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1
Robins, Jenny. "Counselling psychology in a changing National Health Service." Thesis, City University London, 2014. http://openaccess.city.ac.uk/3701/.
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Aim: Within the field of obesity, evidence shows that weight regain following weight loss is extremely common, demonstrating that weight loss treatments are not effective. Considering that attachment history influences a person’s capacity for emotional regulation and that some people use food to self-soothe, increasing our understanding of the relationship between attachment style and obesity might inform better treatments. This study is comprised of two parts: the first part investigates whether attachment style predicts outcome in a 12-session group treatment for obesity and the second part explores the experience of that treatment. Design: The study utilises a mixed methods design with participants from a group treatment for obesity which comprises: the Attachment Style Questionniare (ASQ), completed by 52 group members, along with their body mass index (BMI) measures at the start and end of the treatment, analysed using a backwards multiple regression to test whether the 5 dimensions of the ASQ can predict participants’ change in BMI; and semi-structured interviews with 7 people from the same treatment analysed according to Interpretative Phenomenological Analysis (IPA) guidelines. Method: Data was collected from 52 people attending group treatment for obesity with an NHS service in South East England, which included the ASQ and BMI measures at Week 1 and Week 12 of treatment. The change in BMI was entered as the dependent variable for the regression in SPSS and the five attachment dimensions were entered as predictors. 7 people who had taken part in Part I of this research participated in interviews about their group experience. Transcripts were subjected to IPA. Results: Quantitative findings produced a model in which the ASQ dimension Confidence (in relationships) significantly predicted change in BMI in a negative direction (i.e. the participants who scored higher on Confidence lost less weight than those with lower scores). Confidence explained 8% of the variance (R2=0.08, F(1,50)=4.32, p<0.05). Qualitative findings produced four super-ordinate themes which included: the sadness at the course ending; the support and comfort felt from others in the group experience; the positive aspects of the group treatment; and the negative aspects of the group treatment. Other group members appeared to have a substantial impact on participants, whether positive or negative. Some accounts reflected the importance of others in feeling accepted and supported. Other accounts conveyed less of an emphasis on feeling part of the group and more on feeling separate. Conclusions: The quantitative results are inconclusive and possible reasons for this are discussed. The qualitative findings suggest that it is likely that group intervention for obesity could be improved by attention to attachment and by tailoring treatments more specifically to individuals.
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Davies, A. C. L. "Accountability : a public law analysis of National Health Service contracts." Thesis, University of Oxford, 1999. https://ora.ox.ac.uk/objects/uuid:7fa277f4-ba95-46e6-bd82-81ab2236acd5.
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The thesis takes as its subject the concept of accountability. It examines the use made of the concept in the public law literature, and advances a novel analytical model of the individual accountability mechanism. The model identifies the essential features of that mechanism: setting standards against which an account can be judged; requiring the person being called to account to explain and justify his or her actions; judging the account rendered against the standards set; and responding to the account rendered, where appropriate, with enforcement measures. This analytical approach provides a way of examining, in detail, an individual accountability mechanism, and identifying the main practical problems faced by the parties to it. The approach is applied to an empirical case study of National Health Service (NHS) contracts. (The fieldwork involved an examination of contractual relationships between purchasers (Health Authorities and GP fundholders) and providers (NHS Trusts) in three sample areas, using document analysis, interviews and observation.) The study's main findings fall into three groups. Firstly, purchasers were subject to various pressures and constraints (of time and resources, for example) which affected their actions in calling providers to account. Secondly, the study uncovered some of the complexities of the relationship between the parties to the accountability process. Analytical models of the accountability relationship were developed in order to classify different types of relationship according to the parties' behaviour and their degree of mutual trust. Thirdly, the study examined whether purchasers, as callers to account, could render the accountability process effective. For various reasons, purchasers often lacked the authority to set and enforce the standards they required. The model of the accountability mechanism developed in the thesis also has evaluative potential. Drawing on the public law literature as well as the empirical data, a notion of the good accountability process is evolved. This includes, for example, requirements of maximising the accountability achieved within available resources, maintaining good relationships by using fair procedures, and finding ways of making the whole process effective. Some of these principles may be of more general application to other accountability processes. Possible generalisations are explored, particularly the contribution of the thesis to the development of an explicitly public law concept of contract.
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Donnelly, Pamela Christine. "Marketing planning in the National Health Service : implementation and consequences." Thesis, Anglia Ruskin University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325397.
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Corby, Susan Ruth. "Private sector norms and public service practices : employment relations in the Civil Service and the National Health Service." Thesis, University of Greenwich, 2003. http://gala.gre.ac.uk/6137/.
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This submission for a PhD by published work looks at employment relations in the Civil Service and the National Health Service( NHS) over the last decade and in particular at management/union relations, pay determination and equal opportunities. The focus of research over this period was the extent to which private sector norms are advocated by the State impacted on public sector practices: a) in the Civil Service compared to the NHS b) in employing bodies within the Civil Service(ie executive agencies and employing bodies within the NHS (ie NHS trusts). The submission is in three parts. First, the distinctions between the private and public sectors are discussed along with the change agenda pursued by successive governments since 1979 to make the public sector more like the private sector. Second, four key debates are rehearsed: whether the state as employer is no longer a 'model' employer, whether there has been trade union renewal; whether the public sector ethos has been undermined; and whether the accession of the Labour government in 1997 was a watershed in respect of public sector employment relations. Third, the author's contributions to these debates are demonstrated.
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Bentley, Melissa. "A National Assessment of Ideal Cardiovascular Health among Emergency Medical Service Professionals." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1480456097279235.
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Wood, Aileen J. "Towards a national library and information services policy in public sector healthcare in the United Kingdom." Thesis, University of Brighton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275086.
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Shepherd, Michael Allan. "Public involvement practice in the National Health Service : narratives of power, resistance and partnership." Thesis, University of Bristol, 2004. http://hdl.handle.net/1983/cdce5e32-fac7-4924-8ede-935b6d3aa411.
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Campbell, Lucy Zarina. "Using communication technologies to deliver public health agendas in National Health Service food and drink automated vending." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/10038795/.
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This research responded to a National Health Service (NHS) wide problem. The problem is how to create healthier automated food and drink vending services. The research’s’ interpretation of this central research problem is embedded in the Facilities Management (FM) perspective. Vending retail products do not support government healthy lifestyle policies and initiatives. FMs have to change this through catering contracts. However, there is little guidance on how to design, evidence and operationalise improvement. The research tested vending point of sale designs over a year, trying to reduce the sale of unhealthy products. Secondly, it developed a novel application of a nutritional profile to enable the service design process and evidence change. Thirdly, the research baselined service level information through survey n=1,292. Night shift staff were a key stakeholder as it was thought that vending was their only retail catering and the impact was unknown. Regression modelling and multivariate analysis was used in the survey and design tests. Linear regression was used to understand the impact of vending point of sale design on sales. Logistic regression was used to test service level perceptions in the survey. The statistical methods used were flexible. The survey design and analysis is widely applicable to evaluate many services. The research found that in combination, changing product ranges, adding nutritional labels, and moving water to eye level significantly reduces unhealthy sales. However real change requires healthier vending products. The nutritional profile adapted is highly suitable to standardise service and evaluate how healthy vending products really are. The survey was a novel and statistically robust addition to FM service evaluation. It proved staff perception of poor catering, inadequate breaks, innutritious food and need for staff food education. Vending was central. Finally, making meaningful service improvements and setting thresholds in the statistical models confidently required in depth first-hand knowledge.
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Hardacre, Jeanne E. "Exploring the links between leadership and improvement in the UK National Health Service." Thesis, University of Warwick, 2011. http://wrap.warwick.ac.uk/53648/.
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Whilst the need for leadership in healthcare is well-recognised, there is still a lack of understanding about how leadership contributes to improving healthcare services. The body of knowledge concerning improvement has grown significantly in recent years, but evidence about links between leadership and health services improvement remains poor, especially within the UK National Health Service. It remains unclear how and why leadership is important to service improvement. This thesis describes aspects of a broader study commissioned by The Health Foundation. Firstly, the work aimed to explore the extent to which different types of service improvement require different types of leadership behaviour. Secondly, it aimed to investigate the nature of any links between leadership behaviour and improving services. The work draws on theoretical models and concepts of leadership and improvement in the literature, as well as empirical research in these areas. A typology of healthcare improvement was developed in order to classify different types of improvement work. Data about leadership behaviours were derived from semistructured interviews and using Q-Sort methodology. The study provides insights into which aspects of leadership are used for different types of improvement work. It makes an original and NHS-specific contribution to the literature, providing empirical evidence of how NHS leadership is associated with service improvement. Results highlight the importance of the relational aspects of leadership behaviour in improving NHS services, reinforcing trends in the literature which promote shared and distributed leadership approaches. A model of improvement leadership is proposed, based on the concept of ‘interdependence’. This model could provide the basis for an alternative emphasis in developing leadership in healthcare organisations, away from teaching skills to individuals, towards a collective, team-based approach to leading services with a shared purpose.
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Watson, Julia A. "Patients' choice between the National Health Service and the private sector in the United Kingdom." Thesis, Boston University, 1993. https://hdl.handle.net/2144/38113.
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Thesis (Ph.D.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
The aim of this dissertation is to explain how elective surgery patients choose between the public and private hospital sectors in the United Kingdom, and to analyze government policy changes which affect this choice. First the choice between the public and private sectors is modeled for the case where there is no private insurance available. The model takes into account the different rationing mechanisms used by National Health Service (NHS) and private hospitals to allocate surgery among patients. Private hospitals charge a price and ration on the basis of willingness to pay , while NHS hospitals , which face budget limits, ration on the basis of clinical need and require patients to wait for surgery. Consequently, a patient's choice of sector depends on her income and her level of clinical need. A simulation model is used to compare the efficiency and equity of two policy measures designed to raise the number of people receiving elective surgery : an increase in NHS funding and a subsidy to the price of private surgery. The subsidy is shown to be more efficient and the NHS funding increase more equitable. Within the same framework an expected utility model of the demand for private health insurance is developed. Two cases are analyzed: the case where individuals have no information about their future need for elective surgery and the case where they have partial information. In each case it is shown that for a given insurance premium there is a threshold level of income above which people buy insurance. It is also shown by simulation that in each case the insurance company can set a premium that allows it to break even. Finally the two models are combined. This enables the efficiency and equity of an increase in NHS funding, a subsidy to private care and a subsidy to private insurance to be compared in a situation where some private patients have insurance to cover the cost of their surgery. The NHS funding increase is shown to be most equitable , and depending on the definition of efficiency chosen, one of the two subsidies is most efficient.
