Dissertations / Theses on the topic 'Hospital management'

Este trabalho tem por objetivo identificar quais são os fatores críticos de sucesso na gestão de um hospital e propor um modelo de gestão baseado nas melhores práticas de mercado. Partiu-se da proposição que muitos destes fatores estariam relacionados aos desafios enfrentados atualmente pelos hospitais, às estratégias adotadas, à forma de implementação dessas estratégias e às tecnologias de gestão empregadas. Assim sendo, foi feita uma revisão da literatura sobre estes temas e foram elaboradas perguntas de pesquisa sobre este fundo teórico. Em campo, foram pesquisados cinco hospitais particulares situados na região metropolitana do Rio de Janeiro. Todos eles têm as cirurgias como uma de suas principais atividades, a despeito de, também, realizarem outros tipos de atendimento. Assim, esses hospitais têm o médico como um de seus principais clientes na medida em que utilizam a estrutura hospitalar para realizarem seus procedimentos cirúrgicos. Os resultados revelam um mercado hospitalar cheio de espaços, com gestão predominantemente amadora e familiar e com estratégias informais. Na conclusão, é proposto um modelo de gestão hospitalar que pode ajudar os hospitais a se prepararem para a profissionalização do mercado que está por vir.
This study`s objective is to identify the success critical factors in hospital management and to propose a management model based on the best practices in the market. It was presumed that many of these factors would be related to the challenges faced by the hospital in the market, to the strategies adopted, to the way these strategies are implemented and to the management technologies used. So, a literature review was made and the field questions were created focusing on these topics. In the field, five Rio de Janeiro metropolitan area private hospitals were studied. All of them have the surgeries as one of their main activities, despite of doing many other procedures. So, the doctors are one of their main clients, as far as they need the hospital structure to make their surgeries come to true. The results reveal a spacefull market, a lack of professional management as well as informal strategies. In the end, a hospital management model is proposed. This model may help the hospitals to make themselves ready to the market professionalization that must come soon.

1. A comparative study of hospital management and organisation, in Great Britain and the U.S.A. A comparison is made of the different healthcare systems used in these two countries. A background of each is provided, with a comparison of how hospitals, in each system, manage their limited resources. Following nine months of study at Iowa State University, where I was involved in a student-based Management Engineering Department at one of the local hospitals (Mary Greeley Medical Centre) and several periods spent at two local hospitals in West Glamorgan Health Authority, in Britain - I was able to analyse the basic management and organisation structures of these hospitals, from the U.S. and Britain. By spending time in these hospitals, and by various meetings and discussions with staff me bers (including both management and medical staff) I was also able to analyse how each hospital 'manages' their scarce health resources. 2. Development of the bed and theatre requirements planning model. Following a request made by W.G.H.A., a computer simulation model has been developed to aid in the planning and management of scarce bed and theatre resources. The model analyses the bed and theatre requirements for a given set of inputs, such as given speciality theatre timetables. The model was developed to meet the requirements of the Planning Department of W.G.H.A., as well as the consultants, following a number of meetings and discussions with representatives of both groups. This section looks at the development of the model which has involved the acquiring of actual length of stay and theatre data, from relevant specialist departments in Morriston (and Singleton) hospitals; the problems encountered, and future work and applications for the model (in which both W.G.H.A. and E.G.H.A. have shown an interest). It also includes a discussion of problems of scarce resources in the N.H.S. today, and the application of Operations Research to the field of healthcare. 3. Expert systems in the field of healthcare. The provision of complete, accurate information is important to the efficient management of an organisation. Computer systems have been shown to be useful in providing such data, as well as aiding in the more medical side of the system. Expert systems - a new form of computer technology - have, in recent years, received a lot of attention for their usefulness in the medical decision-making process, helping to provide 'non-experts' with the knowledge of more specialised medical consultants, in an easy, accessible way. In so doing, these systems may be able to help in medical consultations, or in teaching the 'non-expert' more about a specialised field of medical knowledge, without having direct contact with the human 'expert'. Medical experts are in short supply and their knowledge is a valuable and scarce resource, which needs to be well managed to ensure it is utilised in the most efficient way. An investigation is, therefore, provided in this section into recent developments of medical expert systems, and possibilities for their future applications in healthcare. This includes one idea for a simple expert system, to aid in the coding of patient diseases and operations for H.A.A. statistics. A trial model was developed following consultations with one of the orthopaedic surgeons at Morriston hospital, who also provided a limited amount of data, regarding his field of medicine, to provide a basic knowledge-base for the system.

This thesis examines the application of operations management (OM) theory to the management of NHS hospital inpatient bed resources (also known as bed management). The study was initiated by management's desire for improvement in bed management at North Management General Hospital (NMGH), a medium-sized acute hospital which is now part of the Pennine Acute Hospitals NBS Trust (the Trust) in the North West of England. The study made use of published research into the practical application of OM theory in various organisations - particularly the still small number of published studies conducted in the health sector - in order to analyse data collected relating to bed management at NMGH over two periods: April 2002 through to April 2004, and also for the month of May 2005. For the data collection, the study deployed various qualitative and quantitative techniques including, process mapping, interviews, observation and statistical analysis. The purpose of the second, shorter, field-study in May 2005 was to measure the outcomes arising from recommendations made to the Trust following the analysis of data collected between April 2002 and April 2004. This allowed for the re-appraisal of the original recommendations to be incorporated into the results and conclusions of this study. This thesis argues that the benefits of applying OM theory in an English NHS hospital are demonstrated by measurable improvements in the management of throughput and queues when OM theory is used in designing layouts and in augmenting capacity coping systems. However, currently, certain cultural and political conditions within the NHS effectively constrain the usefulness of OM approaches. The thesis argues that cultural and political contingencies in OM theory require further consideration if the benefits of OM theory are to be fully exploited in the English NHS hospital environment. 9

The aim of this study is to explore what the relevant factors of nurses' attitudes to and at work are. These include the separate but related hypotheses - the nature of the profession and changes in terms of management and training; the nature of the work situation including contracts and pay determination; and the nature of work relations as they impinge on nurse status including relations with co-workers and patients. All of which can be understood and compared with other workers in terms of both labour process and industrial relations as Goldthorpe (1968) did in the study of car workers. In the context of the contemporary Chinese social and political economy, the research also evaluates the roles of the government and how it affects nurses' attitudes to the profession. It is grounded in a case study of 330 nurses in a Chinese public sector hospital, using questionnaires, interviews, and documentary evidence on government policies and hospital practices. The findings suggest that nurses at the case study hospital are frequently put under pressure due to the high number of patients they are expected to care for. This was caused by insufficient government funding for public sector hospitals, and the pressure to improve overall efficiency within the health service. The use of different types of employment contracts for nurses has caused strong resentment among nurses because it fails to award 'equal pay for equal work'. In addition, the current system used in many Chinese hospitals for nurse education, recruitment, training and development, and pay have not helped establish realistic expectations of nursing or rewarded nurses for the work they do effectively.

In light of the demanding requirements inherent to the operation of a university hospital, a multitude of compliance risks are entailed in the medical care, training, and research entail which such institutions are engaged in. If such risks materialize, the public will notice, which will substantially tarnish not only the public’s confidence in the proper functioning and the integrity of the impacted hospital, but ultimately, the whole German health care system. In examining the structural and requisite prevention protocols, three risk groups can be distinguished. The Düsseldorf University Hospital provides a leading example in the area of compliance management.

Antimicrobials are unique drugs in that they target "infectious" or "transferable" diseases. There is considerable evidence linking increasing antimicrobial use withincreasing resistance. Resistant bacteria do not know the boundaries, either between countries or within a society between hospital and primary care. Inappropriate prescribing of antimicrobials in hospitals therefore has consequences for whole communities and problems may spread both nationally and internationally. The gathering of reliable measurements of antibiotic use in hospitals employing standardised methods is essential to building an evidence base and highlighting inconsistencies at national and international levels. In this study, after data processing, validating and record linkage, a method forelectronic conversion of drug supply data to the ATC/DDD classification and forlongitudinal analysis was established for Tayside and then for a set of Europeanhospitals. Time series analysis and interrupted time series analysis were described and used for longitudinal surveillance and interventional study of antimicrobial use. This thesis explores issues concerning the evolution and management of hospital antimicrobial use using a wide range of methods. A series of drug utilisation research studies were implemented as the basis of research methods that, in combination of previously described methods, provided novel studies. No single measure can currently capture all of the aspects of hospital antibiotic use. However, a combination of detailed, point prevalence data from individual patients with longitudinal analysis of total consumption can provide meaningful data for comparison between hospitals and for analysis of the relationship between use and outcome. Additionally, there is a need to apply standard processes and novel methods to produce more meaningful surveillances. Longitudinal and point prevalence surveillances together with an explanation ofvariations in hospital characteristics are used to produce a set of coherent measurements of hospital antimicrobial use. Administrative data for longitudinal surveys requires continuous quality control.Whereas drug utilisation researchers and clinicians should target a set of indicators for interventional studies, large studies at national or international level need central data processing by country to identify targets for evaluation and for interventional studies. Support from experts in other fields is needed to address any shortcomings that may be experienced during continuous antibiotic drug utilisation monitoring at national and international levels.

Patient demand for a better quality of healthcare and services has increased as insurance companies have decreased payments to hospitals. The purpose of this qualitative single exploratory case study was to explore hospital managers' strategies to improve customer service. Data were gathered from semistructured interviews with 5 hospital managers who implemented customer service strategies in their hospital systems, hospital policy and procedure documents, and qualitative data from the Consumer Assessment of Healthcare Providers and Systems Hospital Compare website. Expectation-confirmation theory served as the conceptual framework that grounded the study. Data were analyzed using methodological triangulation, and 3 themes emerged: the need to improve interpersonal communication, address issues in the hospital environment, and provide employee training. Engaging in interpersonal communication, maintaining a clean and welcoming hospital environment, and providing employee training can help hospital managers increase customer satisfaction by giving internal and external customers a sense of empowerment and self-worth. The findings from the study, regarding the hospital managers' customer service strategies, could apply with other healthcare managers and leaders working to improve customer service within their organizations. Healthcare professionals and leaders, patients, family members, and the community may benefit from the study by gaining knowledge of the successful strategies hospital managers use to obtain quality service. These strategies promote respect, compassion, and a better quality of life, which are essential to social change in hospitals.

