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1
Aiken, Alexander. "Hospital-acquired infections in two district hospitals in Kenya." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.590555.
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Bedeker, Wiaan Francois. "Impact of basic transthoracic echocardiography at district hospital level." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16935.
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Includes bibliographical referencesThe use and demand of echocardiography has increased worldwide. In developed countries, this has not been translated into improved access outside tertiary centres. Previous studies have favoured the appropriate use of echocardiography over its clinical impact, limiting generalisability to resource constrained settings. Objectives: To assess the impact of an echocardiographic service at district hospital level in Cape Town, South Africa. Methods: A prospective, cross-sectional study was performed. A total of 210consecutive patients, referred to the echocardiography clinic over a five-month period, were recruited. Transthoracic echocardiography was evaluated by its indication, new information provided, correlation with referring doctor's diagnosis and subsequent management plan. Impact included the escalation and de-escalation in treatment, as well as usefulness without a change in management. Results: The results show that 84% of the patients' management was impacted by echocardiography. Valvular lesions were the main indication. The most frequent contribution was information provided towards the diagnosis of heart failure and assessment post-myocardial infarction. Fifty-six per cent of the echocardiograms confirming the referring doctor's diagnosis still had a significant impact. The rational prescription of medication had the major impetus, followed by de-escalation of therapy and screening patients for referral to tertiary facilities. Conclusion: Echocardiography has a positive impact on patient management outside tertiary settings, where the definition of impact appears to be different. The value of a normal study, screening prior to upstream referral and usefulness irrespective of change has been established. This should alert policy makers towards the risk of restricted access and promote training.
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Toni, Gladys Nosisana. "Accelerated staff turnover among professional nurses at a district hospital." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/620.
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The study emanated from the researcher’s experience and involvement in clinical nursing and nursing management. The researcher noted how heavy losses of recruited professional nurses might have had an influence on the quality of service delivery. It is a costly and time-consuming task to recruit enough nurses into the profession and retention of staff is especially difficult. There had been a significant increase in the number of professional nurses leaving the district hospitals either to primary health care service, private hospitals or other countries. Before the commencement of the study the turnover rate at the district hospital where the study was conducted, almost doubled the accepted norm, which was ten percent of the staff. For those reasons the researcher decided to conduct a study named, “Accelerated staff turnover among professional nurses at a district hospital.” The constant heavy losses of qualified nurses from the profession constitute one of the serious challenges for nursing managers. The researcher wanted answers to the following question: “What were your experiences of your job as a professional nurse at the district hospital?” The objectives of the study were: · to explore and describe factors leading to high staff turnover of professional nurses at a district hospital · to develop guidelines to help retain professional nurses. The design of this study, which was conducted in one of the district hospitals in the Makana Local Service Area in the Eastern Cape, is qualitative, descriptive and contextual. Informed permission for conducting the research was obtained from relevant authorities and participants were asked to sign a consent form before the researcher proceeded with the study. Participants that met the selection criteria were selected by means of purposive sampling. Data was obtained by means of semi-structured telephonic interviews that were audio-taped and later transcribed verbatim. To ensure trustworthiness of the study, the researcher applied the four strategies as proposed by Lincoln and Guba (De Vos, 2002:351) namely, credibility, transferability, dependability and confirmability. Collected data was analysed according to the descriptive method proposed by Tesch (in Creswell, 1994:154). The services of an independent coder, who was provided with transcripts and a protocol to guide data analysis, were utilised. A consensus meeting was held between the researcher and the independent coder to discuss the identified themes and sub-themes. Following the data analysis, a literature control was undertaken to highlight the similarities to and differences in comparison between this and previous studies. Four major themes and sub-themes were identified through analysis.
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Lam, Wai-yee Wendy. "Abdominal wound infection after caesarean delivery in a district hospital." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36887122.
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Lam, Wai-yee Wendy, and 林慰儀. "Abdominal wound infection after caesarean delivery in a district hospital." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B39724335.
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Gray, Zara. "Rituals of health : new healing spaces for Khayelitsha district hospital." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/17127.
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The intention of this thesis was to challenge how we, as architects are appropriating new formations of space within the city. The research began as an exploration into how a contemporary African city space could be envisioned, a future trajectory of design thinking that challenges normative systems of design. The diverse nature of South African cities should have an architecture that responds to its lived reality and one that reflects cultural difference. This exploration was narrowed down to view a need that ran across cultural lines. I chose to do this through looking at various health systems that prevail in our current society. The challenge was to critically seek out new ways that one could accommodate for various cultural beliefs while viewing these various health practices. These explorations were carried out in two sections - the first section looks at our current condition and what the prevailing health systems are in our society, as well as the challenges these various views on health pose. The second section focuses on a spatial understanding of how these systems are carried out in our city and seeks to analyse the various spatiality's of healing practices. The idea is to search for how new spaces of healthcare could be realised that reflect cultural difference, rituals and practices and which respond to a South African condition.
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Gangai, Bharti. "Patient satisfaction with health services in a rural district hospital." University of the Western Cape, 2015. http://hdl.handle.net/11394/5216.
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Magister Scientiae Dentium - MSc(Dent)BACKGROUND: The concept of consumer satisfaction is gaining momentum across all business sectors worldwide. In keeping with this trend, health care systems are now also being reviewed to assess patient satisfaction with regard to the quality of care provided. Patient satisfaction is an instrumental tool for identifying shortcomings and challenges of the health system, and provides patients with a constructive outlet to rate their hospital experience. AIM: To determine the perceived levels of patient satisfaction with health care services. METHODOLOGY: A descriptive cross-sectional study was conducted using patients who attended the Outpatients Department of Untunjambili Hospital in Kwa-Zulu Natal. A sample of 250 patients was selected using systematic random sampling. The research instrument, a structured questionnaire consisted of 23 questions which were subdivided into five categories, namely: biographical data; accessibility to the hospital; infrastructure; overall satisfaction and general comments. The 5-Point Likert Scale was used to determine the perceived levels of patient satisfaction. Data collected from the responses was analysed using the SPSS Programme, Version 22.0. A Significance level of (p=0.05) was applied. RESULTS: The response rate of the study was 99.2% (n=248).The majority of the respondents were female (75.4%) and aged between 20-30 years old. The relative ratio of males to females was approximately 1:3. Nearly half of the participants (48.4%) had a secondary education, and a high degree of illiteracy was noted (21.8%). The majority of patients relied on taxis as the mode of transport to reach the hospital (71.4%), with 55.2% having to pay more than R15.00 for travel costs. While statements relating to personality such as staff friendliness, and doctors treating patients respectfully scored highly (93.5%), more than two thirds reported dissatisfaction with the lengthy waiting times (71.8%). In terms of infrastructure, respondents were mainly satisfied with the seating arrangements, cleanliness and air circulation, but were unhappy with the state of the toilet facilities and the unavailability of drinking water. Overall, 90.3% of patients were satisfied with the level of care they received at Untunjambili Hospital, with 89.5% suggesting that they would recommend the institution to others.
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Najjaar, Leilah. "Bed utilisation trends in selected wards across eight district hospitals in the Cape Town district." University of the Western Cape, 2018. http://hdl.handle.net/11394/6889.
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Master of Public Health - MPHBackground: The largest focus areas for the department of health is ensuring access to quality healthcare. The district health system (DHS) model remains the vehicle used by the district managers to deliver on the health department’s goals, objectives and priority focus areas. Strengthening the district health system platform is therefore important to the department to improve access and quality of care to the clients serviced in the province. The district hospitals play a fundamental role since they support primary health care (PHC) and serve as the entry point to more specialised care. The efficient management of beds in the district hospitals is the key in ensuring access to care and preventing bed blocking. Bed Utilisation Rate (BUR) and Average Length of Stay (ALOS) are indicators used to measure the efficiency of hospital beds. This study provides a description of the trends in bed utilisation within the inpatient wards of eight district hospitals in the Cape Town metro district in the 2016-2017 financial period. Methodology: To analyse and compare wards a quantitative approach was used. Inpatient ward activity reports for eight district hospitals were accessed from the department of health’s routine data collection repository. A total of fifty-five wards were compared across small and large hospitals for BUR and ALOS during the financial year period 1 April 2016 to 31 March 2017. Data entry was done in MS EXCEL and analyses were done using STATA 11.0.
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Ricketts, David John. "Reconfiguration and modernisation of a district general hospital clinical biochemistry service." Thesis, University of Portsmouth, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.516885.
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Context: The clinical biochemistry department at the North Middlesex University Hospital successfully won funding under the pathology modernisation initiative to automate the core laboratory in 2000. Following procurement procedures, the contract was awarded to two vendors who offered an 'islands of automation' solution as opposed to the popular fully tracked solution. The automation was installed with minor process change, but process reviews occurring in 2003 with the advent of Lean Six Sigma. Methods: The Executive War College meeting in 2003 introduced new quality management tools Lean, Six Sigma and activity-based costing, to the pathology environment. These methods were incorporated into the clinical biochemistry department and the impact of these was studied over a five year period to assess if any additional benefit could be offered when compared to the implementation of automation on its own. The later being introduced using traditional process management methodology. The process review expanded to include the specimen reception area, as delays at this point had a major impact on the performance of the automated laboratory. Results: Introduction of process management tools improved turn around time for key indicators by as much as 50%, compared to automation alone, whilst removing the variation in time to result due to the pull system of samples setting a defined time for samples to arrive for analysis. The total laboratory space for clinical biochemistry was reduced by 32% allowing for the formation of a molecular laboratory and increasing the sample reception area by 133%. The avoided build cost to extend the department for these works was £265,500 .. The value added activity post process change was scored at 17.21 % which was an international best for laboratories who had been assessed using this tool. Using benchmarking data, £1,350,000 of avoided costs, in the year 2007-8, were calculated as a result of the changes made to the service. A staff survey of the changes supported the change process with positive feedback. Automation of request forms using electronic ordering show a dramatic improvement on quality compared to the hand written forms, which had a Sigma level of between 2 and 3, improving to 4.1 Sigma when the electronic requesting went live. ii Conclusion: All process tools strongly recommend taking a baseline reading of the data before making any change, this recommendation was verified as a must in this study. The advent of automation proved very popular with the staff as it removed repetitive functions and made some manual processes obsolete, thus improving morale. The impact of automation however did not improve significantly the turnaround times, but enabled sample archiving and retrieval to be less prone to error. The study found that by aligning the work processes in specimen reception to those processes in the clinical biochemistry department, this created the major benefit. Therefore a strong recommendation is that process managing of specimen reception areas is a must before undertaking any purchase of automated systems. Any delay in the laboratory is minor compared to the potential for delay that poor process can give in the pre-analytical phase. Benchmarking allowed a year on year comparison to be made, but the study highlighted the need to drill into the data and understand the service change when looking at cost per unit. This allowed the return on investment for the new technology to be assessed, in this study the return was realised in eighteen months. Benchmarking highlighted that the quality improvement that new assays provided to patient care impacted marginally on the test volumes but had a 15% impact on the non-pay budget. The use of activity-based costing compliments both Lean and Six Sigma by allowing the true cost of the work to be assessed with both value adding activity and avoided cost, the money not spent as opposed to direct cost cuts, to be calculated. The activitybased costing allowed staff to focus their jobs onto those tasks which were appropriate to their grade and identify and reduce those tasks which were not, improving job satisfaction and morale. Avoiding cost through good process change has a positive impact on both the patient and the budget, which cannot be achieved by cost improvement programmes based on a percentage change in the money allocated to the department.
