Dissertations / Theses: 'Clinical governance'

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Freeman, Timothy. "Measuring progress in clinical governance." Thesis, University of Birmingham, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.402507.

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Staniland, K. M. "Clinical governance and nursing : a sociological analysis." Thesis, University of Salford, 2007. http://usir.salford.ac.uk/2062/.

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The primary focus for this Thesis is an account of the degree to which nurses and other stakeholders in one National Health Service hospital Trust have responded to the ‘clinical governance’ initiative, the effects on quality improvement and professional regulation and the practical accomplishment of legitimacy. ‘Clinical governance’ involves demonstrating that quality assurance is routine practice within every healthcare organization. A case study was undertaken, using broadly ethnographic methods. The qualitative data were obtained by documentary analysis, non-participant observation of meetings and day-to-day ward activity and semi-structured interviews. In terms of the analysis of documents and observation of meetings, new institutionalism theory was found to be useful as a framework for understanding the political and ceremonial conformity that marked the clinical governance process. Errors and inconsistencies were found in formal documentation and the Trusts’ reporting systems were fraught with problems. Nevertheless, during the same period the Trust obtained national recognition for having appropriate structures and systems in place in relation to clinical governance. A grounded theory approach was adopted in the analysis of the semi-structured interviews. Emerging themes from interview data were identified under the main categories of: ‘Making Sense,’ ‘Knowledge Construction,’ ‘Somebody Else’s Job’ and ‘Real Work.’ It was concluded that at a practice level, clinical governance was poorly understood and that the corporate organizational goals were ambiguous and seen as unrealistic on a day-to-day basis. The study concludes that what is happening is not a ‘failure’ but an unintended consequence that has resulted from an inadequate understanding of how organizations work. It is suggested that the organization has conformed to the appropriate standards in order to survive legitimately, but the ultimate impact of clinical governance on the quality of care in practice is inconsistent.

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Nasr, Joseph Antoine. "Hospital governance in Lebanon : corporate and clinical governance in non-profit private hospitals." Thesis, University of Brighton, 2017. https://research.brighton.ac.uk/en/studentTheses/b678a511-2cda-46a6-982b-8f87bca20980.

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There are multiple internal and external governance mechanisms intended to ensure the functioning of corporations, while maintaining the interests of stakeholders. Although corporate governance is a growing area of research, empirical research is restricted. This research study critically examines historical definitions of corporate governance. It explains the relationship of corporate and clinical governance and explores clinical governance as a subset of hospital governance. It aids an understanding of hospital governance through an examination of the governance of a sample of nonprofit Lebanese hospitals. It examines the relationship of governance with performance. It explores how managers and clinicians are incentivized and the relationship of this to performance. It compares the governance processes between three hospitals and examines the influence of external factors. Mixed methods are used, including quantitative surveys that are developed and explored using factor analysis, and qualitative semi-structured interviews. The findings are used to critically examine major corporate governance theories and their relevance to understanding hospital governance, by understanding the perspectives of those employed in the hospitals. Using critical realism as a theoretical framework, the findings show how the mechanisms of hospital governance are perceived. The survey data from 207 participants were subjected to principal components analysis which resulted in a single factor solution representing individual perceptions of hospital governance for all respondents. The results of perceptions differed according to differences in managerial role, management experience, management education, leadership role, number of years working at the hospital, current role, and the hospital studied. Differences in age and gender had no significant effect. Findings also revealed that clear methods of performance measurement were perceived to be in used in each of the three hospitals, with a good knowledge of the used performance measurement. Hospitals have a good mission, and clear structures. There is a good knowledge of the external stakeholders to the hospitals and their roles, and the involvement of external stakeholders in hospitals is proven to be core to their overall ability to function. The hospitals have good clinical performance and governance systems in terms of quality and safety. On the other hand, there are management deficits. There is an absence of monetary incentives which was mainly caused by corporate governance events represented by a conflict of interest case. This appeared to be caused by the minor role of the board of directors, accompanied with the lack of adequate background, knowledge, and education of its members, resulting in a lack of control over the CEO. These corporate governance events were shown to change interviewees‘ perception of hospital governance. The hospitals also had problems with the internal reporting systems. The contribution of this study lies in illuminating the employees‘ perspectives of corporate governance in the hospital settings. It questions and informs theoretical approaches to the traditional principal-agent and stakeholder models. It creates tools for measuring clinicians‘ and managers‘ perceptions of hospital governance where they work. It shows how corporate governance ̳events‘ affect both clinical and corporate governance. It provides evidence of the importance of the stakeholder approach to hospital governance and demonstrates the influence of external factors on internal hospital governance.

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Cameron, Michelle. "The influence of emotion labour and health discipline rules on the writing and use of health governance documents." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/232768/1/Michelle_Cameron_Thesis.pdf.

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This research explored the generation of emotion and its management for health governance writers and clinicians. It examined health governance process and document content. The thesis provides insight into how emotion management on the part of health discipline members influences governance document content and implementation. It further provides the identification of organisational elements that may improve clinician participatory governance engagement.

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Latham, Linda Ann. "Clinical governance : a study of implementation : a study of change." Thesis, University of Birmingham, 2003. http://etheses.bham.ac.uk//id/eprint/291/.

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The concept of clinical governance was first introduced to the National Health Service in the White Paper published in 1997 (Department of Health); it has been described as the 'linchpin' of the quality reforms and, as of April 1999, is one of the statutory duties placed on NHS Trust Boards. Clinical governance is defined as: 'A framework through which NHS organisations are accountable for continuously improving the quality if their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.' (Department of Health, 1998; p33). The research project upon which this thesis is based took place over an 18 month period and has followed one NHS Trust as it implemented this new policy. Implementation may be conceptualised as both a change process and an end state; to capture this duality, two broad research questions are posed namely: what constitutes the local clinical governance agenda (content) and how has clinical governance been implemented (process). Given that the main purpose of these research questions is to explore and describe, an overarching qualitative framework has been adopted and, within this, an action research approach utilised

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Tiwari, Shashank Shekhar. "The ethics and governance of stem cell clinical research in India." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/14585/.

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India is rapidly becoming established as a major player in the stem cell sector. However, concerns have been raised about the use of unproven stem cell therapies and the exploitation of parents for cord blood banking. This study aims to explore the nature of stem cell activities, how key stakeholders generate expectations around them and frame the ethical issues they raise, and why the biomedical governance system is unable to regulate these emerging practices. The study involved a survey, documentary analysis and qualitative interviews with key scientists, clinicians, representatives of firms and policymakers. The thesis observes that, unlike international commentaries which largely focus on embryonic stem cell treatments, in India it is adult and cord blood stem cells which are dominant in research and clinical settings. Expectations are configured on the basis that stem cells have the potential to: solve the problem of organ shortage; help patients with ailments; provide affordable health care; and establish India as a global player. The creation of expectations is ethically problematic given the potential health risks and economic exploitation of both native and international patients. However, the ethically contested activities are justified by clinicians on the basis that the Helsinki Declaration allows to use an experimental therapy; there are many 'desperate patients' demanding these treatments; and adult stem cells are safe. To date, the government of India appears to be unable to prevent these activities. Contrary to suggestions in previous literature and by some informants that new legislation is needed to address the problem, this thesis finds that state-led mechanisms for biomedical governance lack the ability to implement existing oversight measures. This implementation gap is partly because other forms of governance are not strong enough and partly because there are high expectations at state level aimed at establishing India as a global player in the stem cell sector.

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Howell, J. "An analysis of the involvement of community nurses in clinical governance." Thesis, University of Edinburgh, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.652633.

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The introduction of clinical governance requires that community nurses participate in the development of corporate accountability for clinical performance, accounting for normality as well as exceptional events in practice. The ability to deal with change has become a necessary part of the community nursing role, a factor complicated by the geographical spread and stratification of community nursing teams. If the development of clinical governance is to avoid domination by medical or managerial perspectives, each staff group is required to represent their standpoint. This is a study of the enacted narrative in the community context, to understand how nurses narrate and justify their involvement in these reforms and, to examine the development of a negotiated consensus by community nursing teams. A research approach within the social constructionist tradition informed by Burke’s (1969) dramatist pentad was used to explore and interpret the respondents’ accounts. Narratives of clinical governance were obtained from unstructured interviews with twenty staff, including district nurses and managers in two NHS trusts. The study findings suggested the continuing penetration of nursing practice by management systems, and associated hybridisation of nursing and management roles. Nursing governance is enacted through clinical audit and standard setting systems, building on the history of nursing involvement in these initiatives to develop a nursing consensus on the governance of nursing practice. The majority of nurses are presented as disengaged from these events, with the resultant nursing governance systems underpinned by an apparent rather than actual consensus. The uncertainty of the community nursing knowledge base in the face of clinical governance is illustrated, with practitioners reliant on rationalities drawn from managerial and evidence based logics. It is argued that the marginalisation of the nursing perspective by nursing governance systems, may result in a failure of the profession to develop the dialectical skills and articulacy required to present the nursing perspective in this and future developments. Difficulties arising from the way in which clinical governance is being developed are identified. The findings suggest the requirement of a revised approach to the management of nurses, enabling the explicit inclusion of the nursing majority in future policy implementation.

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Worrall, Adrian. "Clinical governance in mental health services : a study of a quality system." Thesis, University of East London, 2009. http://roar.uel.ac.uk/3746/.

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Clinical governance is the most ambitious quality initiative in the history of the National Health Service. It is a comprehensive system of steps and procedures to ensure patients receive high quality care and, like most quality systems, it attempts to do this by influencing the behaviour of staff members. This study evaluates the implementation of clinical governance in 30 mental health trusts in England and Wales. It is set broadly within the action research paradigm and uses a participative research method to engage staff and help them learn from each other. Trusts were evaluated against a set of standards and using open questions in two annual cycles of self- and external peer-review. The first cycle focused on clinical governance structures and strategy; the second focused on how managers enabled front-line staff - a topic chosen in response to the findings of the first cycle. By the beginning of 2002, 5 years after clinical governance was introduced and when clinical governance was probably at its peak, this study found that only half the key strategies and structures were in place. Most managers view clinical governance as useful, but struggle to implement it under pressure from the government and without sufficient resources. It is of great concern that their clinical governance work is disconnected from the work of front-line staff and hence probably has little impact on patient outcomes. There are 3 main themes from both cycles: there is a hierarchical rather than enabling management style; there are poor resources, e.g. not enough skilled staff; and there are problems with support for front-line staff, e.g. risk management training needs to be provided to more staff. There was no statistically significant association between trust performance in both cycles and whether there had been a recent merger. Organisational theory was found weak and a tentative developmental model is offered. Clinical governance standards may have declined since the study was conducted because it is no longer the focus of statutory regulator's programme of reviews and because there are new policy priorities. Services need slow reforms with a staged pace and need enabling rather than hierarchical management styles. They also need better resources and to develop beyond a basic survival level to one where they are able to focus on growth and investment before embarking on ambitious policy initiatives.

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Boyd, Mary. "Establishing role clarity in clinical governance for members of boards in Irish healthcare." Thesis, Queen's University Belfast, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492335.

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This study examines role clarity in clinical governance. The hypothesis is that there is a lack of role clarity in clinical governance in Irish healthcare and that hospital boards can do much to remedy this. A mixed methods methodology uses secondary analysis of nine inquiries, primary analysis of qualitative semi-structured interviews with experts, and primary analysis of a short quantitative questionnaire. The literature of clinical governance is critically reviewed. Role clarity in clinical governance is defined for the first time as an element in clinical governance. Eleven experts provide deep insights into the extent of this complex nuanced issue. its causes and possible remedies, the impact of training and development. and the clinical governance role of boards. More clarity in roles improves clinical and board governance. Conclusions are that the structure in all acute care hospitals should be more similar so that personnel moving about the health system will orientate qUickly and safely. The multiplicity of terms for posts must be reduced. Everyone should be accountable to the hospital CEO, the CEO accountable to the board, and the board accountable to the Health Service Executive CEO. Teams must have objectives. composition: and boundaries. A performance culture is needed and corporate responsibility for performance must be taken at individual, ward and department level. Job descriptions require review every year. Generic job specifications and job descriptions must be available in a job description database on all HSE staff. The CEO should be accountable to the board for role clarity under a range of headings. Role clarity has not been defined before nor identified as an important determinant of good healthcare. Here it is identified as the fourth most important issue in healthcare and the seventh element of clinical governance. These findings will inform human resource strategy and policy in healthcare. Supplied by The British Library - 'The world's knowledge'

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Addicott, Rachael Kylie. "Power, governance and knowledge : the example of London managed clinical networks for cancer." Thesis, Imperial College London, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430820.