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Hackett, Addy. "An investigation into stress and coaching-needs in the National Health Service and UK hospices." Thesis, City University London, 2009. http://openaccess.city.ac.uk/12365/.
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This thesis explores the issues around stress in the UK Health Service, with a particular focus on stress in the Hospice Service and the benefits of a group coaching intervention for this staff group. Section A provides an introduction to the thesis, explaining the rationale behind the choice of research and how the different sections link together. Section B reports on the research aspects of this thesis which exists of three phases. Phase 1 is a cross-sectional study to assess the levels of stress and the main work-stressors as experienced by members of staff working within two hospices in the UK. Phase 2 is a qualitative study using two focus groups, one at each hospice, to obtain a deeper understanding of the findings of phase 1. Phase 3 is an evaluation of a brief group coaching intervention for stress management, which has been informed by the findings of phase 1 and 2. The theoretical framework of the coaching intervention was Cognitive Behavioural Coaching (CBC). Section C of the thesis presents a case study of a one-to-one stress-coaching intervention. This study also uses CBC as its theoretical framework and uses the same coaching format as was used in the group coaching session described in section B. Using the same model for both the group and one-to-one coaching intervention provides an opportunity to explore the versatility and usefulness of CBC within the context of stress coaching. The critical literature review presented in section D of the thesis examines the effectiveness of traditional stress management programmes used within the nursing profession, which provides a base-line for the development of an effective coaching intervention. The findings of this thesis add to the current understanding of stress in the UK hospice service and provide the foundations of a new approach to staff support and stress management within the Health Service using a CBC coaching model.
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Arowosegbe, Oluwaseyi. "Outcomes of children transferring out of Red Cross War Memorial Children's Hospital HIV cohort using linkage to the National Health Laboratory Service Data." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24873.
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Background and Rationale: Paediatric antiretroviral (ART) care in the Western Cape Province (WCP) has evolved following South Africa's (SA) massive roll-out of antiretroviral therapy in 2004 in response to the country's human immunodeficiency virus (HIV) epidemic. Decentralization of paediatric ART services was adopted in scaling up access to ART services for children living with HIV. Although children now mainly initiate ART at lower level facilities, sick or very young infants continue to initiate ART at tertiary health facilities and become eligible for transfer to lower level facilities after stabilization at tertiary health facilities. There has been limited assessment of the effectiveness of this model of ART care since its implementation. Aims and Objectives: The primary objective of this study is to determine the proportion of children that successfully transferred from Red Cross War Memorial Children's Hospital (RCWMCH) to referral facilities for continued ART within 18 or 48 months of their last appointment at RCWMCH. Successful transfer was defined in two ways: a laboratory test performed by a lower level facility (i) ≤18 months or (ii) ≤48 months after transfer date. The first interval corresponds to guideline recommendations for annual CD4/viral load monitoring; the second captures all children retained in care. Our secondary objectives are as follows: 1. To identify the determinants of successful transfer from RCWMCH. 2. To describe the CD4 and viral load outcomes of children that successfully transferred to referral lower health facilities within WCP. 3. To determine the feasibility of using the SA National Health Laboratory Service (NHLS) data for routine monitoring of children transferring between paediatric ART sites. Methods: A retrospective analysis of prospectively collected data was performed. The study population was children below the age of 16 years who were initiated onto ART at RCWMCH and transferred out to lower level facilities within the WCP from December 31, 2007 - January 1, 2012. We described children's characteristics before transfer out and post-transfer date. In those who successfully transferred, we compared their immunological and virological status at transfer out and at the first visit within 48 months after the transfer out date, using median change for continuous variables and difference in proportions for categorical variables. Results: Data from 1127 children with median age of 5.6 months (interquartile range [IQR] 3.1-19.9) was included; at ART initiation 85% had WHO stage III/IV disease and 57% were severely immunosuppressed. A total of 725 (64%) children were transferred; 69% (496) and 76% (541) successfully transferred within 18 and 48 months respectively. Since there is about 90% compliance with annual CD4/viral load monitoring guidelines, we estimate that up to 85% of children may have actually successfully transferred. Median time to successful transfer was 5.4 months (IQR 3.7-7.8). Among the 184 children (25%) who did not transfer successfully, 11% returned to RCWMCH. In patients who successfully transferred, median (IQR) CD4% increased between transfer out and first visit post-transfer [25.1% (17.3-33.8%) vs 30.2% (22.9-36.6%), p-value = 0.0000]. Children who had their transfer sites recorded in the database and those transferred before 2010 were identified to be associated with successful transfer (adjusted odds ratio (aOR 7.99, 95% Confidence Interval (CI) (2.3-28.5 and aOR 5.21, 95% CI 1.5-18.4 respectively). Conclusion: The proportion of children remaining in HIV care by 48 months after transfer out was at least 76% and 92% of those that transferred successfully reached the referral facility and undergoing a laboratory test within 18 months of transfer out. In children who successfully transferred, CD4% and viral load suppression improved after transfer. This suggests that paediatric ART decentralization is feasible with good outcomes. However, outcomes in those who were lost after transfer out need further investigation.
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Saffin, Catherine. "The practitoner's progress : Developing public health research practice in the bounded and financially constrained setting of the National Health Service." Thesis, University of the West of England, Bristol, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.522570.
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Davies, Ian. "Emerging management education issues for the human services." Thesis, University of Bristol, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343294.
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Cantero, Martínez Josefa. "Crisis and mutation of the public health service in Spain." Pontificia Universidad Católica del Perú, 2016. http://repositorio.pucp.edu.pe/index/handle/123456789/116437.
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The aim of this paper is to analyze the effects that recent health reforms adopted in Spain because of the economic crisis have had on the National Health System. It is not only a matter of mere budgetary cuts or measures of saving in the public expense. Reforms are looking for the efficiency and financial sustainability of health care services. However, a «mutation» in the public service has taken place. Reforms have affected the basic principles of the public system: the insurance model, its universality, the financing of the system and the principles of equity and cohesion of the public service.El objeto de este trabajo es analizar los efectos que las reformas adoptadas recientemente en España con motivo de la crisis económica han tenido en el servicio público sanitario. No se trata solo de meros recortes presupuestarios y de medidas de ahorro en el gasto público. Las reformas buscan la eficiencia y la sostenibilidad económica del sistema sanitario. Sin embargo, han producido una importante «mutación» del servicio público que ha afectado a los principios básicos inspiradores del modelo, al modelo de aseguramiento, a su universalidad, a su financiación y, con ello, a los principios de equidad y cohesión del sistema.
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Bishop, Sarah M. "Service responses to survivors of sexual violence : perspectives of National Health Service and voluntary sector professionals on inter-agency working with survivors." Thesis, University of Warwick, 2013. http://wrap.warwick.ac.uk/58620/.
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The first chapter of this thesis critically reviews the existing literature on Restorative Justice (RJ) for crimes of sexual violence. It considers whether RJ has a contribution to make to the psychological wellbeing of survivors, provides clinicians working in the field of sexual violence with an insight into the potential strengths, weaknesses and gaps in the evidence base for RJ for sexual violence and makes recommendations for further research. The reviewed literature revealed some evidence that supports the use of RJ for crimes of sexual violence. In particular, survivors and professionals who had experienced RJ first-hand reported positive outcomes. However, due to the sensitive nature of sexual violence and the potential for re-traumatisation of the survivor, it was clear from the reviewed papers that RJ needed to be approached with caution. Indeed, where RJ was employed, extensive preparation was consistently identified as a key element to its success. The aim of the second chapter is to gain an in-depth understanding of the perspectives of staff on inter-agency responses to survivors of sexual violence. Professionals from the National Health Service and voluntary sector were interviewed using focus group methodology. Data from focus groups was analysed using thematic analysis. The results highlighted that individual and organisational barriers impacted on services' ability to work together and respond effectively to survivors. The final chapter provides a reflective account of the process of conducting a qualitative research study with professionals who work with survivors of sexual violence. Reflections focus on the impact of emotions on sexual violence research. The account considers both personal and epistemological factors relevant to the research process.
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Scott, Colleen. "Evaluation of Key Components of Draft Guidelines for the National Weather Service TsunamiReadyTM Community Program." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etd/2347.
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The National Tsunami Hazard Mitigation Program partnered with the National Weather Service (NWS) in 2000 to create the TsunamiReadyTM (TR) Community program. TR is designed to help communities in coastal areas plan and prepare for tsunamis. To achieve TR recognition communities must meet certain criteria including specific emergency planning and management actions within the categories of mitigation, preparedness, response, and recovery.
This study’s purpose was to evaluate the acceptability and usefulness of key components of a proposed revised set of TR Community program guidelines. Research was guided by the Elaboration Likelihood Model (ELM) using Community Based Participatory Research methods to gather input from expert panels composed of local expert community stakeholders from 5 states and 1 US territory. Two qualitative data collection methods were used: online prediscussion surveys administered via Survey Monkey© and focus group discussions. Fifty participants attended 1 of 6 focus group discussions, with 20 participants completing surveys.
Data analysis focused on 8 discussion topics: subdivision of communities by vulnerability, proportion of the population to be protected, evacuation effectiveness, evacuation drills or exercises, vertical evacuation, educating businesses, educating residents, and acceptability of a revised guidelines format. Supporting and opposing themes were identified, providing rich information of community-level perceptions regarding the guidelines. Most notably, the fidelity of the 2 ELM pathways were confirmed as separate. The peripheral pathway demonstrated a significant need for clarification and definition of program terms and activities through the surveys, while focus groups facilitated the central pathway for participants to discuss and debate various program guidelines.
This study provides several recommendations based on community input for updating and revising the TR Community program guidelines including: revisions to the overall format, a new focus on community tsunami hazard, and additional actions and activities to improve community tsunami mitigation and preparedness efforts. Finally, the data and recommendations provided will be used to compile a final draft of the TR Community program guidelines for the NWS.
