Rozprawy doktorskie na temat „Admission planning”

Thesis (S.M.)--Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2010.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 135-143).
Poor management of the patient flow in intensive care units (ICUs) causes service rejections and presents significant challenges from the standpoint of capacity planning and management in ICUs. This thesis reports on the development of a simulation framework to study admission control polices that aim to decrease the rejection rate in the ICU at Children's Hospital Boston (CHB), and to provide predictions for the future state of the ICU system. To understand the patient flow process, we extensively analyze the arrival and length of stay (LOS) data from the ICU census. The simulation model for the ICU is developed based on the results from this statistical analysis as well as the currently-practiced scheduling and admission policies of the ICU at CHB. The model is validated to provide accurate estimates for important performance metrics such as rejection rates in the ICU. The simulation model is used to study the performance of many admission control policies. The policies of our interest exploit "caps" to control the number of scheduled patients who are allowed to enter the ICU on a single day. In particular, we consider two cap-based policies: the uniform cap policy (UCP), which is the existing policy in CHB, and the service-specific cap policy (SSCP), which is originally proposed in this thesis. While the UCP implements caps on the total census of surgical patients, the SSCP utilizes the service-oriented heterogeneity of surgical patients' LOS and enforces caps on separate groups of surgical patients based on their average LOS. We show that the UCP can reduce the rejection rate in the ICU at the expense of extra waiting time of scheduled patients. The SSCP is shown to further decrease the rejection rate while increasing the waiting time compared to the UCP. We also demonstrate that the performance of both policies depends on the level of system utilization. In order to validate our results theoretically, a discrete-time queueing model for the ICU is developed and verified to provide estimates for performance measures that are consistent with the results from simulation. Finally, we introduce the notion of state-dependent prediction, which aims to identify the likelihood of the future state of the ICU conditional on the information of a current state. Several experiments are conducted by simulation to study the impact of a current state on a state in the future. According to our results, current state information can be useful in predicting the state of the ICU in the near future, but its impact gradually diminishes as the time difference between the present and future grows. Our major finding is that the probability of unit saturation at a certain future time can be determined almost entirely by the number of current patients who will leave the ICU after that time, regardless of the total number of patients who are currently staying in the unit. These results imply the potential development of adaptive cap-based policies that dynamically adjust caps according to the outcomes of state-dependent predictions.
by Wongsakorn Chaiwanon.
S.M.

In a stroke-certified 500-bed acute care hospital, the 30-day readmission rates for patients discharged to rehabilitation centers or skilled nursing facilities were higher than the rates for patients discharged to home. A review of data by the stroke team showed 44 patients readmitted within 30 days of initial stroke discharge between October 2016 and January 2017. The rate of re-admission for those discharged home was 41% (18 patients), whereas the rate for those discharged to acute inpatient rehabilitation, long-term acute care, or skilled nursing facilities was 59% (26 patients). The practice-focused question for this project assessed whether using a re-admission risk-assessment tool and implementing interventions during the initial acute-care admission, would help to identify and improve risk for 30-day re-admissions for patients diagnosed with stroke. The goal of this research project was to adopt, test, and recommend the implementation of a readmission risk assessment tool to enable discharge planners to identify stroke patients at risk for readmission and implement interventions to help reduce this risk. Lewin’s theory of change was used to inform the project. A stroke re-admission risk-assessment tool in use at a similar hospital was adopted and tested for 1 week on the hospital’s 28-bed stroke unit by nurse case managers. The test was conducted among 5 patients with confirmed diagnosis of stroke. A re-admission data review was performed 30 days after their discharge, which showed no readmissions for the 5 patients involved in the trial. The tool helped to improve case manager awareness of increased risk for readmissions, guide interventions, and improve patient transition and outcomes. The implications of this project for positive change include the potential to improve risk for patients with stroke in the acute-care facility.

Typical public secondary school students seem unable to compete with distinguished public and elite private secondary school students when seeking admission to highly selective colleges. This study has identified the characteristics that distinguish college guidance and school-wide programs at public secondary schools perceived to be the strongest (distinguished) from other public secondary schools. School boards, public secondary school counselors, school administrators, and the communities they serve now have college guidance programs they can emulate to better prepare students for admission to highly selective colleges.
Ph. D.

The Swedish health care system plays a vital role in satisfying the citizens’ demands for quality health care services. To deliver the right services in time in a hospital, an efficient admission plan is required, but this can be difficult to achieve. The Department of Pulmonary Medicine at the University Hospital in Linköping needs a better admission plan for their patients. In the department, the patient demand does not match the capacity, which leads to overcrowding at the ward. The aim of this thesis is to improve the admission plan of patients for the ward at the Department of Pulmonary Medicine by using discrete event simulation. To fulfil the aim, a simulation study is performed to understand how the system is working, where the problems emerged and how to prevent overcrowding. Different experiments are performed to check what could improve the admission plan at the ward. The results from this study shows that an improvement of the admission plan could be reached by better cooperation between involved units, improved documentation at the Department, a queue system of patients based on medical priorities and changed number of care beds. These solutions can prevent overcrowding and deliver health care services in time.

