that helped local people to undermine some of the formal rules and to continue using the forest for their livelihoods under informal governance arrangements. Chapter 4 investigates households' access to forest-based livelihoods as coordinated by informal institutions. To examine the relationships between households' endowments with assets and their use of forest products, a questionnaire survey was administered to the selected households resident in seven of the eight villages (Kebeles) bordering the Harenna forest. The results showed that 86% of households benefited from the forest directly by using one or more of the three non-timber forest products (NTFPs) considered; coffee, beekeeping and livestock grazing. Furthermore, there was no strong evidence that ownership of specific assets explained the difference between those households who used NTFPs and those who did not. However, asset-rich households tended to own larger areas of coffee land and to use multiple forest products compared to asset-poor households. In conclusion, future management approaches should be mindful of the effect that a formalisation of de facto forest use could have on widening the gap between asset-poor and asset-rich households. Chapter 5 reports the ecological legacy of different forest use practices. To assess the vegetation structure and composition of the forest under four different coffee management systems which evolved in the past 50 years, measurements of woody plants were taken from 202 nested plots. The results of the study provide an indication of how well each of the four coffee systems affects structure and composition of the forest. The study highlights the importance of adapting institutions to retain the patchy distribution of the different coffee systems in order to encourage forest dynamics at a landscape level. Together, the findings of the four studies identify the mechanisms by which interventions that specifically target either only forest ecosystems or social systems may undermine the sustainability of social-ecological systems. This emphasises the importance of autonomous local institutions to facilitate adaptive governance within broadly agreed goals, as rigid governance arrangements constrain the resilience of social-ecological systems.
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Kanagwa, James R. "Establishing Mobile Financial Services in Ethiopia." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2319.
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Mobile phone service is increasing among low income populations; however, with over 1 billion mobile service users worldwide, many people still lack banking services. Banks do not reach out to the poor because of the high operational costs involved. Scholars and industry practitioners have indicated that mobile phones could be an alternative channel for delivering financial services to the less advantaged and unbanked, without requiring a traditional bank with a branch network. The purpose of this bounded case study was to explore the strategies bank managers used to implement the new mobile banking service to the Ethiopian community. The new product development theory served as the conceptual framework for this study. Twenty experienced bank managers were interviewed from the leading private bank in Ethiopia. Data were segmented and categorized. After member checking and triangulation, data were sorted into 4 themes: development, testing, commercialization of new products or services, and an organizational commitment to adopt new technologies and innovative processes. The findings may contribute to the body of knowledge regarding strategies bank managers can use for implementing and introducing new products in order to contribute to the prosperity of individuals, businesses, and communities.
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Rashwand, Saeed. "Efficient Wireless Communication in Healthcare Systems; Design and Performance Evaluation." IEEE, 2010. http://hdl.handle.net/1993/9227.
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Increasing number of ageing population and people who need continuous health monitoring and rising the costs of health care have triggered the concept of the novel wireless technology-driven human body monitoring. Human body monitoring can be performed using a network of small and intelligent wireless medical sensors which may be attached to the body surface or implanted into the tissues. It enables carers to predict, diagnose, and react to adverse events earlier than ever. The concept of Wireless Body Area Network (WBAN) was introduced to fully exploit the benefits of wireless technologies in telemedicine and m-health.
The main focus of this research is the design and performance evaluation of strategies and architectures that would allow seamless and efficient interconnection of patient’s body area network and the stationary (e.g., hospital room or ward) wireless networks. I first introduce the architecture of a healthcare system which bridges WBANs and Wireless Local Area Networks (WLANs). I adopt IEEE 802.15.6 standard for the patient’s body network because it is specifically designed for WBANs. Since IEEE 802.15.6 has strict Quality of Service (QoS) and priorities to transfer the medical data to the medical server a QoS-enabled WLAN for the next hop is needed to preserve the end-to-end QoS. IEEE 802.11e standard is selected for the WLAN in the hospital room or ward because it provides prioritization for the stations in the network. I investigate in detail the requirements posed by different healthcare parameters and to analyze the performance of various alternative interconnection strategies, using the rigorous mathematical apparatus of Queuing Theory and Probabilistic Analysis; these results are independently validated through discrete event simulation models.
