Дисертації: "Health services and systems"

1

Kollberg, Beata. "Performance Measurement Systems in Swedish Health Care Services." Doctoral thesis, Linköping : Department of Management and Engineering, Linköpings universitet, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-9302.

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2

Catchpole, C. P. "Information systems design for the community health services." Thesis, Aston University, 1987. http://publications.aston.ac.uk/10620/.

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This system is concerned with the design and implementation of a community health information system which fulfils some of the local needs of fourteen nursing and para-medical professions in a district health authority, whilst satisfying the statutory requirements of the NHS Korner steering group for those professions. A national survey of community health computer applications, documented in the form of an applications register, shows the need for such a system. A series of general requirements for an informations systems design methodology are identified, together with specific requirements for this problem situation. A number of existing methodologies are reviewed, but none of these were appropriate for this application. Some existing approaches, tools and techniques are used to define a more suitable methodology. It is unreasonable to rely on one single general methodology for all types of application development. There is a need for pragmatism, adaptation and flexibility. In this research, participation in the development stages by those who will eventually use the system was thought desirable. This was achieved by forming a representative design group. Results would seem to show a highly favourable response from users to this participation which contributed to the overall success of the system implemented. A prototype was developed for the chiropody and school nursing staff groups of Darlington health authority, and evaluations show that a significant number of the problems and objectives of those groups have been successfully addressed; the value of community health information has been increased; and information has been successfully fed back to staff and better utilised.

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3

Atueyi, Kene Chukwu. "Implementing management information systems in the National Health Service." Thesis, Sheffield Hallam University, 1991. http://shura.shu.ac.uk/4990/.

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As a discipline Management Information System (MIS) is relatively new. Its short history has been characterised with epistemological dialectism. The current conflict and debate about MIS inquiry is broadly between the advocates of the social systems and technical systems perspectives. Few authors have made positive contributions toward clarifying the meaning and nature of MIS, and the appropriate design framework for MIS development. This thesis adds to their effort by using a MIS designed and implemented through action research at the North Western Regional Health Authority. There are seven Chapters in this thesis. Chapters One and Two examine the nature of the problem addressed by this research; the project history, ontological assumptions and research strategy. Chapter Three examines the debate, nature and conflicting views about MIS. It defines the theoretical problem addressed by this thesis and proposes a new concept of MIS. The theoretical problems are dealt with in Chapter Four. In Chapter Five the application of the theoretical concepts developed in Chapter Four is demonstrated in the design of MIS. Chapter Six relates some of the findings of this thesis to the work of other authors. It also examines the problem of human inquiry and the suitability of action research for MIS research. The main findings of this research summarised in Chapter Seven provide a new perspective of MIS as a purposeful system; the taxonomy of purposeful systems; primary context and secondary context of MIS; context analysis and context evaluation of MIS.

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4

Domapielle, Maximillian K. "Extending health services to rural residents in Jirapa District : analyses of national health insurance enrolment and access to health care services." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14803.

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This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit.

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5

Wolfe, Ingrid. "Child Health, Health Services and Systems in UK and other European countries." Doctoral thesis, Karlstads universitet, Institutionen för hälsovetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-35856.

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Background This work in child population medicine describes child health problems, increases knowledge of health services, systems, and wider determinants, and makes recommendations for improvements. Aims To explore trends in UK child health and health service quality and highlight policy lessons from the UK and other European countries To study child health and health services in western Europe and derive lessons from different approaches to common challenges To enhance knowledge on child to adult transition care To describe trends in UK and EU15+ child and adolescent mortality and seek explanations for deteriorating UK health system performance, and make recommendations for improving survival Methods Population level measures of health status and system performance; primary and secondary research on policies and practice for health system assessments. Quantitative: mortality rate trends, excess deaths, DALYs, healthcare processes Qualitative: case reports, system descriptions, analyses Results European child survival has improved, but variably between countries. The UK has not matched recent EU mortality gains. There are 6,000 excess deaths annually in children under 15 years in EU14 countries. There are child survival inequities; countries investing in social protection have lower mortality. Children in the UK, compared with other EU countries, are more likely to be poor than adults. Non-communicable diseases are now dominant causes of child death, disease, and disability. Mortality, processes, and outcomes of healthcare amenable conditions varies between countries. Better outcomes seem to be associated with flexible health care models promoting cooperation, team working, and transition. Conclusions Child health in Europe is improving, but unevenly. Child health systems are not adapting sufficiently to meet needs. Recommendations are made for improving health systems and services.
How do European countries compare when it comes to child health statistics? How do different child health services, systems, and wider determinants impact long term influences for good or harm? Why do some countries seem to do better than others in safeguarding their children’s and young people’s health and wellbeing? And what can we do to make things better for children? This thesis explores some of these difficult but important issues, and despite describing some serious signals of concern about child health, offers recommendations and clear ways forward for countries to ensure healthier futures for children.

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6

Irozuru, E. C. "Information systems in district health authorities : a strategy for management." Thesis, University of Salford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299129.

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7

Simmons, Robert Earl. "African therapeutic systems : their place in health care in Liberia." Thesis, University of Liverpool, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387349.

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8

Al-Haque, Shahed. "Responding to traveling patients' seasonal demands for health care services in the Veterans Health Administration." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/81112.

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Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, 2013.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 60-62).
The Veterans Health Administration (VHA) provides care to over eight million Veterans and operates over 1,700 sites of care distributed across twenty-one regional networks in the United States. Health care providers within VHA report large seasonal variation in the demand for services, especially in healthcare systems located in the southern U.S. that experience a large influx of "snowbirds" during the winter. Since the majority of resource allocation activities are carried out through a single annual budgeting process at the start of the fiscal year, the seasonal load imposed by "traveling Veterans," defined as Veterans that seek care at VHA sites outside of their home network, make providing high quality services more difficult. This work constitutes the first major effort within VHA to understand the impact of traveling Veterans. We found a significant traveling Veteran population (6.6% of the total number of appointments), distributed disproportionately across the VHA networks. Strong seasonal fluctuations in demand were also discovered, particularly for the VA Bay Pines Healthcare System, in Bay Pines, Florida. Our analysis further indicated that traveling Veterans imposed a large seasonal load (up to 46%) on the Module A clinic at Bay Pines. We developed seasonal autoregressive integrated moving average (SARIMA) models to help the clinic better forecast demand for its services by traveling Veterans. Our models were able to project demand, in terms of encounters and unique patients, with significantly less error than the traditional historical average methods. The SARIMA model for uniques was then used in a Monte Carlo simulation to understand how clinic resources are utilized over time. The simulation revealed that physicians at Module A are over-utilized, ranging from a minimum of 92.6% (June 2013) to maximum 207.4% (January 2013). These results evince the need to reevaluate how the clinic is currently staffed. More broadly, this research presents an example of how simple operations management methods can be deployed to aid operational decision-making at other clinics, facilities, and medical centers both within and outside VHA.
by Shahed Al-Haque.
S.M.in Technology and Policy

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9

Field, Kenneth Spencer. "Modelling health care utilization : an applied Geographical Information Systems approach." Thesis, University of Northampton, 1998. http://nectar.northampton.ac.uk/2708/.