Thesis (MTech (Business Information Technology))--Cape Peninsula University of Technology, 2018.
Institutions of higher learning are operating in an environment that is continuously informed by the markets and government regulations, hence the need for continuous improvement initiatives in order to remain relevant to the dynamic changes in higher education. The improvements are done by reviewing the course content, operations, and business processes, which includes an application and admission process. This study analyses the residence application and admission process (RAAP). The business processes and Enterprise Resource Planning (ERP) system support the realisation of the application and admission process of the university. The review of the current application and admission process will be based on business processes, business process reengineering, and the business process modelling theory. Therefore, the problem statement for the study is that the impact of information flow during the application and admission of students for residency at the university involves business processes that are inefficient and ineffective. This results in mistakes being made by administrators, and students who are dissatisfied. The study is based on two research questions: Firstly, what strategies can be used to improve the application and admission process of the role players at the selected tertiary institution, and secondly, how does the application and admission process affect service delivery to the students and residence administrators at the selected tertiary institution? The aim of the study is to explore how the participating students and administrators in the residence application and admission process perceive the efficiency of university business processes. A further aim is to explore how the processes can be reengineered to fulfil the requirements of the students and administrators. The research methodology employed to resolve the problem logically is qualitative in nature. A research paradigm guides the actions of the researcher with regard to the generation and interpretation data, which results in knowledge production. The inductive research approach is well suited for the research strategy. For the purpose of this study, a case study strategy is deemed suitable because of its qualitative nature, and comprehensive knowledge of the university processes is required to understand and address the research problem. The unit of analysis of the study is the university’s administrative department business processes. The purposive, non-randomly selected students who applied for residency and the employees of the applicable departments within the university form the unit of observation, which is also a source of data. The data are collected by means of interviews using semi-structured questionnaires, with the samples being non-random and purposively selected. The data collected in the case study are then be summarised and categorised into themes. The themes are uses to present the “As-Is” and the “To-Be” application and admission process.

The overall aim of the present thesis was to study factors related to transfers of older people between nursing homes, emergency department and hospital care. The thesis was based on four studies and used three methods: focus group discussions, structured review of electronic healthcare records, semi-structured interviews with registered nurses and general practitioners. Study I: nursing home nurses found it difficult to decide whether older residents should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Study II: transfer rate to ED was 594 over 9 months among a total of 431 residents (M 1.37 each). 25% were caused by falls and/or injuries, 63% resulted in hospitalization (M 7.12 days). The transfer rate was 0.00-1.03 transfers/bed; it was higher for private for-profit providers than for public/private non-profit providers. Study III: nursing homes with high transfer rates had fewer updated advance care plans than did nursing homes with lower transfer rates. More nurses from nursing homes with low transfer rates had a specialist education and training in dementia care and had worked longer in eldercare. Study IV: general practitioners perceived registered nurses’ continuity, competence and collaboration with family members as important to quality of care in nursing homes; inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The findings indicate that organizational factors could explain differences in transfer rates between nursing homes. The studies highlight the importance of advance care planning together with residents and family members in facilitating future medical decisions. Registered nurses’ continuity and competence are perceived as crucial to quality of care. To meet increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care several changes should be made: Nursing homes should be equipped with suitable medical equipment and registered nurse staff should be matched accordingly; importantly, registered nurses and general practitioners should be able to access each other’s healthcare record systems.

This study examined the effect of interdisciplinary discharge planning rounds on timing of social work intervention, length of stay (LOS), and readmission for patients aged 65 and over. Data sources were the medical charts of 449 patients discharged during two corresponding 28 day periods (one before end one after the implementation of rounds) supplemented by Discharge Planning Committee minutes (DPCM) and interviews with four key informants. No significant differences in the timing of social work intervention, LOS, or readmissions were found between the two samples. Qualitative research revealed that essential components were either missing (physician participation), or not uniformly included (family participation) in rounds, and that staff felt that rounds improved communication among the disciplines and contributed to improved efficiency in planning hospital and posthospital services. These findings highlight the need to further study all aspects of the complex discharge planning process to identify factors that would reduce LOS and readmissions.