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Berkley, James Alexander. "Invasive bacterial infections in children at a sub Saharan district hospital." Thesis, University of Newcastle upon Tyne, 2002. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289202.
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Beutel, Bernhard. "Preventing venous thromboembolism at a district hospital : a quality improvement study." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/97180.
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Thesis (MFamMed)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Background: Pulmonary embolism (PE) is the most common preventable cause of hospital deaths, and almost all hospitalised patients have at least one risk factor for venous thrombo-embolism (VTE). Despite the availability of highly effective thromboprophylaxis in prevent-ing VTE, numerous studies worldwide have demonstrated its under-utilization. The aim of this study was to review and improve the utilization of thromboprophylaxis in the prevention of VTE in hospitalized patients at Oudtshoorn district hospital. Method: A quality improvement cycle (QIC). Retrospective analysis of files of adult patients admitted to the male and female wards at Oudtshoorn district hospital was performed prior to and after a 5 month intervention phase. The target standards for the QIC were: 1) Availability of a written hospital policy on VTE prevention; 2) Every adult admission should have a for-mal VTE risk assessment documented; 3) Every adult admission who is at risk for VTE should receive thromboprophylaxis. Results: Thirty eight percent of adult patients admitted to Oudtshoorn hospital, excluding the maternity ward, were at risk of developing VTE. There was no written hospital policy on VTE prevention. This was developed and made available during the intervention. In the pre-intervention group there were no patients who had a documented VTE risk assessment. The post intervention group showed a considerable increase with 45.2% having had a completed VTE risk assessment on admission (p<0.00001). In the pre-intervention group only 4.6 per-cent of patients who were at risk of VTE received thromboprophylaxis. There was a statisti-cally significant difference in the number of patients at risk who received thromboprophylax-is in the post-intervention group where 36% of these patients received thromboprophylaxis (p<0.00001). Conclusions: The study identified a major shortcoming in the prevention of VTE in those patients at risk who were admitted to Oudtshoorn district hospital. An intervention as part of a quality improvement cycle has been able to demonstrate a significant improvement in the detection of patients who are at risk of VTE and a subsequent improvement in appropriate thromboprophylaxis. A number of barriers to their implementation have been identified and need to be addressed. This QIC may in time be of value to assist other district hospitals in addressing the issue of VTE prevention.
AFRIKAANSE OPSOMMING: No abstract available.
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Botha, Janes. "Anatomy 101 : a Human Anatomy Centre at the Tshwane District Hospital." Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/30017.
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Interior design has a social responsibility. To facilitate the way in which buildings change, thereby allowing the user to retain interest and awareness of buildings. The sensitivity of built fabric with historical value combined with the symbolic nature of institutional buildings justify the need to reinterpret architecture in order to retain its value to future generations. It is the aim of this dissertation to investigate the interior designer’s role in altering built fabric by reinterpreting the existing design language. A new perspective should evolve from a well informed understanding of the elements present on site and provide a new strategy by reacting to it. The selected project is a Human Anatomy Centre at the Tshwane District hospital that should provide both the academic and non-academic user with the opportunity to reinterpret their understanding of the human body.Dissertation (MInt(Prof))--University of Pretoria, 2011.
Architecture
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Busolo, Mellanda Isia. "Motivation levels of tuberculosis healthcare staff at a district hospital in Kenya." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1008292.
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Background: The success of tuberculosis (TB) treatment largely depends on healthcare team factors within a healthcare system, as healthcare workers play a vital role in fostering patient adherence to TB treatment. Strengthening motivation amongst Kenya’s TB healthcare workers should thus be reinforced in order to improve on clinical outcomes of TB treatment in Kenya. Objectives: To determine motivational needs of TB healthcare staff at a district hospital in Kenya and to provide recommendations on how to enhance their motivation. Design: TB healthcare workers including nurses, doctors, pharmacists and community healthcare workers were purposively sampled from a district hospital in Kenya. Their motivational levels were measured using a questionnaire adapted from Bennet and colleagues (2000). Key Findings: A high level of job satisfaction was present in more than 50 percent of the employees, although the ‘extrinsic job satisfaction’ sub-scale stood out as scoring relatively poorly in comparison to the other ‘job satisfaction’ sub-scales. Cognitive motivation yielded mixed results with 44 percent of respondents rating themselves as being satisfied, and 56 percent between neutral and very dissatisfied. The overall organisational commitment was positive, with the majority (60 percent) of respondents rating themselves as being committed to their organisation. The majority (96 percent) of workers rated their performance at work as very high. Conclusion: Improvement in staff motivation can be attributed to how well a hospital's management organises and runs its hospital. It was recommended that hospitals should provide an environment where motivational strategies are continuously implemented and where change is positively rewarded. This may, in turn, have a positive impact on TB treatment outcomes. The study may be of interest to key decision makers in Kenya’s healthcare system as well as TB programme managers, hospital managers and health managers in general. Further investigations are needed in order to determine whether Kenya’s public healthcare system has a staff retention strategy that is up to date with the motivational needs of Kenya’s health workforce.
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Mitra, Ritabrata. "Modern cardioversion strategies for acute atrial fibrillation in a district general hospital." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.419847.
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Koné, Insa [Verfasser]. "Costing of hospital services in rural sub-Saharan Africa - The case of Nouna district hospital, Burkina Faso / Insa Koné." Greifswald : Universitätsbibliothek Greifswald, 2011. http://d-nb.info/1012030253/34.
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Alagbe, A. O. "Quality improvement cycle in Opuwo district hospital HIV/AIDS clinic, Kunene region, Namibia." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97214.
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The study aimed to assess and improve the quality of care for Opuwo District Hospital HIV/AIDS clinic in Namibia. Currently, there is no literature available on the quality of care for the HIV/AIDS clinic at primary level in Namibia.
Opuwo District has one of the lowest prevalence rates of HIV/AIDS in Namibia with 8.8% among ANC patients. A total of 1714 HIV positive patients are enrolled at Opuwo District Hospital HIV/AIDS clinic and 109 (6.36%) of them are defaulting treatment. Based on these statistics, I decided to do a quality improvement cycle of the HIV clinic system to see if it would improve adherence. Adherence will improve if the quality of care rendered to patients is standard (18).
Aim and Objectives
The aim of the research is to improve the quality of care for patients on ARVs, with concern for factors influencing adherence in Opuwo district Hospital.
The objectives are as follow:
1) To evaluate the quality of care that was given to patient registered at Opuwo HIV/AIDS clinic since 2007
2) To correct inadequacies discovered during initial evaluation of the clinic to improve the quality of care
3) To evaluate if corrected inadequacies have led to improved quality
Method
The study design is a quality improvement cycle
The quality improvement cycle done was a teamwork that involved trained nurses in HIV, data clerk, counsellors, trained pharmacist in ARV therapy and a doctor. This team audited care rendered by looking at the structure, process and outcome of the care given at the clinic; then inadequacies discovered were corrected and the whole system was re-audited to see if there is improvement.
The study population was patients attending HIV/AIDS clinic since 2007 until date and the sample size was fifty with selection made by random sample using simple proportion (HIVQUAL system that was automatically programmed to calculate sample size based on the population of patients entered into the system).
Data on structure was carried out prospectively by observing what is on the ground in term of equipment, staff, tools etc. Data for proper documentation, weight checked at every visit, clinical staging at every visit, counselling at every visit, TB screening etc and outcome (regular in clinic attendance, viral load below 1000 after 6months on HAART, etc) were audited retrospectively using patient’s file.
Results
Using chi-square test to analyse the data, the intervention was successful because the P-values were less than 0.05 in most of the indicators audited for process and outcome.
It was found that after the intervention (in-service training, re-enforce proper documentation, re-enforce health education by all staff not limit it to counsellors alone, wall poster to remind staff on ordering investigation for CD4, viral load when due and follow up results by doctor or nurses, weigh check for all patients before starting consultation, doctor and nurses should prescribe IPT, Co-trimoxazole and multivitamins) was made, adherence improved from 46% to 82% and opportunistic infection declined below 15%.
Conclusion
The quality improvement cycle enabled simple changes like in-service training, re-enforcement of health education by all staff, etc to be made at the clinic, which lead to appreciable quality improvement over a short period.
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Mills, Pamela Ruth. "Hospital electronic prescribing and medicines administration system implementation into a district general hospital : a mixed method evaluation of discharge communication." Thesis, Robert Gordon University, 2016. http://hdl.handle.net/10059/1581.
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Hospital electronic prescribing and medicines administration (HEPMA) system implementation is advocated by national e-health strategies to produce patient safety benefits. No previous study has evaluated HEPMA implementation impacting discharge information communication or assessed discharge prescribing errors. The aims were to assess HEPMA system implementation impact on medicines related discharge communication and prescribing errors, and to gain the perspective of hospital staff involved in the communication process. Following a narrative literature review, a convergent parallel mixed methods was selected, consisting of interpretative phenomenology and experimental before and after study design. Face-to-face semi-structured interviews of a purposive sample of hospital staff involved in discharge information communication were undertaken using the Theoretical Domains Framework (TDF) as a theoretical lens. In addition a quasi experimental retrospective case notes review, both before and after implementation was completed. Pre-implementation, staff described patient safety concerns with traditional discharge communication processes. They cited frequent prescribing errors, and associated adverse events and hospital readmissions. HEPMA implementation was anticipated to improve patient safety and create more efficient discharge communication. Post-implementation staff articulated improved information quality highlighting fewer omitted medicines and improved patient safety. TDF findings of behaviour change highlighted behavioural alteration including adaption of processes to improve discharge quality. Quantitative data collection (n=159 before and after) confirmed qualitative findings; increased compliance with discharge documentation, for example staff grade recorded increased from 40% to 100% (p<0.001). Prescribing error quantity and severity were reduced; errors reduced from 99% to 23% of patients (p<0.001); only 22% of identified errors likely to cause harm. Omitted medicines decreased from 42% to 11% of patients (p<0.001). The findings contribute original knowledge concerning HEPMA implementation impacting discharge information communication and prescribing errors. The study demonstrated reduced prescribing errors and improved patient safety which potentially impacted health and wellbeing. Qualitative findings and quantitative results are transferable and applicable to other NHS organisations or similar healthcare settings.
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Islam, Farzana. "Quality Improvement System for Maternal and Newborn Health Care Services at District and Sub-district Hospitals in Bangladesh." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-48416.
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In Bangladesh, research focusing on the quality of maternal and newborn health (MNH) services in hospitals remains neglected. There have only been a few studies conducted on quality issues and found the quality of MNH care provided at district and sub-district hospitals to be poor. The overall objective of this thesis was to develop, implement and evaluate a framework for quality improvement (QI) system for MNH care at the district and sub-district level government hospitals in Bangladesh. The thesis is comprised of four papers. Mixed methods were used in paper I and paper IV. In paper II quantitative methods were utilized, and to develop the “Model QI System”, exploratory methodological approaches were used and illustrated in paper III. Group discussions, focus group discussions, in-depth interviews, documents review and photography were utilised as qualitative data collection techniques. Through structured observation and exit interviews quantitative data were obtained. Findings of baseline survey identified several keyfactors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under useof patient-management protocols; lack of training; and insufficient supervision. The clinical performance of health care providers was found unsatisfactory. Utilizing the baseline survey findings and existing information on QI models, theories and QI intervention programmes implemented in defferent settings an adapted “Model QI System” and its implementation framework, guidelines and tools were developed. The key areas of this “Model QI System” included health system support, clinical service delivery, inter-departmental coordination; and utilization of services and client satisfaction. The adopted “Model QI System” was incorporated within the existing hospital management system and it was found that the quality of care improved. The evaluation of the study showed that the “Model QI System” was acceptable to the top health managers, health care providers and hospital support staff and feasible to implement in district and sub-district hospitals in Bangladesh.