This thesis has three main parts; performance evaluation and MAC parameters settings of IEEE 802.11e Enhanced Distributed Channel Access (EDCA), performance evaluation and tuning the MAC parameters of IEEE 802.15.6, and designing a seamless and efficient interconnection strategy which bridges IEEE 802.11e EDCA and IEEE 802.15.6 standards for a healthcare system.
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Singprasong, Rachanee. "A framework for rapid problem assessment in healthcare delivery systems." Thesis, Brunel University, 2012. http://bura.brunel.ac.uk/handle/2438/7617.
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Problems in healthcare are difficult to comprehend due to complexity, involvement of multiple stakeholders in decision making and fragmented structure of delivery systems. Major Problem Structuring Methods (PSMs) have been used to aid problem understanding which, in principle, can provide greater clarity to strategic problems and engage diverse decision makers using transparent representation that capture differing perceptions of problems. In reality, PSMs can be difficult in accurately representing problems, limited in highlighting improvement opportunities due to non-intuitive visual representations and requirements for facilitators and stakeholders to be experts in tools used. This research aims to address this gap by developing a framework, taking into account characteristics of healthcare delivery systems, advantages and limitations of PSMs with an aim of providing accurate and holistic representation of delivery workflow, so as to promote problem understanding in a rapid manner. The framework, termed CARE, first establishes nature of problem and a commonly agreed problem statement along with an understanding of stakeholder involvement and operating regulations. It then sets specific guidelines for data collection, representation, verification and validation from stakeholders and provides methodology for data analysis which allows facilitator insight into possible flaws in workflow. A case study approach is used to test effectiveness of CARE across two different healthcare settings, each involving a different nature of problem. Implementation of CARE leads to improved participation and ownership amongst stakeholders, ease of facilitation during individual or multidisciplinary meetings, intuitive and informative representation of workflow, minimized time and effort for implementation and minimized dependencies on learning new tools and terminologies. A post mortem indicates the positive impact of CARE on services rendered to the patients, leading to an increase in patient satisfaction and workflow efficiencies. The research concludes by noting the contributions and lessons learnt from this research for healthcare practitioners and possible future work.
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Helligso, Jesse. "A MICROECONOMIC MODEL OF HEALTHCARE SYSTEMS: FROM THEORETICAL TO PRACTICAL." Master's thesis, University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2374.
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This thesis is a microeconomic market analysis of healthcare systems. Different countries use various forms for financing and providing healthcare, and the effects of market forces on the quality, access and economic efficiency of these divergent healthcare markets is the primary subject. The purpose of this thesis is to describe the forces working in the healthcare market. Free-market healthcare systems allow medical providers to become price-setters. Price-setting by medical providers creates an economically inefficient system which decreases public access to healthcare but creates a high quality system. Single-payer systems make government the price-setter which creates a system in which medical providers are price-takers. Government price-setting guarantees access but quality and economic efficiency vary drastically between countries. Universal single-payer systems tend to set prices higher than the theoretically necessary price which creates a high quality, economically inefficient system. Socialized single-payer systems tend to set prices lower than the theoretically necessary price which creates government savings, wait-lists and poorer quality. The quality, economic efficiency, and equity of the healthcare system are determined by the form of the market used in the country. Ultimately, this market determines price. In a free-market system price is determined by providers of healthcare, in a socialized market price is determined by government, and in a universal healthcare system price is negotiated by both healthcare providers and government. Price negotiation in a universal system creates the greatest access to healthcare, and quality of healthcare. Socialized systems can be more economically efficient than a universal system, but quality and access can be limited. Price negotiation in a universal healthcare system fixes the problems of price negotiation inherent in the healthcare market.M.A.
Department of Political Science
Sciences
Political Science MA
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Chaldoupis, K. "Additive manufacturing implementation in healthcare systems : a supply chain perspective." Thesis, University of Salford, 2018. http://usir.salford.ac.uk/47023/.