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Páscoa, Carla Assunção Parreira. "Adesão à terapêutica como determinante da efectividade dos cuidados de saúde : A problemática da não adesão à terapêutica em doentes submetidos a angioplastia transluminal percutânea coronária." Master's thesis, Universidade de Évora, 2010. http://hdl.handle.net/10174/20840.

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A não adesão à terapêutica é determinante do aumento de taxas de morbilidade e de mortalidade dos doentes e de perturbações e gastos financeiros das organizações de saúde. O presente estudo teve como objectivo identificar determinantes de não adesão à terapêutica antiagregante plaquetária em doentes que foram submetidos a angioplastia transluminal percutânea coronária. Participaram neste estudo duas amostras de doentes com características demográficas semelhantes mas que deferiam no seu comportamento de adesão. Como metodologia para a identificação das crenças dos doentes em relação à doença ao tratamento foi utilizada um entrevista semi-estruturada baseada nas dimensões do Modelo de Crenças de Saúde. Os resultados evidenciam diferenças entre os dois grupos em especial no que diz respeito a: conhecimento da situação clínica e do tratamento; benefícios/custo do tratamento; consequências; percepção de auto-eficácia e vulnerabilidade. Baseado nos resultados apontam-se pistas de intervenção para a melhoria da qualidade dos cuidados de saúde prestados a estes doentes, numa perspectiva de governança clínica. – ABSTRACT: Non-adherence to treatment prescription is determinant of morbidity and mortality and is associated to organizational problems and financial costs. This study aimed to identify determinants of non-adherence to patients with Percutaneous Transluminal Coronary Angioplasty. The sample was constituted by two groups of patients with similar demographic characteristics and with different adherence behaviour. As methodology we used a semi-structured interview based on the Health Belief Model. Results show differences between the two groups in dimensions as: knowledge about the clinical situation and the treatment; benefits/costs of the treatment; consequences of adherence behaviour; self-efficacy and vulnerability: Based on the results we present some contributions to the quality of care of these patients and doing so hope to contribute to better organization in health services.

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Ellis, Beverley Suzanne. "Managing governance programmes in primary care : lessons from case studies of the implementation of clinical governance in two primary care trusts." Thesis, University of Central Lancashire, 2008. http://clok.uclan.ac.uk/19290/.

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This thesis applies a conceptual framework to determine the key insights that complex adaptive system theories provide to the novel challenges facing the introduction of clinical governance in two English Primary Care Trusts (PCTs). It presents empirical research on governance through qualitative case studies of the implementation of clinical governance arrangements within two North West PCTs, during a time of flux and change. The study is located within the English National Health Service (NHS) between 1999 and 2005. The Department of Health (DH) describes clinical governance as an evolving organisational structure and process that: "Provides NHS service organisations and individual health professionals with a framework within which to build a single, coherent local programme for quality improvement." (Department of Health, 1998a p.33). The thesis reviews the literature on governance models, quality improvement frameworks and complexity-based approaches to establish an appropriate theoretical base to the study. The literature relates to the nature of PCTs as a networked structure with autonomous parts. This approach contextualises the origins of clinical governance and related quality concepts. The study encompasses the introduction of the most recent contractual arrangements for primary care in 2004 (NHS, 2004). The research question posed is: "How can governance of quality improvement programmes be managed in a way that is appropriate to the characteristics of English PCTs?" Detailed evidence demonstrates the nature of local clinical governance programmes and the implementation within two North West PCTs, from the perspective of those involved. The results of the analysis show that multiple perspectives were taken into account in the decisions made about the content and delivery of clinical governance programmes. It is suggested that the application of a complex adaptive system conceptual framework helped to provide insight and interpretation of the accounts of those involved in the two case studies. The variation in clinical governance approaches across the two PCTs is explained in part by the strategic and policy orientation of each PCT. The results are consistent with the argument that the characteristics of quality improvement programmes in two PCTs go beyond linear based concepts, and can be thought of as real-world exemplars of the emergent properties of complex adaptive systems. In practice, the lessons learned provide opportunities to inform future management approaches to quality improvement programmes in PCTs.

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Taylor, George Browne. "Has the introduction of clinical governance facilitated the development of quality in general practice?" Thesis, University of Newcastle Upon Tyne, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324788.

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Wedderburn-Maxwell, Morgan Keir. "An evaluation of clinical governance within a private radiology organisation in Durban KwaZulu-Natal." Thesis, Rhodes University, 2017. http://hdl.handle.net/10962/40884.

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South African health care organisations are required to adhere to the National Health Act, 61 of 2003 which contains the national core standards. Clinical governance is a key domain within the national core standards and is directly involved with a health care organisation’s ability to deliver quality care services. It can be described as a framework that ensures doctors and health care employees collaborate to provide superior quality health care services and create clinical accountability. The aim of this research was to evaluate the role of clinical governance within a private radiology organisation in Durban, KwaZulu-Natal (KZN). The goals of this research was to identify and explore the challenges that are associated with clinical governance within a private health care organisation in Durban, KZN. Furthermore, to evaluate the importance and implications of clinical governance for a private radiology organisation in Durban, KZN. The objectives of this research was to investigate how the private radiology organisation is managing clinical governance and to identify whether there is a common understanding of the concept among its members. The research adopted a qualitative approach where semi-structured interviews were conducted to obtain the data that enabled the goals and objectives of this research to be attained. The results indicated that clinical governance is a key factor to the private radiology organisations long-term sustainability. Clinical governance is vital for health care organisations to deliver quality health care services. The private radiology organisation places a significant emphasis among its members to deliver superior quality health care services. As a result, the organisation utilises the key elements within the clinical governance framework to continuously increase the quality of care that it provides and abide to the legally binding standards. The results support the notion that there is a need for the clarity of the definition, roles and responsibilities of clinical governance. The findings of this research suggest that further research is required to identify the contribution that clinical governance makes to improving the quality of care within South African health care organisations. Furthermore, research identifying employees’ perceptions of clinical governance within the private health care sector in South Africa is recommended.

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Hammond, Jonathan. "Health policy, the politics of governance and change : the introduction of Clinical Commissioning Groups in context." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/health-policy-the-politics-of-governance-and-change-the-introduction-of-clinical-commissioning-groups-in-context(c040b684-2e99-4748-9202-48ff2d60299d).html.

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The Health and Social Care Act 2012 (HSCA12) represents one of the more dramatic reforms in the history of the English National Health Service (NHS) in terms of scope and pace. The flagship of the policy was the replacement of Primary Care Trusts with Clinical Commissioning Groups (CCGs): General Practitioner (GP) led “membership organisations” with responsibility for planning and purchasing most NHS care. A new “arm’s length” body, NHS England (NHSE), was created to authorise and oversee CCGs. The purpose of this research was to critically explore the ideational content of the HSCA12 and consider it in relation to social practices at the organisational level of a CCG: to provide a detailed, contextualised account of a CCG’s early operation, paying particular attention to the implications of its officially intended status as a membership organisation. By problematising the HSCA12, I have highlighted how CCGs and the GPs that constituted them were presented as an emancipatory force saving the NHS from ineffectual managers that lacked clinical and local knowledge about what patients needed; membership organisation status was bound up with this claim of local representation, and the policy attempted to orchestrate engagement from GPs as members through normative devices and governance systems including legislation and assessment programmes. However, the policy elided the difference between GPs as individuals and GP practices and left ambiguous precisely who or what constituted a member. Thirteen months of fieldwork using ethnographic methods (meeting observations, interviews, documentary analysis) were carried out with a case CCG: Notchcroft. The policy delineated “the membership” and “the governing body” as sub-groups within the CCG, but I found many others were involved in CCG governance processes and created “the governing core” concept to describe them. Confusion in the policy over exactly who was a member was paralleled in the CCG. The governing core, many of whom were GPs, were involved in performance assessment processes of GPs in order to fulfil a legal obligation to NHSE. This represented a further redrawing of the GP/state relationship and was a source of identity dissonance. The governing core also actively transmitted national policy norms about what it meant to be a member to the broader membership. By trying to “sell” CCG membership and encourage engagement they were attempting to legitimate the organisation and their roles within it. Notchcroft CCG’s unusual structure, with two levels (districts and locales) below central committees, appeared inefficient. This structure developed as a response to previous national commissioning policies. The institutional logics approach—employed as an analytical lens—proved useful in explaining its endurance: districts were containers for identity and interests to be protected, whilst locales were established and maintained as local “self help” organisations to support quality improvement. The initial purposes of districts and locales thus represented different logics of action that appeared self-evident to those involved, although they were less obvious to an external observer. In time, these initial logics were eroded, and districts and locales were given additional functions. These findings illustrate the emergent tension between national policy and local enactment, and demonstrate how local socio-historical context plays an important role in shaping how policy is realised in practice.

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Allen, Susan Roth. "An Ethnonursing Study of the Cultural Meanings and Practices of Clinical Nurse Council Leaders in Shared Governance." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1384334748.

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Hackworth, Naomi Jean, and n/a. "Development and application of a methodology for the evaluation of a health complaints process." Swinburne University of Technology, 2007. http://adt.lib.swin.edu.au./public/adt-VSWT20070928.092053.

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The aim of the current study was to develop and test a methodology that could be applied to the evaluation of the complaints processes of regulatory bodies of health professionals in Australia including mental health regulatory bodies such as the board that the Council of Australian Governments (COAG) are planning to set up to regulate the psychology profession. The methodology was applied to the evaluation of the complaints process at the Office of the Health Services Commissioner of Victoria (HSC). There were four main research questions. The first research question related to the extent to which the methodology was able to determine how well the HSC was performing in their role of resolving health complaints. The second research question explored the implications of the findings of the evaluation of the HSC complaints process for the management of health complaints in general. The third research question related to the strengths and limitations of the methodology when applied in a practical setting and the final research question related to further improvement of the methodology for future applications. Questionnaires and telephone interviews were used to examine the experiences of 133 providers and 150 complainants whose complaints had been reviewed and closed in one year. The methodology proved successful in assessing the performance of the complaints process at the HSC. The findings of the evaluation indicated that complainants and providers were generally satisfied with the process by which their complaints were managed. However, they were in general less satisfied with the outcome. In particular the evaluation highlighted the unintended negative consequences that complaints processes can have on the complainants and respondents. It was concluded that these maladaptive behavioural responses to complaints most probably have their origins in the negative emotional overlay attached to health complaints which has the potential to lead to unrealistic expectations of the process and outcomes on the part of complainants, and maladaptive post-complaint practices for health service providers. The findings highlight the importance of providing advocacy and support for the parties involved in health complaints as a means of minimising these maladaptive responses. Finally, it is acknowledged that these findings are specific to Australian health regulatory systems.

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Sugarman, Philip A. "A model of integrated healthcare governance." Thesis, University of Northampton, 2009. http://nectar.northampton.ac.uk/2716/.