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Sagahutu and Jean Baptiste. "Use of the International Classification of Functioning Disability and Health (ICF) as a theoretical framework to inform interprofessional assessment and management by health care professionals in Rwanda.: a cluster randomised control trial." Thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28379.
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Background: Effective collaboration between health professionals can reduce medical errors and assist in interpretation of health information resulting in improved patient care. The International Classification of Functioning, Disability and Health (ICF) has been suggested as a potential framework to help health professionals develop a common language for better collaboration and to provide more holistic care. In the main, Rwandan district hospitals still utilise the hierarchical medical model of health. Aim: The aim of the study was to determine whether training on interprofessional practice, using the ICF framework, resulted in improved knowledge, attitudes and behaviour(as determined by improved recording of interprofessional assessment and management in patient records) in randomly selected Rwandan District Hospitals. Methodology: This study was composed of two phases. Phase I: Preparation. The intervention programme was developed based on a literature review and input from an international panel of experts. A feasibility study in which self-designed instruments and the training programme were tested was undertaken in one district hospital. Phase II: A Cluster Randomised Control Trial. Four district hospitals were randomly allocated to receive a day’s training in interprofessional practice using the ICF (experimental hospitals) or a short talk on the topic (control hospital). Participants included medical doctors, nurses, physiotherapists, social workers, nutritionists, and mental health nurses/clinical psychologists. Using self-designed and validated measures, pre- and postmeasurements of knowledge and attitudes towards Interprofessional Practice (IPP) were performed at baseline and after training and audit of patients’ records after discharge was performed at baseline and at two, four and six months. The independent t-test and Mann-Whitney U test were used to establish if the two sets of groups were equivalent before and after training at baseline and at two, four and six months. Repeated measures ANOVA and the post-hoc Tukey test were used to compare the audit scores at each time point. The Kruskal Wallis test was used to compare rankings of the scores of attitudes of different professions before and after the intervention. Ethical approval was obtained from the Human Research Ethics Committee of the University of Cape Town and the Rwandan National Ethics Committee.
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Alves, Juliana Araújo. "Do hospital ao bairro: desativação do “hospital-colônia” e criação do bairro Colônia Antônio Aleixo em Manaus - AM." Universidade Federal do Amazonas, 2011. http://tede.ufam.edu.br/handle/tede/3986.
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Outras
The pages that follow deal with originating a neighborhood of closing of the "Hospital-Colônia" Antônio Aleixo, located in the eastern city of Manaus. For years the neighborhood was stigmatized because of the disease known by the term Hansen biased - leprosy. What confirms the geographical breakdown of the neighborhood, about 15 km away from the city center of Manaus. Its initial activities refer to the 1940s, when inmates are transferred gradually Colônia Belizário Penna in Paricatuba. And it ended officially in 1978 when the hospital is shut down and the colony becomes district of Manaus, and declared open to free movement. Understanding this moment of transition from the hospital district, and the spatiality of everyday space was the goal of this dissertation. The research that led to the text portion of people's lives, understanding that they construct and reproduce their lives, even if restricted to the confines of a hospital. The dissertation is divided into three chapters and, consequently, each is divided into three subchapters. The triad is not random. We start with the understanding that there is a questioning, a statement and, again, another question. First, treat the neighborhood as it is constituted today. In the second chapter deal with the pertinent subjects with leprosy, the special pension, compensation for separated children and so on. The last chapter deals with the past of the neighborhood. Far from conclusive research to finish, this dissertation, she introduced us to new questions. The research that gave rise to dissertation was supported by CNPq (Process 556870/2009-3) for the project "From space the disease to living space".
As páginas que seguem tratam de um bairro originário do encerramento das atividades do “Hospital-Colônia” Antônio Aleixo, situado na zona Leste da cidade de Manaus. Durante anos o bairro foi estigmatizado, em virtude, da hanseníase doença conhecida pelo termo preconceituoso - lepra. O que corroborou para a desintegração geográfica do bairro, afastado cerca de 15 km do centro urbano de Manaus. Suas atividades iniciais remetem a década de 1940, quando paulatinamente são transferidos os internos da Colônia Belizário Penna, em Paricatuba. E se encerraram, oficialmente, em 1978 quando o Hospital é desativado e a Colônia torna-se bairro de Manaus, declarada aberta e de livre circulação. Compreender esse momento de passagem de Hospital a bairro, a espacialidade e o cotidiano desse espaço foi o objetivo da presente dissertação. A pesquisa que originou o texto parte da vida das pessoas, entendendo que elas constroem e reproduzem suas vidas, ainda que restringidas aos limites de um Hospital. A dissertação está dividida em três capítulos e, conseqüentemente, cada um deles é dividido em três subcapítulos. A tríade não é ao acaso. Partimos do entendimento de que há um questionamento, uma afirmação e, novamente, outro questionamento. Primeiramente, tratamos do bairro tal como ele é constituído hoje. No segundo capítulo tratamos de termas pertinentes aos portadores de hanseníase, a pensão especial, a indenização aos filhos separados e etc. O ultimo capítulo trata do passado do bairro. Longe das pesquisas conclusivas ao terminarmos, a presente dissertação, ela já nos apresentou novos questionamentos. A pesquisa que deu origem a dissertação foi financiada pelo CNPq (Processo 556870/2009-3) pelo projeto “Do espaço da doença ao espaço da moradia”.
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Ajeneye, Francis O. "Implementation and evaluation of a blood products traceability procedure in a District General Hospital." Thesis, University of Portsmouth, 2012. https://researchportal.port.ac.uk/portal/en/theses/implementation-and-evaluation-of-a-blood-products-traceability-procedure-in-a-district-general-hospital(a3600275-41f8-4423-8dee-f45dea532c56).html.
Full textAbstract:
The main aims of this study were to explore and identify why traceability compliance was poor at the Homerton University Hospital NHS Trust and to implement a suitable model to improve it. This study was a multi-stage exploration of the various practices of staff involved in the blood transfusion chain, both at the Trust and in some other NHS Trusts in the United Kingdom. The study explored the reasons for the Trust's poor traceability of blood products, which eventually led to poor compliance. It identified the risk factors that led to poor traceability, explored why some wards had better compliance than others and evaluated the direct costs and benefits of wastage. The principal aim of these activities was to be able to take an informed decision on the development of a new model to improve compliance. A quantitative approach was adopted as it made it possible to measure the frequency of actions, and this data was used to answer the research questions. Data was collected using questionnaires, observations and an audit of information extracted from the laboratory's information management systems. A questionnaire was designed, piloted and sent to all ward managers at the Trust, and survey data was analysed using the SPSS statistical package. Some of the issues that were addressed and analysed included: staff training in blood product collection and administration; knowledge of staff members of the concept of traceability compliance; laboratory staff professionalism; ward staff responsibilities for traceability compliance; and ward staff attitudes and opinions about the traceability model. To add rigour to the study, the survey was followed by structured observations at the blood collection point and the patient's bedside. This data was also analysed using descriptive statistics and the results showed that traceability compliance was poor in some areas of the Trust. Problems included: the absence of a trainer on the ward, lack of education, few transfusion episodes on the wards, variation in the method of returning labels to the transfusion department, and poor communication between frontline staff and the transfusion laboratory. The study resulted in the implementation of new approaches to the transfusion chain in order to improve practice. These included: the appointment of a medical laboratory assistant to assist with traceability compliance; the appointment of a clinical transfusion nurse specialist to assist with training and ensure safe practice on wards; the provision of trainers and clinical supervision on particular wards; the development of a competence programme to assess staff involved in blood collection and distribution; the development of clinical guidelines; and the administration of an annual skills checks for staff involved in the transfusion chain. Most of the recommendations have been implemented and put into practice. A formal audit will be conducted in the future to evaluate their success but to date, 65% of staff members have passed the annual skills' assessment and the traceability compliance of the Trust has remained at 100%.
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Mwafulirwa, Boss. "Women's experiences of amenorrhea following Depo-Provera use at a district hospital in Malawi." University of the Western Cape, 2016. http://hdl.handle.net/11394/5250.
Full textAbstract:
Magister Curationis - MCurDepo-Provera, an injectable contraceptive, is utilized by about 30% of married women in Malawi. Most women have reported their preference to use Depo-Provera due to its effectiveness in preventing pregnancy, reversibility and easy to use since it is given once at 12-weeks intervals. Despite the method having such advantages, it has menstrual effects, and one of the major concerns for women, particularly in Africa, is amenorrhea. In Malawi, 40% of Depo-Provera users report experiencing amenorrhea after one year of use. Despite the concern for amenorrhea, some women have continued using the method. Literature shows that there is limited information on women's experiences of amenorrhea following use of Depo-Provera. A descriptive phenomenological research design was used to explore and describe women’s experiences of amenorrhea following use of Depo-Provera in order to understand how women experience amenorrhea and give meaning to the experience. Data were collected through in-depth unstructured interviews with six women, who were selected using purposive sampling. The interviews were conducted in Tumbuka language. Data analysis was done using Colaizzi’s method of analyzing descriptive phenomenological data. Five themes and some sub-themes emerged from data analysis. The themes were: "Lack of knowledge on cause of amenorrhea", "Fear of pregnancy", "Misconceptions associated with Depo-Provera Induced Amenorrhea", "Lack of proper counseling on amenorrhea resulting from Depo-Provera use" and "Amenorrhea not perceived as a problem when midwives provide adequate information". The themes showed that women accessing family planning services from Chitipa district hospital were not provided with information on amenorrhea resulting from using Depo- Provera. Hence, they expressed fear when they experienced the side effect. Participants stated that they were afraid of becoming infertile after using the family planning method, getting pregnant as well as amenorrhea itself. Their intention to discontinue using the method was largely associated with negative rumors, beliefs and misconceptions. The conclusion of the study is that there is need for midwives to provide information on amenorrhea resulting from Depo-Provera use. This will assist clients to understand that amenorrhea could occur as a side effect, and hence improve continued utilization of the method.
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Shiviti, Mamere P. "Work related stress amongst nurse managers in a rural district hospital in Limpopo Province." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/75176.
Full textAbstract:
BACKGROUND
Work related stress is a globally discussed and known phenomenon in countries irrespective of their stage of economic development. The nature of work related stress is harmful and uneconomic as it hampers productivity in the provision of quality services in organisations and give rise to undesirable socio-economic effects. Work related stress is a mismatch that occurs between an individual and the work environment, wherein the higher the imbalance between the external demands and an individual’s abilities. Nursing is noted for producing relatively high levels of stress due to the pressure-full and demanding nature of the job. Within nursing, nurse managers are noted to be specifically vulnerable to experiencing higher stress levels due to the stressful situations they are constantly facing, the higher the level of stress that will be experienced. Work related stress may have negative consequences for nurse managers such as lack of concern for themselves or their work and a negative self-image
AIM AND OBJECTIVE
The aim of this study was to explore and describe the perceptions of nurse managers in a rural public hospital regarding work related stress.