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Nguyen, Mai Phuong. "Contribution of private healthcare to universal health coverage: an investigation of private over public health service utilisation in Vietnam." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/225903/1/Mai%20Phuong_Nguyen_Thesis.pdf.
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Achievement of Universal Health Coverage (UHC) is a desirable goal for all countries. Complementary public and private services are essential. This study examined factors that influence consumer choice for private and public health care services in Vietnam. Thirty senior healthcare professionals were interviewed and secondary data on over 35,000 episodes of healthcare gathered during national health surveys in households were analyzed. For Vietnam and similar low and middle-income countries to achieve UHC, it is necessary to overcome incomplete social health insurance coverage, variable quality of private and public health services, unregulated quality in advertising and inefficient competition between sectors.
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Berrios-Ayala, Mark. "Brave New World Reloaded: Advocating for Basic Constitutional Search Protections to Apply to Cell Phones from Eavesdropping and Tracking by Government and Corporate Entities." Honors in the Major Thesis, University of Central Florida, 2013. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1547.
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Imagine a world where someone’s personal information is constantly compromised, where federal government entities AKA Big Brother always knows what anyone is Googling, who an individual is texting, and their emoticons on Twitter. Government entities have been doing this for years; they never cared if they were breaking the law or their moral compass of
human dignity. Every day the Federal government blatantly siphons data with programs from the original ECHELON to the new series like PRISM and Xkeyscore so they can keep their tabs on issues that are none of their business; namely, the personal lives of millions. Our allies are taking note; some are learning our bad habits, from Government Communications Headquarters’ (GCHQ) mass shadowing sharing plan to America’s Russian inspiration, SORM. Some countries are following the United States’ poster child pose of a Brave New World like order of global events. Others like Germany are showing their resolve in their disdain for the rise of tyranny. Soon, these new found surveillance troubles will test the resolve of the American Constitution and its nation’s strong love and tradition of liberty. Courts are currently at work to resolve how current concepts of liberty and privacy apply to the current conditions facing the privacy of society. It remains to be determined how liberty will be affected as well; liberty for the United States of America, for the European Union, the Russian Federation and for the people of the World in regards to the extent of privacy in today’s blurred privacy expectations.B.S.
Bachelors
Health and Public Affairs
Legal Studies
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Blaber, Zlatinka N. "Hybrid professional identities and 'calculative practices' : the case of GPs in the English National Health Service acute care commissioning." Thesis, University of Essex, 2015. http://repository.essex.ac.uk/16269/.
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The objective of this research is to contribute to knowledge and understanding by exploring: first, the professional identities of English General Practitioners (GPs) and other clinicians in the newly-formed Clinical Commissioning Groups (CCGs) and second, their level of involvement in CCG ‘calculative practices’ (Miller, 1990, 2001). The institutional field studied is acute care, i.e. hospital, commissioning in contemporary England. To achieve its objective, this thesis asks four research questions: 1) ‘How appropriate is it for clinicians to be involved in CCG acute care commissioning?’ 2) What motivates clinicians to assume leadership roles in CCGs?’ 3) How involved are clinicians in CCG calculative practices?’ and 4) To what extent do hybridity and calculative practices affect clinicians’ professional identities in CCGs?’ The theoretical framework used is based on the concept of ‘calculative practices’ and elements of the Institutional Logics Theory (ILT). This research employs three research methods – documents’ content analysis, semi-structured, in-person interviews, and non-participant observation of CCG meetings with the public and NHS conferences. The interview subjects are NHS managers and accountants, as well as clinicians. This thesis answers the four research questions and then proposes some additional, incidental to this research findings and contributions to policy/legislation and practice. In conclusion, this study deliberates on the viability of the purchaser-provider split of the early 1990s that established the foundations and raison d’être of CCG commissioning and dwells on the possibility that one day the general taxation-funded and free at the point of service National Health Service (NHS) in England may cede its way to a US-inspired model of full blown privatisation.
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McCraw, Deborah J. "Learning and development at work : opportunities and barriers for non-registered clinical staff in the National Health Service Scotland." Thesis, Edinburgh Napier University, 2008. http://researchrepository.napier.ac.uk/Output/2508.
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The non-registered assistant workforce in the National Health Service Scotland (NHSS) has recently been afforded increased attention due, in part, to forecast changes in demographics and the NHSS workforce and reorganisation in delivery of healthcare. Government health papers pursue the strategic aims of developing the workforce to meet the changing needs of the Health Service. This thesis reports on research into workplace learning in the NHSS. It examines the NHSS in relation to the concepts of ‘The Learning Organisation', ‘Expansive/Restrictive Learning Environments' and the learning initiative of the Scottish Vocational Qualification (SVQ) route, adopted by the NHSS for its nonregistered clinical employees. Participants in the research included non-registered clinical assistants to registered nurses and allied health professionals and learning facilitators and managers. A critical realist methodology was adopted and through an embedded case study, data collection methods included one-to-one semistructured interviews and secondary data from the NHS staff survey. This produced a rich source of data for analysis around the perceptions of the participants. Findings show that the NHSS has introduced the concept of a learning organisation to its strategic plans with no real rigour. Some elements of an expansive learning environment exist but these are evident in only some clinical areas. This means that for the assistant workforce, personal development and learning opportunities are dependent on the place of work and the profession they are employed by. The SVQ is embraced by those who are given the opportunity to undertake this initiative but disparities exist throughout the NHSS. Furthermore, the SVQ is perceived as validation of existing knowledge only that does not provide any new learning. This further curtails development opportunities for the assistant group of staff. This thesis has provided the NHSS with a basis to reconsider their strategic direction around learning and development opportunities at work for their nonregistered clinical staff.
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Merrick, Leigh Ann. "Local Authorities and the Development of the National Health Service (NHS) in Scotland, 1939 to 1974." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/857/.
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Local authorities were at the forefront of the provision of health services and health service planning before the establishment of the National Health Service (NHS) in Scotland and in Britain more generally in 1948. By 1929 the Local Government Act had consolidated the position of local authorities, who provided a range of hospital services and clinics and carried out public health duties. Furthermore, in Scotland local authorities were influential in the planning of health services. They gave evidence, through their associations and individually, to a range of committees including the Committee on Scottish Health Services in the 1930s and the Committee on Post-War Hospital Problems in Scotland in the 1940s. Yet, despite their centrality in the provision of health services and their influence on future planning, historians such as Morrice McCrae and Jacqueline Jenkinson have paid little attention to local authorities in their histories of the NHS which stress consensus and the domination of the medical profession and organisations. The Department of Health for Scotland (DHS) was also increasing their role within the provision of health services through the administration of the Highlands and Islands Medical Service (HIMS) and the war-time Emergency Medical Service. As a result the DHS believed that effective administration of health services, particularly the hospitals, could only be achieved through centralisation under their authority. This created competition between the DHS and local authorities over the administration of hospitals, the most prestigious part of the health services. This thesis provides evidence to support the view of Charles Webster and Rudolf Klein that conflict within consensus characterised the establishment of the NHS in Britain. The thesis argues that conflict was evident within the Scottish NHS as it was in the NHS in England and Wales. The period between 1939 and 1974 witnessed the slow removal of local authorities from the Scottish NHS, initially through negotiations over policy formation. Policy network theory is utilised in this thesis as a tool to analyse the relationship between the DHS and local authorities. Policy network theory suggests that organisations with bargaining resources can influence policy formation in an area in which they have interests, and the policy formation process does not end with the passing of an Act but continues during the implementation process. On this basis local authorities would be expected to have been in a strong position to influence the NHS (Scotland) Act, 1947 and its implementation. This thesis argues that the DHS created a hierarchical relationship with local authorities which prevented them from influencing the development of the NHS in any significant way. The relationship between the DHS and local authorities was both a partnership and hierarchical, making it difficult for local authorities to oppose the proposals put forward by the DHS, particularly the removal of their hospital services. The local authorities’ acceptance of assurances from the DHS, that the removal of services from their remit was temporary, resulted in an auxiliary role for them in the NHS (Scotland) Act, 1947. The implementation process continued the slow removal of local authorities from the administration and planning of health services. Despite local authorities’ attempts to increase their influence within the NHS, the DHS (later the Scottish Home and Health Department) regarded local authorities as service providers of peripheral health services. Only in the development of their own areas of responsibility were local authorities able to assert any influence, with the caveat that it did not have an impact on any other part of the NHS. Throughout its implementation, the NHS continually encountered problems of co-operation, co-ordination and clarity in division of responsibility throughout its implementation. The DHS tended to resolve these issues in favour of the hospitals and general practitioners, rather than the local authorities. Despite the DHS’ attempt to promote the importance of the local authorities’ role in the NHS through publicity, both the attitude of the DHS and the relatively small proportion of NHS expenditure accounted for by local authorities, led local authorities to see themselves on the periphery of the NHS. The removal of local authorities from the NHS continued in the 1950s and 1960s, encouraged not only by the DHS but also by legislation such as the Social Work (Scotland) Act, 1968, which removed many of their health services including mental health services. In 1960s the Scottish Home and Health Department (SHHD) came to the view that the inherent administrative problems within the NHS could only be removed through reorganisation. Local authorities had little bargaining power left by this stage and although they attempted to reassert their position within the NHS were effectively removed from the negotiating table. The reorganisation of the health services in 1974 achieved both the Department of Health for Scotland’s goal of centralisation and the removal of local authorities from the Scottish health services.
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Kim, Jungbu. "Do Different Expenditure Mechanisms Invite Different Influences? Evidence from Research Expenditures of the National Institutes of Health." Diss., Available online, Georgia Institute of Technology, 2007, 2007. http://etd.gatech.edu/theses/available/etd-07022007-131256/.
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Thesis (Ph. D.)--Public Policy, Georgia Institute of Technology, 2008.Katherine Willoughby, Committee Member ; Juan Rogers, Committee Member ; John Clayton Thomas, Committee Member ; Gregory B. Lewis, Committee Member ; Robert J. Eger, III, Committee Chair.
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Aspinal, Fiona. "Evaluating the effects and effectiveness of patient and public participatory strategies in the National Health Service : A grounded theoretical approach." Thesis, University of York, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.516392.