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The history of psychiatry is littered with serious failures of governance, to the detriment of mentally disordered people, especially those resident in psychiatric hospitals. Current mental health providers, increasingly focussed on community care, have also struggled to develop effective internal governance systems. Nine peer-reviewed research papers, published by the author (mostly with others) and the wider literature, reveal deficits in mental health governance at a jurisdictional, professional, and corporate level. In this thesis new governance solutions are developed against this background, built on contemporary principles in mental health and healthcare management. A new model of mental health governance is presented, based on the key demands of the strategic and regulatory environment, articulated as rights, risks and recovery. This integrated healthcare governance approach, covering provider policy, staff training and service audit, can monitor and ensure the protection of patients’ rights, as well as those of others; it also promotes the management of clinical risks, and of patients’ recovery outcomes. Rights-based risk-reduction training is the core interventional element of the model, whilst the monitoring element can be formalised as part of a Balanced Scorecard reporting system. This thesis makes a contribution to research methodology, theory and practice in mental health, human rights, healthcare management and governance. The model generates specific propositions for testing in mental health governance, with the potential for application in wider settings of service provision.

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Brown, Patrick. "The Impact of Clinical Governance and the Audit Culture on Paitent Trust : The Oppurtunity Cost of Instumental Rationality." Thesis, University of Kent, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.499812.

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Moraes, Erika Fernanda Viana de 1981. "O trabalho de uma equipe de atenção básica no cuidado aos portadores de doenças crônicas não transmissíveis : percepções sobre a experiência da 'gestão clínica' em Campinas - SP." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312513.

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Orientador: Aparecida Mari Iguti
Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O aumento da carga de doença relacionado às Doenças Crônicas Não Transmissíveis (DCNT), decorrente do envelhecimento e da exposição a fatores de risco relacionados ao estilo de vida da população, tem sido motivo de iniciativas de reorganização dos Sistemas de Saúde de vários países, visando tornar a Atenção Básica à Saúde mais resolutiva. Em 2009, o Ministério da Saúde, inspirado na experiência britânica, propôs o Projeto Territórios: Estratégia de qualificação da Atenção Primária para ampliação dos limites da resolubilidade na atenção das doenças crônicas não transmissíveis: um eixo de reestruturação da Atenção Especializada no seu papel complementar, introduzindo os conceitos e ferramentas da Gestão Clínica para microgestão dos processos de trabalho e a construção de Linhas de Cuidado como indutores da articulação de redes de Saúde. O Projeto Territórios foi implantado em três municípios brasileiros, entre os quais Campinas (SP), onde ficou conhecido como "Projeto de Gestão da Clínica". Esta pesquisa, de natureza qualitativa, tem como objetivo analisar como os trabalhadores de um Centro de Saúde do Distrito de Saúde Norte de Campinas, partícipe do Projeto Territórios, percebem o próprio trabalho, e como os dispositivos de Gestão Clínica aplicados ao cuidado às DCNT interferiram na organização do trabalho desta equipe. Para tanto, após uma discussão teórica sobre a questão das Redes de Atenção à Saúde e um estudo documental sobre as experiências britânica e brasileira, foi realizado um grupo focal com trabalhadores de uma unidade da Atenção Básica de Campinas ¿ SP. Uma narrativa foi produzida para expressar o resultado da discussão no grupo focal, à maneira como propõem Onocko-Campos e Furtado (2008) e Ricoeur (1997). Após ser apresentada e validada pelo grupo de trabalhadores, a narrativa foi analisada de forma a apresentar as percepções dos trabalhadores acerca de três pontos críticos no remodelamento proposto para os serviços de saúde: (1) a tensão entre programação das ações de saúde e a organização do trabalho para dar respostas à demanda espontânea; (2) a fragilidade das relações entre as pessoas e serviços constituintes das redes de saúde e; (3) a relação entre os trabalhadores da saúde e a gestão, marcada pela assimetria de poder. De modo geral, os trabalhadores percebem positivamente as ações do Projeto Territórios e as identificam com um modelo de trabalho em saúde assemelhado à lógica da Programação em Saúde, localizam que esta proposição não dialoga com a necessidade de estarem organizados para dar respostas à demanda espontânea, mantendo `porta aberta¿ às necessidade de saúde da população, observam que entre a Atenção Básica e outros serviços de saúde do município existe uma relação distante e percebem-se frágeis e pouco potentes diante da necessidade de mudanças no processo de trabalho. Uma conclusão possível é a de que o fortalecimento da Atenção Básica deve conter estratégias de empoderamento e organização do trabalho que legitimem este nível de Atenção para produção de saúde frente a maior parte dos problemas de saúde da população e a lógica da programação em saúde não é potente para a organização das mudanças necessárias
Abstract: The increased burden of disease related to Chronic Noncommunicable Diseases (DCNT), due to aging and exposure to risk factors related to the lifestyle of the population, has been the subject of reorganization initiatives of Health Systems in several countries, aiming to make Primary Health Care more resolute. In 2009, the Ministry of Health, inspired on British experience, proposed the Projeto Territórios: Qualifying Primary Care Strategy to expand the limits of solvability in the care of chronic noncommunicable diseases: a restructuring axis of Specialized Care in its complementary role, introducing the concepts and tools of Clinical Governance for micro-management of work processes and the construction of Care Lines as inducers of articulation of Health. The Projeto Territórios was implemented in three municipalities, including Campinas - SP, where was known as "Projeto de Gestão da Clínica". This research, of qualitative nature, aims to analyze how the workers of a Health Center of the North Health District of Campinas - SP, participant of the Projeto Territórios, realize their own work, and how the devices of Clinical Governance applied to the care of DCNT interfere in the work organization of this team. To that end, after a theoretical discussion on the issue of Health Care Networks and documentary study of the British and Brazilian experiences, a focus group with workers in a unit of Primary Health Care was conducted in Campinas ¿ SP. A narrative was produced to express the result of the discussion in the focus group, to the way proposed by Onocko-Campos and Furtado (2008) and Ricoeur (1997). After being presented and validated by the group of workers, the narrative was analyzed to present the perceptions of workers on three critical points in the remodeling proposed for health services: (1) the tension between programming of health activities and work organization to give answers to spontaneous demand; (2) the fragility of relations between people and constituent services of health networks and; (3) the relationship between health workers and management, marked by asymmetry of power. In general, workers realize positively the Projeto Territórios actions and identify with a working model in health likened the logic of the Health Program, localize that this proposition does not dialogue with the need to be organized to give answers to the spontaneous demand, keeping `open door¿ to the health needs of the population, observe that between Primary Care and other health services in the municipality there is a distant relationship and perceive themselves fragile and underpowered on the need for changes in the work process. One possible conclusion is that the strengthening of primary care must include empowerment strategies and work organization to legitimize this level of attention to Care for health production across most of the health problems of the population and health programming logic is not powerful for the organization of the necessary changes
Mestrado
Política, Planejamento e Gestão em Saúde
Mestra em Saúde Coletiva, Política e Gestão em Saúde

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Helms, Christopher. "Consensus on a Specialist Clinical Learning and Teaching Framework for Australian Nurse Practitioners." Thesis, Australian Catholic University, 2017. https://acuresearchbank.acu.edu.au/download/076a30ffd066dd97be47f344a5e7e97fccc7dfc2f30d6d180e730e48a5209ea7/81980443/HELMS_2017_THESIS.pdf.

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Background The Australian nurse practitioner (NP) role is represented by over 1,400 endorsed NPs practising in over 50 different specialty areas. Generic standards have broadly supported the role’s behavioural, professional and expanded practice expectations since 2006, and have been used for the accreditation of NP Masters programmes nationally. The need for consistent and flexible specialty clinical education for NP students has been described in the Australian literature. The clinical learning and teaching of Australian NP specialty roles has traditionally occurred in the student’s workplace, within a specified area of practice. Jurisdictional differences at state/territory and local levels have influenced how NP students develop and enact their roles once endorsed. Factors such as the student’s clinical supervisor, local legislation and policy, role ambiguity, restrictive local clinical guidelines and protocols influence what NP students learn in their clinical learning environments. These factors contribute to a highly differentiated NP workforce, with differing clinical skills, knowledge and abilities noted within the same specialty area. Similar difficulties have led to the development of broad specialty areas in the United States of America. To better complement the generic learning and teaching students receive through their academic programmes, this research aims to validate a specialist clinical learning and teaching framework for Australian nurse practitioners. This framework will not only enhance consistency in their specialty clinical learning and teaching, but create greater workforce flexibility. A consensus-based research methodology was needed to validate the specialty clinical learning and teaching framework. Delphi Technique is a consensus-based research methodology commonly employed in nursing research to explore solutions to questions that have unclear or indeterminate answers. It aims to achieve a pre-determined level of consensus on a research question, using content experts through an anonymous and iterative process. Critical to the method’s validity is the participation of a heterogeneous group of experts with advanced knowledge of the content area, and whose feedback to other panelists is controlled to minimise social influence. Individual participant characteristics, such as experience level and confidence in decision-making, and the influence of these upon consensus are poorly described in the Delphi literature. There was little previous empirical research to inform how to best describe heterogeneity of opinion informing the specialty clinical learning and teaching framework using nurse practitioners. Aims - To validate a specialty clinical learning and teaching framework for Australian NP students. Specific objectives that addressed this aim were: - To validate a previously developed Australian NP metaspecialty taxonomy. - To validate supporting clinical practice standards used for the metaspecialty taxonomy. - To contribute knowledge of how consensus is achieved when using Reactive Delphi methodology. Specific questions that addressed this aim were: - Does Reactive Delphi methodology potentiate the negative influence of the bandwagon effect in Delphi panelists? - What effect does panelist confidence have on decision-making in Delphi panelists? - How can experience level be objectively demonstrated in individual Delphi panelists? - What effect does experience level have on decision-making in Delphi panelists? - Does confidence relate to opinion change in individual Delphi panelists? - What effect does panel composition have on consensus outcomes? - To demonstrate the application of web-based methods in Delphi research. Specific objectives that addressed this aim were: - Describe the advantages of using a web-based Delphi method. - Describe the risks of using a web-based Delphi method. - Describe how panelist feedback was managed during six concurrent Delphi studies. Methodology and Methods This mixed-methods research used Delphi Technique to achieve consensus on, and therefore validate, a NP specialty clinical learning and teaching framework. Two sequential 3-round Reactive Delphi surveys were used to achieve the research aims. The first Delphi survey was designed to validate a proposed broad Australian NP specialty taxonomy previously established by the 2014 CLLEVER (CLinical LEarning goVERnance) study. The second Delphi survey was designed to validate clinical practice standards, which would support and provide definition to the specialty taxonomy. Together, the taxonomy and standards informed the proposed specialty clinical learning and teaching framework. Consensus Development Conference methodology was used to refine the proposed specialty clinical learning and teaching framework. Data collected during the conduct of the first Delphi survey achieved the second research aim. The third research aim was achieved by using metadata, paradata and embedded data in an advanced web-based survey design for both Delphi surveys. Purposive sampling and snowballing techniques were used to recruit from an eligible population of NPs, endorsed by the Nursing and Midwifery Board of Australia, with at least 12 months’ post-endorsement experience (N=966). Web-based survey technology was used to collect data. Data were analysed using content analysis, descriptive and inferential statistics. The Content Validity Index and non-parametric testing using McNemar’s Test for Change were used to determine consensus that informed the proposed framework. Results Approximately 20% of the eligible Australian NP population contributed to both Delphi surveys. Six broad specialty areas, termed metaspecialties, were validated for the proposed specialty taxonomy. A Consensus Development Conference refined the names of two metaspecialties. The metaspecialties served as a foundation for validated clinical practice standards, which provided substance and definition to the final specialty clinical learning and framework. Heterogeneity of expert NP opinion informing the framework was demonstrated using professional activities representative of advanced practice nursing. There was no indication of negative social influence determining the manner by which panelists achieved consensus on the proposed framework. A novel method of using metadata, paradata and embedded data in web-based surveys was applied, which supported high survey response rates and identified non-response bias. A novel application of web-based surveys allowed the researcher to concurrently conduct six Delphi surveys nested within a larger research project. Conclusion This research demonstrates a rigorous approach in validating a proposed specialty clinical learning and teaching framework for Australian NP students. It contributes new knowledge on the internal and external validity of Reactive Delphi methodology.