METHOD
The study was explorative and descriptive qualitative in nature. Semi-structured interviews were conducted with 33 nurse managers working at the designated hospital. By using content analysis five themes were identified: 1) Causes of work related stress, 2) Signs and symptoms of work related stress, 3) Consequences of work related stress, 4) Current strategies to cope with work related stress, 5) Recommended strategies to cope with work related stress.
FINDINGS
Nurse managers in the rural district hospital are aware of the nature of work related stress in their work, the causes and contributory factors, and several strategies they deem important to assist in the management of work related stress were recommended.
CONCLUSION
Nurse managers in a rural district hospital are exposed to high levels of work related stress due to the nature of their job and poor working conditions in the hospital. Recommendations to assist in the management of work related stress were made.
KEYWORDS: work related stress, nurse managers, rural areas, district hospitalDissertation (MNurs Nursing Management)--University of Pretoria, 2020.
Nursing Science
MNurs (Nursing Management)
Unrestricted
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Chimatira, Raymond. "Challenges, barriers and opportunities in integrating TB/HIV services in Tsandi District Hospital, Namibia." Thesis, University of Western Cape, 2012. http://hdl.handle.net/11394/3308.
Full textAbstract:
Magister Public Health - MPHBACKGROUND: Namibia has generalised Human Immunodeficiency Virus (HIV) and tuberculosis (TB) epidemics. In response to the TB/HIV co-epidemics in Namibia, the Ministry of Health and Social Services approved a policy of TB/HIV collaborative activities at national level and the integration of TB/HIV services at the point of service delivery. The present study explored barriers and facilitators of integration of TB and HIV service delivery in Tsandi District Hospital, which lies in rural northern Namibia. It focused on understanding the perspectives of healthcare workers and service users on integration of TB and HIV services at the health facility. AIMS & OBJECTIVES: The study aimed to describe the barriers, facilitators, and opportunities of integrated TB/HIV service delivery in Tsandi District Hospital. The specific objectives were: to describe the staffing and support systems in place for the integration of TB/HIV care; to describe the perceptions and experiences of integrated TB/HIV care by the health care workers, management and co-infected clients; and to describe the factors that facilitate or hinder the integration of TB/HIV services in the district from the point of view of district hospital managers, health care workers and co-infected clients. METHODS: The study used a descriptive qualitative study design with semistructured key-informant interviews conducted with five healthcare managers and senior clinicians and focus group discussions with 14 healthcare workers and five TB/HIV co-infected patients, supplemented by non-participant observation in Tsandi district hospital over two weeks between May – June 2011. Sessions were audiorecorded, transcribed, and thematically analysed. RESULTS: Several factors influenced whether and to what degree Tsandi district hospital was able to achieve integration of TB and HIV services. These are: (1) model of care and nature of referral links; (2) the availability and use of human resources and workspace; (3) the system of rotating staff among departments in the hospital; (4) the supply and mode of providing medicines to patients; (5) information systems, recording and reporting arrangements; (6) and the amount of follow-up and supervision of the integrated services. The main suggested barrier factors are: (1) poor communication and weak referrals links between services; (2) inadequate infrastructure to encourage and deliver TB and HIV care; (3) staff shortages and high workload; (4) lack of training and skills among healthcare workers; (5) financial constraints and other socioeconomic challenges; and (6) fragmented recording and reporting systems with limited data use to improve service delivery. The four main facilitating factors are: (1) positive staff attitudes towards TB/HIV integration; (2) common pool of staff managing different programmes; (3) joint planning and review of TB and HIV activities at the ARV Committee; and (4) informal task sharing to alleviate healthcare worker shortages. CONCLUSIONS: This study recommends that the district build on the current facilitators of integration, while the inhibitors should be worked on in order to improve the delivery of TB/HIV services in the district. Simple and practical recommendations have been made to address the some of the barriers at district level. It is hoped that these will inform future planning and review of the current model of care by the District nagement Team.
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Linzamo, Freddy Moba. "The Causes of non-compliance to tuberculosis treatment in patients at Matlala District Hospital." Thesis, University of Limpopo (Medunsa Campus), 2011. http://hdl.handle.net/10386/876.
Full text
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Matsie, Manako Alice Tsoana. "The impact of motivation on employee performance at level one district hospitals, with special reference to Metsimaholo District Hospital in Sasolburg / M.A.T. Matsie." Thesis, North-West University, 2008. http://hdl.handle.net/10394/2525.
Full textAbstract:
Work motivation prevails when there is alignment between individual and organisational goals. Work motivation also comes into being when achievement of organisational goals is associated with personally desired outcomes, such as a sense of achievement or personal gain.
While work performance is dependent on, or limited by, resource availability and worker competencies, the presence of these factors is not sufficient as such, to ensure desired worker performance. This is the reason why companies all over the world consciously include motivating employees as part of their strategies. When a company embarks on strategies to motivate employees without specific goals, those strategies will not be as beneficial to the company, and outcomes may not be as positive as the strategy makers may have hoped for. Specific goals in terms of strategy and performance must be stipulated beforehand and ways to measure the required performance standards should be in place. Employees should be made aware of such efforts and how their performance will be measured. A company that makes an effort to motivate its employees will remain competitive and more productive in the long run. This dissertation seeks to establish whether motivational strategies implemented at Metsimaholo District Hospital have achieved the required results of improving employees' performance. For any company to survive and stay competitive, it is very important that its employees are motivated, because motivated employees in a motivating environment will easily be driven to believe that if they put more effort in performance, their needs will be met. When employees feel their personal needs are met at their workplace, they find fulfilment through performance of their duties. They become productive and the company can achieve its production needs and reach its desired level of service delivery. In its attempt to meet critical employee needs to ensure better performance, Metsimaholo District Hospital has implemented different motivational strategies, which are discussed in this study, namely:
Performance Development Management System;
Occupational Specific Dispensation; Training; Financial rewards; Supportive management and leadership; and Individual employee locus of control. Feedback received from the empirical investigation shows that the abovementioned motivational factors have an impact on the way employees perform their duties. When implemented correctly, they encourage employees to perform their duties better. On the other hand, if they are not implemented correctly, or are perceived by the employees as not beneficial to them, or as not assisting to meet their personal needs, they can de-motivate employees and negatively affect their performance.Thesis (M.B.A.)--North-West University, Vaal Triangle Campus, 2009.
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Reachable, Johannes. "Caesarean sections in Abraham Esau District Hospital." Thesis, 2011. http://hdl.handle.net/10539/10843.
Full textAbstract:
BACKGROUND: Maternal and child health is one of the key focus areas of South
African (SA) Department of Health in line with the Millennium Development Goals.
Maternal and child health is therefore identified as a key performance area for
healthcare facilities throughout the country. In SA, availability and/ or lack of
services are often the difference between life and death. Caesarean section (CS)
is regarded as one such intervention that can save both mother and baby’s lives.
Outcome of CS as a life saving intervention are often based on certain factors
(clinical and health systems) that predetermine it. It is important to identify these
factors at institutional level to optimise better outcome. However, the practice of
caesarean sections and the maternal and foetal outcome were not systematically
and extensively studied at the hospital level.
AIM: The aim of the study was to determine the frequency of CS in a district
hospital in South Africa for an eighteen month period and to identify some factors
which might influence that frequency and to describe the maternal and neonatal
health outcomes.
METHODOLOGY: Setting of this study was the maternity ward of the Abraham
Esau District Hospital in Namaqua, Northern Cape Province. Study involved an
eighteen month (1 January 2009 to 30 June 2010) retrospective review of hospital
medical electronic database. No primary data was collected for this study.
Variables used for the study include CS rates, the profile of women who had a CS,
the health outcomes for the women and babies.
RESULTS: The total number of deliveries during this period was four hundred
and sixty two (462). Seventy-six of them were CS (16.4%). Approximately two
thirds 50 (66%) of them were emergencies. The study found that emergency CSs
were more commonly done among teenagers under the age of eighteen.
Emergency CSs were also more commonly performed among patients who were
transferred from surrounding clinics (20.8%). The majority of patients who had CS
were single, unemployed and had no medical aid.
CONCLUSION: The findings of this study will be useful to develop a better
understanding of the frequency of CS at this Hospital and could be utilized by
referring clinics and community health centres as well as other district hospitals for
the improvement of health care service, particularly maternal and child health. The findings could serve as a base for informed decision-making, accurate planning,
appropriate interventions, and optimal resources utilization. Further to this it could
be a reference for future projects of similar nature for academic and clinical
purposes.
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Nzaumvila, Doudou kunda. "Analysis of glass injuries in a district hospital." Thesis, 2016. http://hdl.handle.net/10539/21177.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment for the degree of MSc Med (Emergency Medicine)
Head of Division of Emergency Medicine
Faculty of Health Sciences
Johannesburg 2015Background and aim The Emergency Department (ED) of Embhuleni Hospital is used to see patients with glass-related injuries on a regular basis. This study aimed to compile and analyse data on glass injuries presenting to the ED of Embhuleni Hospital. Objectives The objectives of the study were to describe the demographic profile of patients presenting to the ED of Embhuleni Hospital with glass injuries, to determine the type of glass causing these injuries, to describe the characteristics of the injuries resulting from glass, to identify and describe the circumstances associated with different types of glass injuries, and to determine the social impact of glass injuries. Methods: This study was a prospective descriptive study. From the 1st of February 2013 to the 31st July 2013, the sample size that was used consisted of 104 participants. Descriptive statistics were used to assess the characteristics of the glass injuries. Results: Five different types of glass were reported as the causes of injuries, namely car glass (7.69 %), glass ampoules (3.85 %), glass bottles (82.69%), glass windows (3.85%) and street glass shards (1.92%). Glass bottle injuries were mainly caused by assaults (90.47 %), and the victims were mostly young males (80.23 %). The assaults occurred on alcohol-licenced premises in 65.11% of the cases. These injuries happened mostly over weekends (83.72 %) between 18:00 hours and 4:00 hours. The face (34.23 %) and the scalp (26.84 %) were the most affected body parts. Conclusion: Assault was the leading cause of glass injuries, especially on alcohol-licensed premises. Glass injuries generally resulted in minor lacerations with very few complications (2.68%). Key words: glass injury, district hospital.
MT2016
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Chi, Tony Wing-Cheong, and 池永昌. "Strategic Choice for The Hospital Governance Mode of Taiwan-based Private District Hospital." Thesis, 2004. http://ndltd.ncl.edu.tw/handle/11049509656774979193.