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Mahroof, Kamran. "Exploring the Impact of Business Intelligence (BI) Use on Organisational Power Dynamics: A National Health Service (NHS) Case Study." Thesis, University of Bradford, 2019. http://hdl.handle.net/10454/17460.
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The public sector, particularly healthcare organisations are under ever increasing pressure to do more with less. This coupled with the need to keep up to the constant technological changes and ever increasing abundance of information has led to many public sector organisations adopting Business Intelligence (BI) in order to leverage business value and improve decision-making. However, many organisations such as the National Health Service (NHS) continue to fail in their Information Technology (IT) related initiatives. While the rise of BI and its growing influence in organisations has attracted much academic attention, this has largely been from architectural, design and technological perspectives, whilst little is known about how BI is used by various organisational actors to reach decisions, nor much is understood regarding its resulting impact on organisational power dynamics.
Thus, there remains an under researched area of discussion in the literature from the perspective of BI users. While studies report how BI can impact organisational effectiveness, facilitate data driven decision making and supposedly overcome intuitive decision making, the extent to which BI impacts and alters power dynamics between organisational actors across the organisation has received little attention. Accordingly, this research adopts a qualitative case study approach to explore power resulting from BI use within a large NHS trust by conducting 30 semi-structured interviews consisting of operational managers and BI analysts. Through taking a human-centric approach, this research uncovers how BI is altering power dynamics between organisational actors, whereby BI analysts are becoming increasingly influential as a result of their analytical skills. It was found that operational managers are becoming more reliant upon data analysts, resulting in the analysts having more and more influence. However, this research finds it is only when the analysts supplement their technical skill-set with their institutional knowledge, that they have the ability to influence and enact power within the organisational settings. The research also offers insights into the contestations and conflicts which arise from the use of BI, between operational managers and analysts as well as between in-house analysts, based in the operation setting and the centralised analysts, operating across the entire trust. Accordingly, this research empirically validates a BI Power Enactment Framework and proposes the BI Power Matrix, which may assist policy makers in identifying determining key factors which are contributory to the success or failure of technological initiatives.
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Hoyle, Louise P. "New public management and nursing relationships in the NHS." Thesis, University of Stirling, 2011. http://hdl.handle.net/1893/7507.
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Western governments face increasing demands to achieve both cost efficiency and responsiveness in their public services leading to radical and challenging transformations. Following the imposition of New Public Management (NPM) approaches within England, it is argued that similar elements of NPM can be also seen within Scottish healthcare, despite policy divergences following devolution. This thesis considers the influence of NPM on Scottish hospital frontline nursing staff in their work. It explores the ways in which managerial practices (specifically professional management; discipline & parsimony; standard setting & performance measurement; and consumerism) have shaped the working relationships, interactions, and knowledge-exchange between managers, staff and patients and the ability of staff to carry out nursing duties within an acute hospital setting. The study is a qualitative interpretivist study grounded in the methodology of adaptive theory and draws upon the works of Lipsky (1980) in order to explore how the front-line nurses cope with and resist the demands of the workplace. Based on thirty-one qualitative interviews with front-line nursing staff in an inner city hospital in Scotland, this thesis presents the findings resulting from nurses’ views of management, finances, policies, targets, audits and consumerism. The findings show that these nurses believe there has been a proliferation of targets, audits and policies, an increasing emphasis on cost efficiency and effectiveness, a drive for professional management and a greater focus on consumerism in NHS Scotland. These are all closely linked to the ethos of NPM. From the findings it can be seen that many elements influence the working relationships of the frontline hospital nursing staff. The study suggests that the main reason for conflict between managers and nursing staff is due to their differing foci. Managers are seen to concentrate on issues of targets, audits and budgets with little thought given to the impact these decisions will have on patient care or nurses’ working conditions. Furthermore the findings highlight high levels of micro-management, self-surveillance, control and the regulation of the frontline nursing staff which has led to tensions both between nursing staff and managers, but also with patients and the public. Finally, although there has supposedly been policy divergence between Scotland and England, this thesis has identified many similarities between Scottish and English polices and NPM approaches continues to influence the working relationships of front-line nursing staff within this study despite the rhetoric that Scotland has moved away from such practices.
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Wharam, H. "Improving patient experience and safety in National Health Service (NHS) hospital wards through a ward based clinical accreditation scheme (CAS) : an exploratory trial and process evaluation." Thesis, University of Southampton, 2015. https://eprints.soton.ac.uk/378383/.
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In response to local and national drivers for improvements in quality of hospital nursing care an acute care NHS Trust developed an innovative ward based Clinical Accreditation Scheme (CAS). The scheme aims to assure quality of care and encourage quality improvements. This study aimed to identify changes in the quality and outcomes of care associated with the CAS, to explore the contextual factors and processes by which any effect is achieved and explore how the CAS is embedded into routine clinical practice by examining key participant perspectives on the feasibility and utility of the CAS. A controlled before-and-after study design explored outcomes from three matched pairs of adult general medical and surgical wards over a twelve month period. The Hospital Survey on Patient Safety Culture and Nursing Practice Environment Scale were administered to all study ward staff at study commencement and as follow up at study end. There was no evidence of an association between participation in the CAS and a change in ward culture. Statistical process charts were used to identify changes over time for rates of hospital acquired infections, pressure ulcers and falls but no clear trend emerged. Findings from staff interviews suggest that staff value the assurance and sense of recognition the accreditation process gives. The process of preparing for self-assessment has potential to promote immediate quality improvements but a number of dysfunctional effects and behaviours, and contextual factors such as constant change, were identified as hindering embedding of the process into routine practice. This study provides new knowledge demonstrating how an accreditation scheme is operationalised at the microsystem level. The scheme appears to assure quality of care and promote short term quality improvement but it is a resource intensive scheme and a number of structural changes are required to promote ongoing participation in quality improvement activities.
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Willis, Andrew. "Funding without strings : an investigation into the impact of the introduction of payment by results into the National Health Service on aligning clinical and managerial incentives." Thesis, London School of Economics and Political Science (University of London), 2015. http://etheses.lse.ac.uk/3114/.
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This research investigates whether the introduction of Payment By Results (PbR) into the National Health Service aligned clinical and managerial incentives and improved output, quality, quantity and productivity. The methodology applies three data collection techniques; in-depth interviews; documentary data; and numerical data for each of four foundation trust (FT) case studies. The results indicate that the case studies had not produced consistent and sustained improvements in productivity and did not appear particularly engaged with productivity improvement, or cost control or in the relationship between these factors and tariff under PbR. Boards of directors did not appear to focus on productivity; and the use of service line reporting, to allow clinicians and managers of hospitals to drive productivity improvement, was not widely available at board or clinical level. The results also demonstrated the dominance of Monitor, the FT regulator, in influencing the agenda of FT boards. It suggests that, without central direction and/or external pressure, FTs will not focus on productivity and quality issues. The policy significance of these results are that (a) with the lack of alignment of clinical and managerial incentives, it is unlikely that FTs will be able to produce a sophisticated and targeted review of clinical care pathways to target productivity improvement at areas where there is real opportunity for efficiency improvement; and (b) if, as the research results suggest, NHS management, and the organisations they lead, respond more effectively to central direction and control then, as the NHS enters one of the most financially challenged periods of its history, alternative policy options to the development of quasi markets need to be considered. The research explores several of these options, including: the roll-back of the FT movement, management franchising, creating conditions for increased pressure on hospital performance, a more radical introduction of competition, and options for the use of social enterprises.
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Frimpong, K. O. "Professionalising counter fraud specialists (fraud investigators) in the UK public sector : a focus upon Department for Work and Pensions, National Health Service and the Local Authority." Thesis, Nottingham Trent University, 2013. http://irep.ntu.ac.uk/id/eprint/307/.
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This thesis seeks to examine and explore the professionalisation initiatives of the UK public sector counter fraud specialists (fraud investigators), with a focus upon the Department for Work and Pensions (DWP), National Health Service (NHS) and Local Authority (LA). The conceptual framework used to underpin the study was functionalist / “traits” theory of a profession and professionalisation. The main research question for the thesis concerns the issue of whether counter fraud specialism is a profession or not. Thus the question here is: “Is counter fraud specialism a profession or not?”. Additionally, the thesis seeks to answer the question on how to develop a profession of counter fraud specialists. Thus, the question here is “If we want to develop a profession of counter fraud specialists (CFS), how do we do it?”. Fraud is a growing problem in UK which affects the government, businesses, individuals and society as a whole, and much more than would be assumed by anyone suggesting it to be a victimless crime. Despite this, the reputation of UK public sector fraud investigators had in the past gained negative images resulting from the use of questionable investigative practices, together with the lack of appropriate mechanism for evaluating the training of fraud investigators, and the ease of defrauding the welfare system. This became a great concern for UK politicians/parliamentarians since the 1970’s, resulting in the introduction of government initiatives, which emphasised the need to professionalise and introduce professionalism into anti-fraud work. The professionalisation initiatives led to the creation of a new breed of fraud investigators, otherwise known as “Counter Fraud Specialists” charged with the responsibilities of protecting the public purse and safeguarding it against fraud. In spite of the introduction of those initiatives and the positive contribution by Counter Fraud Specialists in protecting the public purse coupled with the ongoing austerity measures in the UK public sector, there has not been any major academic study assessing those initiatives. The study is important to the researcher because findings from the study will help inform the debate on professionalisation agenda for the UK public sector counter fraud specialists. Additionally, it will contribute to the academic research on the subject, given that, the literature on fraud and professionalisation on Counter Fraud Specialists has failed to address this. The study was undertaken by applying mixed-methods approaches involving the use of survey questionnaires and semi-structured interviews with a selected number of counter fraud practitioners in the UK public sector. In addition, documentary analysis was also undertaken. Generally, the study revealed developments enhancing the status of UK public sector counter fraud specialists as a result of the professionalisation initiatives/agenda. Nonetheless, the strength of the quality of developments remained arguable given identified weaknesses in the “pillars of institution” such as normative, regulative and cultural-cognitive symbols that, together with associated activities and resources provide the bedrock for institutional transformation and professionalising occupations. The study provides recommendations on areas of improvement and future research. Therefore, my contribution to knowledge in this study is that, I have attempted to show how to develop a profession for counter fraud specialists in the UK public sector, mainly, the DWP, NHS and LA. In addition, the study has failed to find evidence that counter fraud meets what the literature says is a hallmark of a profession. The literatures on fraud and professionalisation of counter fraud specialists have failed to address this and this is my contribution to knowledge.