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This research has emanated from the geographical concerns raised by organisational change in the British National Health Service (NHS), namely the ongoing debate relating to health and health care inequalities. This thesis develops a flexible, portable and predictive model of health care utilization capable of assisting improved health care planning and analysis. In so doing it contributes to the current resurgence in medical geography. An applied approach to this research is identified which builds upon methods of modelling spatial patterns and processes in geography and the upsurge of interest in Geographical Information Systems (GIS) technology. In these terms, the use of GIS is central to the research; it supports construction and application of the model; facilitates a wide range of analyses; and provides a basis for visualisation and interpretation of model results. The value of modelling in analysing relationships between health inequalities and the location and allocation of health care is identified through a discussion of previous NHS policy initiatives and previous research. From this, a conceptual model of utilization is developed which incorporates components of need, accessibility and provision. A patient survey of asthmatics and diabetics informs the development of the model and validates the choice of indicators used to measure utilization. Indicators of need, accessibility and utilization are thus defined and subsequently measured using a signed chi-square scoring method. The model was developed and tested for primary care General Practitioner services in the Northampton District Health Authority area and outcome measures are proposed and evaluated. Rigorous testing of the model’s sensitivity and robustness is undertaken and potential for its simplification explored. Components are critically evaluated through a comparison with alternative methods of determining spatial inequalities in disadvantage. The potential of the model of utilization for health care planning and analysis is extensively demonstrated through the application of a variety of modelled scenarios. Emergent issues from the research are considered and potential for future geographical research in this area of study, and the impact upon research agendas more generally, is explored

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10

Holloway, Jacqueline Anne. "Performance evaluation in the National Health Service : a systems approach." Thesis, Open University, 1990. http://oro.open.ac.uk/57302/.

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This research explores the contribution which systems theories, methodologies and models can make in the design and application of effective performance-evaluation processes. Approaches to performance assessment of organisations are reviewed, and the history and structure of the NHS, its objectives, and dimensions for evaluation are described. Drawing on questionnaire and interview data from health service and civil service staff, and secondary data, current performance evaluation and planning processes in the NHS are described and some problems identified. To test the hypothesis that attention to systemic factors could improve performance evaluation, eight topics are analysed by the application of systems methodologies or models. Four of the topic and methodology or model combinations have received detailed analysis: 1. Making and implementing strategic plans; the Open University's Hard Systems Methodology. 2. Controlling NHS performance through structure and process, e. g. the use of annual reviews, performance indicators; double-loop learning and cybernetic control model. 3. Improving the quality of NHS care; Stafford Beer's Viable System Model. 4. Assessing performance through the outcomes of care; Peter Checkland's Soft Systems Methodology. The areas studied in less detail are: 5. Planning for uncertainty and complexity; 6. Issues related to the politics of health; 7. Reducing the length of waiting lists and times; 8. Planning for health (health promotion and the prevention of ill health).

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11

Bennett, Cudjoe A. "Urban Health Systems Strengthening| The Community Defined Health System for HIV/AIDS and Diabetes Services in Korogocho, Kenya." Thesis, The George Washington University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10146927.

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Background: Low- and middle-income countries have been experiencing unprecedented rates of urbanization. Rapid urbanization has attributed to an upsurge in non-communicable diseases, such as diabetes, cardiovascular diseases, and cancers in these countries. Most low- and middle-income countries are also still struggling to control communicable diseases such as HIV/AIDS, tuberculosis, and malaria. This phenomenon, described as the double burden of disease, places greater strains on urban health systems and vulnerable urban populations, such as slum dwellers, who are likely to bear the brunt of any negative health outcomes. Given the potential impacts of urbanization and quality of health services on poverty and disease in the urban poor, there is urgent need to study urban health systems and the ways in which services can be made more available, accessible, and acceptable to socioeconomically disadvantaged and culturally/ethnically diverse populations.

Objectives: This dissertation is a case study that investigated the community-defined health system for Korogocho slum residents in Nairobi, Kenya. Specifically, the purpose of the research study was to (1) determine the readiness of health workers to provide HIV- and diabetes-related services, (2) define the components of the health system as perceived by Korogocho residents; that is, determine the community-defined health system, (3) assess the factors that affect health service utilization with respect to HIV/AIDS and diabetes prevention, care, and treatment, and (4) make recommendations for improving the availability, accessibility, and acceptability of health services for Korogocho residents.

Methods: The case study research employed both quantitative and qualitative methods. Three complementary peer-review quality manuscripts were developed. Manuscript 1 presents results from one of the first assessments of health provider readiness to provide HIV/AIDS- and diabetes-related services using data from the Demographic and Health Survey’s Kenya Service Provision Assessment. A cross-sectional quantitative study was conducted. Readiness was defined as health workers having the training to provide the minimum HIV/AIDS services as prescribed by key government policies. Data analysis was conducted using STATA version 13 to assess the readiness of health workers in terms of a weighted proportion of providers from facility levels 2-4 who were trained in essential HIV/AIDS- and diabetes-related services according to Kenya’s national guidelines. Manuscript 2 details the results of a qualitative inquiry to understand the community-defined health system and identify factors that influence Korogocho residents’ health utilization behavior, especially in relation to HIV/AIDS and diabetes services. Manuscript 3 utilized a qualitative assessment to determine the role of informal health providers (those who have not received a Western biomedical model of medical training) in health service delivery to the Korogocho community. In both Manuscripts 2 and 3, semi-structured interviews were conducted with community members and informal health providers, respectively. Qualitative sampling was conducted with the purpose of generating a conceptual model of the urban health system for slum residents. Analysis of semi-structured qualitative interviews with community members and informal health providers in Manuscripts 2 and 3 was completed through an iterative process using NVivo 11 for Mac.