Full textAbstract:
碩士國立臺灣大學
會計學研究所
92
The trend of the development of Taiwan healthcare industry is following the change of managed care system. Since the National Health Insurance (NHI) has dominantly controlled the redistribution of the healthcare resource, the reimbursement for hospitals is getting more inadequate than before. The referring system of NHI is failure so that the traditional pyramid form of healthcare network has been dissociated. The medical centers at the top level are getting bigger and bigger. They are not only doing the R&D and intensive care but also the primary care that is originally belonging to the district hospitals’ duty. According to the new global budget policy of NHI, the yearly growth rate of the health care system is limited within 4%. It is such a business crisis that the district hospitals at the middle level of the system have to deal with. Several steps have been done by hospitals for the changing of the external environment. Internally, the hospitals pay more attention to cost control, administrative management and flexibility, continue quality improvement, competitive advantage, medical informatics, and the segment of non-insurance payment services. Externally, they are looking for horizontal and/or vertical integrations, strategic alliances and portfolio investments. Take it for granted; the resource of the private district hospitals is in short supply. The strategic revolution of hospital management is going on and on. Systems or networks are being formed continually in Taiwan. We would like to know if any strategic choice for governance mode of Taiwan-based private district hospitals could create a sustainable ability of trans-regional extension of the healthcare enterprise, even entering the healthcare market of Mainland China. Three private district hospitals in Taoyuan County have been chosen purposely as materials in this case study. Deep interviews have been arranged to the top manager in each hospital. Through the interviews, the strategic choices, drivers and governance modes have been detected. The results of the observation are explained and analyzed with the review literatures. All of those hospitals have different strategic choices and governance modes. The hospital, which has a strategic alliance with a medical center, totally reserves its unified ownership and independent organization. The driver for change is induced by shortages of skills. The character of this kind of strategic alliance is in short term and conservative contracting. The other hospital emphasizes value added. Using the concept of centralization, it wants to integrate the resource within its system. The driver for change is induced by quality improvement. It is classified as a system with unified ownership. The last hospital follows the financial leadership. The driver for change is induced by cost containment. Its healthcare network of strategic alliance has been spreading around the whole country rapidly. Each unit preserves the ownership of its hospital. In the other words, the ownership of this kind of network is not unified but hybrid. They share the competitive advantage from cost down as well as the efficiency of professional or non-professional processing. Recently, This hospital is the first successful mover of Taiwan based hospitals extending its network to Mainland China. A suitable governance mode is probably one of the key factors of Taiwan-based private district hospitals not only the growing ability of system/network business locally but also the transnational healthcare business in Mainland China.
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Huang, Ching-Yuan, and 黃清淵. "A Case Study on Total Outsourcing of Hospital Information System in District Hospital." Thesis, 2003. http://ndltd.ncl.edu.tw/handle/5v4fbq.
Full textAbstract:
碩士中原大學
資訊管理研究所
91
Since we bring national health insurance into practice，health environment changes, technology apply widely, and hospitals compete more violently. Therefore, it make hospitals gradually notice the importance of applying technology to improve the competitiveness itself. The advanced and adaptive health information system can reduce the health resource cost, improve the service efficiency、medical quality and enhance hospital management efficiency. Cause the internet age coming, information explode rapidly, it totally subvert the operation style and characteristic of hospital and gradually change the old point-of-view that seller's market is indissoluble. All the hospitals right now are customer service-oriented and more emphasize on customer satisfaction. Therefore, besides to fulfill the customer's need on health service, CRM and hospital management will become the competitive advantage in the future's health market. Generally, there are four ways to maintain the information system of district hospital. One is to develop and maintain by hospital itself. It need to hire two to five mis employee；Other is to buy the software developed by vendors and maintain by hospital or vendors；Other is "Selective Outsourcing", it delegate some part of information system or deploy stage to the professional vendor；Other is "Total Outsourcing", the percentage of IT Outsourcing is up to 80%[Lacity and Hirschheim(1995)]. Because district hospital consider labor cost and the limit resource of IS personnel, most of information system are delegated and maintained by vendors to reach the best service quality and hospital management effect. These days, few hospital carry out the total outsourcing, therefore this study use case study and analyze district hospitals that have already bring total outsourcing into practice to collect the information. This Study found that: (1)When the district hospital implement total outsourcing, it won't level down the information quality. (2)It can cut the cost down. (3)The hospital need not to worry about the risk that vendor will make. (4)When it comes to cost, there are a big gap between the hospital and vendor. (5)It is very difficult for the district hospital to implement total outsourcing. (6)After total outsourcing, there are some difficulty to retain the original MIS employee. In spite of that, When hospital make IT Outsourcing decision and cost is a important factor ,we hope our research result can be a good reference. Key Word: District Hospital, Total Outsourcing, Case Study
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Phala, Makeku Stella. "Assessment of medical equipment in the maternity unit at a district hospital of the greater Tubatse sub-district." Thesis, 2014.
Find full textAbstract:
A research report submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Hospital Management, Johannesburg, 2011Mecklenburg Hospital provides a comprehensive package of promotive, preventive, curative and rehabilitative reproductive health services for women which are not available in primary health care clinics and community health centres. These services require special equipment (such as cardiotochograph machine) and personnel (such as medical doctors) that are not available in these health facilities. The availability of medical equipment is one of the crucial components of effective maternal health services. Specific life saving medical equipment must be available for routine and emergency management of maternal and neonatal complications. This study is undertaken since no formal study has been done to systematically study the availability and related cost of medical equipment in a district Hospital maternity ward.
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Mboweni, Agrey Ernest. "Referral pattern for maternity patients in the Nkhensani district hospital in Giyani sub-district." Thesis, 2012.
Find full textAbstract:
A RESEARCH REPORT SUBMITTED TO THE FACULTY OF HEALTH
SCIENCES, UNIVERSITY OF THE WITWATERSRAND, IN PARTIAL
FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF
PUBLIC HEALTH
JANUARY 2012Background: Nkhensani Hospital is a level 1 district hospital which provides comprehensive and integrated health care for the Giyani sub–district population, which is estimated to be 270 000. The major services provided are casualty, medicine, paediatrics, maternity and surgery. The hospital is experiencing challenges in the maternity ward which is admitting more patients than the 47 allocated beds. Monthly, an average of 400 women are admitted for delivery from clinics. The causes are suspected to be due to a number of different factors like shortage of staff at the clinics, poor referral system, poor services at clinics and health centres, poor facilities, and pregnant woman not attending antenatal care and bypassing lower levels of care. Aim: To describe the pattern and appropriateness of referrals in patients attending the maternity ward at the Nkhensani Hospital. Methodology: A retrospective study was used to review and asses the patient records for the study (January to December 2009). Information was obtained from the Hospital Information System and secondary data from patients records will be used to assess the referral pattern in Nkhensani Hospital’s maternity ward. Results: The data showed that the patients admitted had a mean age of 26 years, with a range from 15 to 45 years. Patients were admitted for various reasons, which when categorised were found to have 57% of inappropriate referrals. Similarly 68% of referrals were found to have low risk pregnancies. About 85% of the deliveries were normal vaginal deliveries. Of the patients who attended the facility, 57% were referred from clinics, 19% from community health centres, 1% from general practitioners and 23% as self referrals. The source of referral was not found to be v associated with appropriate reasons for delivery, risk category, length of stay or mode of delivery. Conclusion: The research showed that the referral pattern in the maternity ward from clinics and health centres as well as self referrals indicated that policies were not being adhered to, which led to an over utilisation of the maternity ward in Nkhensani Hospital under Giyani sub-district
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Yeh, Po-Hsien, and 葉柏顯. "Hospital Pharmacy Drug Label and Patient Perspective- Taking examples for District Hospital in Taiwan." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/49455137435540678907.
Full textAbstract:
碩士雲林科技大學
資訊管理系碩士班
97
Drug Labels on the return home after medical treatment is the most common medication guide,the current requirements of the Department of Health Drug Labels for major hospitals, must be 13 kinds of necessary marked with three kinds of proposals marked,the reference to domestic integrate the views of outside experts.Looking at other countries, there is no uniform standard Drug Labels notice,this article attempts to pharmacists by Pharmacy Department and Information Management''s point of view,the statutory notice and the information point of view self-disclosure to explore Drug Labels marked and patients the quality and quantity of knowledge,trust and the relationship between drug behavior and structural approach to empirical formula.To explore the 13+3 drug labels kinds of information while at the same time trying to model theoretical framework to verify the side effects of treatment with the patient behavior. Department of Health in May 8, 2002, executive order on the request must be marked drug labels and 13 marked three proposed projects,duo to increase drug safety.But people''s awareness drug labels and scholars to explore much of the literature.The Legislative Yuan on April 21, 2009, the Third Reading of law and medical law doctors amendment to require the delivery of public medical institutions Drugs should be marked and must be marked 13 marked three proposed projects. After amending the law regardless of the hospitals, clinics, traditional Chinese medicine or community pharmacies should comply with the law,After this time repairs the law, no matter the hospital, the clinic, the Chinese medicine or the community pharmacy should observe legally, violates heavily may impose 100,000 Yuan fines. When medicine bag announcement, as soon as populace''s cognition viewpoint''s discussion is worth searching. The empirical study of the Department of Medicine for the district hospital from the main population.This research uses the pharmacist questionnaire survey, the grand total sends out 300 questionnaire personally, recycling questionnaire altogether 252, the effective questionnaire produced a final response rate of 84%.After using structural equation model(SEM) to analyze returned questionnaires,the results show fine goodness of fit in measuring model and structure model.In addtion ,7 hypotheses are supported in p-value<0.05.the full support.The results showed that the public notice for drug labels information, medication safety awareness, treatment behavior, health beliefs and inseparable relationship between drug labels. In addition, the research discovered that the side effect the indication indeed will cause the populace regarding to seek medical help the behavior, the healthy faith change, this regarding will obey the doctor''s advice behavior also to have the influence. In conclusion,By way of this survey result, may learn that drug labels and the medication safety cognition the populace, and the confirmation side effect indication the influence which applies drugs to the populace,and the confirmation side effect indication the influence which applies drugs to the populace, and will provide in the future the drug labels revision direction. In addition when also provides each big hospital medicament department, the revision drug labels indication item, provides the ponder the direction.
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Lin, Thin-Yen, and 林信延. "The administrations of hospital on the treatments of physicians – A study of district hospital." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/76638578723081551527.
Full textAbstract:
碩士義守大學
管理學院管理碩士在職專班
99
In order to control the medical cost, Bureau of National Health Insurance had reformed its payment system for several times. The cost of drug has some problems with setting drug price. For reducing drug cost, Bureau of National Health insurance has implemented the routine drug price surveys and reformed its drug payment system. For these reasons, the Hospital’s cost-control measures are more exacting. In order to control the rising drug cost, the Hospital connects the drug cost with paying physicians salary and bonus. In this study, we used case study to explore whether the administration of NHI and hospital affect the treatment of physicians to their patients. The outpatient’s drug cost percentage is 22.51%. The hospitalization’s drug cost percentage is 6.57%. Departments of service, years of service, and management staff of physicians significantly affected the drug cost (p<0.0001). According to analyze the claims data from October 2008 to June 2010 of the case district hospital, the treatment of physicians was influenced by Bureau of National Health Insurance payment system and the administration of hospital. All physicians were submitted the administration of hospital, but not sustained. Reducing drug cost per patient was the main way by physicians to cut down the drug cost. Physicians reduced more drug cost in outpatient services than in inpatient services, because the outpatient’s drug cost occupied the higher percentage（84.16%）in total drug cost. Senior physicians more submitted the policy of hospital than other physicians did. When physicians reduced drug cost, it accompanied with rising examination cost. Using financial way to control the treatments of physicians to cut down drug cost was effective at the beginning, but it could not sustain for a long time.
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Ramodise, Kgaugelo Betrets. "An analysis of theatre utilization at Sekororo District Hospital." Thesis, 2014.