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Du, Preez Karen Kay. "Towards a values-based model to manage joint academic appointments in the health sector in South Africa." Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/28293.
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Joint appointments in the health sector in South Africa are made to serve both service and academic functions in one post. Typically the employing organisations are unequal, as one of them is the paying organisation while the other is the academic employer. This practice has been in existence for decades, and is ruled by expediency rather than being based on values. Joint employees experience role confusion, job confusion, dual loyalty confusion and being managed according to the rules of two organisations. This suboptimal situation leads to lower-than-expected performance in the eyes of both employing organisations. In this study the knowledge and problem areas of joint appointments were explored. The first part of the study consisted of a questionnaire analysis of the knowledge and view of problems as expressed by joint staff as well as by human resources (HR) practitioners. Group discussions, as well as the major part of the study, namely, interviews with senior management staff of both organisations were then conducted. In order to complete the study, an analysis was made of values that might inform on the problem. Joint staff members were found to have limited knowledge of the work requirements of a joint employee, and expressed concern about loyalty and role confusion. When the values were discussed with senior management staff, some values were identified as informing on possible solutions such as joint establishment of vision, joint objectives, respect for all components of the job, as well as generic values, including honesty, transparency, fairness, diversity and others. A framework is suggested commenting on the potential place for a values-based approach. From this a model is proposed by means of which a values-based process can be initiated by a top-level agreement meeting (“meeting of the minds”) of both employers that may lead to a single joint vision and set of objectives. From this agreement a policymaking joint body can establish the rules, while application and implementation are monitored by local joint management committees.Dissertation (MCom)--University of Pretoria, 2011.
Human Resource Management
unrestricted
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Mbebe, Adelaide Humberto. "Internal brain drain in Mozambique’s national health service: medical doctors‟ and managers‟ perceptions of factors that influence intentions to stay or leave the public health sector in Maputo city, Mozambique (2000-2010)." University of Western Cape, 2013. http://hdl.handle.net/11394/3920.
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Magister Public Health - MPHObjectives: To document the distribution of medical doctors between the National Health System (NHS), NGOs and the Private Sector over the period 2000-2010; (2) To explore the perceptions of medical doctors (MDs) and human resources managers (HRMs) regarding factors that influence MD internal brain drain in Maputo city, Mozambique, more specifically, the movement of doctors from the Mozambican NHS to NGOs and the private sector within Mozambique.
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Cresswell, Adele. "How general medical practitioners make sense of their commissioning role in the English National Health Service and why it matters : theorizing field change through the interrelationship of rules, networks, and cognitive frames." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/33667/.
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This thesis includes theoretical contributions to organisational studies and medical sociology, drawn from a three levelled ethnographic case study of commissioning by General Medical Practitioners in the setting of the English National Health service. In order to locate these levels as interrelated structures, the concept of “field” (Bourdieu, 2005, Fligstein, 2001, Fligstein and McAdam, 2012, Lewin, 1997 [1951]) is used. Jens Beckert (2010) has developed a framework in which cognitive frames, networks, and rules are in a relationship of irreducible interdependency. The definitions of analytic categories in the extant framework are under-developed. In this thesis, the framework is empirically applied to add definition to the analytic category “cognitive frame”. Beckert’s Framework and Weick’s (Weick, 1995, Weick, 2000, Weick et al., 2005) Sensemaking Perspective are intersected to develop a reciprocal relationship between the two theories. By conceptualising cognitive frame as a sensemaking process, insight is gained in three different but overlapping facets: wider contexts, temporality, and distributed sensemaking. At the level of an industry a cognitive frame can be described as a sensemaking type, which will have constituent sensemaking styles associated with that industries internal networks. When rules require organisations from separate industries or sectors to form partnerships then actors with different sensemaking types will be required to interact within one network. Organisational development techniques can be used to support and align sensemaking in both of these circumstances. Sensegivers may have an important role in pacing, including suspending, sensemaking. The thesis also contains insights for medical sociology in respect of how and why GPs commission as they do. These relate to the impact of belonging to the NHS family; differing permutations of changes to the profession (hybridisation, restratification, and the delimitation of autonomy) in GP networks; GP compliance with rules; and the characteristics of an inner-city GP workforce.
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Sandberg, Johanna. "Institutionally Shaped Response to the Introduction of National Guidelines : Case Studies in the Swedish Regional Health Policy Arena." Licentiate thesis, Linköpings universitet, Avdelningen för hälso- och sjukvårdsanalys, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-152648.
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The purpose of this thesis is to explore the institutionally shaped response to the introduction of the national guidelines on the Swedish regional health policy arena. The thesis consists of two case studies. Adapting a qualitative approach, the data is based on individual interviews and these were analysed thematically. The first paper explores the response by four Swedish regional health authorities to the introduction of the National Guidelines for Cardiac Care, while the second paper aims to broaden the understanding of how the national guidelines are used for strategic purposes among politicians. As illustrated in this thesis, organizations will respond, adjust and react to external pressure according to conditions shaped by the institutional context. Key findings here are that the national guidelines are a complex policy instrument that, beyond being able to be used in an instrumental fashion by the medical managment, can also serve a legitimizing function for political decision-makers. The goals of the national guidelines, i.e. equal and efficient care, and the uncertainty about who, among multiple stakeholders, is responsible for the guidelines in the regional health authority, is a source of ambiguity and potential conflict. Those who are potentially responsible represent different rationales – a political rationale and a scientific rationale. The dominating scientific rationale of the national guidelines can create instability, when pushing towards the use of explicit priority-setting. Priority-setting in the institutional setting of a regional health authority has strong elements of becoming “wicked problems” since the dilemma of prioritization remains regardless of ambitions to apply a “technocratic fix”. A wicked problem is characterized by high complexity and being persistently hard to solve (Williams et al. 2012). A recurring dilemma is that priority-setting still contains many wicked problems, as social values and political considerations remain important parts of the policy process. One weakness of the national guidelines, identified in this thesis, is that the guidelines discuss each service area separately, and thereby reinforce a silo mentality in the Swedish health policy arena. To sum up, the national guidelines create a multifaceted and complex response in the Swedish health policy arena where different rationalities collide, and where conflicts appear and are dealt with within the regional health authorities.
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Carman, Rebecca Anne. "The impact of immunisation service delivery in general practice on Aboriginal children living in the Perth metropolitan area: An opportunity to reduce the gap?" Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2019. https://ro.ecu.edu.au/theses/2176.
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Santos, Fernanda Flores Silva dos. "Adaptação do Indicador de Salubridade Ambiental (ISA) para análise do saneamento básico na cidade de Brejo Grande/SE." Universidade Federal de Sergipe, 2016. https://ri.ufs.br/handle/riufs/4207.
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In Brazil, to serve the population with total sanitation services is still a challenge. Despite of
the visible progress indicators that show the expansion of the sanitation sector in Brazil
pointed to by the last census of the IBGE (2010), the shares still performed insufficiently
reached the real needs of the population. Public policies aimed at achieving the universality of
this sector in the country, thus obtain positive impacts on public health and is necessary to
have preventive actions involving the health of the environment. In the municipality of Brejo
Grande deficiencies in sanitation combined with the cultural habits conducted by the
population in water bodies, such as washing clothes, bathing and farming, and the very
economic conditions of the same, certainly exposes to health disorders. To achieve
satisfactory levels through health becomes key measure levels of environmental indicators in
a certain locality. Thus, this study aimed to analyze the sanitation conditions in the seat of the
municipality of Brejo Grande/SE and its influence on public health, through the adaptation of
the Environmental Health Indicator (ISA). The adaptation was necessary because the research
focus is based on the analysis of sanitation in the study area, as well as the need to obtain
information to assess the health status of the population. The ISA was called to this work as
ISA/BG, as it is specific to this location. Their analysis took place from the Sub-water supply
indicator, Sub-Solid Waste Indicator, Sub-Sewage indicator, Sub-Drainage indicator Urban
and Sub-Public Health Indicator. For this study, a descriptive exploratory and qualitative and
quantitative nature was developed. The data used to feed the ISA/BG and interpret the results
were collected in the field with the community and government agencies of federal, state and
municipal levels. From the results it was found that the existing sanitation infrastructure in
urban Brejo Grande, negatively interfere with the health of the population. And that despite
the actions taken and in progress by the municipality of Brejo Grande, carried out in order to
fulfill determined by the National Sanitation Policy, the difficulties they pass the sanitation
sector in the country, are reflected in the locality of study.No Brasil, atender a população em sua totalidade com os serviços de saneamento básico ainda é um desafio. Apesar dos avanços visíveis dos indicadores que demonstram a ampliação no setor de saneamento no Brasil apontado pelo último censo do IBGE (2010), as ações executadas ainda não atingiram suficientemente as reais necessidades da população. As políticas públicas voltadas para alcançar a universalização deste setor no país, obterão consequentemente impactos positivos na saúde pública, sendo necessário haver ações preventivas que envolvam a salubridade do meio. No município de Brejo Grande as deficiências do saneamento básico aliado aos hábitos culturais realizados pela população nos corpos d’água, como a lavagem de roupas, banhos e atividade agrícola, e as próprias condições econômicas das mesmas, certamente, a expõe aos agravos de saúde. Para alcançar níveis satisfatórios de salubridade do meio torna-se fundamental mensurar os níveis dos indicadores ambientais de determinada localidade. Desta forma, esta pesquisa teve como objetivo geral analisar as condições do saneamento básico na sede do município de Brejo Grande/SE e sua influência na saúde pública, através da adaptação do Indicador de Salubridade Ambiental (ISA). A adaptação se fez necessária em virtude do foco da pesquisa está baseada na análise do saneamento básico da área estudada, bem como da necessidade de se obter informações para a avaliação do estado de saúde da população. O ISA foi denominado para este trabalho como ISA/BG, visto que é específico para esta localidade. Sua análise decorreu a partir do Sub- Indicador de Abastecimento de Água, Sub- Indicador de Resíduos Sólidos, Sub-Indicador de Esgotamento Sanitário, Sub-Indicador de Drenagem Urbana e Sub-Indicador de Saúde Pública. Para a realização deste estudo, foi desenvolvida uma pesquisa descritiva de caráter exploratório e de natureza quali-quantitativa. Os dados utilizados para alimentar o ISA/BG e para interpretar os resultados foram coletados em campo junto à comunidade e aos órgãos públicos de âmbito federal, estadual e municipal. A partir dos resultados obtidos verificou-se que a infraestrutura de saneamento básico existente na área urbana de Brejo Grande, interfere negativamente na saúde da população. E apesar das ações desenvolvidas e em andamento pelo município de Brejo Grande, realizadas a fim de se cumprir o determinado pela Política Nacional do Saneamento Básico, as dificuldades pelas quais passam o setor de saneamento no país, se refletem na área de estudo.