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Hall, Heather. "An investigation of change management processes involved in the implementation of clinical governance by allied health professionals in Scotland." Thesis, Glasgow Caledonian University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.688257.

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Costa, Ana Clara Lopes. "Aprender a aprender: uma trajetória possível para os trabalhadores do SUS?" Universidade Federal de São Carlos, 2014. https://repositorio.ufscar.br/handle/ufscar/6925.

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The main goal in this study is to analyze the learning process of the Brazilian Unified Health System (SUS) staff when exposed to an interactionist educational initiative. Such initiative aims the transformation of health practices by focusing on clinical management and qualifying care for the users of SUS in 33 hospitals from the 5 Brazilian geographical regions. This study used a specialization course that was developed in 2009-10 that focused on the articulated development of management abilities, support and education in health. The study was based on the principles of qualitative research and the completion of course work drawn by the attendees of the specialization course on Clinical Management was also used as a source of data. The content was analyzed for data interpretation aiming to identify and explain the causes and interactions for the production of the phenomenon. The novelty of the proposal was not an obstacle for the learning process. Student focused learning and the appreciation of previous knowledge where related to the practical application of such content and the broaden of autonomy, especially on what concerns recently acquired information. It was also observed that the participants actions were related to the three areas: clinical management; health awareness and education. The interaction in small groups, communication, integration and open dialogue were valued as fundamental e facilitating elements of learning, group work development and qualification of care. Transformation on practices on health related to management, attention and education were observed and were part of the knowledge that define the profile of clinical management built and developed through the course.
Objetivou-se neste estudo analisar o processo de aprender de trabalhadores do SUS expostos a uma iniciativa educacional interacionista. Esta iniciativa, o Curso de Gestão da Clínica nos Hospitais do SUS, foi orientada à transformação de práticas em saúde, considerando a gestão da clínica como eixo ordenador do cuidado prestado aos usuários da rede pública de saúde. Participaram 33 hospitais das cinco regiões geográficas do Brasil. Realizada entre 2009-10, no formato de uma especialização, objetivou o desenvolvimento articulado de capacidades de gestão, de atenção e de educação na saúde. A investigação foi baseada nos princípios da pesquisa qualitativa e utilizou o Trabalho de Conclusão do Curso, elaborado pelos participantes da especialização em Gestão da Clínica, como fonte para a coleta de dados. Para a interpretação dos dados, foi aplicada a técnica de análise de conteúdo. Foram encontradas três temáticas: (i) Práticas Educacionais; (ii) Práticas em Saúde; e (iii) Transformação das práticas em saúde considerando os pressupostos da gestão da clínica. Na temática das práticas educacionais, os subtemas Aprendizagem Baseada em Problemas e Aprender dialogando no trabalho mostraram que o ineditismo da proposta não foi um obstáculo à aprendizagem. Foram considerados como fatores positivos: a convivência em pequenos grupos, a valorização dos conhecimentos prévios e o diálogo. Observou-se que as transformações nas práticas dos participantes foram relacionadas às três áreas do perfil de competência proposto pelo curso. As práticas de gestão e de atenção à saúde incorporaram os pressupostos da gestão da clínica, especialmente em relação à melhoria da qualidade e da integralidade do cuidado.

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Lacava, Pedro Nelson. "Avaliação da adequação às boas práticas de governança corporativa em instituição filantrópica hospitalar: estudo de caso." reponame:Repositório Institucional do FGV, 2018. http://hdl.handle.net/10438/24597.

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O estudo de caso com desenho transversal descritivo e enfoque qualitativo teve por objetivos avaliar a qualidade da Governança Corporativa em instituição hospitalar filantrópica localizada no Município de São Paulo e analisar as práticas implementadas mediante diretrizes do Instituto Brasileiro de Governança Corporativa e da Healthcare Governance and Tranparency Association. As boas práticas de governança corporativa podem contribuir significativamente para que as instituições filantrópicas hospitalares de excelência, associadas ao PROADI, sejam mais competitivas e autossustentáveis, a fim de que não necessitem de substanciais capitais de investidores, os quais podem, pelo seu interesse intrínseco de ganho, modificar a estrutura de capital, resultando em perda da filantropia, descaracterizando a missão da organização e sua finalidade social. Antecedeu à coleta de dados, a elaboração de instrumento constituído por 220 questões fechadas, com opções de respostas pré-codificadas (sim ou não) referentes às práticas recomendadas de governança corporativa compreendidas em nove dimensões de análise. A coleta foi realizada por meio de entrevistas com os principais gestores da instituição, e para cada questão com resposta afirmativa realizou-se análise documental com o intuito de evidenciar as informações referidas pelos entrevistados. Os principais resultados foram: O índice geral de qualidade da governança corporativa alcançou adequação de 75%; As Dimensões Associações e Conduta, Conflito de Interesses e Divulgação de informações apresentaram-se totalmente adequadas às diretrizes preconizadas; As dimensões Auditoria Independente e Associação Marca/Imagem apresentaram níveis de adequação inferiores a 50%. Os resultados atenderam plenamente aos objetivos da pesquisa, assim como foi possível apontar desdobramentos para futuros estudos, tais como: a inclusão de novas dimensões específicas ao setor de saúde, avaliação e análise crítica pelas organizações no que diz respeito aos resultados decorrentes das práticas de governança corporativa e o aprofundamento da questão referente à atribuição ou não de pesos diferenciados para as dimensões.
This case study with a descriptive and qualitative focus aims at evaluating Corporate Governance in a philanthropic hospital located in the city of São Paulo and analyzes the practices implemented through the guidelines of the Brazilian Institute of Corporate Governance and the Healthcare Governance and Transparency Association. Good governance practices can be important to make philanthropic hospitals of excellence more competitive and self-sustaining, so that they do not need capital from third parties, who can, for their interest in profit-making, modify their social patrimony, causing a lack of philanthropy , misleading the organization's mission and its social purpose. Before the data collection, an instrument was created consisting of 220 closed questions, with the option of pre-coded answers (yes or no) referring to recommended governance practices comprised in nine dimensions of the analysis. The data was collected by interviewing the main managers of the institution, and each affirmative answer led us to carry out the document analysis in order to evidence the information mentioned by the interviewees. The main results were as follows: The overall report on the quality of corporate governance was 75%; The Dimensions Associations and Conduct, Conflict of Interests and Disclosure of Complementary Information seemed to be suitable to recommended guidelines; independent auditing dimensions and brand/image association showed adequacy index below 50%. The results met thoroughly the research objective, but we were also able to find other areas for future studies, such as: the inclusion of new actions in the health sector, evaluation and critical analysis by organizations that are relevant to governance practices results.

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Frawley, Timothy Martin. "An analysis of how senior management team members have influenced the evolution of clinical governance since "A vision for change" 2006." Thesis, Queen's University Belfast, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.680116.

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This qualitative research informed by the interpretivist paradigm analyses how senior management team members in the Irish public and independent mental health sectors have influenced the evolution of clinical governance. A 54 item schedule (the Organisational Progress in Clinical Governance schedule) [OPCG] is utilised to inform a process of semi-structured interviews. A review of the-clinical governance and-other literature is undertaken to frame the research question, to highlight originality and position expectations. Newell and Burnard's 'Pragmatic Approach to Schematic Content Analysis' in conjunction with NVivo is used as the data analysis framework. A reference group is utilised in advance of the study and 25 executive and director level senior management team members are interviewed in their capacity as senior leaders and experts in the research area of clinical governance evolution. 5 separate healthcare organisations (3 public and 2 independent) were purposively selected. Participants completed the OPCG prior to participating in semi-structured interviews. The interview schedule was informed by the results of the OPCG and the literature review. Senior management team members were drawn from an interdisciplinary perspective. Processes to establish the rigour and plausibility of the study are outlined including the use of multiple coding, a reflexive diary and respondent validation. Following data analysis, findings are distilled and presented. Recommendations for education, practice, management and governance are expounded. These refer to strategies to enhance leadership capacity, commentary on the expanding role of regulation in healthcare, discussion of the differences apparent between HSE and independent sector mental health providers and the implementation of key national policies specifically ICT. Additionally, current issues in recruitment, staff and staff management processes, formal and informal power structures, in-service training and education, evaluation of health service re-structuring at national and regional levels and the re-imagining of strategic alliances with the higher education sector are explored.

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Singh, Yesheen. "Communication and collaboration: an exploration of clinical governance Interventions in the Western Cape Department of Health over the past twenty years." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32979.

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Background: The tension between the increasing cost of healthcare provision and the need to provide a quality level of care to a rising number of people is a global phenomenon. A focus on one over the other could result in a rise in adverse patient outcomes, or a health system too costly to be sustainable. Clinical governance is an approach policymakers can use to walk the middle line of creating a healthcare service that meets quality of care standards in a cost-effective manner, as has been done in Australia, Burundi, Egypt, Spain, UK and Yemen (Goyet et al, 2019; Abd El Fatah et al, 2019, Mannion et al, 2015; Aguilar Martin et al, 2019). This study examines the practice of clinical governance in one LMIC setting that has been able to successfully do this balancing walk for 20 years. Understanding how this was done in the Western Cape province of South Africa helps inform how clinical governance can be used to continue adding value as the health system moves towards universal healthcare. In addition, this South African experience adds to the still small pool of relevant experience from low- and middle-income countries reported in the international literature. Methods: A mixed methods qualitative design was used for data collection and involved three phases: (1) a document review of all policies in the province to identify clinical governance structures; (2) observation of these structures in action, comparing lived to written experience of clinical governance; and (3) interviews with key stakeholders in the province to get their perspectives on past, present and future forms of clinical governance. The Donabedian model was used to frame analysis into three dimensions of care, viz. structure, process and outcome. Results: Beyond a comprehensive policy framework, collaborative structures and consultative leadership styles facilitated strengthened clinical governance in the Western Cape. For example, although corporate-governance-inspired structures, such as clinical audits and M&E events, may become punitive and corrosive, the potential negative impact on clinical governance outcomes and organisational culture was tempered by healthy communication and supportive relationships between colleagues. Family physicians have become the champions of clinical governance in a decentralized health system and when supported in this by policy and management, the quality of care in health systems thrive. Conclusions Clinical governance is an effective strategy or tool LMICs can use to ensure quality of care is maintained or improved upon, even in resource-challenged settings. But while some structures, processes and outcomes may be borrowed from other LMIC or HIC settings, these need to be contextualized to local conditions. Appropriate clinical governance champions need to be identified and given the appropriate mandate. Human relationships are key to the successful implementation of interventions of this nature and space needs to be created in policy for this to be cultivated.

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Boeiro, Maria Helena. "Diagnóstico e análise das tendências e condições para a implementação dum modelo de qualidade num serviço de imagiologia hospitalar. O caso da radiologia convencional." Master's thesis, Universidade de Évora, 2011. http://hdl.handle.net/10174/15124.

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O presente trabalho tem por objectivo elaborar um estudo prospectivo e estratégico com a finalidade de desenvolver posteriormente orientações estratégicas para a implementação do modelo de excelência da European Foundation for Quality Management (EFQM), num Serviço de Imagiologia de uma instituição hospitalar, nomeadamente ao nível da radiologia convencional. A partir dos conceitos de qualidade e de análise prospectiva pretendeu-se ao longo deste estudo aplicar a opção metodológica de prospectiva estratégica, designadamente, a adaptação do método de cenários de Michel Godet para a análise; Abstract This work aims to perform a prospective and strategic study with the finality of develop strategic orientations for the implementation of the European Foundation for Quality Management (EFQM) model of excellence, in a Radiology Department of a Hospital, namely in the Conventional Radiology work field. Based in quality and prospective analysis concepts it is intended to apply the methodological choice of strategic prospective, through the Michel Godet scenery adaptation method in order to carry out the analysis of the implementation conditions of a quality system in a Hospital’s Radiology Department Results allowed a global vision of the actors and of the main objectives related to the studied system, allowing that way, the elaboration of strategic recommendations.