Find full textAbstract:
Thesis (M.P.H.)--University of the Witwatersrand, Faculty of Health Sciences, 2013.BACKGROUND – District hospitals provides level of care services that are part of the basic service package for district hospitals. Services applicable to district hospitals’ operating theatres include performance of elective and emergency surgical procedures. A study was conducted at Sekororo district hospital to evaluate the functioning of the operating theatre system. AIM: To describe the profile of patients, theatre down time and theatre throughput efficiencies at the district hospital for the period 1 April 2009 – 31 March 2011. METHODOLOGY: This was a cross sectional study based on a retrospective record review. The study setting was Sekororo District Hospital Operating Theatre. The population included records of all operations performed in the theatre during the study period. Theatre utilization was calculated as well as patient throughput to assess the internal operational efficiencies. The throughput of elective and emergency cases were compared. RESULTS: A total of 702 cases were performed during the study period. The majority of cases performed in the operating theatre were maternity cases (caesarean sections). Maternity cases accounted for 602 cases. The most common indication for caesarean sections (CS) is Cephalo-pelvic Disproportion (CPD) (49.2%). For the maternity cases, the majority were emergency cases (84.33%), and 15.67% elective cases. Theatre utilization for this period was 3% (3.6% for 2009/10 and 3.2% for 2010/11). There was a statistically significant difference (p<0.01) between the average throughput for emergency and elective cases – 25 minutes for emergency cases (confidence interval 20-35 minutes) versus 62.5 minutes for elective cases (confidence interval 38.75 – 78.75 minutes). CONCLUSION: The theatre utilization rate is extremely low for this study period. Patient throughput is much more efficient for emergency cases. Further studies are required to determine resource allocation to the operating theatre that resulted in the low theatre utilization.
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Chien, Sheng-Che, and 簡聖哲. "The Study of Transformation Strategy in the District Hospital." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/30867554356368521178.
Full textAbstract:
碩士國立臺灣大學
醫療機構管理研究所
97
In Taiwan, the medical system was insufficient resources before 1980. The local community hospitals had the most important function that was the front line to help patients in the remote districts. The National Health Insurance (NHI) was established in 1995. In addition, a management-determined system of global budgeting and expenditure limits was beginning in 2002. At the same time more hospitals were established and existing hospitals were expanded their services were. With the advent of NHI, many corporations are interested opportunity in this industry, because the insurance and payment system would be standardization. However, this situation cause a lot of hospitals wants to share this market. The medical industry became very competitive in Taiwan. The hospital income has 95% from the insured of NHI. Because of the density of hospitals vying for the aggregate of payment dollars, the amount a given hospital sees is less each year. In fact, some smaller hospitals are becoming insolvent as a result of this constriction. There were over 750 local hospitals before 1989 in Taiwan, but there were only 300 remaining in 2007. Smaller hospitals are recognizing this serious problem and try to think about the transformation strategy in the hospital. The study uses method of Qualitative Research which examines the successful structures of current local hospitals. The causes of their success include Strategic Alliances, Outsourcing services, Diversification, Deductibles, Community Hospitals, Specialized Hospitals and Medical Corporate Aggregates. These 7 structures were analyzed and infer that strategies for hospital transformation. The study uses the method of SWOT analysis, particularly strengths and opportunities. Also, it has determined 10 strategies for smaller hospitals that want to transform their status or financial solvency. Finally, this study will provide some suggestions to help hospital improvement and transformation of strategy.
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Chen, Wei-Chih, and 陳威志. "The Analysis of Healthcare Intellectual Capital--District Hospital Perspective." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/kr24wm.
Full textAbstract:
碩士靜宜大學
管理碩士在職專班
97
The Analysis of Healthcare Intellectual Capital--District Hospital Perspective Abstract This research was focused on a single district hospital to find out the concept, categories, content, relative importance of intellectual capital (IC) of a hospital, and to explore the difference between the importance and the possession level of healthcare intellectual capital. By analyzing the issue of healthcare intellectual capital, the hospital may develop a set of indicators to measure the level of hospital intellectual capital, and to establish an IC management system in a district hospital. Based on the established system, the hospital could control and accumulate the information of its intellectual capital, and adopt the hospital''s strategies to enhance its competitiveness for long-term value creation. Firstly, by conducting the in-depth interview and questionnaire survey on the experienced employees, this empirical research aimed at identifying perspectives and relative importance of all elements of the hospital intellectual capital. Secondly, through the questionnaires answered by the employees, this study tried to find out the importance and the possession level of hospital intellectual capital. Finally, the factor analysis, paired T-test, Pearson correlation coefficient analysis were used to analyze the data to find out the intellectual capital perspectives, furthermor, to analyze the difference between the importance and the possession level of the hospital''s intellectual capital. According to the literature review and in-depth interview with experienced employees, the intellectual capital of district hospital could be categorized into six dimensions: human capital, process capital, innovative capital, marketing and reputation capital, customer capital, and relational capital. Based on the results from 122 respondents, twenty-four elements of intellectual capital were extracted from factor analysis and eighty-one items of key elements of intellectual capital in the district hospital were constructed. The results of this study showed that the most important IC category in district hospital was customer capital, and the other categories were in the following order: human capital, innovative capital, marketing and reputation capital, process capital, and relational capital. The results of IC possession level showed that district hospital had relatively high level of human capital and relatively low level of innovative capital. This might be due to the fact that the employees were lack of strong desire for aggressive innovation and constant improvement; therefore, the improvement of the hospital, the management of the hospital as well as the future development of the district hospital were hindered. This empirical study showed that there was difference between the importance and the possession level of all the categories and elements of intellectual capital. That means the possession level didn''t meet the required standard, demonstrating that there is still huge space for improving the staff quality, education and training system, management process, innovative medical technique, information technology, media marketing, relationship with customers, and expansion of source of new customers as well as the social network. In the era of knowledge-based economy, the district hospital should establish its intellectual capital management system, accumulate its unique intellectual capital, and effectively combine the practice with the hospital management. Eventually, hospital could strengthen its long-term competitiveness, prove its vitality, and gain new opportunity under the current harsh medical environment.
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Wang, Sheng-Hung, and 王勝弘. "The Study of Hospital fire contingency plan study- Taking Xinzhuang District Hospital as an Example." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/rukxhr.
Full textAbstract:
碩士中華科技大學
土木防災工程研究所在職專班
102
The purpose of this report is to address the need for continued improvement in hospital fire plans, evacuation and training. Hospitals are among the most difficult and challenging facilities for fire fighters to perform their duties. Often tight spaces, crowding and equipment scattered throughout the halls further complicate the safe evacuation of the sick and injured. Special needs patients often need to be transported along with equipment and require nonobstructed pathways. The complexity of these tasks in addition to fighting the fire or disaster require in depth planning, organizing and training of both fire fighters and hospital staff. Hospital fires have such a high potential for loss of life that having the best possible evacuation plan should be high priority. Each hospital staff member should know exactly what their responsibilities are in the event of a disaster and be trained to do it effectively. They should also be trained to recognize potential fire hazards and preventive techniques. A clear order of priorities should be documented and known by responsible staff members. Firefighters should know in advance what resources and equipment is already available at the hospital and how to provide the best support in evacuations with the least amount of casualties. I propose we use the new Taipei Shin Zhuang Hospital as the object of study. To simulate a model for hospital fire and evacuation plans. Teach firefighters to be more effective in rescue and evacuation, as well as controlling and eliminating hazards in less time. This research combined with literature reviews, interviews, computer simulations will be analyzed to formulate comprehensive planning, improvements in procedures, equipment, training and preparedness. Hopefully the information will benfit many hospitals, firefighters and result in the saving of many lives.
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林美惠. "Study of District Hospital service quality and satisfaction-- In case of Pingtung Yu-Sheng Hospital." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/98810654566796235875.
Full textAbstract:
碩士義守大學
管理科學研究所
90
Abstract Medical care has become more accessible since the implementation of the National Health Insurance in 1995. Medical costs have increased because of this development. With the rapid changes in society and improved public health standards, the way we look at diseases is very different from the past. As people become better educated and more aware of their needs, patients will seek health care actively instead of just passively accepting treatment, intensifying competition between clinics. Because of this, the quality of health care and customer satisfaction has become important considerations for the management of hospitals. This study is based on the quality of service and patient satisfaction of Yu-Shang hospital in order to further understand the relationship between patients and clinics. This study integrates Non-difference and SERVPERF service quality graph as the study tool. Patients of Yu-Shang hospital were asked to fill out a questionnaire comparing the importance the tangibles, reliability, responsiveness, assurance, and empathy. A comparison between their expectations and their actual feelings about the hospital was also drawn. This was done to get a general feel of the patients’ overall appraisal of the clinic, their willingness to come back, and whether or not they would recommend treatment at Yu-Shang hospital to their relatives. Results: 1.With regard to Yu-Shang hospital’s quality of health care, most patients rated it as fairly satisfactory. Perhaps this is an area that could use more attention. 2.Patients from different backgrounds showed different results in comparison between expectations and actual feelings when asked about the quality of health care provided by Yu-Shang hospital. It is suggested that measures be taken to improve on the areas deemed unsatisfactory by the patients in order to maintain competitiveness.
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Msiza, Lydia Lebohang Perseverance. "Clinical procedures in the maternity unit of a district hospital." Thesis, 2015. http://hdl.handle.net/10539/17337.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfilment of the requirements for the degree of
Master of Public Health in the field of Hospital Management
July, 2014BACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development Goals (MDGs). The 5th goal is focused on improving maternal health by reducing the maternal mortality rate by 75% by 2015. South Africa has aligned itself with the MDGs. The Gauteng Department of Health and Social Development has also embraced the MDGs and decided to improve its maternal health services. It has decided to target Intra-partum period for interventions to improve maternal health because intra-partum period is associated with a high rate of perinatal death from intra-partum hypoxia (4.8 per 1000 births) (National Department of Health, 2000), as well as a significant number of maternal death (8.7%) (NCCEMD, 2007). This study was planned to systematically study the clinical procedure performed during the intra-partum period at the Heidelberg Hospital (a semi - rural district hospital in the Lesedi Sub – district of Sedibeng District in Gauteng Province). AIM: To describe the clinical procedures and factors related to these procedures and maternal and neonatal health outcomes for the mothers admitted and delivered in the Maternity unit at Heidelberg hospital during one year period (1st April 2010 to 31st March 2011) METHODOLOGY: The setting of this study was the Maternity unit of the Heidelberg Hospital. A cross sectional study design was used based on retrospective review of routinely collected data for 12 months (2010 April 1st to 2011 March 31st). No intervention was done as a part of this study. The study variables included different clinical procedures (such as normal vaginal delivery, assisted vaginal delivery, caesarean section, evacuation of uterus, caesarean hysterectomy), socio-demographic profile of patients (such as age, gender, ethnicity, medical aid), clinical profile (such antenatal diseases, booking status, intra-partum complications, postpartum complications) and maternal and perinatal outcomes. RESULTS: The study found highest number of deliveries (78.6%) were normal vertex deliveries and a very few (1%) assisted and breech deliveries. The caesarean section rate was high (20.4%) as compared to the normal national target (12, 5%). Fetal distress and CPD was the main indications for caesarean section. The majority of women who delivered at Heidelberg Hospital maternity came from poor socio-economic class, mostly single, teenagers, and unemployed. They were the most vulnerable group in the Society. The majority of women were booked and referred from PHC clinic where they were booked for antenatal check-up. Pregnancy induced hypertension was the commonest obstetric problem encountered during antenatal period. Most women who delivered at Heidelberg hospital during the period were discharged without complications, no maternal deaths were reported. There were 8.1% preterm deliveries but a relatively high still birth rate which is of concern. CONCLUSION: The study was the first of its kind to be done at Heidelberg Hospital and the Sedibeng Health District. The study systematically analysed routinely collected data and identified high risk patients, who would require special attention. This study would hopefully assist the Hospital Management to realise the high rate of CS and to develop appropriate measures to reduce unnecessary C/S being done, and to strengthen referral systems. In addition, further study is necessary at clinic level in the sub-district to identify work-loads in the feeder clinics.