Mental health is a growing concern for adolescents. Billions of dollars are spent annually on mental services for youth. Many adolescents experience abuse, suicidal ideations, psychotic disorders, substance abuse, and other challenges. Recurring inpatient psychiatric hospitalizations are increasing among adolescents. The recurring admissions impact adolescents significantly socially, psychologically, and financially. Social workers are a vital part of this treatment process from admission to discharge. The research question asked what were the issues and challenges social workers encounter when conducting discharge planning with adolescents receiving recurring inpatient psychiatric treatment. The purpose for this doctoral project was to carefully examine the discharge planning process while identifying ways social workers can positively impact the process. Key concepts for this project were adolescent, inpatient hospitalization, recurring hospitalization, and discharge planning. Systems theory was used to inform the project. This action research study allowed social workers to share their experiences and perspectives about the role of social workers in discharge planning. Seven participants were identified using purposive sampling. One focus group provided data for project. Data analysis consisted of in vivo and process coding. Four participant-inspired themes identified related to issues and challenges in discharge planning include (a) adequate resources, (b) insurance restrictions, (c) rapport with adolescents, and (d) parental participation. Social work practice and positive social change implications include establishing follow-up protocol for all adolescent discharges from inpatient settings and increasing the use of encouragement and engagement strategies for rapport building with adolescents.

Valvular disorders can be corrected by means of surgery, after which very comprehensive discharge planning should be implemented to prevent the occurrence of post-operative complications. Advances in medical technology and intellect instigate earlier discharge for patients after they have undergone valvular surgery. The aim of this research study is to establish the extent of discharge planning by nurses for patients who have undergone valvular surgery, so that practice guidelines in the form of an in-service educational framework can be compiled for nurses in the management of these patients post-operatively. Patients, many of whom are from rural areas, are discharged without an adequate referral system. There are, currently, no set guidelines or referral persons to direct these patients during their rehabilitation period. Based on the researcher’s personal observations, it is evident that many patients suffer from bacterial endocarditis or clotted valves due to poor post-surgery management. However, both of these conditions could be avoided if proper health education was given to these patients. The study will take the form of a quantitative, exploratory, descriptive and contextual survey. Data will be collected by means of a structured questionnaire that will be completed by the nurses working in the cardiac general ward and the cardiac clinic. Findings of the research study will be used to assist the researcher in developing an in-service educational framework for staff that are both nursing and preparing post valvular surgery patients for discharge. The goal is to prevent complications such as clot formation and endocarditis and to enable patients to deal effectively with their rehabilitation period.

Contends that poor discharge planning for elderly patients in American hospitals is the result of reduced lengths of stay which do not give medical social workers adequate time to assess patients' needs. A survey methodology was used to assess social service and community resource needs of hospitalized elderly patients and their family members at Riverside Community Hospital in California. Argues that the results of the survey can be used to improve discharge planning and lead to a more client-centered practice in hospitals.

In this thesis, by being motivated from the challenges in perinatal networks, we address design, evaluation and flow control of a stochastic healthcare network where there exist multiple levels of hospitals and different types of patients. Patients are supposed urgent; thus they can be rejected and overflow to another facility in the same network if no service capacity is available at their arrival. Rejection of patients due to the lack of service capacity is the common phenomenon in overflow networks. We approach the problem from both strategic and operational perspectives. In strategic part, we address a location & capacity planning problem for adjusting the network to better meet demographic changes. In operational part, we study the optimal patient admission control policies to increase flexibility in allocation of resources and improve the control of patient flow in the network. Finally, in order to evaluate the performance of the network, we develop new approximation methodologies that estimate the rejection probabilities in each hospital for each arriving patient group, thus the overflow probabilities among hospitals. Furthermore, an agent-based discrete-event simulation model is constructed to adequately represent our main applicationarea: Nord Hauts-de-Seine Perinatal Network. The simulation model is used to evaluate the performance of the complex network and more importantly evaluate the strength of the optimal results of our analytical models. The developed methodologies in this thesis are combined in a decision support tool, foreseen under the project "COVER", which aims to assist health system managers to effectively plan strategic and operational decisions of a healthcare network and evaluate the performance of their decisions.

Questa tesi riguarda il problema della schedulazione degli interventi nel blocco operatorio di un presidio ospedaliero, noto anche come Operating Theatre Planning & Scheduling. Il blocco operatorio è la struttura che eroga servizi a più alto impatto sui costi di un presidio ospedaliero ed è legato ad attività ad alto rischio. E' quindi fondamentale gestire in modo ottimale questa risorsa. In questa tesi, si considera come caso studio l'applicazione reale di un presidio ospedaliero dell'Emilia Romagna con un orizzonte temporale di una settimana, ovvero la cosiddetta programmazione operativa. L'obiettivo è quello di ottenere un utilizzo efficiente del blocco operatorio, garantendo al contempo la priorità agli interventi più urgenti. Data la complessità del problema, vengono proposti algoritmi euristici che permettano di ottenere buone soluzioni in tempi di calcolo ridotti. Studi precedenti hanno infatti evidenziato la difficoltà di trovare soluzioni ottime al problema, mediante l'utilizzo di solver commerciali per modelli di Programmazione Lineare Intera, senza introdurre ipotesi semplificative. Sono stati elaborati tre algoritmi euristici costruttivi di tipo multi-start che permettono di generare soluzioni ammissibili con diverse caratteristiche. Gli algoritmi si differenziano principalmente per le modalità con cui collocano gli interventi nel tempo disponibile delle risorse (induction room, operating room, recovery room), cercando di migliorarne l’utilizzazione e dando priorità ai pazienti più urgenti. Gli algoritmi sono stati implementati utilizzando il linguaggio JAVA e sono stati testati su istanze realistiche fornite dal presidio ospedaliero. I risultati hanno evidenziato un alto grado di utilizzazione delle sale operatorie, un fattore molto rilevante per una ottimale gestione del blocco operatorio. E' stata, infine, svolta un'analisi di sensitività alla variabilità delle durate.