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Hewitt, Janet. "Exploring the impact of clinical governance on the professional autonomy of general practitioners in a primary care trust in the North West of England." Thesis, University of Sheffield, 2006. http://etheses.whiterose.ac.uk/14706/.

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Employing a single-site exploratory case study research methodology, this study seeks to paint a rich and detailed picture of managerial and professional perspectives of the impact of clinical governance on the professional autonomy and self-regulation of general practitioners (GPs) in a Primary Care Trust (referred to as the Utopian PCT), in the North West of England. The study defines clinical governance in the context of general practice; identifies the requirements for and barriers to its implementation; explores the role of GP Medical Advisers to the PCT and determines whether clinical governance is contributing to the deprofessionalisation (Haug 1973; 1975; 1977; 1988), proletarianisation (McKinlay and Arches 1985; McKinlay and Stoeckle 1988; McKinlay and Stoeckle 2002; Coburn 1992; Coburn et al 1997) or restratification of general practice (Fried son 1975; 1983; 1984; 1985; 1986). There are a small number of existing studies examining the impact of clinical governance on the professional autonomy and self-regulation ofGPs (SheafTet a12002; 2003; 2004; Locock et at 2004). This study focuses on the whole process of clinical governance whilst others focus on the implementation of National Service Frameworks. This is the only study employing a single-site exploratory case study methodology seeking to 'particularise' rather than to 'generalise' and to paint a rich and detailed picture of the 'human-side' of the Utopian peT and the associated general practices. Whilst never intending to be generalisable, the results of the study add to the growing body of evidence that the restratification of general practice has begun in England through GP Professional Representatives (referred to as GP Medical Advisers at Utopian PCT), employed in hybrid advisory/supervisory roles within PCTs. My study also supports Sheaff et aI's (2004) findings, suggesting that in the case of general practice, restratification does not divide the profession into separate occupational groups (Fried son 1984). Instead, knowledge management, supervision and general practice are different aspects of the same role (Sheaff et a12004; Courpasson 2000). The study demonstrates that despite the structural constraints imposed by clinical governance on general practice GPs are by no means helpless victims of government policy. Where possible they use clinical governance to their own advantage and to the advantage of their patients. They unenthusiastically implement those aspects of clinical governance they dislike but cannot avoid. The GPs participating in the study objected to what they perceived to be the managerial interference embodied in clinical governance and continued to adhere to a professional rather than a 'neo-bureaucratic' culture. The study suggests that in the future the new General Medical Services Contract (2004) will be influential in reinforcing the implementation of clinical governance in general practice.

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Macbeth, Deborough Anne. "An investigation of the assumptions that inform contemporary hospital infection control programs." Thesis, Queensland University of Technology, 2005. https://eprints.qut.edu.au/16113/1/Deborough_Macbeth_Thesis.pdf.

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The purpose of the study was to investigate the assumptions that underpin contemporary hospital infection control programs from the perspective of the influence of clinical culture on the integration and ownership of the infection control program. The results of numerous studies have linked low levels of adherence with infection control principles amongst health care providers as the most significant factor contributing to nosocomial infection. Despite early successes in reducing nosocomial infection rates, results derived from current research demonstrate that nosocomial infection has remained a challenge to healthcare providers and patients alike and outbreaks are regularly reported in the infection control literature. Serious economic and social impact has resulted from the increasing levels of antibiotic resistance that have been reported amongst pathogens associated with nosocomial infection. This interpretive study takes an ethnographic approach, using multiple data sources to provide insight into the culture and context of infection control practice drawing upon clinicians' work and the clinician's perspective. There were three approaches to data collection. A postal survey of surgeons was conducted, a group of nurses participated in a quality activity, and a clinical ethnography was conducted in an intensive care unit and an operating theatre complex. Data were analysed in accordance with the qualitative and quantitative approaches to data management. Findings indicate that the clinical culture exerts significant influence over the degree to which the infection control program activities change practice and that rather than imposing the infection control program on the clinical practice setting from outside, sustained practice change is more likely to be achieved if the motivation and impetus for change is culturally based. Moreover surveillance, if it is to influence clinicians and their practice, must provide confidence in its accuracy. It must be meaningful to them and linked to patient care outcomes. Contemporary hospital infection control programs, based on assumptions about a combination of surveillance and control activities have resulted in decreased nosocomial infection rates. However, sustained infection control practice change has not been achieved despite the application of a range of surveillance and control strategies. This research project has utilized an ethnographic approach to provide an emic perspective of infection control practice within a range of practice contexts. The findings from this study are significant within the context of spiraling health costs and increasing antibiotic resistance associated with nosocomial infection.

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Macbeth, Deborough Anne. "An investigation of the assumptions that inform contemporary hospital infection control programs." Queensland University of Technology, 2005. http://eprints.qut.edu.au/16113/.

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The purpose of the study was to investigate the assumptions that underpin contemporary hospital infection control programs from the perspective of the influence of clinical culture on the integration and ownership of the infection control program. The results of numerous studies have linked low levels of adherence with infection control principles amongst health care providers as the most significant factor contributing to nosocomial infection. Despite early successes in reducing nosocomial infection rates, results derived from current research demonstrate that nosocomial infection has remained a challenge to healthcare providers and patients alike and outbreaks are regularly reported in the infection control literature. Serious economic and social impact has resulted from the increasing levels of antibiotic resistance that have been reported amongst pathogens associated with nosocomial infection. This interpretive study takes an ethnographic approach, using multiple data sources to provide insight into the culture and context of infection control practice drawing upon clinicians' work and the clinician's perspective. There were three approaches to data collection. A postal survey of surgeons was conducted, a group of nurses participated in a quality activity, and a clinical ethnography was conducted in an intensive care unit and an operating theatre complex. Data were analysed in accordance with the qualitative and quantitative approaches to data management. Findings indicate that the clinical culture exerts significant influence over the degree to which the infection control program activities change practice and that rather than imposing the infection control program on the clinical practice setting from outside, sustained practice change is more likely to be achieved if the motivation and impetus for change is culturally based. Moreover surveillance, if it is to influence clinicians and their practice, must provide confidence in its accuracy. It must be meaningful to them and linked to patient care outcomes. Contemporary hospital infection control programs, based on assumptions about a combination of surveillance and control activities have resulted in decreased nosocomial infection rates. However, sustained infection control practice change has not been achieved despite the application of a range of surveillance and control strategies. This research project has utilized an ethnographic approach to provide an emic perspective of infection control practice within a range of practice contexts. The findings from this study are significant within the context of spiraling health costs and increasing antibiotic resistance associated with nosocomial infection.

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Revez, Silvana Cardoso. "Reabilitação no internamento hospitalar: prospectiva na dinâmica de Actores. Implementação da governação clínica num hospital E.P.E." Master's thesis, Universidade de Évora, 2011. http://hdl.handle.net/10174/18174.

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O presente estudo apresenta uma visão de Prospectiva Estratégica, numa adaptação do Modelo de Cenários, centrado na imagem futura da implementação de medidas estratégicas, segundo o modelo de Governação Clínica, para a prática da equipa de Reabilitação num contexto de internamento hospitalar com o utente de A.V.C. Da análise sócio - organizacional efectuada, com vista ao caminho da qualidade organizacional, construiu-se uma lógica relacional de actores onde as chefias intermédias assumem o papel central no jogo de poderes. Os cenários obtidos mostram que os actores visualizam a sua actuação futura de acordo com os pilares de Foco no Doente, em termos de qualidade de cuidados, segurança e participação activa. Contudo, a matriz relacional de actores apresenta um carácter instável, onde as raízes das suas convicções e acções são essencialmente mutáveis. Daí que, como proposta de plano de intervenção sugere-se um modelo de desenvolvimento da eficácia colectiva baseado no conceito dos Seminários Prospectivos, com o intuito de encontrar uma qualidade interna que crie um sentimento de pertença, compromisso e motivação colectiva face a uma dinâmica de mudança organizacional; ABSTRACT: This study presents an overview of Strategic Foresight, an adaptation of the model scenarios, centered on the future picture of the implementation of strategic measures, following the model of Clinical Governance for the Rehabilitation team practice, in the context of hospitalization with stroke patient. The socio-organizational analyses, with a view to the path of organizational quality, build up a relational logic of middle management where players assume the role in the power game. The scenarios obtained show that the actors envision their future action in line with the pillars of Patient Focus, in terms of quality of care, security and active participation. However, the relational matrix of actors has a volatile nature, where the roots of their beliefs and actions are essentially mutable. Hence, as a proposed plan of action arises a development model of collective efficacy based on the concepts of Prospective Seminars, with the aim of finding an inner quality that creates a sense of belonging, commitment and motivation in the face of a collective dynamics of organizational change.

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Jerndahl, Fineide Mona. "Controlled by Knowledge : A Study of two Clinical pathways in Mental Healthcare." Doctoral thesis, Karlstads universitet, Fakulteten för ekonomi, kommunikation och IT, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-12937.

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Standardisation of professional work is a major policy concern to ensure quality and efficiency of services and a number of hospitals are now focusing on the use of clinical pathways as an important tool to standardise their work. This study sheds light on the processes set in motion when notions of standardisation meet local practice. In order to gain insight into what clinical pathways mean for professional work in mental health care, the focus of the study was to explore the contexts in which standardisation by “rule production” takes place. Two empirical cases from Norwegian mental health care show how dedicated professionals are in charge of carrying out the standardisation work, strongly influenced by a steering framework of defined governmental policies where employee involvement and responsibility ensured loyalty to the idea. Along with a “package” of ideas, new bodies and techniques, clinical pathways contribute to the institutionalisation of prima facie knowledge in demonstrating that evidence basing is linked to steering and control of employees. Thus, professional autonomy is threatened in an insidious way: through the institutionalisation of evidence-based knowledge as ‘prima facie’ knowledge in combination with professionals who standardise and control their own work. The thesis therefore concludes that the control of professional work has now become a complex and sophisticated process where professional work is “controlled by knowledge”.

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Rao, Mala. "Assessing the quality of care in general practice : is the general practice assessment survey an adequate summary measure for a practical approach to clinical governance in primary care organisations?" Thesis, London School of Hygiene and Tropical Medicine (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.536757.

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Botha, Johanna Catharina. "Rapid sequence intubation: a survey of current practice in the South African pre-hospital setting." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32615.

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Background: Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. In South Africa, pre-hospital RSI was first approved for non-physician providers by the Health Professions Council of South Africa in 2009 and introduced as part of the scope of practice of degree qualified Emergency Care Practitioners (ECPs) only. The aim of the research study was to investigate and describe, based on the components of the minimum standards of pre-hospital RSI in South Africa, specific areas of interest related to current pre-hospital RSI practice. Methods: A descriptive cross-sectional study design in the form of an online survey were conducted amongst operational ECPs in the pre-hospital setting of South Africa, using convenience and snowball sampling strategies. Results: A total of 87 participants agreed to participate. Eleven (12.6%) incomplete survey responses were excluded while 76 (87.4%) were included in the data analysis. The survey response rate could not be calculated. Most participants were operational in Gauteng (n=27, 35.5%) and the Western Cape (n=25, 32.9%). Overall participants reported that their education and training were perceived as being of good quality. An overwhelming number of participants (n=69, 90.8%) did not participate in an internship programme before commencing duties as an independent practitioner. Most RSI and post-intubation equipment were reported to be available, however, our results found that introducer stylets and/or bougies and EtCO2 devices are not available to some participants. Only 50 (65.8%) participants reported the existence of a clinical governance system within their organisation. Furthermore, our results indicate a lack of clinical feedback, deficiency of an RSI database, infrequent clinical review meetings and a shortage of formal consultation frameworks. Conclusion: The practice of safe and effective pre-hospital RSI, performed by non-physician providers or ECPs, rely on comprehensive implementation and adherence to all the 51 components of the minimum standards. Although there is largely an apparent alignment with the minimum standards, recurrent revision of practice needs to occur to ensure alignment with recommendations. Additionally, there are areas that may benefit from further research to improve current practice.