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Silveira, Perolah Caratta Macedo Portella. "Comunicação, promoção da saúde e espaço social alimentar: um estudo exploratório na ECA-USP." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/27/27154/tde-12012016-095017/.
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Esta dissertação explora as interfaces e possíveis articulações entre os conceitos de Comunicação, Promoção da Saúde e Espaço Social Alimentar. Por meio de revisão bibliográfica, traça-se a história do conceito da Promoção da Saúde no mundo e no Brasil. Em seguida, debate-se o papel do profissional de Comunicação como possível agente de mobilização social, destacando-se a Comunicação Pública como conceito essencial para o desenvolvimento da cidadania. Pautando-se no pensamento da Escola de Montreal, aborda-se a Comunicação Organizacional e suas interfaces com a Comunicação Pública. Propõe-se os modelos comunicacionais de Haswani e de Jaramillo López, como alicerce teórico para ações de Comunicação Interna. A análise da Política Nacional de Promoção da Saúde (PNPS) e da Política Nacional de Alimentação e Nutrição (PNAN) expõe a importância de práticas alimentares adequadas e saudáveis para a promoção da saúde. Elas são contextualizadas, em relação ao estudo exploratório realizado com os funcionários da Escola de Comunicações e Artes da Universidade de São Paulo (ECA-USP), sobre suas práticas alimentares. A metodologia de Jean Pierre Poulain, da Sociologia da Alimentação, pauta o estudo exploratório. A pesquisa pretende ser o primeiro passo para a estruturação de um banco de dados sistematizado sobre fatores condicionantes e determinantes da saúde dos funcionários desta instituição. Este banco proverá dados essenciais para a elaboração e implementação de políticas e ações que visem a Promoção da Saúde na Escola no futuro.This dissertation explores the commonalities and possible interactions between the concepts of Communication, Health Promotion and Food Social Space. The literature review retraces the historic evolution of Health Promotion as a concept worldwide and regionally in Brazil. It then correlates that field with the current state of Public Communication research in Brazil, defending the notion that Communication professionals have a role to play as health promoters. Based on the theories of the School of Montreal, this paper connects Organizational Communication and Public Communication concepts, with the goal of establishing a path for action that corroborates the defended thesis of the role of the Communication professional in Health Promotion. Lopez and Haswani\'s Public Communication models are used as the theoretical basis for action. The analysis of two public policies (on \"Health Promotion\" and \"Food and nutrition\") lays the ground for the empirical study developed with the employees of ECA-USP. Jean-Pierre Poulain\'s Sociology of Food methodology is adopted in the study of the food practices of the aforementioned public. This dissertation seeks to be a first step in structuring a database with information that can guide future organizational action and programs aimed towards the promotion of employees\' health.
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Miranda, Geyse Clea Silva de. "A implementação da Comissão Estadual de Integração Ensino Serviço - CIES Bahia." Instituto de Saúde Coletiva-ISC, 2014. http://repositorio.ufba.br/ri/handle/ri/17394.
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As Comissões de Integração Ensino-Serviço foram instituídas pela Portaria GM/MS nº 1.996/2007 sendo definidas como instâncias intersetoriais e interinstitucionais permanentes que participam da formulação, condução e desenvolvimento da Política Nacional de Educação Permanente no âmbito do Sistema Único de Saúde. O Estado da Bahia instituiu no ano de 2010 a Comissão de Integração Ensino-Serviço (CIES BA), com vistas ao cumprimento dos dispositivos da Política Nacional de Educação Permanente em Saúde e visando o fortalecimento a Política Estadual de Gestão do Trabalho e Educação Permanente em Saúde do SUS Bahia. Este trabalho tem como objetivo geral analisar a implementação da CIES BA no período de 2010 a 2013. Trata-se de um estudo descritivo e exploratório, de abordagem qualitativa, do tipo estudo de caso. A coleta de dados se deu por meio de análise documental a partir do conjunto normativo legal relacionado ao tema e dos documentos institucionais produzidos pela CIES BA durante o período em estudo, sendo a análise desses dados feita a partir das categorias de análises adotadas, a saber: objetivos, dinâmica de funcionamento e discussões e produtos da CIES BA, abordando os critérios propostos no trabalho. Como resultados foi identificado que os objetivos da Comissão apresentam conformidade com o disposto nas diretrizes nacionais e estaduais para a implementação da PNEPS. Além disso, a CIES BA possui clareza de objetivos, uma dinâmica de funcionamento bem definida e qualidade nas discussões, porém os produtos apresentados não acompanharam a mesma cadência das discussões, demonstrando incipiência na implementação de suas ações.
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Alberto, Luciane Galdino. "Análise do quadro de trabalhadores do Ministério da Saúde e entidades vinculadas nos anos 2000." reponame:Repositório Institucional da FIOCRUZ, 2010. https://www.arca.fiocruz.br/handle/icict/2514.
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Previous issue date: 2010Este estudo analisa a situação do quadro de trabalhadores do Ministério da Saúde e entidades vinculadas Agência Nacional de Vigilância Sanitária (ANVISA), Agência Nacional de Saúde Suplementar (ANS) e Fundação Oswaldo Cruz (FIOCRUZ) _ noperíodo de 2000 a 2008, segundo algumas variáveis selecionadas, com destaque para o tipo de vínculo desses trabalhadores. Além da análise da evolução quantitativa da força de trabalho federal em saúde, procurou-se relacionar a situação atual com os condicionantes históricos e as políticas recentes voltadas para o funcionalismo público federal. O institucionalismo histórico é a principal corrente utilizada como referencial teórico do estudo, por reconhecer a importância do Estado como ator político e valorizar os condicionantes históricos, o papel das instituições e dos atores na conformação das políticas. As estratégias metodológicas utilizadas foram: revisão bibliográfica, análise documental e análise de dados primários e secundários sobre o quadro de trabalhadores federais em geral e na saúde. Os resultados sugerem que, no período recente, após o início do governo Lula em 2003, houve uma inflexão na tendência de redução do funcionalismo público federal, a qual vinha sendo observada desde os anos 1990, relacionada ao aumento dos concursos públicos para reposição de quadros. Tal movimento não atinge de forma homogênea todas as áreas,sendo que a saúde apresentou um aumento no quadro de servidores ativos inferior à média total do Executivo Federal. Foram observadas diferenças na situação do quadro de trabalhadores do Ministério da Saúde e entidades vinculadas incluídas no estudo. O nível central do Ministério foi pouco beneficiado com a realização de concursos e o funcionamento de áreas estratégicas do nível central do Ministério permanece dependente de profissionais inseridos como consultores ou por contratos temporários. As agências reguladoras da saúde, criadas no início dos anos 2000, foram beneficiadas com concursos para a contratação de servidores de carreiras específicas, principalmente a partir de 2005, mas ao final do período ainda apresentavam uma quantidade expressiva de trabalhadores com outros tipos de vínculos. Já na FIOCRUZ, observou-se um aumento do número de servidores no período, porém um aumento ainda maior na incorporação de trabalhadores terceirizados. Por fim, discutem-se os desafios de conformação de uma força de trabalho federal na saúde suficiente, estável e adequada para dar conta das atribuições estratégicas do Ministério da Saúde e entidades vinculadas, visto que, no Brasil, a esfera federal tem um papel fundamental para a consolidação do Sistema Único de Saúde, mesmo em um contexto de descentralização político-administrativa.
This study investigates the staffing of the Brazilian Ministry of Health and associated entities – namely, the National Public Health Surveillance Agency (ANVISA, National Agency for Supplementary Health Care (ANS) and the Oswaldo Cruz Foundation (FIOCRUZ) – during the period from 2000 to 2008, in terms of a selected set of variables,with particular focus on the types of employment relation. As well as an analysis of the quantitative growth of the federal work force in health, the study involved relating the current situation to historical factors and recent policies aimed at the federal civil service. Historical institutionalism is the main theoretical branch referenced in the study as it recognizes the importance of the State as a political actor and values the historical conditioning factors and the role of the institutions and actors in policy making. The methodological techniques used were a bibliographical review, documental analysis and analysis of primary and secondary data on federal staffing in general and in health care. The results suggest that since the dawn of the Lula government in 2003, the trend of a shrinking federal civil service observed since the 1990s has been reversed as a result of increased civil service admissions to replenish staffing levels. However, this movement has not affected all the different areas in a uniform manner, and the increase in active public health workers is lower than the average increase of the Federal Executive. Differences were found in the staffing situations of the Ministry of Health and of the associated entities included in this study. The central office of the Ministry benefitted only slightly from the civil service admission examinations conducted and the operations of strategic areas of the Ministry central office remain dependent on professionals hired as consultants or by temporary contracts. The health regulatory agencies, created in the early 2000s, have benefitted from civil service admission examinations for the admission of specific professions, especially since 2005, but at the end of the period there was still a considerable proportion of workers employed under alternative types of engagement. Meanwhile at FIOCRUZ, although an increase was observed in the number of civil servants in the period, there was an even greater increase in the number of workers employed under other types of contracts. Finally, a discussion is developed on the challenges involved in forming a federal work force in health which is large enough, stable and adequate to address the strategic 10 responsibilities of the Ministry of Health and associated entities, bearing in mind that in Brazil the federal governmental sphere plays a fundamental role in consolidating the Unified Health System (SUS), even against the backdrop of political-administrative decentralization.
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Zhang, Yanchun. "Economic Evaluation of Disease Management in China: The Case of Hypertension." Thesis, 2020. https://vuir.vu.edu.au/41835/.