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Additive Manufacturing (AM), or “3D Printing”, also called the ‘Third Industrial Revolution’, allows companies and individuals to “print-out” solid objects layer-by-layer based on access to 3-dimensional computer data. Several authors have pointed out that AM has the potential to reduce the number of stages in the traditional supply chain and to fundamentally revolutionize manufacturing operations and supply chains. Evidence suggests that AM technology as a driver of supply chain transformation it can achieve precision, speed, affordability, and materials range. Therefore, it has the potential to redesign products with fewer components and to manufacture products near the customers. Production applications of AM technologies can be found mainly in aerospace, automotive, medical, and consumer goods. Although a number of companies are already using AM technologies they face particular difficulties in the implementation process. In particular, studies on AM implementation are disappointingly absent, especially in relation to supply chain. Most studies on supply chain focus mainly on the potential disruptions of AM in distribution/logistics and therefore on location of manufacturing. Hence, an investigation on the key AM implementation factors within the various stages of a supply chain from the selection of raw material-equipment suppliers towards the customers needs to be examined. This study proposes an AM implementation framework on supply chain. It focuses on the healthcare sector and medical device manufacturers. Healthcare organisations must constantly monitor supply chain performance to add value across entire supply chain. AM presents an effective and promising commercial proposition to respond to the increasing healthcare demands in the developing world by providing customized products, which can improve medical care, reduce healthcare costs by decreasing time spent under direct care and improve success rates. It is carried out through a case study research approach combined with background theory on advanced manufacturing systems. Three case studies were conducted to examine the AM implementation process on supply chain. The most significant contribution of the research is the proposed AM implementation framework from a supply chain perspective. At the time of writing this is the first study which examines the AM implementation process on the supply chain of medical device manufacturers. Hence, AM medical device manufacturers can use it as a guide to develop their own implementation plans.
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El-Grégorie, S. "Whole systems healthcare : traditional Chinese medicine acupuncture under the microscope." Thesis, City, University of London, 2018. http://openaccess.city.ac.uk/20129/.
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Aim The aim of this study was to investigate the efficacy of a specific school of acupuncture, Traditional Chinese Medicine Acupuncture (TCMA), as a whole complex intervention, as it operated in a clinic setting, on a wider representation of users and spectrum of diseases than the typical acupuncture user profile, and to explore potential variations in health outcomes. Design and Setting This was a retrospective study that employed a Whole Systems Research (WSR) design that involved outcome evaluation, to determine the efficacy of TCMA, together with process evaluation, to determine patient perceptions of how the intervention worked in practice, with regards to health, wellness, and Quality of Life (QoL). The research focused on a subsidised clinic that was located in a socially deprived area of London. Methods The retrospective study period was February 2007 to March 2008. Scores from Measure Yourself Medical Outcome Profile (MYMOP), an outcome measure used to investigate changes in health outcomes over time, were extracted from individual patient files (N=208) that had fulfilled the inclusion criteria of attendance at six consecutive treatment sessions, delivered from baseline treatment, irrespective of outcome or symptom. MYMOP scores on Symptom, Activity and Wellbeing, that were completed at baseline (treatment 1) follow up (treatment 2), follow up (treatment 3), follow up (treatment 4), follow up (treatment 5) and follow up (treatment 6), were analysed using repeated measures ANOVA to investigate whether a significant difference in QoL, a variable derived from the mean of the nominated MYMOP scores, existed between baseline treatment and outcome for patients over the six week treatment period; statistical analysis was also completed to explore variations in treatment outcomes in relation to patient’s socio-demographic characteristics, age, gender, ethnicity and social grade, and the wide range of health conditions reflected in the sample. Written patient commentaries (N=117), concerning experiences of TCMA, that were provided on patient discharge forms were extracted and analysed using Thematic Analysis. Results Significant differences were found in the direction of better reported MYMOP Symptom, Activity and Wellbeing scores following TCMA treatments and a significant difference in QoL was found between baseline assessment and outcome for TCMA patients over the 6-week course of treatment. Statistical analysis produced no evidence that the perceived benefits of TCMA treatment were associated with patients’ gender, age, ethnicity, social class, or presenting condition; no evidence was found that either demographics or presenting condition operated as outcome modifiers. Thematic analysis resulted in the identification of five themes which together provided insight into, and a way of understanding, both the outcomes and the processes that operated within TCMA. Conclusion Findings from the present study show that TCMA delivered perceived global and multidimensional beneficial changes in health, wellbeing and QoL; furthermore, the perceived positive treatment outcomes, which were unrelated to illness type or severity at the time of initial treatment, were consistent across socio-demographic subgroups and a wide spectrum of challenging cases of both physical and mental pathology. The study’s findings are important because they have advanced understanding of TCMA treatment efficacy and the workings of this particular style of acupuncture (TCMA) in terms of health, wellness and QoL.