Hospital admissions for patients close to the end of life are considered ‘inappropriate’ in contemporary English health policy. Hospitals are supposedly unable to offer a ‘good’ death for patients, and dying there is thought to contradict patient choice, since patients are assumed to want to die at home. However, almost half of all deaths in England in 2015 occurred in hospital, and of these, nearly a third died within three days of admission. This thesis seeks to explore why these admissions are considered to be a problem and how they occur. Through a systematic review of UK literature I found that it cannot be stated that most patients want to die at home, because of the extent of missing data (preferences not asked, expressed, reported or absent). This finding challenges the justification that admissions are inappropriate because they contravene patient choice. Similarly inconclusive evidence about the undesirability, cost, and lack of need for patients to be in hospital were also found in a review of policy. Together with analysis of historical trends in hospital and hospice provision, it is apparent that attitudes towards end-of-life admissions reflect existing tensions about the role of hospital as an acute provider, and as a place of death. An analysis of interviews conducted with healthcare staff and next-of-kin involved in the admission of patients (case-patients) who died shortly after being admitted to Meadowbridge, a large English hospital explored these tensions further. I found that whilst hospital was not recognised as a place where ‘good’ deaths typically occurred, it was acknowledged as an emergency place of care. In this context, patients without obvious need for hospital care were nevertheless admitted to the hospital and the environment was subsequently recognised to offer distinct benefits. The need for emergency care reflected the difficulties of providing end-of-life care in the community. For dying to occur appropriately, home had to be adapted and care organised by healthcare staff. Both tasks were complicated by the unpredictability of dying, and family carers helped to absorb much of the uncertainty and support patients to die at home. Ambulance staff became involved when patients had care needs that exceeded care quickly and easily available in the community. When called to the case-patients, ambulance staff instituted familiar practices in transferring them to hospital. Hospital was recognised as a default place of care because ambulance staff struggled to facilitate alternative care and lacked sufficient professional authority to keep patients at home. The admissions of the case-patients represent the best attempts of staff to navigate the tangled practices of end-of-life care. These practices are the result of the actions of the staff, which in turn both constrained and enabled their action in providing care to patients. The term ‘inappropriate’ to describe admissions does not encompass these attempts, and moreover, devalued the significant care provided by healthcare staff in the community and hospital.