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To combat the challenges of cardiovascular diseases (CVDs), the Chinese government launched a program in 2009 called the National Basic Public Health Service (NBPHS). This provides disease management services in primary healthcare facilities for hypertensive patients. Although a large amount of money has been invested since 2009, little is known about the benefits of such a large investment. Based on national datasets, this study conducted an economic evaluation of hypertension management in the NBPHS from 2009 to 2015.
A trend model was built based on data from 1991 to 2009, which was used to predict hypertension control rates for 2015. The direct impact of the NBPHS on hypertensives was generated by comparing the predicted hypertension control with that of the observed levels in 2015. This generated a figure of 9,532,719 hypertensives who were able to get their blood pressure (BP) under control incrementally during 2009-2015.
A hypothesized scenario in which the NBPHS had not been implemented was created to compare with the NBPHS scenario. Following the pathway of risk prediction studies on CVDs, a Markov model was developed to estimate the long-term health outcomes of the NBPHS by comparing the two scenarios from 2016 to 2045. It was estimated that at the end of the 30-year projection period, there would be 25,012, 296,258, and 744,493 hypertensive patients who would have avoided coronary heart disease, stroke and death, respectively, by being part of the NBPHS.
A standard model of economic evaluation was developed by estimating gross domestic product increases from labour force participation and productivity gained by averting morbidities and mortalities. Net present value (NPV) was used to estimate healthcare expenditure saved, and the economic and social benefit of morbidity and mortality averted. It was predicted that from 2016 to 2045, there would be an economic benefit of 169,857 million CNY in NPV, or 267,297 million CNY when including social benefit. Given that hypertension management accounts for 14.59% of the NBPHS funding: the benefit-cost ratio would be 6.0 at a discount rate of 3%, and if the social benefit is included, the benefit-cost ratio would be 15.4 at the same discount rate. The internal rate of return would be 14.6% if only the economic benefit is considered and 20.7% if the social benefit is included. This is a very high benefit investment compared to that identified in other studies.
This study contributes to academic knowledge by providing an economic framework of health interventions in primary healthcare settings in China. To some extent, it also fills a gap by addressing the economic evaluation of chronic disease interventions in China.
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Babooa, Sanjiv Kumar. "Public health service delivery at the Sir Seewoosagur Ramgoolam National Hospital." Diss., 2004. http://hdl.handle.net/10500/2044.
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This dissertation analyses public health service delivery at the Sir Seewoosagur Ramgoolam National Hospital (S.S.R.N.H.) in Mauritius. Particular emphasis is laid on the historical development of public health service delivery at S.S.R.N.H. Public health service delivery has been approached from the view points of its nature and scope. The core components of the research survey have been on some major obstacles and flaws in effective public health service delivery at S.S.R.N.H. The measuring instrument used for the research survey was a self administered questionnaire. The main findings were discussed especially absenteeism, personnel turnover, stress, burnout, morale, sexual harassment, lethargy and disobedience, nepotism, shirking responsibility, alcohol and drug abuse, active political interference, bribery and corruption, dishonesty and retaliation and neglect of duty.
Attention was also devoted on the current national health policy for improving public health service delivery at S.S.R.N.H., inter-alia, the National Policy for Public Heath Act 17 of 2000 and the White Paper on Health Sector
Development and Reform of December 2003.
The public health environment is constantly altering. Therefore, it is essential to adjust to the changing health environment. This dissertation has addressed the future challenges in the micro health environment and macro health environment of S.S.R.N.H. Ultimately, a holistic instead of a parochial approach to addressing shortcomings identified in public health service delivery at S.S.R.N.H. has been advocated in this dissertation.Public Administration
M.Admin. (Public Admin)
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Fallaize, R., A. L. Macready, L. T. Butler, J. A. Ellis, A. Berezowska, A. R. H. Fischer, M. C. Walsh, et al. "The perceived impact of the National Health Service on personalised nutrition service delivery among the UK public." 2015. http://hdl.handle.net/10454/7211.
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YesPersonalised nutrition (PN) has the potential to reduce disease risk and optimise health and performance. Although previous research has shown good acceptance of the concept of PN in the UK, preferences regarding the delivery of a PN service (e.g. online v. face-to-face) are not fully understood. It is anticipated that the presence of a free at point of delivery healthcare system, the National Health Service (NHS), in the UK may have an impact on end-user preferences for deliverances. To determine this, supplementary analysis of qualitative data obtained from focus group discussions on PN service delivery, collected as part of the Food4Me project in the UK and Ireland, was undertaken. Irish data provided comparative analysis of a healthcare system that is not provided free of charge at the point of delivery to the entire population. Analyses were conducted using the ‘framework approach’ described by Rabiee (Focus-group interview and data analysis. Proc Nutr Soc 63, 655-660). There was a preference for services to be led by the government and delivered face-to-face, which was perceived to increase trust and transparency, and add value. Both countries associated paying for nutritional advice with increased commitment and motivation to follow guidelines. Contrary to Ireland, however, and despite the perceived benefit of paying, UK discussants still expected PN services to be delivered free of charge by the NHS. Consideration of this unique challenge of free healthcare that is embedded in the NHS culture will be crucial when introducing PN to the UK.
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McIntosh, Bryan, and Sue West. "A new hope: Public social partnerships." 2016. http://hdl.handle.net/10454/10403.
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Dayal, Harsha. "Management of rehabilitation personnel within the context of the National Rehabilitation Policy." Thesis, 2009. http://hdl.handle.net/10539/7373.
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M.P.H.(Health Policy and Management), Faculty of Health Sciences, University of the Witwatersrand, 2008The provision of rehabilitation services has received little attention within the context of health sector reforms in South Africa. This study explores the human resource (HR) management component of the National Rehabilitation Policy (NRP), formulated to improve access to rehabilitation services within the public health sector. Qualitative methodology was used to understand the alignment of policy to practice, with data derived from both the deductive approach (document reviews); and inductive approach (key informant interviews and focus group discussions). The findings reveal that there is a gap between policy and practice. Resistance to integration, problems with professional identity and capacity constraints at national, provincial and local levels hindered the implementation of an integrated rehabilitation service. In addition, polices and norms and standards that aim to guide HR in public health are not coherent. These directly influence HR performance, and have served to highlight the social and institutional phenomena impacting on service delivery.
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YU, LI-LING, and 游麗玲. "The Preparation and Demand of Public service staff for Retirement – A case study of National Health Insurance Administration." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/yzd3an.
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碩士萬能科技大學
經營管理研究所在職專班
106
The proportion of elderly people over 65 years old has reached 13.9% in the end of 2017 in Taiwan, and will be an ageing society due to over 14% in year of 2018. Base on the data, there are around 450 thousand employees will be retired in the next 10 coming years, and seriously affect the quality of life of the elderly in the future. Meanwhile, public service staff retirement benefits might be affected by the retirement pension reform on July 1 of 2018. The purpose of this paper is to study the requirements and preparations of retirement for the public service staff, and the results of this study as follows. First, most of the public service staff has the similar understanding for the requirements and preparations of retirement. Second, it exits significant difference between population variables for the preparations of retirement, but requirements of retirement. Finally, it is positive correlation between preparations of retirements and requirements of retirement.
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McLeod, H., D. Blissett, S. Wyatt, and Mohammed A. Mohammed. "Effect of pay-for-outcomes and encouraging new providers on national health service smoking cessation services in England: a cluster controlled study." 2015. http://hdl.handle.net/10454/9266.
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YesPayment incentives are known to influence healthcare but little is known about the impact of paying directly for achieved outcomes. In England, novel purchasing (commissioning) of National Health Service (NHS) stop smoking services, which paid providers for quits achieved whilst encouraging new market entrants, was implemented in eight localities (primary care trusts (PCTs)) in April 2010. This study examines the impact of the novel commissioning on these services. Accredited providers were paid standard tariffs for each smoker who was supported to quit for four and 12 weeks. A cluster-controlled study design was used with the eight intervention PCTs (representing 2,138,947 adult population) matched with a control group of all other (n=64) PCTs with similar demographics which did not implement the novel commissioning arrangements. The primary outcome measure was changes in quits at four weeks between April 2009 and March 2013. A secondary outcome measure was the number of new market entrants within the group of the largest two providers at PCT-level. The number of four-week quits per 1,000 adult population increased per year on average by 9.6% in the intervention PCTs compared to a decrease of 1.1% in the control PCTs (incident rate ratio 1108, p<0001, 95% CI 1059 to 1160). Eighty-five providers held 'any qualified provider' contracts for stop smoking services across the eight intervention PCTs in 2011/12, and 84% of the four-week quits were accounted for by the largest two providers at PCT-level. Three of these 10 providers were new market entrants. To the extent that the intervention incentivized providers to overstate quits in order to increase income, caution is appropriate when considering the findings. Novel commissioning to incentivize achievement of specific clinical outcomes and attract new service providers can increase the effectiveness and supply of NHS stop smoking services.
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Hung, Kuang-Chen, and 洪恭誠. "A Research Biobliometric Study of the Top Two Public Medical Centers in Taiwan and the Relationships between these Indicators and Medical Expenditures & Service from National Health Insurance, 1996-2008." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/85436078391596500043.
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博士亞洲大學
健康產業管理學系健康管理組
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Objectives: The academic research productivity and quality are important subjects which the academic unit pays close attention to them now. There are many qualified personnels gathering in the medical center and they bear the tasks of the research, teaching and service. Each medical center gets the considerable funds from many research institutions and applies lots of cost from national health insurance bureau every year. Cost and benefit are the indicators to evaulate research quality. Methods: The method of our study is to analyze the research performance and medial expenditures & services of the top two medical centers ( Medical center A & Medical center B ) in Taiwan during 1996-2008 by the way of secondary databases. They compose of three parts: (1) Bibliomteric analysis from ISI database. (2) Medical expenditures and services analyses from NHIRD (3) Further research for the relationships between the above two kinds of indicators. We utilize SPSS 18.0 vision and Microsoft Excel 2010 to perform description analysis, and use the slope test to evaluate the differences between two medical centers. Results: The results show that two medical centers increase in publishing the quantity of the articles year by year, but decrease progressively in the respect of the quality. In the bibliometric analysis, it show that hospital A exceed hospital B in all documents and articles only aspects ; In addition, in the average impact factors of published articles, hospital A increases year by year, but hospital B reduces year by year. The costs and services amount in national health insurance research database, there are not any significant difference between two hospitals in the numbers of physicians, numbers of medical staffs, numbers of bed, hospital and outpatient costs and outpatient visits. There are no significant differences between two hospitals in quality and quantity of this research index. Conclusions: Although, the results of our research indicators cannot support sufficient evidences to the relationships between the research quality & quantity and medical expenditures & services, they can offer the evidence–based data for hospital managers and owners of research granted institution to evaluate the research ability of medical centers and priority setting of research funds allocation.