Results: The results of this research demonstrate the complexity of urban health systems. Korogocho residents utilize health services from a variety of facilities and providers from both the formal and informal sectors. Their health utilization behavior is primarily influenced by the availability, accessibility, and acceptability of health services, health facilities, and health providers. Informal health providers play a critical role in terms of expanding the availability and accessibility of health services to Korogocho residents. The results of this case study also reveal that training levels of health providers in Nairobi for the delivery of HIV- and diabetes-related services are low. On average, 12% of health workers interviewed in the 2010 Kenya service provision assessment reported having training in the previous 2 years in the full complement of essential HIV-related services as prescribed by Kenyan Government policies. There were similar low proportions of training for the provision of diabetes-related services among the three health worker cadres included in this analysis of the 2010 Kenya service provision assessment. Moreover, the community’s perceptions of the availability and accessibility of diabetes services lagged behind HIV services.

Conclusions: The results of this research reveal key information that can impact the health systems strengthening agenda, particularly for improving the availability and accessibility of health services to the urban poor. It is also clear from this research that there is an urgent need to scale up the training of health providers to handle the current double burden of disease. Further, among socioeconomically disadvantaged populations, such as urban slums, the intentional incorporation of informal providers into the health system is a key step towards ensuring that much needed health services reach the urban poor.

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12

Wilson, Nicola Ann. "Modelling intermediate care services as part of an integrated care pathway." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20290.

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This study explores the implications of implementing enhanced or redesigned intermediate care initiatives in the Western Cape of South Africa from the 2014/15 financial year onwards. Using a dynamic modelling methodology, we developed an empirical model of an integrated care system to explain the linkages, relationships and interactions among service components and analyse the implications of one of the proposed Healthcare 2030 policy interventions - intermediate care - on hospital admissions, waiting times and length of stay of all patients. We tested and compared a number of alternative intervention points using a simulation model parameterised with service component data from the Department of Health Information Systems. The findings from the study show the inconsistencies between the perceived structure and the available data from the respective service components that describe the resultant behavioural effects on an integrated care system, especially when care pathways cross organisational boundaries. The main managerial learning was around the existence and nature of organisational boundaries that require joint working and sharing of information. We conclude from the simulation results for the alternative scenarios tested that the implementation of enhanced or redesigned intermediate care initiatives can moderate the rate of growth in the demand for hospital services by reducing a percentage of hospital readmissions.

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13

Warner, Lora Hanson. "Control of Hospital Strategy in Small Multihospital Systems." VCU Scholars Compass, 1987. https://scholarscompass.vcu.edu/etd/5086.

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Hospitals are joining multihospital systems (MHSs) with growing frequency. About 80% of MHSs are small, composed of 2-7 hospitals. An important management issue in MHSs is the extent to which member hospitals retain control over their own strategic directions. Using a contingency framework, this study uses both system and hospital—level determinants to explain the extent to which hospital members of MHSs control their own strategies. Survey and secondary data from 272 member hospitals of 62 small multi hospital systems (size 2-7 hospitals) are analyzed. System dispersion, size, ownership, strategic type, and age along with hospital occupancy, size, relationship to the MRS, and market factors are determinants of hospital control of strategy. Two types of hospital strategic decisions were revealed by factor analysis: tactical and periodic. For tactical decisions, such as those relating to hospital budgets, service additions, and formulation of strategies, Catholic system ownership is a significant predictor of greater hospital control. Prospector system strategy and older system age are significant predictors of reduced hospital control. For periodic decisions, such as appointment of hospital board members, sale of hospital assets, and changes in bylaws, older system age is negatively associated with hospital control, and a hospital which is owned by the system has significantly less control. The results are analyzed using the framework of the Hickson, Butler, Cray, Mallory, & Wilson (1986) typology of strategic decisions. Thus the results of this work can be useful to managers in identifying the nature of a decision and understanding its associated decision process.

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14

Li, Jun. "The use of child health computing systems in primary preventive care : an evaluation." Thesis, University College London (University of London), 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274686.

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15

Friedman, Nicole Lisa. "Impactful Care: Addressing Social Determinants of Health Across Health Systems." PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/5073.

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There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse. The goal of this applied research project is to examine Kaiser Permanente Northwest's patient navigator program as a case study for how health systems can transform into organizations that bridge clinical, social and behavioral health and redefine what it means to be a prevention-oriented delivery system. Kaiser Permanente Northwest (KPNW) provides high quality, patient-centered care to over 550,000 medical members and 240,000 dental members in Oregon and Southwest Washington. In conjunction with the Care Management Institute, KPNW created a patient navigator administered, social needs screening tool called "Your Current Life Situation" (YCLS). This thesis focuses on the data collected from this screening tool with an emphasis on operations management, workflows, and the technical tools that have been supported to do this work. The analysis also uses semi-structured qualitative interviews from patient navigators, physicians, social workers, community organizations and members to better understand the experience of social needs screening in clinical practice and its impact on members and community partners as they receive referrals for services outside the health care delivery system. Through using anthropological theory and methods, I seek to help health systems think and act differently by elevating the voice and experience of the community and translating vulnerable populations' needs into a language that can be integrated into multiple systems of care.

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16

Collin, Anne (Anne Claire). "Improving access through stochastic modeling in Veterans Affairs Mental Health Services." Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104817.

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Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society, Technology and Policy Program, 2016.
This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 85-88).
In this thesis, I created a tool for a particular VA clinic to simulate the delays veterans face in a network of mental health programs. Based on queueing theory, including blocking and reneging, different operations management strategies are compared using this discrete event simulation tool. To simulate wait times, users input arrival rates, service times, patience, probabilities of relapses and probabilities to go from one program to another. We determine that blocking is one of the main drivers of the delays. This model is not only useful for direct decision making, such as increasing capacity in one of the programs, but also to enable systems thinking in the VA. Indeed, if more quantitative methods were used at different levels of the organization, managers could take more informed decisions faster. This also prompts for rigorous data collection, which is something the VA needs, especially wait times for mental health clinics.
by Anne Collin.
S.M. in Technology and Policy

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17

Lee, Fock Choy. "A quantitative performace measurement framework for health care systems." Diss., Columbia, Mo. : University of Missouri-Columbia, 2006. http://hdl.handle.net/10355/4583.

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Thesis (M.S.) University of Missouri-Columbia, 2006.
The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file viewed on (June 26, 2007) Includes bibliographical references.