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Rexhepi, Hanife. "Improving healthcare information systems : A key to evidence based medicine." Licentiate thesis, Högskolan i Skövde, Institutionen för informationsteknologi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-11019.
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Delivering good quality care is a complex endeavor that is highly dependent on patient information and medical knowledge. When decisions about the care of a patient are made, they must, as far as possible, be based on research-derived evidence rather than on clinical skills and experience alone. Evidence based medicine (EBM) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise as well as patient values and preferences to guide healthcare decisions. Following the principles of EBM, healthcare practitioners are required to formulate questions based on patients’ current clinical status, medical history, values and preferences, search the literature for answers, evaluate the evidence for its validity and usefulness, and finally apply the information to the patient. Information systems play a crucial role in the practice of evidence based medicine, by allowing healthcare practitioners to access clinical evidence and information about the patients’ health as they formulate their patient-care strategies. However, current information systems solutions are far from this perspective for various reasons. One of these reasons is that existing information systems do not support a seamless flow of patient information along the patient process. Due to interoperability issues, healthcare practitioners cannot easily exchange patient information from one information system to another and from one healthcare practitioner to another. Consequently, vital information that is stored in separate information systems and which could present a clear and complete picture of the patient cannot be easily accessed. All too often, units have to operate without knowledge of the problems addressed by other healthcare practitioners from other units, the services provided, medications prescribed, or preferences expressed in those previous situations. The practice of EBM is further complicated by current information systems that do not support practitioners in their search and evaluation of current evidence in everyday clinical care. Based on a qualitative approach, this work aims to find solutions for how future healthcare information systems can support the practice of EBM. By combining existing research on process orientation, knowledge management and evidence based medicine with empirical data, a number of recommendations have been initiated. These recommendations aim to support healthcare managers, IT–managers and system developers in the development of future healthcare information systems, from a process-oriented and knowledge management perspective. By following these recommendations, it is possible to develop information systems that facilitate the practice of evidence based medicine, and improve patient engagement.
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Shemilt, Katherine. "Quality healthcare in NHS hospitals : the impact of prescribing systems." Thesis, Liverpool John Moores University, 2015. http://researchonline.ljmu.ac.uk/4357/.