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Correia, Tiago. "A gestão das incertezas nas certezas da gestão: uma abordagem sociológica sobre os efeitos da empresarialização hospitalar nas relações profissionais." Doctoral thesis, 2011. http://hdl.handle.net/10071/11401.
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Este trabalho analisa alterações verificadas no sector hospitalar público português, decorrente de uma situação transversal entre os países dotados de modelos de Estado-Providência: a dificuldade de coadunar a acumulação da riqueza à sua distribuição. A solução tem passado pela empresarialização dos prestadores, gerindo o sector público em convergência com regras outrora circunscritas ao sector privado.
Até agora não se sabia o alcance e limitações destas mudanças, sobretudo tendo em conta o poder profissional detido pela medicina. No fundo, os hospitais representam sistemas abertos, cuja realidade não pode destrinçar influências externas e internas. Além disso, e ao contrário do que se esperaria, profissionalismo e managerialismo são forças não necessariamente opostas. Esclarece-se, por isso, as condições para a sua articulação. Em causa está uma nova configuração da burocracia hospitalar não prevista pelas teorias organizacionais, e que reforça o poder profissional da medicina.
Recorrendo a uma metodologia intensiva-qualitativa num estudo de caso, avança-se com uma proposta de teorização da acção individual por intermédio de uma perspectiva sistémica, que articula dimensões instituicionais e individuais. Uma das conclusões a que se chega é a não adequação de modelos normativos de acção que ignorem as liberdades individuais e discricionariedade permitidas pelos lugares ocupados. O modo como os indivíduos constroem e usam os seus papéis profissionais introduz efeitos nas relações entre médicos e gestores que importa conhecer. Comprova-se que os indivíduos são mais do que meros receptáculos de influências sociais, fazendo usos de interesses e expectativas que, em articulação com influências inculcadas, diversificam o curso da acção.This work focuses on recent changes in the Portuguese hospital sector derived from a commonly felt situation among those countries where the welfare model was developed: the difficulty to coadunate the wealth accumulation to its distribution. The solution has been the „empresarialização‟ [corporatization] of the health providers, applying to the public organizations once restricted management rules of the private sector. A further attention on the scope and limits of such changes is required, mainly if we take into consideration professional power held by medicine. Hospital results as an open system influenced both by external and internal pressures. Contrary to what could be expected, professionalism and managerialism are not necessarily opposite forces, being explained the conditions for such articulation. At stake is a not predicted hospital bureaucracy's configuration by organizational theories that allows the strengthening of the medical power under a managerial context. A qualitative-intensive methodology applied to a case study allowed the theorization of the individual action by a systemic perspective that articulates institutional and individual dimensions. One of the main conclusions reached is the non adequacy of normative models for action that ignores the individual freedom and the discretionarity associated to certain social positions. The way how individuals assemble and use their professional roles introduces several deflections on the doctors-managers relation that is important to understand. It proves therefore that individuals are much more than just receivers of social influences and the course of their actions is diversified by a combination of their own interests and expectations and inculcated influences.
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Pereira, Mónica Alexandra Ribeiro. "Caracterização das equipas de cuidados continuados integrados, na região de saúde de Lisboa e Vale do Tejo." Master's thesis, 2018. http://hdl.handle.net/10071/18475.
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A política integrada dos cuidados continuados em Portugal é muito recente contudo, o
resultado dos serviços prestados até ao momento demonstra a sua mais-valia e a
capacidade dos atores e politicas se reajustarem às necessidades das comunidades.
A Rede Nacional de Cuidados Continuados Integrados (RNCCI) assenta num modelo
integrado de intervenção, numa filosofia de descentralização, com níveis de
coordenação e responsabilização diferenciados, contudo cooperantes e
interdependentes.
Após doze anos de existência, a RNCCI assiste a uma mudança de paradigma, que
procura investir nas equipas domiciliárias (ECCI) e privilegia a recuperação funcional
em contexto familiar, sempre que possível.
A base desta dissertação, por que tem que existir um início, foi o trabalho desenvolvido
por algumas das Equipas de Cuidados Continuados Integrados da Região de Saúde de
Lisboa e Vale do Tejo.
Para chegar às conclusões que se apresentam, foi importante contextualizar o
crescimento da RNCCI, compreender o caminho percorrido, analisar as estratégias
implementas, caracterizar os atores deste processo e refletir sobre as políticas
executadas.Although there is a new integrated policy of continuing cares in Portugal, the provided services results have already shown both its added value and a strong adjustment capacity of the actors and the policies to the community needs. The Rede Nacional de Cuidados Continuados Integrados (RNCCI) is based on an integrated model of intervention, in a philosophy of decentralization, with different levels of coordination and accountability, yet cooperating and interdependent. After twelve years of existence, there is a paradigm shift in the RNCCI seeking to invest in home teams (Long-Term Care Teams) and favouring the functional recovery in a family, whenever possible.Although there is a new integrated policy of continuing cares in Portugal, the provided services results have already shown both its added value and a strong adjustment capacity of the actors and the policies to the community needs. The Rede Nacional de Cuidados Continuados Integrados (RNCCI) is based on an integrated model of intervention, in a philosophy of decentralization, with different levels of coordination and accountability, yet cooperating and interdependent. After twelve years of existence, there is a paradigm shift in the RNCCI seeking to invest in home teams (Long-Term Care Teams) and favouring the functional recovery in a family, whenever possible.The basis of this dissertation, is the work developed by some of the Long-Term Care Teams of the Administração Regional de Saúde de Lisboa e Vale do Tejo. To come to these conclusions, it was important to contextualize its growth, to understand the path taken, to analyze the implemented strategies, to characterize the actors in the process and to reflect on implemented policies.
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Cordeiro, Tiago Miguel Luzio. "Análise da satisfação dos beneficiários do serviço de assistência na doença da Polícia de Segurança Pública." Master's thesis, 2021. http://hdl.handle.net/10400.26/37072.
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O SAD/PSP existe como meio complementar ao SNS, para satisfazer as
necessidades de uma parte dos cidadãos portugueses que, correm riscos, suportam
exigências e vivem penosidades próprias da função policial. A qualidade de beneficiário
do SAD/PSP é obrigatória para todos os Polícias e implica o desconto de uma
percentagem do seu vencimento/pensão, que lhes dá direito ao regime convencionado e
livre. É devido a esta obrigatoriedade, que é fundamental conhecer o grau de satisfação
dos beneficiários com os serviços prestados pelo subsistema, de maneira a poder melhorá los. Neste sentido, pretendeu-se essencialmente realizar: um périplo histórico pelos
subsistemas SAD/PSP, SAD/GNR, ADM, ADSE e SNS; um paralelismo entre SAD/PSP
e SAD/GNR; e uma avaliação do nível de satisfação, através de estudo quantitativo por
questionário, feito a uma amostra representativa dos beneficiários do SAD/PSP. Deste
último, verificou-se que a maioria dos beneficiários está satisfeita com os serviços
prestados pela rede convencionada; a maioria dos beneficiários acredita que não existe
igualdade geográfica no número de acordos com prestadores de serviços; a maioria dos
beneficiários acredita que existe igualdade no facto de todos contribuírem na mesma
percentagem, para o SAD/PSP; mesmo que não fosse obrigatório, a maioria dos
beneficiários titulares continuaria a ser contribuinte deste subsistema; a maioria dos
beneficiários do SAD/PSP acredita que o prazo de reembolso das faturas que submetem
ao subsistema, é um dos principais fatores que influenciam a sua satisfação com o
subsistema. Concluiu-se que existe um nível neutral, com tendência para a satisfação, por
parte dos beneficiários do SAD/PSP.The SAD / PSP exists as a complementary means to the SNS, to satisfy the needs of part of the portuguese citizens who, at risk, support the demands and live the hardships typical of the police function. The status of beneficiary of the SAD / PSP is mandatory for all policemen and implies the discounting of a percentage of their salary / pension, which entitles them to the agreed and free regime. It is due to this obligation, that it is essential to know the degree of satisfaction of the beneficiaries with the services provided by the subsystem, in order to be able to improve them. In this sense, the intention was essentially to carry out: a historical tour through the subsystems SAD / PSP, SAD / GNR, ADM, ADSE and SNS; a parallel between SAD / PSP and SAD / GNR; and an assessment of the level of satisfaction, through a quantitative study by questionnaire, made to a representative sample of the beneficiaries of the SAD / PSP. Of the latter, it was found that the majority of the beneficiaries are satisfied with the services provided by the agreed network; the majority of beneficiaries believe that there is no geographic equality in the number of agreements with service providers; the majority of beneficiaries believe that there is equality in the fact that everyone contributes the same percentage to the SAD / PSP; even if it were not mandatory, the majority of the beneficiaries would continue to be contributors to this subsystem; most beneficiaries of the SAD / PSP believe that the repayment term of the invoices they submit to the subsystem, is one of the main factors that influence their satisfaction with the subsystem. It was concluded that there is a neutral level, with a tendency towards satisfaction, on the part of the beneficiaries of the SAD / PSP.
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Witthuhn, Jacqueline. "Identifying challenges related to providing community-based environmental health education and promotion programmes." Diss., 2001. http://hdl.handle.net/10500/16496.
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This research study was initiated by the desire to identify the constraining and enabling factors experienced by environmental health officers (EH Os) and their management in the implementation of environmental health education and promotion programmes in the environmental health sector. The research contextualises the issues of health promotion, the role of education in health promotion, and community-based environmental health service provision with specific reference to the role of the EHO in relation to these issues. The foremost value ofthis study lies in the fact that it profiles the need for change in the delivery of community-based environmental health education and promotion programmes and identifies distinctive policy changes and skills development needs in the field of environmental health promotion which are central to improved and sustainable community-based environmental health education and promotion.Educational Studies
M. Ed. (Environmental Education)