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18

Mitchell, Penelope Fay. "Mental health care roles and capacities of non-medical primary health and social care services : an organisational systems analysis /." Connect to thesis, 2007. http://eprints.unimelb.edu.au/archive/00003854.

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19

Chadwick, Lionel Kevin. "Incentives influencing general practitioners in selected Western European health systems : a 1985 comparative study." Thesis, London School of Economics and Political Science (University of London), 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364370.

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20

Schira, Norma. "A Survey of Health Promotion Activities of Health Systems Agencies." TopSCHOLAR®, 1986. http://digitalcommons.wku.edu/theses/1980.

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The National Health Planning and Resources Development Act. Public Law 93-641, the last major step in the regulation of the health care system, created a network of health system agencies and state level health planning agencies. Subsequent legislation, the Health Planning and Resources Development Amendment 1929, Public Law 96-79, amended 1974 Law and changed the role and function of health systems agencies to include more regulatory activities. By 1981, the activities of Health System Agencies were being curtained by the action of the Reagan administration. The Health promotion/wellness movement which seeks to improve health has been developing as a compliment to medical medicine for several years. Previous research has determined that health systems agencies were active in health promotion and identified several planning and implementation activities related to this involvement. This is a survey of health systems agencies to determine their efforts in healthy promotions. Resources allocated to these activities, and opinions of the director relevant to agency involvement in health promotion. All active healthy system agencies listed in the 1980. Directory of Health System Agencies (DHSH) were surveyed by a mailed questionnaire. Reponses were receive from 112 agencies (57%) and the respondents were found to be representative of the population. The results revealed health systems agencies to be involved in health promotion. More than 90 percent of the responders listed some type of health promotion activity in their Healthy System Plans for the 1979-1980 planning year. Approximately half of the responders reported some community activity in health promotion. The majority of executive directors saw health systems agencies as being only moderately effective in controlling health care costs: considered healthy promotion as a viable means of controlling health care cost: and believed that modifications of individual life-styles had the greatest potential for improving health status. The survey revealed that Healthy System Agencies did not restrict the wellness/health promotion activities to traditional health facilities, but were defining health broadly and working with a variety of agencies to develop services.

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21

Scott, Shane P. (Shane Paul). "Network governance for the provision of behavioral health services to the US Army." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/79535.

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Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, 2012.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 230-234).
Under a charter from the Chairman of the Joint Chiefs of Staff, the author participated in a study of the military's behavioral health system for the purpose of determining the means and effectiveness of that system for the treatment of PTSD and related conditions. This work focuses on the architecture and means of control over the existing arrangement of semi-independent enterprises, organized into functional work groups that necessarily collaborate to provide a full spectrum of behavioral health services to service members and their families. The author suggests a rearrangement of the system architecture to enable integrated work across organizational boundaries in order to reduce waste generated through structural inefficiencies. Implementation of network architecture and control relies heavily on the development of shared strategic objectives that direct network processes in supporting overall organizational goals. Further, performance measurement systems and stakeholder behavior change through use of incentives are used as the drivers of inter-enterprise process development. Finally, a governance structure, focused on development of integrative processes and outcomes is established to foster inter-organizational relationships, direct process improvement, and resolve system conflicts.
by Shane P. Scott.
S.M.

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22

Frascina, Anthony Cosimo. "The integration of hospital information systems through user centred design." Thesis, Sheffield Hallam University, 1994. http://shura.shu.ac.uk/3185/.

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The development of computer systems in UK hospitals has in recent years been focused on the provision of hospital-wide information systems, known as Hospital Information Support Systems (HISS). This development has been motivated by National Health Service reforms and a realisation that earlier fragmented systems were not meeting the requirements of clinical and nursing staff in the most effective way. Such systems were often developed by external, centralised agencies using systems analysis techniques appropriate to the development of information systems in product orientated organisations. However, the hospital ward, an environment existing at the 'sharp end' of health care, in which many diverse and non-computer related activities take place, presents the system designer with many of the classic problems with which the discipline of Human Computer Interaction (HCI) is concerned. Although a HISS has the potential to improve both the work conditions of clinical staff and the delivery of health care, this may be impeded by many of the common obstacles associated with the introduction of a large and complex computer system into a work environment where tasks are ill defined. This thesis reports on a project that is based upon the application of HCI methods to the health care environment and their contribution to the solution of the problems that such an environment presents. Requirements for the users' interface to the potential HISS are derived using a task analytic approach, involving Task Analysis for Knowledge Descriptions (TAKD). A prototype system has been designed and subsequently evaluated in a hospital ward. The contribution of TAKD to the design and its further applicability to the environment are assessed. The research represents an original application of a formal task analysis method to the design of ward based computer systems, and as such makes a valuable contribution to the areas of medical informatics and HCI. It shows that TAKD has real but limited applicability in this sphere, in that its use can lead to the design of more usable interfaces, while there is a need to combine it with methods aimed at broader systems design if these benefits are to accrue in the development of a HISS. The potential for the integration of task analysis with Design Rationale methods is also demonstrated.

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23

Keen, Justin Robert. "A systems approach to modelling services for people with dementia." Thesis, City University London, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.245863.

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24

Harris, Jenine K., Kate E. Beatty, J. P. Leider, Alana Knudson, Britta L. Anderson, and Michael Meit. "The Double Disparity Facing Rural Local Health Departments." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6825.

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Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.

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25

Shoopala, Anna-Liisa. "Design of a backend system to integrate health information systems – case study: ministry of health and social services (MoHSS)-Namibia." Master's thesis, Faculty of Engineering and the Built Environment, 2021. http://hdl.handle.net/11427/34011.

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Information systems are the key to institution organization and decision making. In the health care field, there is a lot of data flow, from the patient demographic information (through the electronic medical records), the patient's medication dispersal methods called pharmaceutical data, laboratory data to hospital organization information such bed allocation. Healthcare information system is a system that manages, store, transmit and display healthcare data. Most of the healthcare data in Namibia are unstructured, there is a heterogeneous environment in which different health information systems are distributed in different departments [1][2]. A lot of data is generated but never used in decision-making due to the fragmentation. The integration of these systems would create a flood of big data into a centralized database. With information technology and new generation networks becoming a called for innovations in every day's operations, the adaptations of accessing big data through information applications and systems in an integrated way will facilitate the performances of practical work in health care. The aim of this dissertation is to find a way in which these vertical Health Information System can be integrated into a unified system. A prototype of a back-end system is used to illustrate how the present healthcare systems that are in place with the Ministry of Health and Social Service facilities in Namibia, can be integrated to promote a more unified system usage. The system uses other prototypes of subsystems that represent the current systems to illustrate how they operate and, in the end, how the integration can improve service delivery in the ministry. The proposed system is expected to benefit the ministry in its daily operations as it enables instant authorized access to data without passing through middlemen. It will improve and preserve data integrity by eliminating multiple handling of data through a single data admission point. With one entry point to the systems, manual work will be reduced hence also reducing cost. Generally, it will ensure efficiency and then increase the quality of service provided.