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Os Hospitais de Ensino tÃm papel fundamental e estratÃgico para o Sistema Ãnico de SaÃde, para cumprirem sua missÃo na assistÃncia, ensino e pesquisa contribuindo para o desenvolvimento deste sistema, como referencia em alta complexidade e pÃlo formador de recursos humanos em saÃde, necessitam de alternativas que possibilitem o fortalecimento e sustentabilidade dessas unidades acadÃmicas. Este estudo traz como objetivo investigar a gestÃo e as prÃticas de ensino em saÃde na visÃo dos gestores e professores no Hospital UniversitÃrio Walter CantÃdio (HUWC) da Universidade Federal do Cearà (UFC). A metodologia utilizada no estudo apresenta caracterÃsticas de uma pesquisa com mÃtodos mÃltiplos. Foi aplicado um questionÃrio aos gestores e professores totalizando 57 pesquisados, sendo 40 gestores e 17 professores. O estudo identificou e analisou um conjunto de 36 determinantes com potencialidades para influenciar positivamente uma gestÃo sustentÃvel e boas prÃticas de ensino no HUWC. Os determinantes estÃo relacionados com os principais atores do processo que sÃo o MinistÃrio de EducaÃÃo, o HUWC, UFC, o Sistema Ãnico de SaÃde e o MinistÃrio da SaÃde e as prÃticas de ensino.Em 27 determinantes houve convergÃncia na visÃo dos gestores e professores, e 09 divergÃncias. Os maiores graus de convergÃncias foram a falta de concurso pÃblico para reposiÃÃo das aposentadorias e a consequente contrataÃÃo de serviÃos prestados, que traz como conseqÃÃncia grande repercussÃo financeira comprometendo a sustentabilidade da gestÃo. Outro percentual relevante de concordÃncia foi que, apesar da crise financeira em todas as dimensÃes, o ensino no HUWC ainda garante boa formaÃÃo de profissionais de saÃde. A defasagem da tabela do SUS, que contribui para a falta de sustentabilidade da gestÃo e reduÃÃo da qualidade do ensino tambÃm obteve alto percentual de concordÃncia dos professores e gestores respectivamente. Os resultados mostram 25% do total de divergÃncia, ficando os maiores percentuais com as questÃes relacionadas com a polÃtica de RH estabelecida pelo MEC que contempla recursos para treinamento e capacitaÃÃo. Para o grupo de professores e gestores a divergÃncia relacionada com o comprometimento dos servidores tÃcnico-administrativos com o HUWC tambÃm obteve alto percentual. Outra divergÃncia relevante entre professores e gestores foi que o HUWC contempla boas prÃticas de ensino de acordo com as diretrizes curriculares para os cursos de graduaÃÃo. Dentre outras conclusÃes, esta pesquisa revelou necessidade de um novo modelo de gestÃo, complementaÃÃo do quadro funcional, conhecimento de gestÃo e programas de capacitaÃÃo e formaÃÃo para gestores e professores, reconhecimento da importÃncia do HUWC pelo gestor local do SUS, acompanhamento permanente dos residentes pelos preceptores e fortalecimento de pesquisas clÃnicas sÃo encaminhamentos para soluÃÃo de alguns problemas relacionados com a gestÃo sustentÃvel e boas prÃticas de ensino.
Teaching hospitals have a key and strategic role for the National Health System to fulfill its mission of giving assistance, teaching and developing research to contribute to the development of the system. To serve as reference to the high complexity and the forming base for the human resources in health care it is necessary to find alternatives to fortify and sustain those academic units. The goal of this study is to investigate the management and teaching tools from the point of view of managers and professors in the Hospital UniversitÃrio Walter CantÃdio (HUWC) from the Universidade Federal do Cearà (UFC). The methodology used in this study presents characteristics of research with multiple methods. A questionnaire was sent to all the managers and professors (57 subjects responded). Out of those 57, 40 were managers and 17 professors. The study identified and analyzed a group of 36 determinants with potential to positively influence sustainable management and good teaching tools in the HUWC. The determinants are related to the main entities which are the Department of Education, HUWC, UFC, National Health System and Department of health and teaching tools. In 27 of the determinants there were convergences in the opinion of the mangers and professors, and 09 divergences. The biggest convergences were the lack of an entrance exam to replace people that got retired and as a consequence they ended up contracting services rendered and as a consequence the high costs compromise the sustainability of the management. Another relevant topic which was agreed upon is that, despite the financial crises in all dimensions, the teaching in HUWC is still able to form health professionals of good quality. The discrepancy in the chart of the National Health System which contributed to the lack of sustainability of the management and lowering the quality of teaching tools was also agreed upon by a high percentage of professors and managers. The results show 25% of divergences, most of them were related to the politics of Human Resources which are determined by the Ministry of Education. Most of these policies are related to the purpose of capacity building and training. For the group of professors and managers the divergence related to the commitment of the administrative workforce with the HUWC also obtained a high percentage. Other important divergence for professors and managers was that the HUWC contemplates good teaching practices according to curricular guidelines to graduate courses. The research showed the necessity of a new management model, complementing the workforce, the development of management and programs for capacity building and forming new managers and professor. The research also shows how important the HUWC is for its local management and the importance and necessity of monitoring the residents and fortifying clinical researches. These were some of the ways found to solve some of the problem related to a sustainable management and good teaching tools.

Information technology (m has become crucial to the functioning of modern hospitals. It includes a range of human elements, infornlation, equipment, knowledge and systems. It is important to hospitals, as these are complex environments including many systems with diversity of functions, sub-systems, and professionals. The adoption of technology can be explained by four general theories: economic, political, social and globalization theory. Based on these theories five sets of reasons can account for the adoption of IT in a hospital environnlent. They are, practical; to solve existing problems, economic/business; to achieve d profit or reduce costs or both, rational; to achieve efficienL1' and effectiveness, social; to respond to pressure from society for political reasons and to increase positive image, and supply driven forces by which IT producers seek to sell their products and services. However, no one theory or set of reasons can by itself explain the precise drive for use of IT because nluch depends on each hospital's needs and surrounding drcunlStances. The purposes of this research are to investigate the extent to which IT is being used in Gulf Corporation Council (GCC) public hospitals, why IT has been adopted, and the impact of IT on hospital managementThe methods used in conducting this research were based lllainly on three established methods for searching and collecting infomlation; a literature review, the surveyor questionnaire, intervie,,'s and case studies. Five case studies in Qatar, the United Arab Emirates (UAE) and Bahrain were undertaken to cover Gee hospitals and medical centres populations. Most health and medical services in Gee Countries are provided by public hospitals which account for approximately 64% of total hospital provision, employ most medical professionals, mainly expatriates, and contain most patient beds. In Gee hospitals, IT is still in the early stages of implementation. IT has been found to be adopted at a low level due to reasons such as lack of awareness, other priorities in health policy strategies, and the low level of funding allocated. IT can provide hospitals with many benefits, solve many problems and has many inlpacts on human and functional systems, internal power balances and on the social status of hospitals. The benefits are found to be mostly in the areas of processing work. Therefore, the areas which were given priority for IT implementation were medical records, finance, and personnel areas. No significant impacts v"ere found on hospital structure, chain of conlllland, span of control and nUlllber of employees, however, itwas found that IT increased management power, hospitals' social in1age and hospital political power, while there were disagreements about IT impacts on employees' social relations. The evaluation of IT impacts on Gee hospital management shows that the impacts were not at the same level of intensity or direction, for example, sonle impacts ,",'ere positive and some negative; some significant, moderate or nurunlal, some ambiguous or obvious, were some were slow and some fast. Some efforts at Gee States level were made to develop a model of adopting IT but no real results were detected. However, the future role of IT in Gee public hospitals will be increasing perhaps at a slower pace, but two strategic issues should be given proper consideration; first; the role of the education system, research centers, and industrictl foundation, and the second strategy concerns hospital systems and services structure. This later is related to increased privatization of medical services, economic pressure, and changes in governments' employment strategy. The importance of this thesis is to draw the attention of decisionmakers to the role of IT as an efficient managerial tool in some respects and to provide a foundation for future studies