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Court, Alex J. "They're NICE and neat, but are they useful? : a grounded theory of clinical psychologists' beliefs about, and use of, NICE guidelines." Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/12832/.

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There is a growing research interest into investigating why NICE (National Institute for Health and Care Excellence) guidelines are not consistently followed in UK mental health services. The current study utilised grounded theory methodology to investigate clinical psychologists’ use of NICE guidelines. Eleven clinical psychologists working in routine practice in the NHS were interviewed. A theoretical framework was produced conceptualising the participants’ beliefs, decision making processes and clinical practices. The overall emerging theme was “considering NICE guidelines to have benefits but to be fraught with dangers”. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, as a result of pressure, and also the rewards that follow from being seen to comply with NICE guidelines, they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. This is the first theoretical framework that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. Attention is drawn to the proposed benefits and limitations of guidelines and how these are managed. This study highlights the importance of clinical psychologists articulating and advertising their specialist skills. The findings are integrated with existing theory and research, and clinical and research implications are presented.

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Pereira, Vanessa. "Caracterização das estruturas de qualidade e segurança do doente." Master's thesis, Universidade Nova de Lisboa. Escola Nacional de Saúde Pública, 2012. http://hdl.handle.net/10362/10628.

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RESUMO - Título: “Caracterização das Estruturas de Qualidade e Segurança do Doente” A segurança dos doentes assume-se, hoje em dia, como prioridade máxima e é um paradigma de qualidade dos cuidados de saúde. Definida como um conjunto de medidas destinadas a melhorar a segurança e a qualidade de prestação de cuidados de saúde, surge a gestão de risco. Assim, um programa de gestão de risco poderá ser definido como um conjunto de procedimentos e de objetivos pré-definidos com o intuito de promover uma cultura de segurança no seio das organizações de saúde. A nível nacional, no processo de busca da excelência, é necessário estabelecer exigências que formalizem os mecanismos que as instituições de saúde e os seus profissionais terão que utilizar para assegurar que os cuidados de saúde que prestam aos cidadãos, respondem aos critérios da qualidade definidos pelo Departamento da Qualidade na Saúde. Tornou-se, então, pertinente verificar as estratégias que existem sobre a gestão de risco, a nível nacional, e por outro lado, como é que as unidades de saúde têm estruturada esta área nas suas organizações. Como tal, com este estudo pretendeu-se caracterizar as Estruturas de Qualidade e Segurança do Doente, tendo como população as unidades de saúde da região de Lisboa e Vale do Tejo. Foi utilizada uma abordagem metodológica do tipo observacional descritiva, que integrou a aplicação de um questionário. De forma geral, foi possível concluir que todas as unidades de saúde (N=7) afirmam ter implementada a gestão do risco, no entanto há unidades que não fazem a avaliação e identificação do risco (N=4) e a maioria não realizam auditorias clínicas regularmente (N=5). Considera-se que estes resultados podem contribuir para a criação de oportunidades para as organizações e para os profissionais, com o objetivo de melhorar a prestação de cuidados, com consequente melhoria na segurança do doente.
ABSTRACT - Title: “Structures characterization of Quality and Patient Safety" Patient safety is, nowadays, a top priority and a paradigm of quality health care. Risk management is defined as a set of measures to improve the safety and quality of health care delivery. Thus, a risk management program can be defined as a set of predefined objectives and procedures with the aim of promoting a safety culture within healthcare organizations. At national level, in the pursuit of excellence is necessary to establish requirements that formal mechanisms that health care institutions and professionals will have to use to ensure that the health care they provide to citizens, respond to criteria of quality defined by “Departamento da Qualidade na Saúde”. Then became relevant to check the strategies that exist on the risk management at national level, and on the other hand, how the health units have structured this area in their organizations. As such, this study was to characterize the structures of quality and patient safety, having, as population, health units in the region of Lisboa e Vale do Tejo. Was used a methodological approach of observational descriptive type, which included the application of a questionnaire. In general, it was possible to conclude that all health units (N = 7) claim to have implemented risk management, however there are units that do not make the assessment and identification of risk (N = 4), most do not perform regular clinical audits (N = 5). Considers that these results may contribute to the creation of opportunities for organizations and for professionals, with the objective of improving the provision of care, with subsequent improvement in patient safety.

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Padarath, Ashnie Pooran. "The status of clinic committees in primary level clinics in three provinces in South Africa." Thesis, University of the Western Cape, 2009. http://hdl.handle.net/11394/2775.

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Magister Public Health - MPH
In South Africa, governance structures in the form of clinic committees, hospital boards and district health councils are intended to provide expression to the principle of community participation at a local and district level. They are meant to act as a link between communities and health services and to provide a conduit for the health needs and aspirations of the community to be represented at various local, districts, provincial and national levels. This study aimed to assess the functioning of health governance structures in the form of clinic committees. Specifically, the study sought to ascertain the number of clinic committees associated with public health facilities in three provinces in South Africa namely the Eastern Cape, Free State and KwaZulu Natal and to identify the factors that are perceived by clinic committee members to either facilitate or impede the effective functioning of clinic committees.
South Africa

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Oliveira, Flávia Barreto de. "Gestão da clínica e clínica ampliada: sistematizando e exemplificandoprincípios e proposições para a qualificação da assistência hospitalar." reponame:Repositório Institucional da FIOCRUZ, 2009. https://www.arca.fiocruz.br/handle/icict/2421.

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perspectivas teórico-metodológicas da Gestão da Clínica e da Clínica Ampliada, identificando seus princípios, proposições, arranjos institucionais e dispositivos de gestão, além de analisar,sob o olhar dessas abordagens, duas experiências brasileiras de qualificação da assistência hospitalar. Revisão de literatura e estudo de casos compõem a metodologia da pesquisa, sendo as categorias de análise para o estudo das experiências: (1) qualidade da assistência; (2) foco no paciente; (3) adesão profissional. São discutidas a abrangência e escopo das experiências,as dimensões da qualidade nelas consideradas, além dos resultados, dificuldades e limites da implementação de mudanças. Gestão da Clinica e Clínica Ampliada buscam a melhoria da qualidade das práticas em saúde, através de atendimento individualizado, realizado por equipe multiprofissional e interdisciplinar, com um projeto terapêutico personalizado. Destacam a importância da assistência como dimensão central da gestão, colocando o paciente no foco do cuidado. Enfatizam a necessidade da participação do paciente e de seus familiares nas decisões clínicas, e preconizam mecanismos de estratificação de risco e monitoramento da qualidade assistencial. Adicionalmente, sublinham a capacitação, treinamento e valorização dos profissionais como estratégias para se obter adesão aos projetos de mudança e consideram o papel da liderança no sucesso na implementação de mudanças. Na análise de experiências conduzidas pelo Hospital São João Batista (HSJB) - Volta Redonda, RJ e Hospital Geral de Bonsucesso (HGB) Rio de Janeiro, RJ que exemplificam as duas abordagens, este trabalho discute a complexidade da implementação de mudanças na cultura organizacional no que tange à qualidade assistencial, considerando seus êxitos e fatores limitantes. Resultados observados indicam, na experiência do HSJB, aumento e qualificação da assistência, ganhos em eficiência, mudanças na cultura organizacional e no modelo de gestão do hospital, além de avanços na democratização institucional e na legitimidade do hospital junto à população. Na experiência de qualificação da assistência ao infarto agudo do miocárdio (IAM) no setor deemergência do HGB, após a implementação das estratégias facilitadoras da adesão a diretrizes clínicas, houve aumento significativo na utilização de intervenções reconhecidas como cientificamente eficazes, diminuição da iatrogenia, drástica redução da perda de oportunidadede reperfusão miocárdica, além de melhoria no preenchimento do formulário de coleta de dados. Conclui-se que, mesmo considerando a complexidade da implementação de mudanças na cultura organizacional de hospitais e o limite na incorporação de elementos teórico metodológicosem experiências concretas de qualificação da assistência hospitalar, as experiências do HGB e HSJB, embasadas na Gestão da Clínica e Clinica Ampliada, permitem a apreensão dos mecanismos de sua operacionalização, trazem contribuições para pensar a melhoria da qualidade assistencial dos hospitais públicos e endossam a perspectiva de viabilidade de um sistema de saúde mais qualificado.
This work is aimed at systematizing, based on the literature, theoretical and methodological perspectives of Clinical Governance and Extended Clinic, identifying their principles, propositions, institutional arrangements and management devices, and analyzing, under the perspective of those approaches, two Brazilian experiences on hospital care quality improvement. Literature review and cases’ study compose the research methodology, being the categories of analysis applied in the study of experiences: (1) quality of care, (2) focus on the patient, (3) professional adherence. We discuss the comprehensiveness and scope of the experiences, the dimensions of quality considered, in addition to results, difficulties and limitations of implementing changes. Clinical Governance and Extended Clinic search for quality improvement in health care practices, through individualized care, conducted by an interdisciplinary team, with a personalized therapeutic project. They emphasize the importance of health care as a central dimension of management, identifying the patient as the focus of care. They also point out the need of patients and their families’ involvement in clinical decisions, and recommend mechanisms of risk stratification and health care quality monitoring. Additionally they underline the importance of capacitating, training and awarding the professionals as strategies to achieve adherence to the project of change, and consider the role of leadership for a successful implementation of change. In the analysis of the experiences conducted by Hospital São João Batista (HSJB) - Volta Redonda, RJ – e Hospital Geral de Bonsucesso (HGB) – Rio de Janeiro, RJ, that exemplify the two approaches, this work discuss the complexity of the process of implementing changes in the organizational culture regarding care quality, accounting for successes and limiting factors. Results observed indicate, in the HSJB experience, health care increment and improvement, efficiency gains, organizational culture and management model changes, in addition to advances in institutional democratization and in hospital legitimacy in the population. In the acute myocardial infarction care quality improvement experience of HGB emergence room, after the implementation of strategies to facilitate adherence to clinical guidelines, there was significant increase in the use of interventions scientifically recognized as efficacious, reduction of iatrogenic events, drastic reduction in reperfusion loss of opportunity, besides improvement in fulfillment of the form applied in data collection. It is concluded that, even considering the complexity of implementing changes in hospitals’ organizational culture and the limited incorporation of theoretical and methodological elements in concrete experiences of hospital care improvement, the experiences of HGB and HSJB, based on Clinical Governance and Extended Clinic, allow us to capture mechanisms of their operation, bring contributions for consideration of health care quality improvement in public hospitals, and ratify the perspective that is a more qualified health care system is viable.

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Carmo, Carolina Mendes do. "Gestão assistencial da fisioterapia hospitalar: indicadores." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-27022019-150527/.