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26

Timmons, Stephen. "Resistance to computerised care planning systems by nurses in the NHS." Thesis, Anglia Ruskin University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368274.

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27

Casino, Cembellin Francisco Jose. "Privacy-Preserving Crowdsourcing-Based Recommender Systems for E-Commerce & Health Services." Doctoral thesis, Universitat Rovira i Virgili, 2017. http://hdl.handle.net/10803/456380.

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En l’actualitat, els sistemes de recomanació han esdevingut un mecanisme fonamental per proporcionar als usuaris informació útil i filtrada, amb l’objectiu d’optimitzar la presa de decisions, com per exemple, en el camp del comerç electrònic. La quantitat de dades existent a Internet és tan extensa que els usuaris necessiten sistemes automàtics per ajudar-los a distingir entre informació valuosa i soroll. No obstant, sistemes de recomanació com el Filtratge Col·laboratiu tenen diverses limitacions, com ara la manca de resposta i la privadesa. Una part important d'aquesta tesi es dedica al desenvolupament de metodologies per fer front a aquestes limitacions. A més de les aportacions anteriors, en aquesta tesi també ens centrem en el procés d'urbanització que s'està produint a tot el món i en la necessitat de crear ciutats més sostenibles i habitables. En aquest context, ens proposem solucions de salut intel·ligent (s-health) i metodologies eficients de caracterització de canals sense fils, per tal de proporcionar assistència sanitària sostenible en el context de les ciutats intel·ligents.
En la actualidad, los sistemas de recomendación se han convertido en una herramienta indispensable para proporcionar a los usuarios información útil y filtrada, con el objetivo de optimizar la toma de decisiones en una gran variedad de contextos. La cantidad de datos existente en Internet es tan extensa que los usuarios necesitan sistemas automáticos para ayudarles a distinguir entre información valiosa y ruido. Sin embargo, sistemas de recomendación como el Filtrado Colaborativo tienen varias limitaciones, tales como la falta de respuesta y la privacidad. Una parte importante de esta tesis se dedica al desarrollo de metodologías para hacer frente a esas limitaciones. Además de las aportaciones anteriores, en esta tesis también nos centramos en el proceso de urbanización que está teniendo lugar en todo el mundo y en la necesidad de crear ciudades más sostenibles y habitables. En este contexto, proponemos soluciones de salud inteligente (s-health) y metodologías eficientes de caracterización de canales inalámbricos, con el fin de proporcionar asistencia sanitaria sostenible en el contexto de las ciudades inteligentes.
Our society lives an age where the eagerness for information has resulted in problems such as infobesity, especially after the arrival of Web 2.0. In this context, automatic systems such as recommenders are increasing their relevance, since they help to distinguish noise from useful information. However, recommender systems such as Collaborative Filtering have several limitations such as non-response and privacy. An important part of this thesis is devoted to the development of methodologies to cope with these limitations. In addition to the previously stated research topics, in this dissertation we also focus in the worldwide process of urbanisation that is taking place and the need for more sustainable and liveable cities. In this context, we focus on smart health solutions and efficient wireless channel characterisation methodologies, in order to provide sustainable healthcare in the context of smart cities.

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28

Al-umaran, Saleh. "Culture dimensions of information systems security in Saudi Arabia national health services." Thesis, De Montfort University, 2015. http://hdl.handle.net/2086/11393.

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The study of organisations’ information security cultures has attracted scholars as well as healthcare services industry to research the topic and find appropriate tools and approaches to develop a positive culture. The vast majority of studies in Saudi national health services are on the use of technology to protect and secure health services information. On the other hand, there is a lack of research on the role and impact of an organisation’s cultural dimensions on information security. This research investigated and analysed the role and impact of cultural dimensions on information security in Saudi Arabia health service. Hypotheses were tested and two surveys were carried out in order to collect data and information from three major hospitals in Saudi Arabia (SA). The first survey identified the main cultural-dimension problems in SA health services and developed an initial information security culture framework model. The second survey evaluated and tested the developed framework model to test its usefulness, reliability and applicability. The model is based on human behaviour theory, where the individual’s attitude is the key element of the individual’s intention to behave as well as of his or her actual behaviour. The research identified a set of cultural and sub-cultural dimensions in SA health information security and services.

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29

Maguire, Stuart. "The development of a methodology for the introduction of information systems within the National Health Service." Thesis, Lancaster University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287250.

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This thesis represents over five years of research focusing on the development and implementation of information systems within the National Health SefV1ce. It aims to contribute towards a better understanding of the information systems development process from inception through to system evaluation and review. Five long-term interventions have been undertaken in a range of National Health Service sites, examining different aspects of information provision. The length of the interventions ranged from nine months to almost two years. The five sites were all at different stages of system development. The research has been carried out using a combination of participant observation and action research. This has meant working with National Health Service staff on a series of system projects. The aim of the research is to try and help National Health Service (NHS) organisations deal more successfully with their information provision. The research question asks, "how can NHS organisations think about, and hence go about their information provision in such a way that successful information systems are introduced'!". Information systems development has generally been regarded as a technical discipline. This has led to a narrow view being taken of a number of areas that may affect the success or otherwise of system projects. Historically, the system development process has been concentrated in the hands of a small number of experts even though the implementation of systems can have far-reaching consequences for the organIsation. The output of the research is a set of issues that should be addressed when introducing information systems within the NHS. These have been translated into the OASES materials which form the appendices. OASES is not a prescriptive methodology but a set of principles and guidelines to try and improve the way that information systems are developed within the NHS. It IS hoped that the outcome of the research will be a situation in which effective information systems are developed that take account of the behavioural, cultural, and organisational issues that are important within complex organisations.