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: The objective of the study was to critically assess the management practices of Dr Yusuf Dadoo Public Hospital in terms of the five public management functions, namely: policy-making, planning, organising, leading and controlling. From the study it is evident that managers of the public hospitals work in a complex and dynamic environment. This is as a result of the pressure felt due to expectations of the public on the quality of service rendered in the hospitals. The primary function of public managers is to ensure that efficient and effective services are rendered to the public. Therefore, all public managers are subject to compliance to the unique guidelines of the relevant legislative framework. In the study, the five public management functions were explained in terms of the broad theoretical framework on management practices on the part of the public sector. The research approach was qualitative and the diagnostic evaluation design was used. The target population for the study included all 48 managers of Dr Yusuf Dadoo Public Hospital who occupy supervisory and higher positions. From the results in the analysis of the questionnaire it is evident that the five public management functions, namely, policy-making, planning, organising, leading and controlling were satisfactory - except the leadership function that needed attention. Public managers of hospitals are an important link between the legislature and the community who are the recipients of policy and are involved at the ground level in the execution of policy. These managers are at an advantage to identify the shortcomings in the existing policy and bring them to the attention of policy-makers. Policies and procedures at Dr Yusuf Dadoo Public Hospital were developed, interpreted and implemented. When discipline on employees was taken, relevant policies as stipulated in the Labour Relations Act, no 66 of 1995, were followed. Policies that support personal development through training and development were not implemented satisfactorily. The existing updated policy manuals were not adequately available to all the employees of Dr Yusuf Dadoo Public Hospital. The function of planning at the hospital referred to the planning processes and mechanisms that were designed to facilitate the planning work. The purpose of planning as a management function was to give guidelines to the managers of Dr Yusuf Dadoo Public Hospital on what they would do in the future. Management of Dr Yusuf Dadoo Public Hospital ensured that employees understood the vision and mission of the hospital. These employees were involved in developing the operational plan of the hospital. Management of Dr Yusuf Dadoo Public Hospital also ensured that operational plans of the employees supported the overall goals of the hospital. Recruitments, selections and appointments were done by human resource department, as was the orientation of new employees to the job. The organisational structure gave employees a clear idea of their responsibilities, the authority they had, and the person to whom they had to report. The functional structure of Dr Yusuf Dadoo Public Hospital grouped together similar or related occupational classes. Expectations were clearly explained by supervisors to subordinates when assigning tasks. Activities and functions were organised and managers allocated responsibility commensurate to authority when delegating tasks to subordinates. Personnel expenditure at Dr Yusuf Dadoo Public Hospital did not impede service delivery. The hospital needed strong leadership to survive and overcome challenges that managers faced. The leadership function at Dr Yusuf Dadoo Public Hospital related to the way management defined what the future of the hospital would look like, to align people with the vision and inspire them to make things happen. Not enough was done by the management of the hospital in this area. The management of Dr Yusuf Dadoo Public Hospital should do everything it could to train and develop managers and those employees who show potential in this area. The five public management functions, namely, policy-making, planning, organising, leading and controlling are executed in a complex and dynamic environment. It is necessary to assess, regularly, the management practices of public hospitals, focusing on the five public management functions. It is also necessary for public managers of Dr Yusuf Dadoo Public Hospital to ensure that the public management functions are carried out, to realise the set goals of the hospital.
AFRIKAANSE OPSOMMING: Die doel van die studie was om die bestuurspraktyke van Dr. Yusuf Dadoo Openbare Hospitaal krities te assesseer in terme van die vyf openbare bestuursfunksies, naamlik beleidmaking, beplanning, organisering, leiding en beheer. Uit die studie is dit duidelik dat bestuurders van openbare hospitale in ’n komplekse en dinamiese omgewing werk. Dit is die gevolg van die druk wat ervaar word vanweë verwagtinge van die publiek ten opsigte van die gehalte van dienslewering in die hospitale. Die primêre funksie van openbare bestuurders is om te verseker dat doeltreffende en effektiewe dienste aan die publiek gelewer word. Derhalwe is alle openbare bestuurders onderworpe aan voldoening aan die unieke riglyne van die betrokke wetgewende raamwerk. In die studie is die vyf openbare bestuursfunksies verduidelik in terme van die breë teoretiese raamwerk vir bestuurspraktyke aan die kant van die openbare sektor. Die navorsingsbenadering was kwalitatief en die diagnostiese evalueringsontwerp is gebruik. Die teikenpopulasie vir die studie het al 48 bestuurders van Dr. Yusuf Dadoo Openbare Hospitaal wat toesighoudende en hoër posisies beklee, ingesluit. Uit die resultate van die ontleding van die vraelys het dit geblyk dat die vyf openbare bestuursfunksies, naamlik beleidmaking, beplanning, organisering, leiding en beheer, bevredigend is – behalwe die leierskapsfunksie wat aandag moet geniet. Openbare bestuurders van hospitale is ’n belangrike skakel tussen die wetgewer en die gemeenskap wat die ontvangers van beleid is en op grondvlak betrokke is by die uitvoering van beleid. Hierdie bestuurders het die voordeel dat hulle die tekortkominge in die bestaande beleid kan identifiseer en onder die aandag van beleidmakers kan bring. Beleide en prosedures by Dr. Yusuf Dadoo Openbare Hospitaal is ontwikkel, vertolk en geïmplementeer. Wanneer dissiplinêre stappe teen werknemers gedoen is, is toepaslike beleide gevolg soos voorgeskryf in die Wet op Arbeidsverhoudinge, no. 66 van 1995. Beleide wat persoonlike ontwikkeling deur opleiding en ontwikkeling ondersteun, is nie bevredigend geïmplementeer nie. Die bestaande bygewerkte beleidshandleidings is nie toereikend vir al die werknemers van Dr. Yusuf Dadoo Openbare Hospitaal beskikbaar nie. Die funksie van beplanning by die hospitaal verwys na die beplanningsprosesse en meganismes wat ontwerp is om die beplanningswerk te vergemaklik. Die doel van beplanning as bestuursfunksie is om riglyne aan die bestuurders van Dr. Yusuf Dadoo Openbare Hospitaal te verskaf oor wat hulle in die toekoms sal doen. Die bestuur van Dr. Yusuf Dadoo Openbare Hospitaal het seker gemaak dat werknemers die visie en missie van die hospitaal verstaan. Hierdie werknemers was betrokke by die ontwikkeling van die bedryfsplan van die hospitaal. Die bestuur van Dr. Yusuf Dadoo Openbare Hospitaal het ook seker gemaak dat bedryfsplanne van die werknemers die oorkoepelende doelwitte van die hospitaal ondersteun. Werwing, keuring en aanstelling word deur die menslikehulpbron-departement gedoen, asook die oriëntering van nuwe werknemers. Die organisasiestruktuur gee aan werknemers ’n duidelike idee van hul verantwoordelikhede, hul gesag en die persoon aan wie hulle moet rapporteer. Die funksionele struktuur van Dr. Yusuf Dadoo Openbare Hospitaal groepeer soortgelyke of verwante beroepsklasse saam. Verwagtinge word duidelik deur toesighouers aan ondergeskiktes verduidelik wanneer take toegewys word. Aktiwiteite en funksies is georganiseerd en bestuurders wys verantwoordelikheid in ooreenstemming met gesag toe wanneer take aan ondergeskiktes gedelegeer word. Personeeluitgawes by Dr. Yusuf Dadoo Openbare Hospitaal belemmer nie dienslewering nie. Die hospitaal het sterk leierskap nodig om uitdagings waarmee bestuurders te doen het, te oorleef en te oorkom. Die leierskapsfunksie by Dr. Yusuf Dadoo Openbare Hospitaal hou verband met die manier waarop die bestuur die toekoms van die hospitaal gedefinieer het, die belyning van mense met die visie en die inspirasie van mense om dinge te laat gebeur. Nie genoeg is deur die bestuur van die hospitaal op hierdie gebied gedoen nie. Die bestuur van Dr. Yusuf Dadoo Openbare Hospitaal moet alles moontlik doen om bestuurders en daardie werknemers wat potensiaal op hierdie gebied toon, op te lei en te ontwikkel. Die vyf openbare bestuursfunksies, naamlik beleidmaking, beplanning, organisering, leiding en beheer, word uitgevoer in ’n komplekse en dinamiese omgewing. Dit is noodsaaklik om die bestuurspraktyke van openbare hospitale gereeld te assesseer deur op die vyf openbare bestuursfunksies te fokus. Dit is ook noodsaaklik dat openbare bestuurders van Dr. Yusuf Dadoo Openbare Hospitaal verseker dat die openbare bestuursfunksies uitgevoer word om die gestelde doelwitte van die hospitaal te verwesenlik.

Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, direct observation, and a review of discharge documents. Data analysis took place using the modified van Kaam method. Two emergent themes were identified relating to strategies for efficient communications and facilitating effective leadership. Implications for positive social change include the potential to improve health services within the community where access to health care is limited or the need exists for additional hospital beds. Positive leadership strategies in hospitals tend to contribute to the success and wellbeing of employees, patients, communities, and the economy.

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This thesis reports a descriptive exploratory case study with qualitative and quantitative approach carried out at the Hospital das Clínicas of the Federal University of Goiás. Its objective is to analyze the possible impacts resulting from the contractualisation process implemented in 2004 with the Municipal Secretary of Health of Goiânia. It analyzed the period from 2001 to 2013, focusing on the production of health care, indicators of hospital performance, financial aspects and investments. A document analysis was made available by the institution and a semi-structured interview with seventeen managers who worked in the management before and after the contracting process of the institution, the Municipal Health Department of Goiânia and the Ministries of Education and Health. The quantitative data and the content analysis for the qualitative ones, using WebQDA software. The results showed that there was a financial impact with contracting, with a reduction in hospital care production, unmet physical goals, low institutional performance with reduction of occupancy rates, idleness, turnover, and reduction in the number of beds. In the manager’s perception, contracting is a definitive policy for hospitals that attend the Brazilian Unified Health System and its effectiveness has brought several benefits, although there are still aspects to be reviewed, such as quantity and quality of human, financial and other resources. It is concluded that this process contributes to decisions and executions actions related to this management model, committed to the quality of health services provided to the population. Negotiations and more feasible pacts are suggested, with compliance with the Ordinance and constant participation of federal, municipal and institutional managers, favoring both hospital performance and improved quality.
Esta tese relata um estudo de caso descritivo exploratório com abordagem qualitativa e quantitativa realizado no Hospital das Clínicas da Universidade Federal de Goiás, tem como objetivo analisar os possíveis impactos decorrentes do processo de contratualização implantada em 2004 com a Secretaria Municipal de Saúde de Goiânia. Analisou o período de 2001 a 2013, com foco quanto à produção da assistência à saúde, dos indicadores de desempenho hospitalar, dos aspectos financeiros e dos investimentos. Realizada uma análise documental disponibilizadas pela instituição e por uma entrevista semiestruturada com dezessete gestores que atuaram na gestão antes e após o processo de contratualização da instituição, da Secretaria Municipal de Saúde de Goiânia e dos Ministérios da Educação e da Saúde. Conduzido uma análise horizontal para os dados quantitativos e a análise de contéudo para os qualitativos, utilizando o software WebQDA. Os resultados mostraram que houve impacto financeiro com a contratualização, com redução na produção da assistência hospitalar, metas físicas não cumpridas, apresentou baixo desempenho institucional com redução das taxas de ocupação, ociosidade, rotatividade, e redução no número de leitos. Na percepção dos gestores a contratualização é uma política definitiva para os hospitais que atendem o Sistema Único de Saúde e sua efetivação trouxe diversos benefícios, apesar de existirem ainda aspectos a serem revistos, tais como quantidade e qualidade de recursos humanos, financeiros e outros. Conclui-se que esse processo contribui para tomadas de decisões e execuções ações relacionadas a esse modelo de gestão, comprometida com a qualidade dos serviços de saúde prestados a população. Sugere-se negociações e pactuações mais exequíveis, com cumprimento da Portaria e participação constante dos gestores federais, municipais e da própria instituição, favorecendo tanto no desempenho hospitalar quanto a melhoria da qualidade desenvolvida.