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Lu, Nan-Han, and 呂南翰. "Research of Marketing Strategy Management in a Military District Hospital." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/7r95ba.
Full textAbstract:
碩士國立中山大學
高階經營碩士班
95
The main responsibility of the medical institution is to provide medical services that meet patients’ needs as well as create health value in a patient’s life. Hospital marketing, a type of service marketing promoting intangible products, is a way of utilizing medical service marketing to provide patients with more efficient medical service. Since the implementation of National Health Insurance, Taiwan’s medical system has experienced an increased of enterprization in hospital management, the implementation of a global budget payment system, the financial crisis and the impact of rising medical right demanded by the Taiwanese. The military district hospitals that are responsible for maintaining the combat power of the military staff also pay an important role in the National Health Insurance medical system. While confronting the change in the competitive environment and the transformation of the entire medical ecology, military district hospitals should take a step further to adjust and develop a new marketing strategy. The research method of this paper adapts a case study based on information from a military district hospital located in southern Taiwan. The discussion focuses on the changes in current medical ecology and the competitive advantages of the subject hospital. Diamond Theory by Michael Porter and SWOT analysis are used to evaluate the strengths and weakness in and outside of the hospital, determine the trend choice for the hospital’s new positioning, and define the right strategy to target to its market segment. All of these are based on the concept of national defense. The paper will also take into consideration the subject hospital’s special features and competitive advantages, and build an 8P marketing model centering on patients in order to formulate the best combination of marketing strategies for the subject hospital. The paper has three conclusions, first of all, recognize the competitive advantages and the opportunities of the subject hospital; second, assert the new positioning of the transformed medical service; finally, establish a patient-oriented marketing strategy. In addition, this paper also suggests the best marketing strategy combination by applying innovative and pragmatic managerial thinking in order to give the military hospital a brand new image.
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Wang, David, and 王信隆. "A Study of Information System Success in a District Hospital." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/33199864333621038529.
Full textAbstract:
碩士樹德科技大學
資訊管理研究所
97
As National Health Insurance was established in Taiwan, most patients nowadays could see a doctor with ease. Simultaneously, due to increase of health service, more and more health institutions have established and extended service variety. However, it leads the cost of National Health Insurance raise. To control the cost of National Health Insurance, the government has modified relevant medical policy to continually lower the cost. Hence, most of hospitals adopt Information Technology (IT) to enhance the performance and competition. The aim of this study is to develop an integrative understanding of the factors that support or inhibit individuals to adopt the health information system (HIS) and to find whether organization commit would also influence the performance of HIS. We applied information system successful model (ISS), and we also add one dimension for discussion: organization commit. This research used a case study and assembles the questionnaire from individuals who have experienced health information system, and applies survey and Structural Equation Model (SEM) to analyze the results from the questionnaires. Finally, results confirm that individuals are satisfying to use the HIS if it considers service quality and system quality. Furthermore, organization commits and user satisfaction are positively influence the performance of HIS.
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Hung, Ssu-Wen, and 洪思雯. "Effects of Market Position and Competition on District Hospital Closures." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/74264382176794253783.
Full textAbstract:
碩士中國醫藥學院
醫務管理研究所
89
The study was designed to investigate the effects of operational strategies and market competition on the closures of district hospitals in Taiwan. From 1996 to 1998, all hospitals accredited as district hospitals in Taiwan were selected to be research samples. Market was partitioned according to the sixty-three sub-medical regions from the Department of Health, Executive Yuan. The dependent variable was dichotomized as "closure" or "not closure". The independent variables were categorized into three groups：market position, competition, and control variables. Data were obtained from three sources, including the “Hospital Medical Care Organization Survey in Taiwan Area” which were collected annually by the Department of Health, Executive Yuan, “Taiwan-Fukien Demographic Fact Book” published yearly by the Ministry of the Interior, and “Report on the Survey of Family Income and Expenditure in Taiwan Area of Republic of China” published annually by the Directorate-general of Budget, Accounting and Statistics, Executive Yuan. To analysis the relationship of dependent variable and independent variables, Logistic regression was adopted as statistical method. The major finding of this study was that both operational strategies and market competition had impacts on the closure of district hospitals. District hospitals operating in market with high density measured by the hospitals had high risk of closure. In terms of operational strategies, district hospitals that differentiated from others in the size on the basis of the number of full-time employments were significant on the closure of hospitals. District hospitals with more employees were tend to close. Finally, the ownership and the number of outpatient visit were also significant factors of the closure of hospitals. Private hospitals and hospitals with less number of outpatient visit had high risk of closure. Based on the results of this study, the implications of hospitals’ managements, the health policy, and the future study research were discussed.
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簡鈺玫. "The Factors Affecting Hospital Wireless Nurse Station Adoption : A Case Study of South District Teaching Hospital." Thesis, 2004. http://ndltd.ncl.edu.tw/handle/61432474328227901244.
Full textAbstract:
碩士國立中正大學
資訊管理學系
92
The change of the medical environment has caused violent competition and pressure among hospitals. Most managers of the hospitals have used business process reengineering and organization reengineering to deal with the problem. They hope the operating cost can be reduced and improve the performance of the hospitals thus attracting more customers. The development of information technology has offered a great opportunity for an organization in the process of re-engineering and gaining higher competition ability. Recent studies indicate that using information technology has a positive impact in raising efficiency in the organization. One of the most discussed issue is using portable computer of PDA combining the access on the internet to establish a mobile nursing station. Through the assistance of the internet, mobile nursing station enables the hospitals to operate on a larger scale and reduce manpower. However, most literatures published in Taiwan focused on establishment of the mobile nursing station, and no study discusses the users’ acceptance of using this technology. This study adopts technology acceptance model (TAM) and uses the in-patient department of a teaching hospital in Chiai City as a case to find out the influencing factors of users acceptance of the mobile nursing station. All the nurses in the department using the mobile nursing station are included in the survey. 185 of questionnaire were sent out and I received 181 were returned. The percentage of returned rate is 97.8%. The number of valid questionnaire is 165 and invalid is 16. Therefore, the rate of explaination is 91.2%. Analysis of variation and stepwise regression analysis are used to analysis the results. The results show that (1) The influencing factors of users’ intention to use the mobile nursing station are: The perceived usefulness, the safety issue, and the perceived ease of use of the system. (2) The most important factors affecting the users to use the mobile nursing station is the perceived usefulness and the perceived ease of use convenience. The results confirmed the hypothesis of TAM. The least important factor is the support from high level managers. The results of the study can beused as references for hospital managers to reduce the chances of failure when adopting a mobile nursing station.
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Lourens, Adriaan Eksteen. "Trends of adult admissions in a district hospital in Limpopo Province." Thesis, 2011. http://hdl.handle.net/10539/10782.
Full textAbstract:
BACKGROUND: District hospitals play an intermediary role between primary
health care (PHC) clinics and community health centres; (CHC), (predominantly
run by nurses) and regional hospitals, (predominantly run by specialists and
doctors). However, in the absence of efficient and adequate network of PHC clinics
and CHC’s, district hospitals often have to render these services. In addition, due
to geographic distances between district hospitals and regional hospitals, it often
has to offer specialist services such as Orthopaedics, Gynaecology, as well. This
increases the burden on district hospitals. The profile of patients admitted to district
hospitals have not been clearly described and this study seeks to describe and to
compare trends over a two year period and factors influencing these trends, to
allow for informed decisions to be made for future planning. No formal study on the
trends for admissions to District hospitals have been conducted, as far as could be
determined, and this study aimed to look into and describe the trends of
admissions over a two year period from April 2007 to March 2009, to allow for
informed decisions to be made to guide future plans.
AIM: To determine the trends of adult admissions in a district hospital in Limpopo
Province.
METHODOLOGY: A cross-sectional study design was used for this study. A
descriptive retrospective review of existing hospital records was conducted from
routine information captured on the MEDICOM patient administration system and
in ward and OPD/casualty registers. No intervention was done for this study.
The setting was F. H. Odendaal Hospital in Modimolle, which is a district hospital
situated in a rural area of the Limpopo Province. It serves a catchments population
of over 103 000 people. Data was collected from 4481 admitted adult patients from
which a random sample (n=800) was selected consisting of males (n=400) and
females (n=400). Data on variables such as the case load (number of adult
admissions during the research period), patient profile (gender, age, hospital
classification and geographic location) and clinical profile (mode of admission, agnoses and associated ICD-10 code/s as well as the mode of discharge) were
collected.
RESULTS: This study revealed that this hospital experienced an increase number
of adult admissions during the two years study period. During the same period it
could reduce the length of stay, thereby improve usable bed utilisation rate. This
reflected in more discharges and less death. This was probably due to availability
of more experienced medical officers and the fact that outreach services has been
conducted on a weekly basis by doctors and Clinical Support Services since
2008/09 financial year.
The majority of the patients who were admitted over the study period were Africans
residing in and around Modimolle. The majority was also classified as H1, meaning
that most of the patients admitted to this hospital are capable of paying the nominal
fee for services. The institution experienced an increase in the number of
admission over the two years by 11.7%. The mean age was 42.5 years for adults.
Of the top 5 diseases/conditions for which patients were admitted, Pneumonia,
Diarrhoea and Gastroenteritis, Retrovirus infections and Diabetes Mellitus were
present for both males and females. Although this disease pattern persists for a
number of years, it seems as if services provided manage to reverse discharge
trends as more patients were discharged home in the second year than in the first
year and the mortality rate decreased by 4.5% for adults between the two years.
CONCLUSION: Information obtained through this research could be extrapolated
to other district hospitals for the management of services, including the
management of beds. It could also serve as the basis for future research, as a
reference base to students and the teaching of students.
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Yang, Hui-Tsun, and 楊惠淳. "Whether the Services from Hospital Volunteers Fit What Medical Staffs Need? The Example of T District Hospital." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/57080884794013750620.
Full textAbstract:
碩士國立雲林科技大學
商管專業學院碩士班
100
Recently, a lot of reports and discussions focused on a shortage of medical stuffs and working overtime in hospital in Taiwan. This issue drives my interest to concern about it. It is not surprised to see lots of nice volunteers worked in the hospital, and tried to make their efforts to assist patients and medical stuffs。Here, I asked whether the efforts from volunteers could help medical stuffs to release their pressure or loading from works. Therefore, in order to answer this question, this paper explores whether the hospital''s volunteer services fit the needs of healthcare professionals via content analysis and interviews in T district hospitals. In this study, the 32 staffs working in the T district hospital were conducted interviews. They worked in emergency room, outpatient, nursing and medical technology department. Summarized and analysis the degree of difference for the services provided by existing volunteers and the health care staffs required to be assisted . On the one hand the hospital is able to adjust and to improve the services projects of volunteers, and the other hand health care workers to be more appropriate to get assistances. The conclusion of this study is that medical staff services provided by hospital volunteers are in the affirmative and it is necessary. However, volunteers are concentrated in some specific groups, leading to inadequate number of emergency room and ward volunteers. Just few volunteers assist in those departments. Hospital volunteer services should be more flexible maneuvering in order to help to more health care workers.