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Introdução: A gestão da qualidade e segurança assistencial do paciente é requisito mundial para todos os serviços de saúde, inclusive em fisioterapia hospitalar. Identificar e compor painéis de indicadores para monitorar a qualidade assistencial é determinante na avaliação, tomada de decisão e propostas de melhorias destes serviços. O Balanced Scorecard é uma metodologia de medição de desempenho e planejamento estratégico que transforma um grupo de indicadores escolhidos em um painel de qualidade e desempenho organizacional. Publicações sobre indicadores e gestão de serviços de fisioterapia hospitalar são escassas. Essa escassez mostra a necessidade de desenvolver um modelo de gestão sólido, com indicadores de qualidade que estejam alinhados à visão tática e estratégica do serviço para proporcionar melhor direcionamento e resultados à fisioterapia. Objetivos: Propor e validar um conjunto de indicadores de qualidade e desenvolver painéis de indicadores, táticos e estratégicos, como ferramenta de gestão assistencial da fisioterapia hospitalar. Método: O estudo foi realizado na Divisão de Fisioterapia do Instituto Central do HCFMUSP e conduzido em quatro fases: identificação dos indicadores (táticos e estratégicos); desenvolvimento de fichas técnicas; validação dos indicadores por avaliadores especialistas e desenvolvimento dos painéis de indicadores. A identificação de indicadores se baseou em reuniões do pesquisador com o diretor da Divisão e foram norteadas pela análise de dados assistenciais, objetivos estratégicos e de critérios recomendados para definição de indicadores. As fichas técnicas foram desenvolvidas para cada indicador de forma sistematizada. O processo de validação foi realizado utilizando a técnica Delphi e questionário eletrônico para avaliação dos indicadores. Os critérios de avaliação atribuíram escores de 1 a 5 pontos, sendo 1 \"discordo totalmente\" e 5 \"concordo totalmente\". O consenso dos avaliadores ocorreu quando o índice de validade de conteúdo foi maior ou igual a 4. Doze gestores de serviços de saúde hospitalar constituíram os avaliadores especialistas. Resultados: 1ª fase: o pesquisador identificou trinta e cinco indicadores táticos e seis indicadores estratégicos para compor a análise da qualidade assistencial. 2ª fase: Todos os indicadores foram estruturados e descritos por meio de fichas técnicas. 3ª fase: A validação dos indicadores táticos ocorreu após duas rodadas de respostas e ajustes nas fichas técnicas compartilhadas no Google drive. Ao fim das rodadas, vinte dos trinta e cinco indicadores, foram validados. A validação dos indicadores estratégicos ocorreu em somente uma rodada. Conforme sugestão dos avaliadores, as fichas técnicas de todos os indicadores foram ajustadas para facilitar a compreensão dos usuários. 4ª fase: Após validação, os indicadores foram compilados seguindo as perspectivas do Balanced Scorecard e objetivos estratégicos da Divisão de Fisioterapia para compor os painéis de indicadores táticos e estratégicos. Conclusão: O estudo validou e desenvolveu painéis de indicadores de qualidade, táticos e estratégicos, para gerenciamento assistencial da fisioterapia hospitalar. Os indicadores foram inseridos em um modelo de gestão estruturado evidenciando boas práticas gerenciais
Introduction: Quality management and patient care security are worldwide requirements for all health services, including hospital physiotherapy. Identifying and compiling indicator panels to monitor the quality of care are decisive in the evaluation, decision-making and proposals for improvement of these services. The Balanced Scorecard is a methodology of performance measurement and strategic planning that transforms a set of chosen indicators into a panel of quality and organisational performance. Publications on quality indicators and the management of hospital physiotherapy services are scarce. This scarcity shows the need to develop a solid management model with quality indicators that are aligned with the tactical and strategic vision of the service to provide better targeting and results of physical therapy. Objectives: To propose and validate a set of quality indicators, and to develop tactical and strategic indicator panels as a management tool for hospital physiotherapy. Method: The study took place at the Physiotherapy Division of the Central Institute of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and involved four phases: (1) the identification of indicators (tactical and strategic); (2) the development of technical data sheets; (3) the validation of indicators by expert evaluators and (4) the development of indicator panels. The researcher\'s meetings with the division director served as the basis for the identification of the indicators, and the analysis of care data, strategic objectives and recommended criteria for defining the indicators further guided the process. A complete guide resulted in the development of datasheets for each indicator. The Delphi technique and an electronic questionnaire to evaluate the indicators effected the validation process. The evaluation criteria assigned scores of 1 to 5 points, 1 being \"totally disagree\" and 5 being \"totally agree\". Consensus of the evaluators occurred when the content validity index was greater than or equal to 4. Twelve hospital health service managers served as the expert evaluators. Results: Phase 1: The researcher identified 35 tactical indicators and 6 strategic indicators to compose the analysis of the quality of care. Phase 2: Fact sheets structured and described all indicators. Phase 3: The validation of the tactical indicators occurred after 2 rounds of responses and adjustments to the shared datasheets in Google drive. The validation of 20 of the 35 indicators occurred at the end of the rounds. The validation of the strategic indicators occurred in only 1 round. At the suggestion of the evaluators, adjustments to the datasheets of all indicators facilitated user understanding. Phase 4: After validation, the perspectives of the Balanced Scorecard and the strategic objectives of the Division of Physical Therapy composed the panels of tactical and strategic indicators. Conclusion: The study developed and validated strategic and tactical quality indicator panels for the management of hospital physiotherapy. The indicators\' insertion into a structured management model evidenced good managerial practices

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Forrest, Mia. "Swedish Obesity Specialists : Obesity and its Treatment at a Specialist Clinic in Stockholm." Thesis, Stockholm University, Department of Social Anthropology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-31035.

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Swedish Obesity Specialists examines how obesity is conceptualized as a medical condition by the staff working at an obesity clinic in Stockholm Sweden. Through eight weeks of participant observations and eight semi-structured interviews this thesis answers the question of how specialist working in the field of obesity construct obesity as a medical site. The thesis aims at understanding how obesity is becoming an issue for medicine, further how obesity’s entry into medicine creates new understandings of the body and medical treatments. Through the theoretical concepts of global assemblages and bio-power I argue that obesity as a disease is defined through seemingly objective criteria aimed at defining a population of sufferers, simultaneously for obesity to be viewed as disease scientifically valid treatments on an individual level must be put into place. By viewing obesity’s entry into medicine as a process of shared consensus, this thesis examines the relationship between global levels of knowledge production and their application and negotiation at one clinic treating obesity. Here expert knowledge and governance are integrated to create both treatment and an idea of what obesity as a medical condition is. In this thesis I argue that the application of expert knowledge and global criteria leads to unexpected views on what can be conceived as medical treatment. Further the thesis discusses how the body of the patient becomes reinterpreted once obesity becomes a medical condition.

Key words: Obesity, medical expertise, global assemblages, governance, lifestyle alteration

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Cunha, Gustavo Tenório 1969. "Grupos Balint Paideia : uma contribuição para a co-gestão e a clinica ampliada na atenção basica." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312378.

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Orientador: Gastão Wagner de Souza Campos
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A prática gerencial hegemônica costuma privilegiar a padronização de condutas e a fragmentação do trabalho, em lugar do apoio aos profissionais de saúde no desafio de fazer uma clínica ampliada, que reconheça a singularidade dos sujeitos e grupos. Esta prática gerencial reforça um tipo de clínica que costuma ter dificuldade para lidar com pessoas reais, uma vez que enxerga na complexidade do adoecimento e do sofrimento, apenas os aspectos diagnósticos e recortes disciplinares, com graves conseqüências para a qualidade da atenção. É necessário, portanto, que os profissionais desenvolvam tanto alguma crítica a este tipo de conhecimento universalizante (e ao hábito quase inconsciente de tomar a "parte" pelo "todo") quanto alguma capacidade de lidar com a subjetividade inerente ao trabalho em saúde (do usuário, dos grupos e dos próprios profissionais). Michaël Balint, em meados do século passado, foi pioneiro em apontar que o aprendizado clínico não se reduzia aos seus aspectos cognitivos, propondo a criação dos GRUPOS BALINT para o apoio através da discussão supervisionada de casos clínicos. O presente trabalho aborda alguns dos principais desafios da atenção básica e apresenta a elaboração e experimentação de um instrumento de apoio à gestão da clínica e formação dos profissionais: os Grupos BALINT-PAIDÉIA, que procura adaptar os grupos BALINT para a realidade atual do SUS em síntese com o Método Paidéia para a co-gestão de coletivos. Inicialmente, apresentam-se instrumentos conceituais relevantes - Método Paidéia, Grupos Balint, Equipe de Referência e Apoio Matricial, Projeto Terapêutico Singular (PTS) e Clínica Ampliada - juntamente com uma breve contextualização da Atenção Básica no SUS. Em seguida, apresenta-se a formulação da proposta de GRUPOS BALINT PAIDÉIA (GBP) como instrumento complementar de apoio e formação em serviço, privilegiando a clínica ampliada e a co-gestão. Apresenta-se, então, o relato da experimentação prática de um GBP com 18 profissionais médicos e enfermeiros da rede básica na cidade de Campinas, elaborada a partir do diário de campo, metodologia utilizada no acompanhamento do grupo. Na seqüência, são apresentados alguns possíveis aprendizados teóricos a partir desta experiência: (1) sobre a importância e as implicações da coordenação de casos clínicos; (2) sobre o tema da Clínica Ampliada e sua relação com os conceitos de Flash e Intuição, com o Método Clínico Centrado na Pessoa (MCCP), com algumas das contribuições de Nahman Armony ; (3) sobre a medicalização e os paradigmas de saúde; (4) sobre a influência das religiões nas práticas de saúde; e (5) sobre os desafios no processo de formação dos profissionais de saúde
Abstract: The hegemonic management practice usually focuses on the hegemonic standards of conduct and fragmentation of work, instead of supporting health professionals in the challenge to make an extended clinic, which recognizes the singularity of individuals and groups. The hegemonic practice reinforces one type of clinic that frequently shows difficulties in dealing with real people, since it withdraws from the complexity of illness and suffering, only the diagnostic aspects and disciplinary particularities, carrying serious consequences for the quality of health care as result. Hence it is necessary that professionals develop critical positions related to such universalizing knowledge (and to the almost unconscious habit of taking the "part" as the "whole") specially referring to some capacity to deal with the subjectivity which is inherent in working in health care (related to the user, to the groups and to the professionals themselves. Michael Balint, in the middle of last century, was the pioneer in pointing out that clinical learning is not reduced to its cognitive aspects. He proposed the creation of BALINT GROUPS as support by means of monitored discussion of clinical cases. This thesis addresses some of the major challenges of primary care and presents the development and experimentation of a support instrument to clinical management and training for health professionals: Groups BALINT-PAIDEIA, aiming to adapt the groups BALINT to the current reality in the Brazilian National Health System (SUS) and working with Paideia, a Method for collective co-management of groups. Initially, this work presents relevant conceptual tools - Method Paideia, Balint Groups, Reference and Support Team Matrix, Singular Therapeutic Project (TSP) and Extended Clinic - along with a brief contextualization of Primary Care in SUS. Then it presents the formulation of the proposed BALINT GROUPS PAID (GBP) as a complementary instrument to support and in-service training, focusing on clinical and expanded comanagement. It is then reported the hand-on practice experimentation of a GBP including 18 professional doctors and nurses of the core network in the city of Campinas, prepared from daily field notes, methodology which is used in monitoring the group. In sequence is presented some possible theoretical learning from this experience: (1) on the importance and implications for coordination of clinical cases, (2) on the issue of Extended Clinical its relationship along with the concepts of Flash and Intuition, along with to The Patient- Centred Clinical Method and finally with some contributions from Nahman Armony, (3) on the paradigms and the medicalization of health, (4) on the influence of religion in health care practices, and (5) on the challenges in the training of health professionals
Doutorado
Saude Coletiva
Doutor em Saude Coletiva

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CERADINI, JACOPO. "SVILUPPO DI UN MODELLO INTEGRATO DI GOVERNO CLINICO IN UN CENTRO DI CARDIOCHIRURGIA PEDIATRICA DI III LIVELLO." Doctoral thesis, 2013. http://hdl.handle.net/11573/918544.

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Gupte, A., Bryan McIntosh, and B. Sheppy. "When two worlds collide: corporate and clinical governance." 2012. http://hdl.handle.net/10454/6527.

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Clinical and corporate governance have been an area of ongoing concerns in the NHS. Since the Bristol Royal Infirmary scandal of the 1990s and the events concerning Sir Jimmy Savile there has been a dilemma of its true nature and relationship. Clinical and corporate governance are closely related as the two of them share similar processes such as openness, performance review, striving for effective end results, and accountability in the use of resources and power within healthcare management.

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McVey, Lynn, Natasha Alvarado, J. Keen, J. Greenhalgh, M. Mamas, C. Gale, P. Doherty, et al. "Institutional use of National Clinical Audits by healthcare providers." 2020. http://hdl.handle.net/10454/17997.