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A complexidade da gestão hospitalar, em conjunto com um cenário de escasez de recursos financeiros, compromete as atividades desempenhadas em hospitais públicos universitários. O presente estudo tem o objetivo de analisar as práticas de gestão hospitalar no Hospital Universitário Antonio Pedro (HUAP), no sentido de identificar oportunidades de aprimoramento em seus processos administrativos, bem como os fatores críticos responsáveis, refletindo sobre a maneira como tais fatores estão inter-relacionados. Sob a perspectiva metodológica, o estudo apoia-se em uma vertente teórica, baseada na coleta de dados secundários através do levantamento bibliométrico do acervo técnico-científico referente à gestão hospitalar, relevantes para subsidiar a pesquisa empírica proposta para ser realizada junto a atores-chave do HUAP. Já em termos empíricos foram realizadas entrevistas semiestruturadas com as lideranças funcionais tanto administrativas, quanto de assistência. Os resultados obtidos evidenciam lacunas nas interfaces de trabalho, sobretudo na relação entre as equipes médica e a administrativa, o que impacta sobre o faturamento da organização. Além disso, observaram-se hiatos na definição de processos, o que compromete algumas atividades, tanto na esfera assistencial quanto administrativa, gerando conflitos entre profissionais e impactando no atendimento aos pacientes. Uma vez evidenciados os fatores críticos, elaborou-se um mapa conceitual, que apresenta o processo gerencial do HUAP como um sistema composto pelos referidos fatores, bem como a forma como estão conectados, facilitando a observação das relações de causalidade entre estes.
The complexity of hospital management, together with a scenario of scarcity of financial resources, compromises the activities performed in public university hospitals. This study aims to analyze the hospital management practices at the Hospital Universitário Antonio Pedro (HUAP), to identify opportunities for improvement in their administrative processes, as well as those responsible for critical factors, reflecting on how these factors are interrelated. Under the methodological perspective, the study relies on a theoretical, based on secondary data collection through the bibliometric survey of technical and scientific evidence related to hospital management, relevant to support the empirical proposed research to be conducted with key players of HUAP. In the empirical study were carried out semi-structured interviews with the managers of the institution. The results show flaws in the work interfaces, especially in the relationship between medical staff and administrative, which has a direct impact on revenues of the organization. In addition, there were shortcomings in the definition of processes, which undertakes some activities, both in care as administrative, generating differences between professionals and impacting on patient care. Once the critical factors were evidenced, a conceptual map was elaborated, presenting the HUAP management process as a system composed of these factors, as well as the way in which they are connected, facilitating the observation of the causal relationships between them.

Effective leadership is essential for the achievement of any organisational success. The need for strong leadership and increased diversity is a prominent issue in today’s health service workforce. Effective leadership involves influencing others towards achieving the goals of the organisation. Leadership is the central ingredient necessary for progress as well as for the development and survival of organisations, especially in a changing environment such as is evident in South Africa. This study was undertaken to explore and describe the views of health professionals with respect to factors that promote or influence leadership effectiveness in public hospitals, with specific reference to Uitenhage Provincial Hospital. The research design of this study was a quantitative, explorative, descriptive survey. Interviews were conducted to explore and describe the views and perceptions of healthcare professionals (clinical and nonclinical), and the management of the Uitenhage Provincial Hospital, regarding leadership effectiveness in a public hospital. Firstly, a literature study was conducted on healthcare leadership generally and to identify various leadership approaches and factors that influence leadership effectiveness. More emphasis was put on the current and the most recent approaches to leadership. Secondly, an empirical study was conducted to gain the views and ideas of health professionals regarding leadership effectiveness in the institution. Lastly, the results of the empirical study were evaluated, conclusions were drawn and recommendations were made, based on the information obtained from both the literature study and the empirical study.

Background: The Hong Kong Hospital Authority (HA) has adopted the Australian Council on Healthcare Standards (ACHS) scheme for their public hospital accreditation program. Continuous improvement is a vital aspect of the ACHS criteria and facilitates the movement from status quo to the desired state; therefore, change is necessary, and change management may be useful. Objectives: To identify the current level of evidence regarding change management with respect to hospital accreditation and to identify the common change management tools that may be relevant to hospital accreditation. Methods: The primary method was a search of MEDLINE and PubMed for articles published between January 2001 and April 2011. Grey literature was identified via a Google search. Unpublished data was retrieved from an on-going qualitative study of hospital accreditation in Hong Kong. Results: No literature with the keywords “change management” and “hospital accreditation” were found in MEDLINE or PubMed. By adjusting these keywords to identify articles about change management in healthcare, 84 citations were identified, 18 of which were included for review. The majority of the literature described increased communication as a change management intervention. Change management framework and tools were also found in the grey literature review. Results: No literature with the keywords “change management” and “hospital accreditation” were found in MEDLINE or PubMed. By adjusting these keywords to identify articles about change management in healthcare, 84 citations were identified, 18 of which were included for review. The majority of the literature described increased communication as a change management intervention. Change management framework and tools were also found in the grey literature review.
published_or_final_version
Public Health
Master
Master of Public Health

The relationship between hospital length of stay (LOS) and Nurse Case Management (NCM), defined as the coordination of care along a continuum of hospital and community, was investigated. Three groups of discharged patients in the Diagnostic Related Groups (DRGs) of the Respiratory and Circulatory Medical Diagnostic Categories (MDCs) were described and compared: those who had NCM pre-hospitalization (n = 43), those who had NCM initiated during hospitalization or shortly afterward (n = 22), and those who had no NCM (n = 50). The NCM pre-hospitalization group was older and more likely to live alone. The non-NCM group had more admissions to Critical care. The NCM pre-hospitalization group entered the hospital with lower acuities. The NCM initiated during hospitalization group had significantly higher LOS than the other two groups. There was no significant relationship between LOS and the number and duration of NCM visits. The findings suggest that (1) NCM subjects were at higher risk due to age and living situation and (2) NCM may be associated with reduced LOS on subsequent admissions.

Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management, 2013.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 30).
Private health players in emerging countries have increased their presence and contributed to global health issues, but have been undervalued in financing. A variety of health players have evolved and hospitals have played a pivotal role. However, hospitals in developing countries face significant challenges in getting the financing they need to expand their operations by adding additional facilities and equipment partly due to under valuation. The objective of the thesis is to understand the fundamental values of those hospitals in emerging countries and to learn why under valuation happens by conducting the case valuation of Life Healthcare. This thesis is primarily intended to serve as an investment guide for potential investors and financers, such as commercial banks, investment funds, microfinance institutions, leasing companies, and other types of financial institutions. It discusses how the enterprise value should be assessed. The secondary audience is hospital management teams who want to understand the source of hospital value and key potential drivers for improvement. The thesis conducts the sensitivity analysis to identify how the key drivers affect the enterprise value. Accordingly, management teams can identify where to improve to maximize corporate values and satisfy customer needs. For these purposes, the thesis will be structured as follows. Summarizing recent trends of private healthcare industries in emerging countries, it starts with explanation of hospital business models and survey results of the financial issues in Romania. After examining two different valuation approaches, the paper will conduct valuation with the discounted cash flow model, taking the example of Life Healthcare Group, a private healthcare player in South Africa. The valuation results with third-party estimations identify the different assumptions, especially in terms of market growth and the weighted average cost of capital. Finally, the paper will explore other valuation issues and improvement ideas based on valuation results and comparative analysis.
by Tsuyoshi Segawa.
M.B.A.

Adverse drug reactions (ADRs) are a significant public health problem. This thesis examined the incidence and nature of adverse drug reactions following admission to hospital. An initial pilot study was conducted to develop methodology, which was then utilised in a study of 3695 patients. Approximately 15% of patients experienced an ADR following admission, of which one-third were serious Commonly used drugs such as opioids, diuretics and anticoagulants were the most frequent causes of ADRs. Bleeding, renal impairment and Clostridium difficile were the ADRs with the greatest impact on patient length of stay and thus should be key areas for intervention strategies. Adoption of methods used in the assessment of hospital patient safety incidents such as root-cause analysis may help in identifying underlying factors leading to ADRs as well highlighting the importance of ADRs to senior hospital managers.

In recent years, concern about the rising costs of health care has prompted the development of programs aimed at reducing utilization of hospital services and facilities while maintaining an acceptable standard of care. One of the major strategies that has emerged in the effort to accomplish these dual objectives, is utilization management. Although there are a number of different approaches, the primary aim of all utilization management programs is to identify and eliminate unnecessary and inappropriate hospital use. To date, most of the utilization research and program development has taken place in the United States. To a great extent, this effort has focussed on the development and use of norms for utilization based on a breakdown of length of stay data by diagnostic-related groups (DRG's). Canadian interest in this type of approach is reflected in the recent development of data bases defined by case-mix groups (CMG's). However, while continued efforts are being made to refine these schemes, they have been vulnerable to the criticism that they do not provide adequately objective criteria for establishing what constitutes appropriate patterns of hospital use. In addition, because they are based on statistically derived norms, they have been criticized as lacking sufficient clinical relevance to encourage physician support. Since hospital utilization is largely determined by the medical staff, utilization management programs that fail to obtain physician support are unlikely to succeed. An alternative approach, which appears to be gaining in popularity, involves the formulation of criteria which can be used to determine what constitutes appropriate and necessary hospital use. Essentially, it is argued that by directly identifying the source and nature of misutilization, it should be possible to develop more effective strategies for the resolution of identified problems. The American Appropriateness Evaluation Protocol designed by Gertman & Restuccia (1981) is one of the earliest and most highly tested examples of a criterion-based system. In Canada, interest in this type of approach is more recent and, consequently, little attention has as yet been focussed on the development and use of clinical criteria in utilization review and management. One exception, however, is the SWITCH Index System. This system, which was developed and implemented in 1984 by the Peace Arch District Hospital (White Rock, B.C.), makes a direct attempt to identify and eliminate days of hospital stay during which no appropriate acute care services are being provided. The criteria used in this system are classified under the headings Signs, Wind, Intramuscular Therapy, Tubes, Consultant, and Hospice. Patients are considered to be appropriately placed in the hospital if, on any given day, at least one of the specified criteria are met. Otherwise they are classified as Off-Index and action is taken to identify the source of the problem and to initiate corrective action. Since a major objective of the SWITCH system is to identify and eliminate inappropriate use, an observable outcome, if the program is successful, should be a reduction in length of stay. The present study investigated this hypothesis by comparing pre- and post- intervention length of stay trends at the Peace Arch District Hospital. In addition, to take into account any general secular trends in length of stay over time, the Peace Arch length of stay was compared to the length of stay observed for a control group of three peer-group member hospitals. Although data covering the four year period 1982 to 1985, indicated that the length of stay at the Peace Arch District Hospital had been decreasing over time, no component of this general decline could be attributed to the SWITCH Index System. Time series regression analyses failed to detect changes in either the slope or the height of the estimated response curve. However, limitations in the study design do not permit any conclusions regarding the potential effectiveness of this system. Characteristics specific to the Peace Arch District Hospital may have prevented the detection of an effect. In addition, because it is likely that there would be a lag between when the program was implemented and when it might be expected to effect a reduction in length of stay, the follow-up period of eleven months may have been too short for the determination of the program's effectiveness.
Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate