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The National Health Service (NHS) focuses on quality of care as a priority. With the NHS planning to go paperless by 2018, more hospitals in England are making the transition from paper to electronic prescribing (ePrescribing) systems. The aim of this programme of work was to understand and explore the influence different in-patient prescribing systems can have on key NHS healthcare professionals (doctors, nurses and pharmacists) working practices in England and quality healthcare. The programme of work, a three phase sequential design, used both qualitative and quantitative approaches. The first phase involved structured telephone interviews with chief pharmacists. Chief pharmacist interviews (n=65) focused upon the type of in-patient prescribing systems in use within each Trust and gained a management perspective of the different prescribing systems. Phases two and three were carried out at three acute NHS hospitals in England, at various stages of developing and implementing their prescribing systems. Phase two data were collected through multidisciplinary team (MDT) focus group discussions. The MDT discussions explored a number of areas associated with the prescribing systems in use: these included clinical workflow, communication, collaboration, patient safety and the use of a clinical indication on the prescription chart. Phase three data were collected using documentation analysis of the prescribing system and medical records, taken from patients cared for by the MDTs involved in phase two. Information extracted included any documentation made of a newly initiated medication, as well as the design of the prescribing system. The clarity and accuracy of documentation in the prescribing system and medical notes were compared to the GMC standards Good Practice in Prescribing Guidelines. Triangulation of data indicated how a change in prescribing system can impact upon individuals working practices by changing the design and clarity of the prescription chart, enforcing of regulations, accessibility and reliability, communication between key HCPs and the patient. These influences can be considered latent conditions in the systems that need addressing to prevent quality of patient care being compromised. The use of Socio-technical systems (STS) theory considered the interaction between humans and technology when using the prescribing systems. Understanding the issues where social and technical aspects interact in the prescribing system, emphasised where healthcare quality is impacted and therefore facilitated recommendations to improve working practices. The findings will help healthcare organisations to consider the impact a change in prescribing system can have on working practices and the latent failures that need consideration within the prescribing systems. The Electronic Prescribing and Medicines Administration (EPMA) system design must take into account the visual and physical needs of the user and consider how they can be improved to facilitate clinical workflow.
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Hashmi, Sahar. "Healthcare Systems : three studies of patient management and policy change." Thesis, Massachusetts Institute of Technology, 2018. https://hdl.handle.net/1721.1/124589.
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Thesis: Ph. D. in Engineering Systems, Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society, 2018Cataloged from PDF version of thesis. "Doctor of Philosophy in Healthcare Systems: Management and Policy Research."
Includes bibliographical references.
For my PhD thesis, I conducted behavioral science research and wrote three first- author journal format papers, of which one paper has been published and the other two will be submitted to healthcare management journals after completion of my degree. All three papers introduce new information about either the cost or the behaviors of patients in local clinics, filling a gap in the healthcare system's management and policy literature. The first paper studies patients with diabetes who are non-adherent to scheduled appointments with physicians in a specialized diabetes clinic setting in Boston. I developed and introduced new and interesting ''technology comfort" measures and a "Smartphone usage" scale, to evaluate if patients would be able to use smart technologies for their disease self-management. This paper not only suggests that patients with diabetes could potentially benefit from using existing advanced technologies, but that new policies can be introduced to reduce the rate of diabetes patients' appointment-related non-adherence. The second paper examines the system of adherence or self-management in five areas ( diet, exercise, medications, doctor's appointments and regular glucose monitoring), revealing how it is correlated to emergency visits and patient lifestyle satisfaction. I analyze predictors of emergency room visits and propose potential policies to reduce these ER visits through the use of advanced smart technologies. The third paper identifies the incidence and consequences of not practicing non- pharmaceutical interventions, during the time of a pandemic, in a student population at a local university clinic.
by Sahar Hashmi, MD.
Ph. D. in Engineering Systems
Ph.D.inEngineeringSystems Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society
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Kurji, Jaameeta. "Assessing the Determinants of Maternal Healthcare Service Utilization and Effectiveness of Interventions to Improve Institutional Births in Jimma Zone, Ethiopia." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42162.
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The strong emphasis placed on improving equality and well-being for all in the Sustainable Development Goals underscores the importance of tackling persistent within-country disparities in maternal mortality and poor health outcomes. Addressing maternal healthcare access barriers is, thus, crucial, particularly in low-resource settings. Numerous studies investigating determinants of maternal healthcare service use in Ethiopia exist but are limited by their focus on individual and household factors, and by methodological weaknesses. A nuanced understanding of the role of socioeconomic and geographic context in influencing access to care is needed to respond effectively.
Maternity waiting homes (MWHs) are a potential strategy to address geographical barriers that delay women’s access to obstetric care. However, in addition to concerns about service quality, there is limited evidence on their effectiveness and on what models meet women’s needs. My research goals were, therefore, to contribute to the understanding of what contextual factors influence maternal healthcare service use in general; and to determine whether or not upgraded MWHs operating in an enabling environment could improve delivery care use in rural Ethiopia. My primary data sources were household surveys conducted as part of a cluster-randomized controlled trial evaluating MWHs and local leader training in Jimma Zone, Ethiopia.