INTRODUÇÃO: As doenças relacionadas ao saneamento ambiental inadequado (DRSAI) continuam presentes em áreas metropolitanas no Brasil. OBJETIVO: Analisar as hospitalizações por DRSAI na rede pública da região metropolitana de Porto Alegre (RMPA)/RS de 2010 a 2014. MÉTODOS: Análise das hospitalizações com diagnóstico principal dos códigos CID-10 correspondente às DRSAI a partir do Sistema de Informações Hospitalares SIH/SUS, disponíveis publicamente. RESULTADOS: Do total de 13.929 hospitalizações por DRSAI de residentes na RMPA, no período de 2010 a 2014, a maioria relaciona-se às doenças de transmissão feco-oral como diagnóstico principal. Dentre as internações, o maior número (20,4%) corresponde ao de crianças de 1 a 4 anos de idade (28,1 hospitalizações/10.000 hab./ano). As internações por 10.000hab./ano variam de 1,4 em Glorinha e Nova Santa Rita a 27,6, em Triunfo. A taxa de letalidade hospitalar pode ser avaliada como baixa, pois a cada 100 internações ocorrem 2,2 óbitos, mas se considerarmos que esse tipo de doença é evitável e que não deveria gerar internação temos um número expressivo. Dentre as causas de óbito segundo CID-10, as mais frequentes foram as doenças de transmissão feco-oral. A utilização de UTI atingiu 2,0% (284), cujo destaque foram as hospitalizações por leptospirose, com uso de UTI em 13,2%. O gasto total com as internações foi cerca de R$ 6,1 milhões. O valor médio de internação mais elevado foi no município de Viamão (R$ 626,82) e o mais baixo em Alvorada (R$ 258,36). Entre todos os municípios da RMPA, São Sebastião do Caí foi o município com maior percentual (100%) de internações dos próprios residentes no total de internações por DRSAI. CONCLUSÃO: Ainda hoje as DRSAI são um importante problema para saúde pública e, por meio de trabalhos como este, é possível mapear a situação para promoção de ações para seu devido enfrentamento e melhor alocação de recursos.
INTRODUCTION: Diseases Related to Inadequate Environmental Sanitation (DRSAI, in Portuguese) still represent a burden in metropolitan areas in Brazil. OBJECTIVE: To analyze the hospitalizations for DRSAI in the public health network of the Metropolitan Region of Porto Alegre (MRPA)/RS during 2010-2014. METHODS: Analysis of hospitalizations with primary diagnosis of ICD-10 codes corresponding at DRSAI of a national public hospitalization basis (SIH / SUS). RESULTS: We found 13,929 hospitalizations for DRSAI of the MRPA´s residents during 2010-2014, most related to feco-oral transmission diseases as first-listed diagnosis. The largest number (20.4%) among the admissions corresponded to children 1 to 4 years old (28.1 hospitalizations / 10,000 inh/year). The admissions (10.000 inh/year) ranged from 1.4 in Glorinha and Nova Santa Rita up to 27.6 in Triunfo. The hospital mortality rate was low, for each 100 admissions deaths occur in 2.2, but if we consider that this kind of disease is preventable and should not generate hospitalization, it may represent a significant number. Among death causes according to ICD-10, feco-oral transmission disease was the most frequent. Use of Intensive Care Unity (ICU) reached 284 hospitalizations (2.0%) and Leptospirosis with ICU use was the highest (13.2%). Total expenditure on hospital admissions was approximately R$ 6.1 million. The average hospital stay cost was higher in Viamão (R $ 626.82) and lowest in Alvorada (R$ 258.36). Among all municipalities of MRPA, Sao Sebastião do Cai had the highest percentage (100%) of admissions of residents own a total of hospitalizations for DRSAI. CONCLUSIONS: DRSAIs are still today a major problem for public health, and that through research like this, it´s possible to map the situation for promoting actions for their proper coping and better resource allocation.

碩士
國立交通大學
工業工程與管理系所
106
Based on a real case, this work investigates the admission control and capacity planning problems at a wafer reconstruction company in Taiwan. The admission control problem refers to whether or not to accept an incoming order or to decision which orders to accept among a set of new orders. The capacity allocation refers to assign an order accepted to production area or production line to maximize the profits. We formulate a mixed integer programming (MIP) problem to integrate these two decisions, and develop a solution procedure based on the genetic algorithm (GA). The theoretical results are implemented as a spreadsheet-based optimization tool that can served as a decision aid for industry practitioners.

by Xiaoqing Wang.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2000.
Includes bibliographical references (leaves 43-45).
Abstracts in English and Chinese.
Acknowledgments --- p.ii
Abstract --- p.iii
Chapter 1 --- Introduction --- p.1
Chapter 2 --- The General Architecture of the VoD System and the Related Issues --- p.4
Chapter 2.1 --- A Brief Description of VoD System --- p.4
Chapter 2.2 --- Why Video Streams in VoD Service are VBR in Nature? --- p.6
Chapter 2.3 --- The Video Storage Media in the VoD Systems --- p.8
Chapter 2.4 --- The Data Placement Scheme in the VoD System --- p.9
Chapter 2.5 --- An Overview of Disk Scheduling in VoD System --- p.10
Chapter 2.6 --- The Admission Control in VoD System --- p.12
Chapter 3 --- Our Admission Control Algorithm for VoD System --- p.14
Chapter 3.1 --- QoS Requirements We Choose --- p.14
Chapter 3.2 --- System Model --- p.15
Chapter 3.3 --- The Admission Control for the Storage Sub-system --- p.19
Chapter 3.4 --- The Admission Control for Network Sub-system --- p.21
Chapter 3.4.1 --- Preliminaries --- p.22
Chapter 3.4.2 --- The Admission Control Algorithm for Network Sub-system --- p.27
Chapter 4 --- Experiment --- p.33
Chapter 5 --- Conclusion and Future Work --- p.41
Chapter 5.1 --- Conclusion --- p.41
Chapter 5.2 --- Future Work --- p.42