This thesis provided a definition and conceptual framework for hospital disaster resilience; it used a mixed-method, including an empirical study in tertiary hospitals of Shandong Province in China, to devise an assessment instrument for measuring hospital resilience. The instrument is the first of its type and will allow hospitals to measure their resilience levels. The concept of disaster resilience has gained prominence in the light of the increased impact of various disasters. The notion of resilience encompasses the qualities that enable the organisation or community to resist, respond to, and recover from the impact of disasters. Hospital resilience is essential as it provides 'lifeline' services which minimize disaster impact. This thesis has provided a framework and instrument to evaluate the level of hospital resilience. Such an instrument could be used to better understand hospital resilience, and also as a decision-support tool for its promoting strategies and policies.

The administration of the public service of health, historically organized for the state, passes for transformations that search the improvement of the service offered to its public, the using citizen. The state of São Paulo implemented from 1998 a management system that uses recognized entities socially (SOH - Social Organization of Health) to execute the planned and controlled actions of health for the government. In agreement to this trend of opening and development of the public politics, the federal government search to improve the quality of relationship in its sectors of attendance. The presented research evaluated questions organizations of a clinic of specialties of the city of São Paulo that functions operated for a SOH. Using the perspective of the user, it searched to verify with are the administrative questions that are perceived and valued for the citizen. The results had evidenced low the capacity of perception and evaluation of the users of the clinic. The analysis perceived in the data of the research with superficial characteristics and without criteria technician, can be related with the low educational level of the layers poor of main the Brazilian population that are user public system of health. (National system of health). The research proved the development of the public management in the health area, as well as the viability of application of research correlated to the applied model.
A administração do serviço público de saúde, historicamente organizada pelo Estado, passa por transformações que buscam a melhoria do serviço oferecido ao seu público alvo, o cidadão usuário. O estado de São Paulo implementou a partir de 1998 um sistema de gestão que utiliza entidades reconhecidas socialmente (OSS Organização Social de Saúde) para executar as ações de saúde planejadas e controladas pelo governo. Em concordância à essa tendência de abertura e remodelamento das políticas públicas, o Governo Federal busca melhorar a qualidade de relacionamento em seus setores de atendimento. A pesquisa avaliou questões organizacionais de um ambulatório de especialidades da cidade de São Paulo que funciona operacionalizado por uma OSS. Usando a perspectiva do usuário, buscou verificar quais são os quesitos administrativos que são percebidos e valorizados pelo cidadão. Os resultados evidenciaram a baixa capacidade de percepção e avaliação dos usuários do ambulatório. A análise percebida nos dados da pesquisa, com características superficiais, emotivas e sem critérios técnicos, pode estar relacionada com o baixo nível educacional das camadas mais pobres da população brasileira que são os principais usuários do sistema público de saúde (SUS Sistema Único de Saúde). A pesquisa provou o desenvolvimento do gerenciamento público na área de saúde, assim como a viabilidade de aplicação de pesquisas correlacionadas ao modelo aplicado.

In the UK, the prevalence of diabetes in adults in the general population is currently reported as just over 6% in 2014-15 [1]. This rose from a prevalence of 5.5% in 2010. However, the most recent data from the 2016 United Kingdom National Diabetes In-patient Audit reported that the prevalence of diabetes amongst hospitalised in-patients was 17% [2]. This represented a rise of over 15% since the first National Diabetes In-patient Audit was carried out in 2010, and was the same rise in prevalence seen in the general population during that time. Thus diabetes is disproportionately over represented in the in-patient population. It has been recognised for many years that in-patients with diabetes experience ‘glucose-related’ harms. Any form of dysglycaemia is associated with increased harms – in terms of poor outcomes (however that is defined) and also increased mortality [3]. For many years it was well recognised that having long term high glucose concentrations was associated with an increased risk of developing the long term micro and macrovascular complications of diabetes. It was only with the publication of the two seminal trials, the Diabetes Control and Complications Trial in type 1 diabetes and the United Kingdom Prospective Diabetes Study in type 2 diabetes that showed conclusively that in an outpatient population tight glycaemic control was associated with a reduced risk of developing those complications [4,5]. However, to date whilst there are a great deal of data to show that high glucose concentrations are associated with harm in hospitalised in-patients with diabetes, there are almost no data to show that improving glucose concentrations is associated with benefit. However, most authorities agree that glucose concentrations between 6.0 and 10.0mmol/l (with an acceptable range of 4.0 to 12.0mmol/l) are likely to be most beneficial (or rather, least likely to be associated with harm). In the UK there is an organisation called the Joint British Diabetes Societies for Inpatient Care group (JBDS), of which I am a senior member. JBDS is a group of professionals interested in the care of in-patients with diabetes. This group, which is funded by Diabetes UK and the Association of British Clinical Diabetologists and is a collaboration between these two national organisations and the National Diabetes Inpatient Specialist Nurse Group, had as it’s ‘mission statement’ the focus on producing evidence based or, where this was not possible, consensus based, clinical guidelines for the management of diabetes in hospitalised in-patients. These guidelines were designed to be used by non-specialists, and written in a user friendly way to make them clinically useful. I have been involved in writing or contributing to most of the guidelines produced by the group, and have been the lead author on two of the most widely read / used documents – peri-operative care and diabetic ketoacidosis. Indeed, as a result of my involvement in these writing groups, I am now recognised as an international expert on these two subjects. I am regularly invited to speak on these subjects, but also invited to write about them as well. This thesis is a journey through various aspects of my involvement in in-patient care for patients with diabetes from the time I was first appointed as a consultant in Norwich in 2004 to the spring of 2017. In particular my hypothesis is that because of the work I and others have published, the management of in-patients with diabetes has improved the care of this vulnerable group.

This study describes self management behaviour and attitudes among asthmatics, in usual self care, in acute episodes and in behaviour in the month before admission. It relates these behaviours to morbidity, admission history (single admittees versus multiple admittees) and outpatient status (current, discharged or never outpatient). Two hundred and thirty four patients between 16 and 65 years old were interviewed for the study. One hundred and thirty were in hospital at interview, the remainder were not in hospital but had all had a hospital admission between January and December 1987. Details of admissions in the following twelve months were collected for the hospitalised interviewees. In both hospitalised and non hospitalised groups self management was related to being in current specialist care, rather than to admission history. Patients in current specialist care were more compliant and acted at earlier stages of deterioration. When care type was controlled for, patients with multiple admissions were more non compliant with regular medication, and non compliant patients had significantly more frequent episodes. Forty (30%) of the hospitalised group were readmitted within 12 months of interview. Readmission was not related to self management before the 1991 admission or asthma attitudes. It is argued that this is because patients are likely to be referred to specialist care after an admission (almost 50% of first admissions and almost 100% of second admissions) and that this referral will change both their medical management and their self management. Hence, pre admission behaviour and attitudes cannot predict post admission risk. The study concludes that patient behaviour is most strongly influenced by being in specialist care, and that differences in self management, particularly compliance with prophylaxis and early action in deterioration, affect the risk of severe episodes and hospital admission.

This is a quantitative study. The primary research objective is to investigate the importance of hospital management’s involvement when implementing lean elements in healthcare. In reality, incidents and quality problems are prime reasons why healthcare leaders are calling for redesign in healthcare delivery and systems. This paper presents a proposal for developing a lean culture in healthcare facilities equipped with managers who will be able to drive the implementation of lean elements from the top down, making use of multidisciplinary teams, including physicians, to deliver value-added services. This study ultimately endeavors to indicate the importance of management, multidisciplinary teams and physician involvement in implementing lean principles in healthcare successfully. “If we keep doing what we’re doing, we’re going to keep getting what we’re getting.” – Stephen Covey. The reasons why lean management is a particularly important strategy in healthcare currently, includes the following: •The need to reduce waste in healthcare cost; •The need to improve quality and on-time processes; •Fast-paced technological changes; •Ever-increasing patient expectations; and •The need to standardise processes and systems to get the high-quality results anticipated (Chalice, 2010).