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Hlatywayo, Nanana Glory. "Deliveries at maternity ward at Evander District Hospital in the Mpumalanga Province." Thesis, 2014. http://hdl.handle.net/10539/15275.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public
Health in the field of Hospital Management
APRIL 2014Background: The South African Department of Health stipulated that district hospitals must provide comprehensive package of preventive, promotive, curative and rehabilitative reproductive health services for women that requires medical and special resources, not found in the health centres and clinics (Department of Health, 2002). The Evander District (ED) Hospital, a district hospital situated in the Govan Mbeki Subdistrict in the Mpumalanga Province provides both in-patient (36 beds in maternity unit and four nursery beds) and outpatient services. The Hospital Maternity Unit has recently been criticised by the Mpumalanga Department of Health for high rate of CS (30%), and perinatal mortality rate (40 per 1000). But, the Hospital never analysed the data collected routinely to develop an understanding of the challenges faced by the Unit. The Unit staff complained about inadequate resources as one of the reasons. The Hospital has introduced a Cost centre in the Maternity Unit for efficient management of resource allocation for the Unit. This study analysed the routinely collected data from the Hospital Information System and Maternity Unit Cost centre for assessing the maternity services currently rendered by the Evander District Hospital. Aim: To described the deliveries at the Evander Hospital over a period of 6 months from 01st January 2011 to 30th June 2011. Methodology: It was a cross sectional study that reviewed the records from Hospital Information System (all antenatal cards and Obstetric files of the women who delivered at the labour ward during the study period) and Maternity Unit cost center. The variables used for the study included number and type of deliveries, socio-demographic and clinical profiles of patients, maternal and perinatal complications and outcomes. In addition, costing information collected during the same period. Descriptive and inferential statistics were used for analysis. Permissions were obtained from the Mpumalanga Department of Health and University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. Results: A total of 1,081 deliveries were performed at the Evander Hospital over sixmonth period. The highest number of deliveries was NVD (67.44%), followed by caesarean sections (31.82%). The majority of the women who delivered came from poor socio-economic class and mostly single and black, which is a reflection of the characteristics of the catchment population of the Evander Hospital. Teenage pregnancy rate was quite high (20%). The majority of the subjects were primipara (41%). Although most of them (91.3%) of them were booked, only 14% had stipulated number of antenatal visits (4 or more visits) and 7.4% of booked mothers, did not have booking blood results, which was a missed opportunity. HIV was the most prevalent (33, 31.3%) medical conditions, which is similar to the HIV prevalence reported in antenatal sero-prevalence survey in South Africa. Only 17% had planned and scheduled CS. Very few patients had post-partum complications indicating well managed third stage of labour. There was no maternal death during this period. All patients were discharged home. More than 17% (n=185) subjects had low birth weight babies (less than 2500 g), which is just above national average of 16%. The median Apgar score among children delivered at Evander Hospital was 9. Interestingly, the Apgar scores of babies of subjects who had operative deliveries were significantly lower than those who had nonoperative deliveries. Most of the babies were born alive. Stillbirth rate (7 per 1000 live births) was significantly lower than South African national average 17.8 per 1000 live births. The total medical cost for the maternity ward for the six months studied amounted to R 4,584,466, the average monthly cost being R 76,407.67. The most expensive items were drugs and pharmaceuticals and least expensive being the medical consumables. Conclusion: This study was the first of its kind to be done in this Hospital and the Health District. The study identified gaps where management of pregnant women in the Evander Hospital could be further improved through improved booking, planned deliveries and thereby reducing low birth weight rates and still birth rate. This would assist the Hospital Management to develop appropriate measures to reduce unnecessary CS being done, NVD being delivered in the hospital rather than using CHC, and strengthening referral system and strategies to reduce HIV and AIDS incidence. In addition, further study is necessary at the PHC facilities in the Sub-district to identify determinants for high rate of teenage pregnancy.
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Yang, Shin-yi, and 楊心怡. "Strategic responses of district hospital to national health insurance 1995-1997." Thesis, 1998. http://ndltd.ncl.edu.tw/handle/81461323396844913457.
Full textAbstract:
碩士高雄醫學院
公共衛生學研究所
86
Abstract The purpose of this study is to survey whether there are changes occurring in the service quantity and management strategy of district hospitals after the enforcement of National Health Insurance Policy. Method of the survey is a filled-in questionnaire approved by specialists .There are four major sessions in the questionnaire including information of hospitals, difficulties encountering after the enforcement of National Health Insurance Policy, responses of National Health Insurance Policy, informatioof examinee. Responses of National Health Insurance Policy refer to both internal and external management strategies. Starting from September 1997, the survey had been horizontally conducted on district hospitals (including district teaching hospitals.) Examinee are 479 contracted hospitals of National Health Insurance Bureau in Taiwan area (including Taiwan, Penghu, Chinmen and Matsu), listed in 1996 Annual Report of Public Health published in September 1997 as well as evaluated as district hospitals oristrict teaching hospital by Public Health Bureau. Questionnaires were conducted through mail. There were 157 valid questionnaires in return and the retrieving rate is 32.77%. The result of survey indicates changes of service quantity including outpatient and inpatient services. Over 50% of sampling hospitals think that their service quantities have been reduced. About the same percentage of hospitals believe their net revenue and profitability has been reduced comparing with those before the implement of National Health Insurance. As far as the internal management strategy is concerned, 91.08% of examinee consider patients with National Health Insurance as first priority in their management strategy. 62.24% of total sampling hospitals choose to focus on items, which are not covered by National Health Insurance. 57.32% have been emphasized treatments for chronic diseases. In items of vertical integration (strategy alliance, chain alliance, or the participation of consulting company of hospital management), currently there are 3participant hospitals comparing with 18 before the implement of National Health Insurance. It is expected to have 56 participant hospitals three years later. This shows that more and more district hospitals choose vertical integration as their management strategy. There were 131 hospitals operated exclusively with their own investment. The number reduces to 110 now. After three years, only 49 hospitals will be operated exclusively with their own investment. It indicates that fewer hospitals choose to e old management strategy to cope with the change of national policy. Factors affecting internal management strategy: hospitals, which consider patients with National Health Insurance as first priority, related hospital workers (p=0.0303.),hospital which choosing to offer service for patients with chronic disease(p= 0.0303); and beds(p= 0.0189,hospitals choosing to focus on patients who will pay medical bill by themselves: related hospital worker(p= 0.042); and beds (p=0.05).Factors affecting external management strategy are linked with the management strategy in next the years, hospital managers (p=0.013), and total numbers of hospital workers (p=0.0006). Owing to the confidentiality of financial resources, data concerning actual operation of sampling hospitals are not available in this survey. As a result, in this regard, no comparison and evaluation of management efficiency before and after the implement of National Health Insurance Policy can be done.
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Nyathi, Fridah Busisiwe Gillian. "An audit of perinatal mortality and morbidity at a district hospital." Thesis, 2013. http://hdl.handle.net/10539/12683.
Full textAbstract:
BACKGROUND: Globally, perinatal mortality accounts for a large proportion of child deaths. Perinatal mortality rate (PNMR) is taken as an index of efficient obstetric care, and also serves as an indicator for the Millennium Development Goals (MDGs) 4 and 5, that is related to infant mortality rate and improving maternal health (Day, Monticelli, Barron, et al., 2010). In developed countries, perinatal mortality rate has shown a marked decrease over the past few years. This is mostly due to the changing patterns in reproductive health, improved socio-economic factors and quality of maternal and child care (World Health Organization, 2006). However, developing countries are still struggling to curb perinatal deaths. In South Africa, there has been a gradual decline in the PNMR in public health facilities from 38.6 in 2003/2004 to 31.0 per 1000 live births in 2008/2009. However, there has been a slight increase to 32.8 per 1000 live births in 2010/2011 (Day, Barron, Massyn, et al., 2012). In the Mpumalanga province, the PNMR has decreased slightly from 34.9 per 1000 live births in 2008/2009 to 33.2 per 1000 live births in 2010/2011. Carolina Hospital itself has a PNMR which is far too high at 43 per 1000 live births from January to June in 2008/2009. It is assumed that because the sub-district is underserved with primary health care facilities as well as having a poor attendance of antenatal care services by pregnant women, this has subsequently had a negative effect on perinatal care. However, this has never been formally assessed.
AIM: The aim of the study was to describe the perinatal mortality and morbidity, and to identify the causes and avoidable factors of perinatal mortality and morbidity at Carolina Hospital for the period 1st April 2009 to 31st March 2011.
METHODOLOGY: The setting for the study was the maternity unit of Carolina Hospital, a district hospital in the Gert Sibande district, Mpumalanga. It comprised of
a retrospective record review of data from the maternity registers and the Perinatal Problem Identification Programme (PPIP); from the 1st April 2009 to the 31st March 2011. All the records of perinatal deaths (N=94) and admissions (N=35) of babies 7 days old and younger during the study period were included in the study and no sampling was done for these two groups of patients. For all other delivery records, systematic sampling was utilized by choosing every tenth record listed on the sampling frame. Data was extracted from the PPIP and maternity registers using data extraction sheets. Data was captured onto a Microsoft excel based spreadsheet, imported into and analyzed with EPI-Info software version 3.5.1 using descriptive and analytic statistics. Data was collected the number of perinatal deaths, admissions, total number of deliveries, neonatal and maternal profile, causes of perinatal mortality and morbidity and factors associated with perinatal mortality and morbidity
RESULTS: During the period of the study there was a total of 1 604 deliveries with 94 perinatal deaths and 35 perinatal admissions. The perinatal mortality rate was 61.4 per 1000 live births with a stillbirth rate of 47 per live births; and an early neonatal death rate of 14.4 per 1000 live birth. Nine percent of the mothers were unbooked, and this accounted for 11.4% of perinatal morbidity and 17% of the mortality which occurred during the study period. Over a third (34%) of the perinates who died were born from HIV positive mothers; whilst more than halve (54.3%) of those perinates who were admitted during the perinatal period were born from HIV positive mothers. Over two thirds (63.2%) of the perinatal deaths were below 2500g while half (45.7%) of admissions were below this birth weight. Intrauterine death (40.4%) was the leading cause of perinatal mortality at Carolina Hospital for the two years of study. Over the two year study period, patient related factors were the highest avoidable factors given, accounting to 72.9% of the total while health care related avoidable factors accounted to 39.5% of the perinatal mortalities and morbidities.
CONCLUSION: The study found that there was a high PNMR and high still birth rate at Carolina Hospital. The majority of the avoidable factors were patient related. The
reasons for this included late booking, delay in seeking medical attention during labour, never initiating antenatal care, infrequent visits to the clinic, and inappropriate response to poor fetal movement. In order to achieve the Millennium Development Goal 4 more attention should be given to reducing perinatal deaths. These indicate a need to strengthen the quality of ANC rendered, especially in the primary health care facilities.
RECOMMENDATIONS: There is a need to strengthen maternal and child health services in the maternity unit of Carolina Hospital, and in the surrounding clinics within the Albert Luthuli sub-district. Clinical governance should be strengthened within Carolina Hospital. There is also a need for maternal and child health specialist outreach services within the Gert Sibande district health as a whole.
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Naidu, Karmisha. "Patient satisfaction with complete dentures received from an urban district hospital." Thesis, 2018. https://hdl.handle.net/10539/25382.
Full textAbstract:
Aim
Edentulousness usually impaires a patient's ability to chew and perform other oral functions, resulting in a wide range of health and oral-helath-related quality of life impacts. Whilst implant-retained overdentures have clear benefits, for the majority of edentulous patients, implant retained dentures will never be a reality, and mucosa-borne dentures will be their only choice. [Abbreviated Abstract. Open document to view full version]LG2018