Discharge planning is an integral part of patient care, which involves the transfer of patients from the hospital to the community, taking into account the patient’s unique and complex needs. However, this process is often fraught with complexities. This study was designed to explore challenges of current practices in discharge planning and to establish factors and effective strategies for future management. A qualitative and descriptive study was undertaken to understand the views of health care professionals on discharge planning within a tertiary hospital setting in KwaZulu-Natal. A comprehensive, rather than a disease-specific approach was used. Systems theory and the bio-psycho-social model formed the appropriate theoretical framework for the current study, which considered a holistic approach, taking into account systemic factors, relationships, physical, psychological and social aspects of patient care. Purposive sampling was used to identify 26 members of the multidisciplinary team with the relevant knowledge and experience. Semi-structured interviews, that were audio-recorded, were undertaken as the primary method of data collection, from which transcripts were thematically analysed. The study identified the key themes in terms of major challenges that included inter-hospital transport and referrals, resource constraints, patient compliance, and caregiver preparedness. The poor socio-economic circumstances of patients and their families formed a grim background. A documentation analysis of discharge summaries, utilized as a secondary method for the purposes of triangulation, revealed inconsistencies in the discharge summary system that varied between incomplete or well written reports. Based on the study findings, recommendations are made in respect of practice, policy and further research in the designated area of study. Some of the strategies recommended include collaboration with the multidisciplinary team, improving patient and caregiver education and establishing a formalized system of discharge planning, policies and discharge summaries.
M.A. University of KwaZulu-Natal, Durban, 2014.

Submitted in fulfillment for the Degree of Doctor of Technology: Public Management, Durban University of Technology, 2010.
In South Africa, the transformation of public higher education has placed much emphasis on the accountability and performance of individual institutions. Various indicators are used to assess institutional performance, as is the case internationally. Examples of such indicators include teaching and learning, research outputs, graduate employability, financial sustainability and productivity and the use of resources. This case study which is predominantly qualitative, examined: i) Performance by a selected South African University of Technology, the Durban University of Technology (DUT), in specific performance indicators as determined by policy on student enrolment planning. Student enrolment planning is an important strategy adopted by government to address a number of distortions in the higher education system which had been developed over a number of years within the ideology of apartheid. ii) The measures taken by the institution to give effect to the policy. The case study utilised multiple methods of data collection within three units of analysis. The three units of analysis of the case are: Unit of analysis One: The practices used at the DUT for marketing, student recruitment, student selection and admission to achieve the input indicators of the student enrolment plan. Unit of analysis Two: implementation strategies for meeting the output (success) indicators of the plan. Unit of analysis Three: The problem of low student retention. The original contribution made by this research study is that it provides detailed insight into the implementation of policy of student enrolment planning, using the Durban University of Technology as an example. In so doing, the researcher has identified critical areas that impact on student enrolment planning in South Africa, as well as specific weaknesses in the implementation of the policy at the DUT. A part of the study’s findings is that the DUT is well–placed to meet the performance indicators of the enrolment plan. However, the addressing of weaknesses in the areas of student selection, marketing and recruitment could improve the DUT’s ability to exert more influence over its enrolments. The study determined that the problem of low student retention is a factor that threatens the DUT’s throughput and graduation rates. Broad and specific recommendations are made for implementation, including the adoption of the organisational framework of enrolment management supported by institutional research.