175 p.
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Esta dissertação tem como objetivo compreender os efeitos dos conhecimentos gerados pelos estudos da gestão da informação na promoção de melhorias na gestão do Hospital Jorge Valente, de atuação geral, privado e de médio porte. O trabalho está fundamentado por um quadro teórico baseado na gestão da informação e no contexto organizacional relacionado ao conceito de hospital como um dos elementos integrantes do sistema de saúde e articulado com uma pesquisa de campo aplicada, onde o problema foi abordado como um estudo de caso, exploratório e de cunho qualitativo com análise de conteúdo. O instrumento de pesquisa utilizado baseia-se em Rezende (2002), que propõe quatro construtos: sistemas de informações, tecnologia da informação, recursos humanos e contexto organizacional. Foram conduzidas entrevistas seguindo o enquadre desses construtos e as respostas foram categorizadas seguindo a temática de Bardin (1977). À guisa de conclusão, o presente estudo indica a necessidade de uma gestão da informação e traz contribuições às discussões que já vêm sendo realizadas no campo teórico, tendo em perspectiva o ambiente hospitalar. Demonstra ainda que a utilização de estratégias qualitativas de pesquisa pode contribuir para os avanços que vêm sendo realizados na área da gestão hospitalar. Além disto, oferece um panorama de dados devidamente categorizados que possibilitam uma compreensão dos efeitos dos conhecimentos gerados pelos estudos da gestão da informação na promoção de melhorias na gestão hospitalar. Vários trabalhos futuros são sugeridos visando maior aprofundamento e melhor investigação sobre a gestão da informação hospitalar.
Salvador

A Thesis submitted to the faculty of Commerce, Law and Management, University of Witwatersrand, School of Governance in 50% fulfilment for the Master of Management in the field of Monitoring and Evaluation 9 May 2016
The purpose of the study was to analyse the Supply Chain Management (SCM) approaches used in the Public Hospital Outpatients Pharmacy and compare the findings with successful supply chain practices from other industry sectors. The study of academic literature locates the unavailability of drugs in the public hospital pharmacies to the domino effect of the lack of governance and accountability in the public hospital. The data for the study was gathered from public and private hospitals in Gauteng, and large FMCG manufacturers and retailers. The study finds that the public sector adoption of SCM in the absence of a coherent technology and human resource support environment results in a lack of accountability and coherence across systems. The research study corroborated the view of academics and the interviewees that the unavailability of drugs in the public hospital is a multidimensional problem that has its roots in the lack of governance throughout the drug supply chain. It is a complex manifestation of policy, processes, practices, structure, people, communication and donor funding that contribute to the problem. Resolving the drug availability issues will require the ‘whole supply chain re-engineering’ with the added focus on developing the operational capability and capacity of the actors within the supply chain continuum.
MT2017

碩士
國立高雄應用科技大學
工業工程與管理系
97
By the analysis of our hospital in energy utilities, in order to establish the basic data of electricity consumption. Once these dates have been collected, the promotion of energy consuming efficiency can be heaved by managing electricity and appraising power potency to achieve overall energy expense disbursement. The paper further analyze the structure of power vs price to help to retrench a large mount of power expenditure by carrying out power management, reasonable contract capacity, escalating power work ratio, selecting appropriate electricity computing mode, establishing air conditioner facility, applying discount power price. This strategies not only shift the peak power load but also balance the power unility in Taiwan , reducing the establishment of new power plant and the impact of nature environment as well as the in convenient curb on power consumption.

碩士
樹德科技大學
資訊工程系碩士班
107
Nowadays, as the continuous growth of the economics in the world, it has been recovered steadily, and also improved in our country. In the new epoch, the information technology has become an inexhaustible driving force to promote the economic development of the worldwide, and the information industry has transformed to one of the critical industries in economic development. The information technology industry, as the term suggested, takes information development to serve as the kernel to inspire the development of other industries through advanced information technology. For example, e-commerce is produced under the environment of the lasting development of information technology, and the e-commerce industry has refreshed the domestic''s economy, improved the employment rate, and also excited the energy of the economy. In spite of the domestic''s e-commerce industry or the others, the development of information technology has become the main flow of the power for expanding the economics. In this processing, how to manage hospital information more conveniently, how to better manage drug storage, discharge and patient registration has become one of the key tasks of major hospitals. With the development of the Internet and the information technology industry, computers play an active role in various industries in modern society. Using the dedicated computer to develop an information management system suitable for hospitals can not only reduce the cost of medical services, but also enhance the incoming, and carry out the informatization implementation of hospitals. The hospital information management system achieve the purpose of the digitalization, informatization and networking for medical services. It can be accomplished by the intelligent management of hospital information in the case of utilizing several advanced database technologies and programming language. In a summary, it includes seven modules: hospital information management, patient discharge management, transfer information management, payment information management, drug information management, public medical management and hospital personnel management.

碩士
國立彰化師範大學
企業管理學系國際企業經營管理
97
Under the increasing influence from the external environmental pressure on the execution of National Health Insurance System, the hospital industry in Taiwan area has caused hospitals to develop toward the cooperative management model similar to business network, forming the so-called hospital alliance system., the purpose of which is to obtain through the system the various kinds of resources needed for its own development. With the fast-changing environment outside, this research is based on network theory, resource depending theory and resource base theory. Through some case in the hospital system currently operating in Taiwan, this research conducts survey and indepth interviews. From the two factors of " cooperation between affiliated hospitals and its system" and " the management mechanism of affiliated hospitals" this research tries to explore what influences the difference in resource pattern obtained by the member hospitals in the system. The case study in the research includes seven member hospitals with different scales. Each member hospital builds up its own cooperation model with the head hospital. The results of this study can be applied to different sizes of hospital in Taiwan and can serve as references for hospitals in evaluating and establishing the cooperation patterns. The results of the study indicate: 1. The more cooperative pattern hospitals build up with the system, the more resource patterns they get, and the easier it is for them to get such less intangible resource patterns in organization, network and techniques. 2. To obtain manpower resource becomes one of the motivations for hospitals to join the system, and the more intimate and higher levels of cooperation the hospitals build up with the system, the more items and resource patterns in manpower resources they get. 3. Regardless of the cooperation patterns established between hospitals and the system, all hospitals can get the resources mechanism in the system with hierarchy, mechanism and relation mechanism. 4. Hospitals adopting hierarchy mechanism can get the most resource patterns, with the relation mechanism running next and market mechanism getting the least. 5. If the hospitals adopt the hierarchy mechanism, they can effectively obtain the organization resource from the system and network resources. 6. Hospitals often collectively adopt different management mechanisms to obtain the various kinds of resources from the system. This research increases the ability of the network-related theory in its application to hospital industry and provides the reference basis for hospitals in evaluating cross-hospital cooperation strategies.

This paper explores the evaluation of a patient safety structure. The study aims to help managers and healthcare providers to analyse possible mechanisms that promote patient safety monitoring across the different stages of a service process. The research extended the literature in the domains of healthcare services. First, we explore prior terminologies of patient safety and errors and clarify their meaning. Second, an integrative framework is conceptually developed, and its application presented with an illustrative model. The model highlights the importance of analysing different drivers of patient safety. Finally, the paper discusses the insights that can be derived by applying the integrative framework. This may facilitate service design in healthcare practice by offering new ways to solve and to correct errors.

Stroke is a preventable disease. Minor stroke and transient ischaemic attack (TIA) are important warning signs of the possibility of a major stroke. Worldwide, stroke is the third most common killer and the largest cause of disability. The incidence of stroke is predicted to increase with the predominance of unhealthy lifestyles and the aging population. The adoption of a healthy lifestyle can reduce many of the risk factors. This descriptive study was designed to explore patients’ understanding of modifiable risk factors of cerebrovascular disease. It investigated lifestyle changes actually made, as well as the factors affecting patients’ decisions about whether to make lifestyle changes. The two major factors considered were patients’ sources and level of knowledge and their attitudes and beliefs around making changes. A convenience sample of patients who had suffered a minor stroke or TIA was recruited through a major metropolitan hospital. Thirty-five subjects responded to a postal questionnaire. The mean age was 68 years and 37% of the subjects had sustained some disability as a result of the TIA or minor stroke. The results demonstrated that many subjects had a poor understanding of risk factors of stroke. While smoking was well recognised as a risk factor, subjects showed less awareness of other risk factors, such as excessive alcohol consumption and obesity. Subjects also reported significant confusion regarding diet. Sixty-six percent of subjects depended on doctors as their main source of health information. This may be problematic as the current shortages of General Practitioners has put pressure on doctors to keep appointment times short and reduce the time available for health education. The main barriers to lifestyle change, were lack of motivation, and inadequate, knowledge, guidance, and support and the inability to access good information. Although 83% of subjects suffered from hypertension, medication was the accepted method of control, few subjects realised the significance of lifestyle factors. Nine percent of subjects were only diagnosed with hypertension after their stroke or TIA and few monitor their own blood pressure, despite the wide availability of home monitoring devices. From the findings of this study it is concluded that health promotion and education are very important strategies in the prevention of stroke and it is recommended that this kind of education begins in childhood with tailored, age-specific programs delivered to the public over the lifespan. The role of health screening cannot be underestimated in the detection of risk factors such as hypertension and obesity. Early detection makes effective treatment possible and helps prevent the occurrence of strokes, thus reducing the cost to the community. Long-term health strategies such as improving health resource distribution and enhancing health education are needed where patients and their families participate together in comprehensive education programs. It is hoped that this may lead to a shared understanding, which may translate to patients being more supported, and therefore more able, to make the necessary lifestyle changes. Dysphagia is a common complication following stroke, which can result in significant morbidity and mortality. Multidisciplinary collaboration facilitates management strategies, decision-making and the efficiency of rehabilitation. Nurses are responsible for coordination of management and in particular for continuous monitoring, assessment of swallowing and nutritional state, maintaining safety and preventing complications. An understanding of the issues and strategies relating to management may provide valuable information to enhance the safety, cost-effectiveness and quality of care. A retrospective review of patients’ medical records was used to collect data. A sample of ninety-five adults who were admitted to an Australian public hospital between January 2003 and April 2006, with a diagnosis of dysphagic stroke were recruited. Statistical Package for Social Sciences (SPSS) was used to analyse the quantitative data, while content analysis was used to analyse the qualitative data. All subjects were assessed by a speech pathologist, the mean age was 75 years and 50.5% were male. Except for critically ill subjects, almost all were assessed within three days. Ninety-six percent of subjects had communication problems and 81% had upper limb motor impairment. During hospitalisation almost 60% of subjects had an improvement in their oral intake including 8% resuming their premorbid diet. Eighteen percent were on enteral tube feeding upon discharge, 4% deteriorated and 16% died. It appears that oral intake of most subjects was unsatisfactory. When recorded the mean body weight lost was 2.3kg. At least 22% had malnutrition or dehydration. Forty-five percent aspirated and 22% had respiratory infection. Almost half of the subjects (48%) were discharged to aged care facilities. Eighty percent had no documented follow-up scheduled for management of their dysphagia. Early identification of dysphagia, prudent supervising of appropriate oral intake and mouth care may help to maintain safe swallowing, preventing aspiration and chest infection. Regular checks of body weight, serum albumin level, oral intake and early enteral feeding are essential to guide nutritional support, minimise malnutrition and problematic medication administration. Encouraging oral intake and providing families with support could promote recovery of swallowing skills and help patients to regain the ability to eat independently. Providing helpful information on the care options available may allay patient and family anxiety. A qualified nurse practitioner could assess patients and ensure that a tailored care plan was designed to meet patients’ needs and this may improve the outcomes considerably.
http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320650
Thesis (D.Nurs.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