Random effects multivariable logistic regression analysis of survey data brought to light the social and financial resources that facilitate MWH use, highlighting the need for complementary interventions to make access more equitable. Spatial analyses identified subnational variation in service use at a finer scale than routinely reported and unmasked local variation in the relevance and magnitude of associations between individual-, interpersonal-, and health system factors and maternal healthcare use. These findings have implications for relying upon homogenous national responses to improve equality in access to care and health outcomes. Finally, analysis of trial data found a non-significant effect of interventions on delivery care use likely due to implementation issues and extraneous factors. The need to generate strong evidence of effectiveness of MWHs in improving maternal healthcare service use using sustainable and equitable MWH models using methods appropriate for complex intervention evaluation remains.
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Gebreslassie, Teklebrhan Woldearegay. "E-Business Strategy to Adopt Electronic Banking Services in Ethiopia." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4366.
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E-banking services in Ethiopia are increasing among low-income populations; however, with over 53 million mobile service users countrywide, more than 85% of the population still lacks access to banking services. A single case study was used to explore e-business strategies that bank managers use to promote the adoption of electronic banking services to the unbanked population in Ethiopia. The extended resource-based view of strategy served as the conceptual framework for this study. Data were collected from interviews with 12 experienced bank managers from leading commercial bank in Ethiopia. Data were analyzed using coding techniques and word clustering, with the help of qualitative data analysis software. After member checking and methodological triangulation, data were sorted into 5 themes including ensuring leadership, creating accessibility, fostering customers' acceptance, leveraging unique features and organizational resources, and building an e-banking ecosystem. The result showed that bank managers need to develop a customer-centric organizational posture and they should focus to build e-banking ecosystem inside and outside the country so that they can realize their vision to become global competitors. The findings from the study may contribute to positive social change for the unbanked communities in Ethiopia by informing bank managers options of e-banking adoption strategies thereby improve the convenience and accessibility of banking services.
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Blackadar, Kerry Jean. "A content analysis of US newspaper coverage of Canada and the UK’s healthcare systems during America’s healthcare reform." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/27836.
Full textAbstract:
This study examines how Canadian Medicare and the United Kingdom’s National Health Service (NHS) were represented in US newspaper coverage between January 2008 and the first quarter of 2010, a period marked by changing healthcare policy in America and dramatic shifts in the journalism industry at large. Through a content analysis of print news from the New York Times, Wall Street Journal, and USA Today, this paper tracked and assessed reporting dimensions and coverage themes to illustrate the quantity and quality of coverage. The analysis was based on the seminal work of Pauline M. Vaillancourt Rosenau, who performed a content analysis of newspaper coverage of Canada’s healthcare system between 2000 and mid-June 2005 in the NYT and WSJ.
Findings from this thesis reveal that recent US newspaper coverage of Medicare, though narrow, is more accurate and balanced compared to coverage during Rosenau’s study timeframe. The NHS received far greater attention in US newspapers, indicating that outside factors, potentially including collaboration in the Iraq war, have spawned greater US media interest in the UK at large. On occasion, this study found coverage of the NHS to be critical, relying on anecdotal evidence to suggest systematic failure of aspects of healthcare in the UK. With respect to coverage themes, wait lines for treatment was a dominant issue in US newspaper reporting of both Canadian Medicare and the NHS. Medical tourism and problems associated with paying for universal healthcare also emerged in US representation of the NHS.
This paper concludes with a discussion of outside factors that may have influenced American newspaper coverage during the study period. Considering the current state of print journalism, this paper predicts that, in the years ahead, American print coverage of foreign healthcare will continue to decline. However, in conjunction with this, it is likely that increased online representation of foreign healthcare stories will occur, as new journalism platforms, such as blogs, continue to proliferate. Finally, as American reporters continue to gain greater access to online healthcare research databases, this study suggests that the quality of US coverage of Medicare and the NHS is likely to improve.