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30

Khan, Jahanzeb, and Muzammal Shahzad Arif. "Investigating the behaviour intention to use e-health services by Swedish Immigrants." Thesis, Örebro universitet, Handelshögskolan vid Örebro Universitet, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-39574.

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31

Nolan, Michael Robert. "Timeshare beds : a pluralistic evaluation of rota bed systems in continuing care hospitals." Thesis, Bangor University, 1991. https://research.bangor.ac.uk/portal/en/theses/timeshare-beds--a-pluralistic-evaluation-of-rota-bed-systems-in-continuing-care-hospitals(5cbe7718-983f-4e5d-a6f6-ced07a4d4a36).html.

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This thesis reports the results of a pluralistic evaluation of rota bed systems providing respite care to carers of the dependent elderly. Using a multi-method triangulated design the study examines: the sources and determinants of carers' stresses and rewards; the subjective views of the main stakeholder groups as to the benefits and problems of the rota bed system; the rota bed experience as indicated by the environment and regime of care and the activity levels of rota bed users at two contrasting continuing care hospital wards. Using data from a national sample survey of members of the Association of Carers, convincing empirical support is provided for the transactional approach to the understanding of carer stress. In addition the results extend the conceptualisation of caring to include sources of satisfaction. The benefits and problems of the rota bed system are explicated and, on the basis of these suggestions are made as to how both respite care and related services to carers might be improved. Within the context of recent policy initiatives consideration is given to the nature of professional responses to carers and their dependants with particular reference to the role of the nursing profession.

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32

Gomes, Mafalda Cristina Almeida. "The impact of the economic crisis on the quality of health services." Master's thesis, NSBE - UNL, 2014. http://hdl.handle.net/10362/11761.

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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics
purpose of this project is to analyze the impact of the crisis on the quality of health care provided, as well as the extent in which the levels of quality were affected by the decrease in resources and increase in patients’ health problems. By using patient level data from the DRG database, the effects will be estimated taking into account the demand and supply side factors, individual and illness’ episode characteristics. Results convey a deterioration of the quality indicators from 2009 to 2010. However, unemployment, a variable characterizing the crisis due to its magnitude, showed to have no significance statistically. Finally, the results also suggest that, the effects of the crisis created pressure in the financial situation of the hospitals, which led to inferior quality health services.

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33

Winkelmann, Regina Anette. "Evaluation of cancer surveillance systems in the New Independent States of the former Soviet Union." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299377.

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34

Gremu, Chikumbutso David. "Building an E-health system for health awareness campaigns in poor areas." Thesis, Rhodes University, 2015. http://hdl.handle.net/10962/d1017930.

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Appropriate e-services as well as revenue generation capabilities are key to the deployment and the sustainability for ICT installations in poor areas, particularly common in developing country. The area of e-Health is a promising area for e-services that are both important to the population in those areas and potentially of direct interest to National Health Organizations, which already spend money for Health campaigns there. This thesis focuses on the design, implementation, and full functional testing of HealthAware, an application that allows health organization to set up targeted awareness campaigns for poor areas. Requirements for such application are very specific, starting from the fact that the preparation of the campaign and its execution/consumption happen in two different environments from a technological and social point of view. Part of the research work done for this thesis was to make the above requirements explicit and then use them in the design. This phase of the research was facilitated by the fact that the thesis' work was executed within the context of the Siyakhula Living Lab (SLL; www.siyakhulaLL.org), which has accumulated multi-year experience of ICT deployment in such areas. As a result of the found requirements, HealthAware comprises two components, which are web-based, Java applications that run in a peer-to-peer fashion. The first component, the Dashboard, is used to create, manage, and publish information for conducting awareness campaigns or surveys. The second component, HealthMessenger, facilitates users' access to the campaigns or surveys that were created using the Dashboard. The HealthMessenger was designed to be hosted on TeleWeaver while the Dashboard is hosted independently of TeleWeaver and simply communicates with the HealthMessenger through webservices. TeleWeaver is an application integration platform developed within the SLL to host software applications for poor areas. Using a core service of TeleWeaver, the profile service, where all the users' defining elements are contained, campaigns and surveys can be easily and effectively targeted, for example to match specific demographics or geographic locations. Revenue generation is attained via the logging of the interactions of the target users in the communities with the applications in TeleWeaver, from which billing data is generated according to the specific contractual agreements with the National Health Organization. From a general point of view, HealthAware contributes to the concrete realizations of a bidirectional access channel between Health Organizations and users in poor communities, which not only allows the communication of appropriate content in both directions, but get 'monetized' and in so doing becomes a revenue generator.

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35

Jones, R. T. "The development of the medical laboratory scientific officer profession : Qualifying systems, professional politics and technical change." Thesis, University of Sussex, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.373914.

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36

Nganda, Benjamin Musembi. "Structural reform of the Kenyan health care system." Thesis, University of York, 1994. http://etheses.whiterose.ac.uk/14168/.

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37

Mtwazi, L. M. "A district health system for Khayelitsha." Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51564.

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Thesis (MPA)--Stellenbosch University, 2000.
ENGLISH ABSTRACT: Sharp divisions featured between curative and preventative health care in the Public Health Services of South Africa before the democratisation process. There was fragmentation in authority structures and inequalities between urban and rural areas as well as along racial lines. This resulted in a situation where there was duplication and inequality in the distribution of resources amongst the different levels of health care which led to costly inefficient and ineffective health services. The introduction of the White Paper Towards the Transformation of Health System in South Africa in 1997, aims at the restructuring of health services towards a unified health system which is capable of delivering quality health care to all in a caring environment. The District Health System (DHS) is featured as the key to ensuring decentralised, equitable Primary Health Care (PHC) to all the citizens of South Africa. This study looks at the reorganisation of health services in the clinics and the day hospitals which are rendered by the Health Department of The City of Tygerberg and the Community Health Service Organisation (CHSO) of the Provincial Administration of the Western Cape(P AWC) in Khayelitsha with the aim of achieving comprehensive PHC services. Inthe absence of legislation for the integration of health services, initiatives for the achievement of quality comprehensive PHC within the district are envisaged.
AFRIKAANSE OPSOMMING: Openbare Gesondheidsdienste in Suid Afrika was voor die demokratieseringsproses gekenmerk deur 'n skeidig tussen kuratiewe en voorkomende gesondheidsdienste. Daar was fragmentasie van bestuurstrukture, ongelykheid tussen stedelike en landelike gebiede asook ongelykheid op grond van ras. Dit het gelei tot duplisering van, en ongelykheid in, die verspreiding van hulpbronne op die verskillende vlakke van gesondheidssorg. Die Witskrif op die Transformasie van Gesondheidstelsels in Suid-Afrika, 1997, fokus op die herstrukturering van gesondheidsdienste en het 'n verenigde gesondheidstelsel ten doel wat daartoe in staat is om gehalte gesondheidsorg in 'n sorgsame omgewing aan almal te lewer. Die Distriksgesondheidstelsel (DGS) word gekenmerk deur gedesentraliseerde, gelykmatige Primêre Gesondheidsorg (PGS) dienslewering aan al die inwoners van Suid-Afrika. Hierdie studie kyk na die herorganisering van gesondheidsdienste wat deur die gesondheidsdepartement van die Stad Tygerberg en die Gemeenskapsgesondheidsdiens organisasie van die Provinsiale Administrasie van die Wes-Kaap (PAWK) in die klinieke en daghospitale in Khayelitsha gelewer word met die doel om omvattende Primêre Gesondheidsorgdienste te voorsien. Weens die afwesigheid van wetgewing vir die integrasie van gesondheidsdienste word inisiatiwe vir die bereiking van gehalte omvattende Primêre Gesondheidsorg binne die distrik beoog.