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Yes
Healthcare systems worldwide devote significant resources towards collecting data to support care quality assurance and improvement. In the United Kingdom, National Clinical Audits are intended to contribute to these objectives by providing public reports of data on healthcare treatment and outcomes, but their potential for quality improvement in particular is not realized fully among healthcare providers. Here, we aim to explore this outcome from the perspective of hospital boards and their quality committees: an under-studied area, given the emphasis in previous research on the audits' use by clinical teams. Methods: We carried out semi-structured, qualitative interviews with 54 staff in different clinical and management settings in five English National Health Service hospitals about their use of NCA data, and the circumstances that supported or constrained such use. We used Framework Analysis to identify themes within their responses. Results: We found that members and officers of hospitals' governing bodies perceived an imbalance between the benefits to their institutions from National Clinical Audits and the substantial resources consumed by participating in them. This led some to question the audits' legitimacy, which could limit scope for improvements based on audit data, proposed by clinical teams. Conclusions: Measures to enhance the audits' perceived legitimacy could help address these limitations. These include audit suppliers moving from an emphasis on cumulative, retrospective reports to real-time reporting, clearly presenting the “headline” outcomes important to institutional bodies and staff. Measures may also include further negotiation between hospitals, suppliers and their commissioners about the nature and volume of data the latter are expected to collect; wider use by hospitals of routine clinical data to populate audit data fields; and further development of interactive digital technologies to help staff explore and report audit data in meaningful ways.
Health Services and Delivery Research Programme, Grant/Award Number: 16/04/06

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Pereira, Vanessa Andreia Azevedo. "Governance of an OpenEHR based local repository compliant with the OpenEHR Clinical Knowledge Manager." Master's thesis, 2019. https://hdl.handle.net/10216/119499.

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Pereira, Vanessa Andreia Azevedo. "Governance of an OpenEHR based local repository compliant with the OpenEHR Clinical Knowledge Manager." Dissertação, 2019. https://hdl.handle.net/10216/119499.

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HSU, SU-CHUN, and 許夙君. "Risk Factors of Patient Safety in Medical Center－ From the Point of View of Clinical Governance." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/13755969283065727133.

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碩士
國立成功大學
高階管理碩士在職專班
94
Based on the research results of 2 studies,” Harvard Medical Practice Study”(1986) and “ IOM Investigation Report-To Err Is Human”(2000), Medical industry is a high risk industry. 　According to “ Harvard Study”, 3.7% hospitalized patients suffer from medical injury, and 76% of it are avoidable . “ IOM Report” mentioned, the annual death result from medical error in the United States is approximately 44,000 to 98,000. people, among these, 53% to 58% are avoidable. Because of the severity and importance of this issue, the improvement of “ patient safety “ is urgent and must be raised to national priority. 　　According to the IOM report, medical errors are systemic management factors ( not limited to individual error), should consider learning from aviation industry. 　This study is based on the conclusion of the research of “ IOM Report”, and utilizing the “cheese theory” which had been used in the aviation safety to build up the primordial model of this research , also take the characteristics of medical industry into consideration. Referring to the 21st century new concept of clinical governance to get patients involved, we construct a more comprehensive study model PAPSO, taking “ Patient involvement”, “ unsafe Act”,” Preconditioning of unsafe act”, “unsafe Supervision” and “ Organizational influence” as five dimension to investigate the risk factors of patient safety from the point of view of organization level and management system. There are 52 items used as evaluation index which are accumulated and organized from all the references available(including aviation safety and medical safety related articles ). From the point of view of risk management, by finding out all the risk factors in every aspect is the only way to be bale to identify risk, evaluate risk, further more to respond to risk , control risk , and finally achieve the goal of preventive risk management. all the endeavors for patient safety purpose should prove the concept of “ Prevention is better than Treatment”. 　The orders of risk factors (selections of the first 12 items in 52 items) : 1. misconduct of operation method. 2. Operations violate the instructions or standards. 3.lack of knowledge of patient safety. 4. patients unable to bring up the questions or express the opinions when there is doubt . 5. lack of manpower 6. miscommunication between health care providers 7. lack of regulation of standard procedures for patient safety 8. lack of standardization of operation procedures or systemic design 9. concept of lack of determination or ability to put into act about patient safety. 10. miscommunication between health care provider and patients 11. lack of regulation and management about high alert category medication 12. Long working hours and not enough rest of doctors. 　This study investigates the risk factors in all the five dimensions which affect the patient safety of Medical Centers, and prioritizes their orders, according to the practical value , analyzes the possibilities of making improvement in managing major risk factors. By integrating ,categorizing and grouping the importance and possibility of major risk factors, come up with the strategy mapping , provide recommendations for those who are in charge of the strategy making or promotion of patient safety to refer to.

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Stewart, Lee. "How does a clinical governance framework contribute to the changing role of nurse leaders in Fiji?" Thesis, 2007. https://researchonline.jcu.edu.au/2100/1/01front.pdf.

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The incidence of adverse clinical events in health care organisations is an international problem. While intense interest has focused on this issue world-wide, with various responses including the introduction of clinical governance in developed countries, it has been less of a focus in developing countries, where the struggle to provide minimal resources for health care is often a priority. In Fiji, with the introduction of health reform funded by international aid agencies, improving patient care is now topical. The role of nurses, and particularly leaders in the nursing profession, is of paramount importance in the goal to provide better and safer health care to communities. Research shows that a key component of the successful implementation of clinical governance is effective clinical leadership. My main interest with this study was about the impact of nursing leadership. While extensive research has been conducted into the impact of nurses on safer care and better health services, this has not yet extended into developing countries such as those in the Western Pacific. There is a gap, therefore, in knowledge about how nursing leadership, and the nursing profession, effects health care policy and practice leading to better patient care in this region. This critical ethnography set out to expand understanding about the role that nursing leadership has in improving patient care in Fiji. The study pursued the question: ‘How does a clinical governance framework contribute to the changing role of nurse leaders in Fiji?’ The study had three specific objectives: 1) To undertake a critical literature review of the application of clinical governance principles within both developing and developed countries, with particular emphasis on the impact for nursing leaders; 2) To undertake a study of the evolution of nursing leadership in Fiji; 3) To critically investigate the situation for nurse leaders in Fiji, as the health care system embraced a continuous improvement framework and increased leadership accountability for effective nursing practice. With the recognition that organisational life is socially constructed and that the nurse leaders functioned within the bureaucratic structure of the Fiji Ministry of Health, social constructionism formed a basis for this research. Taking a critical theory approach with the research proved vital, given Fiji’s extensive history of colonization and the intention that participants had an opportunity for positive social change if they so chose. From a methodological perspective, Carspecken’s (1996) five recommended stages for critical qualitative research provided a framework within which the study was conducted, analysed and used to partially explain findings. Habermas’s theory of communicative action (1984) comprised the analytical lens through which participant interview data, field notes and various official documents and media reports were explored. This critical ethnography involved conducting interviews with six nurse leaders in Fiji over a two-year period and extensive time spent with staff of the Fiji Ministry of Health. The participants in this study were all experienced nurse leaders who held senior leadership positions, either in hospitals and community health services, or in the Head Office of the Ministry. During the interviews, participants shared extensive information about what it meant to be a nurse leader in Fiji, and what the impact of clinical governance was having on their professional lives. Attention to postcolonial issues was vital throughout the conduct, analysis and writing up of this research. The participants were all indigenous Fijians and spoke explicitly about the effect of colonization on the nursing profession in that country. I carried a heavy responsibility to appreciate the issues inherent in conducting the research as a non-indigenous researcher. Analysis from a critical perspective revealed three major themes, which are presented as distinct but related chapters in the thesis. The themes are: Findings our voices: understanding that we are powerful; Legitimizing our role as the facilitators of best patient outcomes; and Recognition of our capacity to take a leading role in health care. Themes are presented from the perspective of the participants’ narratives as well as field notes and documents, with my interpretations, based upon the Carspecken methodology and a Habermasian reading of the data. The findings are presented initially from the perspective of the analytic themes and the literature comprehensively reviewed. They are then discussed in terms of the literature identifying a link between effective nursing leadership, nursing conditions and optimum safe patient care. The recommendations from the study are identified as they emanate from the findings and include those concerning nursing leadership, education, nursing practice and patient care, as well as recommendations for potential further research.

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Smith, A., S. Latter, and Alison Blenkinsopp. "Safety and quality of nurse independent prescribing: a national study of experiences of education, continuing professional development clinical governance." 2014. http://hdl.handle.net/10454/10665.

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No
Aim. To determine the adequacy of initial nurse independent prescribingeducation and identify continuing professional development and clinicalgovernance strategies in place for non-medical prescribing.Background. In 2006, new legislation in England enabled nurses with anindependent prescribing qualification to prescribe, within their competence. In 2006,non-medical prescribing policies released by the Department of Health outlinedthe recommendations for education, continuing professional development andgovernance of non-medical prescribing; however, there was no evidence on a nationalscale about the exte nt of implementation and effectiveness of these strategies.Design. National surveys of: (i) nurse independent prescribers; and (ii) non-medical prescribing leaders in England.Methods. Questionnaire surveys (August 2008–February 2009) coveringeducational preparation, prescribing practice (nurse independent prescribers) andstructures/processes for support and governance (non-medical prescribing leaders).Results. Response rates were 65% (976 prescribers) and 52% (87 leaders). Mostnurses felt their prescribing course met their learning needs and stated courseoutcomes and that they had adequate development and support for prescribing tomaintain patient safety. Some types of community nurse prescribers had less accessto support and development. The prescribing leaders reported lacking systems toensure continuity of non-medical prescribing and monitoring patient experience.Conclusion. Educational programmes of preparation for nurse prescribing werereported to be operating satisfactorily and providing fit-for-purpose preparationfor the expansion to the scope of nurse independent prescribing. Most clinicalgovernance and risk management strategies for prescribing were in place inprimary and secondary care.
Department of Health (UK)

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Malesela, Ledile Mmabatho Hendricca. "An analysis of ethical issues arising in the current governance of clinical trials for Complementary Medicines in South Africa: looking towards the future." Thesis, 2017. https://hdl.handle.net/10539/24800.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in the field of Bioethics and Health Law Johannesburg, October 2017.
The WHO (World Health Organization) estimates that 80% of the world’s population use Complementary Medicines (CMs) as their primary source of healthcare. Similar figures have been reported in the South African population (Siegfried &Hughes, 2012: 2). The high numbers of CMs users in South Africa (S.A) raises considerable questions about how best to safeguard patient and population health, and what responsibilities the government has towards regulation of medicines and practitioners. This, in turn raises the issues of how best to assess CMs – and thus whether clinical trials are an appropriate method of assessment. The considerable difference between the systems of CMs and Allopathic Medicines raises concerns when applying clinical trial practices to CMs assessment. Clinical trials, as the gold standard for assessing medical efficacy in Allopathic Medicine, reflect specific interpretations of medicine and health. It has been noted that the key practices in clinical trials for Allopathic Medicines such as randomisation, blinding and placebo can be very difficult to adhere to when investigating CMs. Thus, the use of clinical trials to assess CMs raises a range of different concerns, from the validity of the trials to the potential harm to trial participants. There is considerable interest in S.A to improve legislation governing the widespread use of CMs. Nonetheless, the development of legislative oversight requires further consideration. In this research report, I will be critically interrogating the current legislation in S.A from an ethical perspective to identify areas requiring further attention. These issues include threats to participant well-being, threats to the efficacy of the trials, and long-term threats caused by potentially incomplete trial data. My research considers ways in which these ethical considerations can be ameliorated by directed changes to the legislation. This research report will conclude by offering a range of recommendations for improvement to the governance of CMs clinical trials in S.A. The recommendations are made to the relevant departments which are making decisions with regards to clinical trials in S.A.
LG2018

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Dissertations / Theses on the topic 'Clinical governance'

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