The major focus and question emanating from the research is: to what extent do the operational action plans, policies, functions, procedures and activities as well as their implementation within the Directorate: Student Admissions and Registrations correlate with the strategic objectives of the University of South Africa (Unisa)? In alignment with the above, the major challenge of the study was to identify adequate and appropriate approaches to ensure appropriate correlation levels between strategic objectives and their successful implementation relevant to the Directorate: Student Admissions and Registrations. The challenge of every Departmental Head is to turn theory into practice; to make something happen and to translate strategic plans into real business results. This will be accomplished only when there is synergy or connectivity between strategic and operational planning towards effective implementation. Various literature reviews and research topics on strategic management focus either on strategic planning or strategic implementation as separate identities. Few publications address the challenge of connecting the pursuit of strategic objectives with operational plans. Even fewer literature reviews indicate the relationship or correlation levels between strategic objectives and operational plans of an organisation; the desirable or appropriate level thereof, to ensure the effective pursuit of strategic objectives. The outcomes of this study could contribute to the identification of an appropriate approach and measurement criteria to ensure connectivity/alignment between specific strategic objectives and operational plans relevant to the Directorate: Student Admissions and Registrations. By doing this, the strategic objectives are effectively and efficiently promoted to those responsible for carrying out the execution plan. The researcher has adopted a comprehensively-integrated-aligned-strategic-processmanagement- approach as part of the standardised operational plans of the Directorate: Student Admissions and Registrations so as to ensure more effective and efficient (appropriate) correlation levels in respect of specific strategic objectives relevant to the Directorate: Student Admissions and Registrations due to a lack of correlation in some instances. The above approach represents a total view of an organisation‟s strategic management and control systems and consists of the strategic planning, operational plans and resultsmanagement plans. The mentioned approach will also consist of a measurement criterion which identifies critical enablers, dependencies and drivers to ensure vertical and horizontal alignment in respect of original planning (the what and why) with the implementation plans (when, how and by whom).The integrated-aligned-strategic-management-process-approach enforces the timely availability of major enablers, dependencies and drivers necessary to support the execution of activities, related to specific strategic objectives. It also identifies the possible lack thereof prior to the implementation of strategic plans. Specific alternatives or workarounds can be identified to ensure continuity in respect of the implementation processes related to specific strategic objectives. In this way, the above approach will enhance the effective and efficient management and coordination of an organisation to drive intended strategic outcomes within a specific process, taking into account project management-driven principles within a specific sequence of activities (grouping together what belongs together). The latter will involve all roleplayers in the work situation accountable for the implementation process (creating ownership). By doing this, duplication and overlapping of activities will be eliminated and connectivity/alignment between specific strategic objectives and their implementation will be enforced. The focus falls on the entire key/core process and cycle, producing outcomes of success in respect of the implementation of objectives (the right people will be doing the right things at the right time).The integrated-aligned-strategic-management-process-approach enforces the timely availability of major enablers, dependencies and drivers necessary to support the execution of activities, related to specific strategic objectives. It also identifies the possible lack thereof prior to the implementation of strategic plans. Specific alternatives or workarounds can be identified to ensure continuity in respect of the implementation processes related to specific strategic objectives. In this way, the above approach will enhance the effective and efficient management and coordination of an organisation to drive intended strategic outcomes within a specific process, taking into account project management-driven principles within a specific sequence of activities (grouping together what belongs together). The latter will involve all roleplayers in the work situation accountable for the implementation process (creating ownership). By doing this, duplication and overlapping of activities will be eliminated and connectivity/alignment between specific strategic objectives and their implementation will be enforced. The focus falls on the entire key/core process and cycle, producing outcomes of success in respect of the implementation of objectives (the right people will be doing the right things at the right time). The integrated-aligned-strategic-management-process-approach enforces the timely availability of major enablers, dependencies and drivers necessary to support the execution of activities, related to specific strategic objectives. It also identifies the possible lack thereof prior to the implementation of strategic plans. Specific alternatives or workarounds can be identified to ensure continuity in respect of the implementation processes related to specific strategic objectives. In this way, the above approach will enhance the effective and efficient management and coordination of an organisation to drive intended strategic outcomes within a specific process, taking into account project management-driven principles within a specific sequence of activities (grouping together what belongs together). The latter will involve all roleplayers in the work situation accountable for the implementation process (creating ownership). By doing this, duplication and overlapping of activities will be eliminated and connectivity/alignment between specific strategic objectives and their implementation will be enforced. The focus falls on the entire key/core process and cycle, producing outcomes of success in respect of the implementation of objectives (the right people will be doing the right things at the right time). The integrated-aligned-strategic-management-process-approach enforces the timely availability of major enablers, dependencies and drivers necessary to support the execution of activities, related to specific strategic objectives. It also identifies the possible lack thereof prior to the implementation of strategic plans. Specific alternatives or workarounds can be identified to ensure continuity in respect of the implementation processes related to specific strategic objectives. In this way, the above approach will enhance the effective and efficient management and coordination of an organisation to drive intended strategic outcomes within a specific process, taking into account project management-driven principles within a specific sequence of activities (grouping together what belongs together). The latter will involve all roleplayers in the work situation accountable for the implementation process (creating ownership). By doing this, duplication and overlapping of activities will be eliminated and connectivity/alignment between specific strategic objectives and their implementation will be enforced. The focus falls on the entire key/core process and cycle, producing outcomes of success in respect of the implementation of objectives (the right people will be doing the right things at the right time).
Public Administration & Management
M.A. (Public Administration)

Efficient management of patient admissions plays a critical role in increasing a hospital's resource utilization and reducing health care costs. We consider the problem of fi nding the best available admission policy for elective hospital admissions under real time constraints. The problem is modeled as a Markov Decision Process (MDP) and we investigate current state-of-the art real time planning methods. Due to the complexity of the model, traditional mode-based planners are limited in scalability since they require an explicit enumeration of the model dynamics. To overcome this challenge, we apply sample-based planners along with efficient simulation techniques that given an initial start state, generate an action on-demand while avoiding portions of the model that are irrelevant to the start state. Results show that given reasonable resources, our approach generates improved deci- sions over existing alternatives that fail to scale as model complexity increases. We also propose a parameter tuning method that can be easily and efficiently implemented.