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38

Miller, Bruce M. "Medicare subvention and the Military Health Services System." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 1995. http://handle.dtic.mil/100.2/ADA305882.

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39

Kanu, Alhassan Fouard. "Health System Access to Maternal and Child Health Services in Sierra Leone." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7394.

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The robustness and responsiveness of a country's health system predict access to a range of health services, including maternal and child health (MCH) services. The purpose of this cross-sectional study was to examine the influence of 5 health system characteristics on access to MCH services in Sierra Leone. This study was guided by Bryce, Victora, Boerma, Peters, and Black's framework for evaluating the scaleup to millennium development goals for maternal and child survival. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment dataset, which comprised 100% (1, 284) of the country's health facilities. Data analysis included bivariate and multivariate logistic regressions. In the bivariate analysis, all the independent variables showed statistically significant association with access to MCH services and achieved a p-value < .001. In the multivariate analysis; however, only 3 predictors explained 38% of the variance (Rï¿½ = .380, F (5, 1263) = 154.667, p <.001). The type of health provider significantly predicted access to MCH services (Î² =.549, p <.001), as did the availability of essential medicines (Î²= .255, p <.001) and the availability of basic equipment (Î²= .258, p <.001). According to the study findings, the availability of the right mix of health providers, essential medicines, and basic equipment significantly influenced access to MCH services, regardless of the level and type of health facility. The findings of this study might contribute to positive social change by helping the authorities of the Sierra Leone health sector to identify critical health system considerations for increased access to MCH services and improved maternal and child health outcomes.

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40

Bekui, A. M. "A health management information system for the district health services in Ghana." Thesis, University of Leeds, 1990. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492369.

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41

MacDonald, Morag. "HIV and AIDS in prison : a comparative analysis of the Italian and English and Welsh prison systems." Thesis, Birmingham City University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272094.

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42

Sines, David Thomas. "Valuing the carers : an investigation of support systems required by mental handicap nurses working in residential services in the community." Thesis, University of Southampton, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.305651.

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43

Gray, C. J. "Electronic health record systems in a centralized computing services environment| critical success factors for implementation." Thesis, Robert Morris University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3628910.

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In 2009 the American Recovery and Reinvestment Act (ARRA) was signed into law. As part of ARRA, the HITECH Act set aside $29 billion in Medicare and Medicaid incentives for healthcare organizations. To collect these incentives, healthcare organizations must install an electronic health record (EHR) system and achieve meaningful use. Implementation of an EHR must be completed by 2015 in order to acquire any of the incentives available. Small medical practices consisting of one to five physicians are finding it easier to implement a cloud-based EHR system due to minimal upfront costs and no need for technical capabilities within the medical practice. This study was done using a modified Delphi technique developed by Roy Schmidt to find critical success factors for the implementation of electronic health record systems within a centralized computing services structure. For purposes of this study a centralized computing services structure was considered a cloud or cloud-based environment.

This study found that the top five critical success factors for the implementation were the following: (1) EHR Training – implementing a strong training / education process for EHR users; (2) Usability – practical application of EHR features in a real medical office setting; (3) Reliability – Specifically high levels of redundancy and system availability. If the system is down, patient safety is a risk, and that is an unacceptable norm; (4) Strong clinical representation in the project to ensure workflows, processes and education needs are met; (5) Support services such as deployment / implementation services, help desk, and online support. Of these five factors, four are actually related to usability of the system, and not necessarily strictly based on implementation. This leads us to believe that the success of an implementation is reliant upon user perception based on system usage.

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44

Rodriguez, Adriana. "Stakeholder Views on Children’s Mental Health Services." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2891.

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Identification of evidence-based treatments (EBTs) has been an important development; however recently, some shortcomings of the approach have been highlighted. These complexities have led to a surge in transportability research in mental health services science with goals of identifying needed strategies to encourage the adoption of innovations. The mental health system ecological (MHSE) model is an approach necessary to assist with closing this gap effectively as it integrates mental health contexts: client-level, provider-level, intervention-specific, service delivery, organizational, and service system characteristics. The aim of this study is to use the MHSE model to examine perspectives of mental health stakeholders on their needs. Data consists of qualitative transcripts from parent, therapist, and administrator interviews/focus groups. Mixed methods were used to develop and analyze codes according to the MHSE model. Results suggested that stakeholder groups mentioned needs relevant to the group of interest and thus have implications for future dissemination efforts.

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45

Weng, Chao. "A pilot evaluation study on benefits of a record linkage between a hospital diabetes database and the information systems within the NHS." Thesis, King's College London (University of London), 2000. https://kclpure.kcl.ac.uk/portal/en/theses/a-pilot-evaluation-study-on-benefits-of-a-record-linkage-between-a-hospital-diabetes-database-and-the-information-systems-within-the-nhs(065d944e-29fe-442e-a981-15012719d063).html.

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46

Mazur, Lukasz Maciej. "The study of errors, expectations and skills for medication delivery systems improvement." Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/mazur/MazurL0508.pdf.