Stroke is a preventable disease. Minor stroke and transient ischaemic attack (TIA) are important warning signs of the possibility of a major stroke. Worldwide, stroke is the third most common killer and the largest cause of disability. The incidence of stroke is predicted to increase with the predominance of unhealthy lifestyles and the aging population. The adoption of a healthy lifestyle can reduce many of the risk factors. This descriptive study was designed to explore patients’ understanding of modifiable risk factors of cerebrovascular disease. It investigated lifestyle changes actually made, as well as the factors affecting patients’ decisions about whether to make lifestyle changes. The two major factors considered were patients’ sources and level of knowledge and their attitudes and beliefs around making changes. A convenience sample of patients who had suffered a minor stroke or TIA was recruited through a major metropolitan hospital. Thirty-five subjects responded to a postal questionnaire. The mean age was 68 years and 37% of the subjects had sustained some disability as a result of the TIA or minor stroke. The results demonstrated that many subjects had a poor understanding of risk factors of stroke. While smoking was well recognised as a risk factor, subjects showed less awareness of other risk factors, such as excessive alcohol consumption and obesity. Subjects also reported significant confusion regarding diet. Sixty-six percent of subjects depended on doctors as their main source of health information. This may be problematic as the current shortages of General Practitioners has put pressure on doctors to keep appointment times short and reduce the time available for health education. The main barriers to lifestyle change, were lack of motivation, and inadequate, knowledge, guidance, and support and the inability to access good information. Although 83% of subjects suffered from hypertension, medication was the accepted method of control, few subjects realised the significance of lifestyle factors. Nine percent of subjects were only diagnosed with hypertension after their stroke or TIA and few monitor their own blood pressure, despite the wide availability of home monitoring devices. From the findings of this study it is concluded that health promotion and education are very important strategies in the prevention of stroke and it is recommended that this kind of education begins in childhood with tailored, age-specific programs delivered to the public over the lifespan. The role of health screening cannot be underestimated in the detection of risk factors such as hypertension and obesity. Early detection makes effective treatment possible and helps prevent the occurrence of strokes, thus reducing the cost to the community. Long-term health strategies such as improving health resource distribution and enhancing health education are needed where patients and their families participate together in comprehensive education programs. It is hoped that this may lead to a shared understanding, which may translate to patients being more supported, and therefore more able, to make the necessary lifestyle changes. Dysphagia is a common complication following stroke, which can result in significant morbidity and mortality. Multidisciplinary collaboration facilitates management strategies, decision-making and the efficiency of rehabilitation. Nurses are responsible for coordination of management and in particular for continuous monitoring, assessment of swallowing and nutritional state, maintaining safety and preventing complications. An understanding of the issues and strategies relating to management may provide valuable information to enhance the safety, cost-effectiveness and quality of care. A retrospective review of patients’ medical records was used to collect data. A sample of ninety-five adults who were admitted to an Australian public hospital between January 2003 and April 2006, with a diagnosis of dysphagic stroke were recruited. Statistical Package for Social Sciences (SPSS) was used to analyse the quantitative data, while content analysis was used to analyse the qualitative data. All subjects were assessed by a speech pathologist, the mean age was 75 years and 50.5% were male. Except for critically ill subjects, almost all were assessed within three days. Ninety-six percent of subjects had communication problems and 81% had upper limb motor impairment. During hospitalisation almost 60% of subjects had an improvement in their oral intake including 8% resuming their premorbid diet. Eighteen percent were on enteral tube feeding upon discharge, 4% deteriorated and 16% died. It appears that oral intake of most subjects was unsatisfactory. When recorded the mean body weight lost was 2.3kg. At least 22% had malnutrition or dehydration. Forty-five percent aspirated and 22% had respiratory infection. Almost half of the subjects (48%) were discharged to aged care facilities. Eighty percent had no documented follow-up scheduled for management of their dysphagia. Early identification of dysphagia, prudent supervising of appropriate oral intake and mouth care may help to maintain safe swallowing, preventing aspiration and chest infection. Regular checks of body weight, serum albumin level, oral intake and early enteral feeding are essential to guide nutritional support, minimise malnutrition and problematic medication administration. Encouraging oral intake and providing families with support could promote recovery of swallowing skills and help patients to regain the ability to eat independently. Providing helpful information on the care options available may allay patient and family anxiety. A qualified nurse practitioner could assess patients and ensure that a tailored care plan was designed to meet patients’ needs and this may improve the outcomes considerably.
Thesis (D.Nurs.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

Background: The National Department of Health adopted decentralisation of hospital management as a key policy in pursuit of a more efficient, effective, responsive and accountable public sector hospital system. The proposed decentralisation of hospital management represented a fundamental policy shift in the decision making processes between National, Provincial health departments and Hospitals. Provincial health departments were to “delegate significant decision making powers to hospital managers, including the authority to make decisions relating to personnel, procurement, and financial management” Objective: To gain in-depth understanding of the decentralisation of hospital management processes between 1996 and 2007 as it relates to the Human Resource Management function in public hospitals. Methodology: The study design was a descriptive qualitative comparative case study design. Results: Decentralisation was promoted as a policy reform to improve efficiency, equity and effectiveness of hospitals in South Africa. There was no formal policy from the National Department of Health guiding the implementation of decentralisation of hospital management. There was a shift of power over the control of HRM function between 1996 and 2007. Regional hospital gained more space and had more wide range of choices allowed in almost all HRM activities. District Hospital has gained some space and now has moderate choice allowed. The experiences and understanding of health managers vary on what happened during the policy process. Conclusion: The study found conclusive evidence that there are changes to HRM function during the ongoing debate on decentralisation of hospital management. More HRM functions were delegated to Hospitals.

碩士
義守大學
管理研究所碩士班
96
The medical industry is a kind of highly knowledge–intensive service industry. For the hospital, knowledge becomes very important capital of the hospital. And such a capital is made up by professional knowledge, technology and ability of the medical personnel in the hospital. The medical personnel play a quite important role in participating the medical knowledge management activity in the organization. In terms of system implementation, the personnel are one of the important factors on conducting the knowledge management in the hospital efficiently. The subject of the study is one KM system in one regional hospital in South Taiwan, which this study would describe the understanding and the realization in the participation of knowledge management in hospital refers to medical nursing staff and administrative staff. Furth more, this study would figure out the cognitive variation on suck a KM system refers to executives. The study would also figure out the recognition of knowledge management and the understanding of knowledge management in the hospital refers to the basic level staff and the middle level managers. According to the empirical results of the study, it finds out that there is a little differences on the employees’ awareness of knowledge management and on the employees’ awareness of hospitals’ knowledge management between the executives and the staff. After comparing the medical staff’s cognition with the administrative staff’s cognition, the study finds out that there is a significant difference between both cognition. While discussing the performance of the knowledge management activities, the study finds out the relationship among personal characteristics, employees’ awareness of knowledge and employees’ awareness of hospital’s knowledge management. The study also finds out that the relationship between knowledge function of self–awareness and employees’ awareness of knowledge management will be interacted significantly. In other words, employee knows that knowledge’s function will affect the employees’ awareness of knowledge management based on hospital. Finally according to the result, it would show some examples for any interested hospitals.

碩士
國立交通大學
經營管理研究所
92
The early 21st century newly developed contagious disease – the Severe Acute Respiratory Syndrome,(SARS) rolled over the globe as sudden as lightning and Taiwan also could not escape this by sheer luck. In fact, the occurrence of this crisis is not incompletely predictable as the SARS epidemic situation burst out and became widespread in Quangzhou in November 2002. Thereafter, it was stretched to Vietnam, Singapore and Canada etc. from Hong Kong. However, the overseas experience and lesson were not vigilant and emphasized by the Taiwan government and various large hospitals. From the first case of Taiwanese merchant Mr. Chin reported by the National Taiwan University Hospital in March 14, 2003 till the day before the sealing off of the Hoping Hospital in April 24, all together for the nine quarantined SARS patients in National Taiwan University Hospital, there was no news on case of death. Although the epidemic situation appeared calm on the surface, yet stealthily this disease silently spread out all over Taiwan. In April 20 in the same year, Taiwan convened the first global SARS International Symposium and boasted its excellent achievements of 「zero death, zero transfer out, zero community infection」. Until April 24 in the same year when Hoping Hospital had to seal off its hospital due to serious cross infection inside the hospital, the government and various large hospitals were alerted by the arrival of the crisis. Therefore, during the arrival of SARS epidemic situation, Taiwan had already lost its first opportunity to control the epidemic situation and to adopt related contingency measures. In addition, due to the furious development of the epidemic situation, it became irremediable. For X Hospital, before the epidemic situation attacked Taiwan, the Infection Control Committee was responsible for the monitoring and mastering of the SARS epidemic situation. When the National Taiwan University reported the first SARS case, X Hospital immediately sent people to understand and to learn and actively planned related contingency measures in the defense against SARS. When X hospital received the first reported SARS patient, they already prepared related preparation measures. On the next day of the sealing off of the Hoping Hospital, the Head of X Hospital immediately instructed the senior doctor of the thoracic cavity department to be the chief executive to fight against SARS. Thereafter, following the increase and expansion of the epidemic situation, X Hospital immediately enhanced its crisis management level and expanded the crisis management team. In this battle against SARS, X hospital adopted considerable complete action and successfully took over SARS patients transferred from Hoping Hospital and National Taiwan University. Due to the professionalism and attention of X Hospital, the epidemic situation could be effectively controlled and would not spread to other hospital. Therefore, in the course of the battle against SARS, the hospital won the approval and affirmation from CDC in US, AIT, National Taiwan University Infection Control Team and National Prevention and Cure Battle Center Commander Professor Lee Ming-Liang and the head of Disease Control Bureau, Su Yi-Ren. This research attempts to analyze and investigate on the course of SARS crisis management of X Hospital in this SARS case. In addition, through the result of in-depth interview with the crisis manager of X Hospital and from the three crisis management phases including the activity before the bursting of crisis, activity during the bursting of crisis and the activity after the crisis is solved and the communication activity under the crisis situation, an exploration is conducted so as to summarize the experience and lesson of fighting against SARS by X Hospital. Furthermore, aiming at the crisis management of X Hospital, suggestion is presented on how to keep on improving.