Yes
Background: Reducing emergency admissions to hospital has been a cornerstone of health care policy. There is little evidence of systematic interventions which achieved this aim across a population. We report the impact on unplanned admissions to hospital through a complex intervention over a 44 month period in Frome, Somerset. Aim: A population health complex intervention of an enhanced model of primary care and compassionate communities to improve population health and reduce emergency admissions to hospital Design: A cohort retrospective study of a complex intervention on all emergency admissions in Frome compared to Somerset from April 2013 to December 2017. Setting: Frome Medical Practice, Somerset Methods: Patients were identified using broad criteria including anyone with cause for concern. Patient centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome. Results: There was a progressive reduction, by 7.9 cases per quarter (95% CI: 2.8, 13.1; p=0.006) in unplanned hospital admissions across the whole population of Frome, over the study period from April 2014 to December 2017. At the same time, there was sharp increase in the number of admissions per quarter, within the Somerset, with an increase in the number of unplanned admissions of 236 per quarter (95% CI: 152, 320; p<0.001). Conclusion: The complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital with reduction of healthcare costs across the whole population of Frome

碩士
國立臺北護理健康大學
長期照護研究所
106
The senior population in Taiwan is growing rapidly, and the highest percentage of health care costs are spent on the elderly. Among the various kinds of the health costs for the elderly, hospitalization remarks the highest. In order to decrease the unplanned readmission and reduce the cost of the health resource, Taiwan Joint Commission on Hospital accreditation has been promoting the discharge planning services. In literature reviews, the correlation between the discharge planning services and the unplanned readmission in the elder patients of the thoracic medicine department is lacking. Therefore, the purpose of this study is to reexamine the correlation. This study pertained to a cross-sectional design with secondary analysis. The study subjects were the patients at the age of 65 and above from the thoracic medicine department in the regional teaching hospital in New Taipei City, Taiwan. Data were extracted from medical charts which were collected by trained case managers. Andersens Behavior Model of medical service utilization was applied to analyze the relationships between the unplanned readmission and the discharge planning service. The result of our study demonstrated that the incidence of unplanned readmission within 14 days was associated with the marital status, living status, stroke and the remaining of tracheostomy tube. The age, living status, care providers, the number of comorbidities, chronic illness with stroke and pneumonia, remaining of nasogastric tube, Foley catheter or tracheostomy tube, the number of catheters, conscious status, the home care supporting system influence the opportunities for the patients to receive discharge preparation service. The logistic regression demonstrated that the uncoupled status and the care instituition were the predictors of unplanned readmission within 14 days after discharge. Providing discharge planning service was not associated with the unplanned readmission within 14 days after discharge. Our study took the elderly patients from the thoracic medicine department in single regional hospital in the New Taipei City, therefore caution was required when generalizing our research findings to other settings. Our findings were still applicable given that the patient characteristics were similar in many medical settings. One of the limitations lied in the number of elderly patients receiving discharge planning that were relatively fewer. In the future, rigorous research designs such as randomized control tests may be employed to explore the relationship between the discharge planning service and unexpected readmission. The finding of this study also pointed to the way in which discharge planning services need to be carried out more systematically to assure their outcomes.

This study deals with the impact of educational policy on the National Senior Certificate: Pre-1994 and Post democracy South African case. The qualitative approach was used in this study, and the research findings were based on the analysis of documents. The transition from apartheid education to the present education system in South Africa has not been without challenges. In the past, South African education reflected the fragmented society in which it was based. Outcomes based education (OBE)/Curriculum 2005 (C2005), since its inception, was riddled with challenges. OBE/C2005 by its nature is complex. It is not user-friendly for developing countries such as South Africa. The aim of this study is to explore the impact of educational policies on the 2008 National Senior Certificate results. Historical-educational research is undertaken with the view of putting the education phenomenon into proper perspective. Venter (1985) is of the opinion that historical education investigation refers to the systematic placing of historical education variables in the spotlight. The general, continual pedagogical and fundamental problems are accentuated against the multiplicity of historical detail. This then makes historical-educational research an orderly (systematic and controlled) process of knowledge enrichment (Venter & Van Heerden 1989:106). The National Senior Certificate was established in terms of National Education Act 27 of 1996. Curriculum 2005 has been described in policy documents as a “paradigm shift” because it represents a radical departure from the previous curriculum in terms of the following: theoretical underpinnings, structure and organisation, teaching and learning process, and assessment (South Africa, Department of Education 1997:1). Pre-1994, the researcher discovered that the education of black people in rural areas in particular and South Africa in general was, in most instances, negatively impacted by policies of the previous government (1948-1953). The apartheid government used poor funding models to ensure that there were low teacher-pupil ratios and teacher qualifications were of unequal standard. Unequal pattern of spending continued well into the post-1994 democratic era. This poor funding model which impacted negatively on rural schools made infrastructural provision in rural areas difficult. Post -1994 democratic dispensation, the researcher discovered that the government have competitive legislative policies in place, but the challenges lay in the fact that those policies were impulsively implemented. Hence the many challenges. This is shown by the frequency of curriculum changes which took place in a very short space of time. Stakeholders played a major role in insuring that schools received quality service by challenging some of the decisions the government was taking. The government has had to take the recommendations into account.
Public Administration and Management
M.Admin. (Public Administration)