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Medication errors occurring in hospitals are a growing national concern. The enormous gaps in knowledge related to medication errors are often seen as major reasons for increased patient safety risks and increased waste in the hospital setting. However, little research effort in industrial and management engineering has been devoted specifically to medication delivery systems to improve or optimize their operations in terms of patient safety and systems efficiency and productivity. As a result, the current literature does not offer integrated solutions to overcome the workflow and management difficulties with medication delivery. Therefore, a better understanding of workflow and management sources of medication errors is needed to help support decisions about investing in strategies to reduce medication errors. Using qualitative and quantitative research methods the work reported in this dissertation makes several contributions to the existing body of knowledge. First, using healthcare professionals' perceptions of medication delivery system, a set of simple and logical workflow design rules are proposed. If properly implemented, the proposed rules are capable of eliminating the unnecessary variations in the process of medication delivery which cause medication errors and waste. Second, a theoretical model of 'expectations' for effective management of medication error reporting, analysis and improvement is provided. The practical implication of this theoretical model extends to effective management strategies that can increase feelings of competence and help create a culture that values improvement efforts. Third, eight propositions for effective use of a systems engineering method (in this research the "Map-to-Improve" (M2I) method) for medication delivery improvement are offered. Finally, a set of skills needed for future healthcare professionals to effectively use systems engineering methods is provided. The proposed insights into these areas can result in improved pedagogy for professional development of healthcare professionals. The practical implication extends to the development of better methods for healthcare systems analysis. In summary, the author of this research work hopes that the findings and discussions will help healthcare organizations to achieve satisfactory improvement in medication delivery.

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47

Mazza, Jessica. "Organizational culture in children's mental health systems of care." [Tampa, Fla] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002351.

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48

Mangan, Brian Gerard. "The implementation and evaluation of a quality assessment and quality improvement system in mental health services within a health board." Thesis, Queen's University Belfast, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301742.

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49

Zangana, Goran Abdulla Sabir. "Understanding Iraq's basic health services package : examining the domestic and external politics of post-conflict health policy." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/25905.

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Background: Iraq is a higher middle-income country with a GDP of $223.5 billion (as of 2014). In the 1970s and 1980s, an extensive network of primary, secondary and tertiary health facilities was built, and the country recorded some of the best health indicators in the Middle East. However, two decades of conflict (both inter- and intra-state), sanctions and poor planning have reversed many of the previous gains. In the aftermath of the 2003 war, the government of Iraq introduced a Basic Health Services Package (BHSP) with a user fee component. International actors often advocate BHSPs as a means of rapidly scaling-up services in health systems that are devastated by conflict. User fees have also been promoted as a way of raising revenue to enhance the financial sustainability of healthcare systems in such contexts. While Iraq is a conflict-affected state, it has retained an extensive healthcare infrastructure and has a ministry of health with considerable financial and administrative capacity. In such a context, the introduction of a BHSP is a notable and distinctive feature of health policy in this setting, and the process through which this occurred have not yet been examined. Aim: To explore the processes through which the BHSP was conceived and designed in Iraq. It compares Iraq’s BHSP with similar policies in other post-conflict settings. It examines the roles of domestic and external actors and models in the policy’s conception and design. It explores the preferences of internal and external actors about the financing of service delivery through user fees. The study also examines the extent of policy transfer in the formulation of Iraq’s BHSP. Methodology: The thesis utilises a qualitative case study approach, incorporating analysis of semi-structured elite interviews and documents. Twenty Skype, phone, and face-to- face interviews were conducted between January 2013 and August 2014. Interviewees included former ministers of health, directors of departments of health, academics and officials at donor agencies, bilateral and multi-lateral bodies and consultancies. Documents included 47 official government publications, evaluations, reports, policy briefs and assessments. Literature review: A search of the literature on health policy making in post-conflict and fragile settings identified three key gaps in existing evidence; first, there is a dearth of published work examining health policy in post-conflict Iraq. Second, the literature focuses mainly on the impact of policy action in post-conflict contexts, largely neglecting the processes through which those policies are introduced. Third, while the literature concentrates on the roles of external actors, it pays limited attention to the role of domestic actors and politics. Results: Iraq’s BHSP shares commonalities with the other selected countries (Uganda, Afghanistan, and Liberia) in its primary aims, influential actors, interventions included or excluded, and financing principles. However, Iraq’s BHSP also aims at broader, and longer-term, structural reform, while the BHSP in other countries is often motivated by short-term objectives. The MoH in Iraq also appears to assume a prominent role in this case relative to others. Also, Iraq’s BHSP includes a greater number of interventions compared to the other countries. The Iraq war of 2003 offered the opportunity for wide-ranging structural change in the healthcare system. External actors, especially the WHO, were influential in advocating for a BHSP drawing on the recent experience of a similar initiative in what was in some ways the similar context of Afghanistan. However, the removal of former politicians and the emergence of internal policy actors with considerable technical and financial capacity allowed the domestic authorities to debate, dispute and challenge the recommendations of external actors. Relatedly, some of the internationally distinctive features of the BHSP in Iraq, including user fees, are similar to those that exist elsewhere in the health system. Most interviewees agreed that the BHSP was a means of enhancing financial sustainability and that it would help to enhance efficiency by targeting resources at population health need. The BHSP, according to some, represented the categories of healthcare that the government should finance, while allowing the private sector to meet demand for other services. However, many domestic actors supported the introduction of user fees as part of the BHSP. Several external actors either distanced themselves from this decision or declared no position, claiming that this was properly a matter for the government of Iraq. Discussion: While the BHSP’s ‘label’ is new in the context of Iraq, its substantive content is not. The BHSP can be seen as the outcome of the combination of old (existing) technologies and instruments presented in new (and introduced) ways. The existing health system offered ideas, techniques and processes that were maintained and reproduced even if these were packaged in new ways, to create a policy framework which is genuinely novel. External experts highlighted the idea of the BHSP and provided models (such as Afghanistan) on which the policy could be based. Internal decision-makers, however, were active players in policy formulation, not passive recipients who did not question or modify the policy during the process of transfer. On the contrary, it seems that the latter exerted considerable influence. User fees represent one aspect of that continuity. Ownership of policies by ministries of health in post-conflict is often advocated. However, such involvement introduces the potential for replicating old structures and policies, and may result in a degree of policy incoherence. Policy ideas are likely to change significantly where there is considerable local engagement in policy design and implementation.

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Carney, Philip Sheridan. "Managed healthcare and integrated delivery systems: A model for getting ahead of the change curve." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2103.

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Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.

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Дисертації з теми "Health services and systems"

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