碩士
國立清華大學
工業工程與工程管理學系
100
Facing the income ceiling policy, quality protocols, industry competition, and expanding financial burden among others, individual hospitals in Taiwan need to find ways to maximize its resources and minimize its costs in order to generate more profits. In spite of the fact that most of the Taiwan hospitals have adopted one method or another to help manage its administration or operation performance, the result seems partial and there is still a gap between available resources and overall integration. This study adopted the Total Resource Management (TRM) framework and aims to develop a systematic and effective Plan-Do-Check-Action (PDCA) methodology to optimize operational resources in the context of hospitals. By benchmarking proven successful models and standards in the medical industry, domestic hospitals are therefore able to sustain continuous growth by establishing its own advanced hospital management models. This Hospital Total Resource Management (HTRM) facilitates hospitals to examine the 5-M resources, which are man, machine, material, method, and money, in a more efficient and effective manner. First of all, the HTRM helps identify 11 fundamental objectives and 39 performance indexes from the 5-M resources in the hospital. Secondly, the HTRM requires all accountable to develop and implement feasible action plans to deliver the means objectives, which improves on the overall effectiveness. Finally, under the supervision by the HTRM working committee, all accountable must monitor, evaluate, improve, and report the progress on a regular basis, in order to meet up the fundamental objectives and performance indexes originally set by the hospital authority. The HTRM framework per se was introduced to a regional hospital located in Hsin-Chu, Taiwan, and successfully proved on its feasibility and validity through two case studies, which are respectively the OEE utilization analysis over the Whole Body System for Routine SPIRAL CT scanning, and the SMART procurement evaluation over major medical equipments in the hospital.

A presente investigação teve como objetivo comprovar a eficácia da aplicação de metodologias de Lean Management ao setor da saúde, nomeadamente em logística hospitalar. Através da ferramenta VSM ("Value Stream Map"), foi possível identificar potenciais pontos de melhoria na cadeia de valor atual associada à produção de cestos cirúrgicos (kits de consumíveis para cirurgia) utilizados no Hospital da Luz Lisboa, unidade hospitalar pertencente ao grupo Luz Saúde. Concluiu-se com essa análise, que a empresa que centraliza as compras do grupo, a "Glsmed", teria as condições necessárias para assegurar essa produção, a serem implementadas algumas mudanças e melhorias em processos. As mudanças foram sugeridas à luz do "lean management", sendo que desta forma foi possível traçar um VSM ideal para a cadeia de valor associada aos cestos cirúrgicos, com ganhos estimados de tempo e recursos humanos. O VSM ideal obtido permite ganhos de 1 FTE (Equivalência a tempo inteiro) / ano, só para a produção de cestos cirúrgicos da especialidade de Cirurgia Geral. Desta forma, a cadeia de valor fica mais fluida, rápida, previsível e menos suscetível a variações, podendo ser replicada enquanto serviço prestado pela "Glsmed" não só ao Hospital da Luz como a qualquer unidade do grupo Luz Saúde.
This research aimed to prove the efficiency of applying lean management methodologies to the healthcare industry, in particular to hospital logistics. The identification of potential aspects to improve in the current value chain linked to the surgical basket production (i.e. consumable kits for surgery) used in Hospital da Luz Lisboa - a hospital unit owned by the Luz Saúde Group - was made possible through the use of the VSM (Value Stream Map) tool. Given this analysis, it is concluded that the company through which the purchases are centralized - Glsmed - would have the necessary conditions to guarantee production. Additionally, some changes and improvements in processes would have to be improved. These changes were suggested according to lean management, hence being possible to layout an ideal VSM for the value chain linked to the surgical baskets, which in turn would represent estimated gains of time and human resources. The optimal VSM allows for 1 FTE (Full-Time Equivalent) /year only in terms of surgical basket production for General Surgery. Thus, the value chain improves its flow, speed, predictability and is less prone to variations. Furthermore, it will be possible to replicate it as a service provided by "Glsmed" for any unit inside the Luz Saúde Group, and not just to Hospital da Luz.

碩士
中國醫藥大學
醫務管理研究所
93
Abstract Objectives: To ensure the medical quality, cope with the financial shortfalls, and maintain comprehensive medical benefits to the public, the Bureau of National Health Insurance implemented the hospital-based budget payment (HBBP) program. The purpose of this research is to examine whether joining the HBBP program will affect a hospital’s cost control, customer service, and relative operating strategies. This study further explores the impact of the HBBP program, under the global budget reimbursement system, on the management strategies of participating hospitals. Method: Using all accredited teaching hospital as a target, sixty hospitals responded to our structural questionnaire. In addition to applying descriptive statistics and multi variable analyses to measure the degrees of intentions for all adjustment strategies regarding the HBBP program, this study employs multiple regressions to explore the influence of HBBP and other related factors on managerial strategies. Results: Under the global budget reimbursement system, there are more than half of the sample hospitals which have had the experiences of participating in the HBBP program. HBBP- participating hospitals have higher strategic intentions on strengthening financial and cost managements and customer-oriented strategy than those which never enroll in the HBBP program. Relative to local community teaching hospitals, academic medical centers and metropolitan hospitals have higher degrees of intentions for revenue-increasing strategies. Compared with private hospitals, public hospitals also show a higher degree of intention toward revenue-increasing strategies. There exists a negative relationship on the cooperative strategy between sample hospitals with branches and those without branches. Among thirty-one surveyed strategies, the strategy of establishing and internalizing cost consciousness earns the highest consensus, while the strategy of avoiding the catastrophic illness has the lowest consensus. Conclusions: Overall, this study finds that after joining the HBBP program, the sample hospitals had a higher intention to enhance medical quality to the public and increase cost controls. Therefore, we suggest that: (1) While pursuing cost controls, hospitals should take patients’ rights and benefits into considerations. (2) Hospitals need to pay more attention to the related strategies of improving medical quality. (3) Health service authorities need to observe the effect of the HBBP program on the development of Taiwan medical processes and the allocation of medical resources. Keywords: Hospital-Based Self-Management, Hospital-Based Global Budget, Strategic Management

碩士
元培科技大學
經營管理研究所
97
The purpose of the study is to investigate the cognition of knowledge management(KM) among hospital employees and the relationship between KM and the KM enabler activities (financial, customer, internal business process, learning and growth) in a regional hospital in Taiwan. Both qualitative and quantitative research were used in this study. The instrument was conducted using in-depth interviews of three policy-makers as participants. The quantitative data were collected from a regional hospital in the Northern part of Taiwan with a 77% effective response rate (N=154). The findings in this paper indicate that: Ⅰ.The policy-makers emphasized that KM as powerful and positive assets. Ⅱ. The policy-makers expect that subordinates working in the hospital to be brave in taking new responsibility and complying with hospital operation norms. Ⅲ.The subordinates as managers do best in executing the hospital goals and visions and the subordinates in administration department do best in implementing the concept of knowledge circulation and sharing. Ⅳ.The high and middle cognition in environment of organization have significant differences among financial, customer, internal business process and learning and growth factors. Ⅴ.The idea of KM has significant positive influence in financial, customer, internal business process and learning and growth factors.

博士
國立交通大學
管理科學系所
93
The World Health Organization and Bureau of National Health Insurance have proposed that every hospital should promote the efficient utilization and high quality under the circumstance of limited medical resources. A procedure is composed of 2 parts. Part 1 is “Technical efficiency of large hospitals in Taiwan: an application of data envelopment analysis (DEA) , and then uses Tobit (censored) regression to find the effects of quality and environmental variables on these efficiency scores.” Part 2 is “The effect of managerial factors on the incidence of medical operations: the case of Cesarean sections in Taiwan.” Part 1: Taiwan started its National Health Insurance Program (NHIP) on March 1, 1995. Because NHIP subsidizes each hospital visit, reducing the transaction cost for a patient to go to a large hospital directly. We use the latest 1993-2002 official panal data set and select 49 hospitals with medical centers and regional hospitals for analysis. This research applies the DEA to compute hospital efficiency scores, and then uses Tobit (censored) regression to find the effects of quality and environmental variables on these efficiency scores. Our major empirical findings are as follows: (1) Quality and environmental variables significantly affect the technical efficiency scores of large hospitals in Taiwan. (2) The relatively negative productivity trends of large hospitals in Taiwan are mainly caused by technological regress. Part 2: Increasing Cesarean section rates are a pandemic trend all over the world, and also in Taiwan. This research collects Taiwan’s official data on Cesarean section and the associated socio-economic factors during 1992-2001. We analyze factors determining Cesarean section rates from both supply and demand sides. Our major empirical findings are as follows: (1) Cesarean section rates in public hospitals are significantly higher than those in private hospital. (2) Medical centers have the highest, regional hospitals have the median, and district hospitals have the lowest Cesarean section rates. (3) Different geographic areas in Taiwan also have significantly different Cesarean section rates. (4) An increase in Christian and Catholic population ratio significantly reduces the Cesarean section rate in an area.

碩士
國立東華大學
資訊工程學系
95
Digitalization jeopardizes information security wherever it is applied, and hospitals are not an exception. The information they possess is very personal, while the trust between the patient and the hospital is one basic factor for quality care. Therefore hospital information security and privacy are major issues that cannot be ignored. This research uses case study methods to observe and understand the information security management system of our research subject. We used a four point scoring survey that was developed on the basis of “ISO/IEC 27001”to develop models that could verify their information security management systems. Our research subject was the first hospital under the jurisdiction of the Department of Health and the first in Taiwan to receive an ISO/IEC 27001:2005 certificate. Therefore, their information security management is very good and can be viewed as a standard for others to follow. We have come up with some extremely constructive suggestions via our extensive research. These suggestions and experience will be presented to our hospital, provided to future researchers, and serve as reference for those that wish to use such a system.