Dissertations / Theses on the topic 'Healthcare service system'
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Yip, Man Hang. "Healthcare product-service system characterisation : implications for design." Thesis, University of Cambridge, 2015. https://www.repository.cam.ac.uk/handle/1810/249205.
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The engineering design process transforms stakeholders’ needs and desires into design specifications. In this process, manufacturers make decisions that impact how much value can be generated from a new product/service. Clear design specification can enhance the value of a product/service. This research study focuses on the engineering design process for systems of products and services - product-service systems (PSSs). An unambiguous PSS classification could help manufacturers to produce clearer design specifications, however there is a lack of clear PSS classifications for engineering design. Existing classifications rely on an out-dated distinction between tangible objects as products, and everything else as a service, a division that inappropriately classifies digital products as services. To develop a coherent PSS classification, it is necessary to understand which characteristics of PSS can clarify its design specification. This research addresses this problem by determining the PSS characteristics that are useful for clarifying the design specification. The research aims to develop a PSS characterisation scheme and explore how the scheme influences design specifications. To achieve these aims, case study and action research methods are employed. This study has developed a PSS characterisation scheme that clarifies design specifications and a method to systematically apply this scheme, the PSS characterisation approach. This approach proves useful for practitioners to clarify design specifications, and has extended the application of the theory of technical systems to instruments supporting the engineering design process. The PSS characterisation scheme comprises four characteristics: customer perceived value level, ‘connectivity number’, type and degree of connectivity and configuration type. The scheme does not use the ‘tangibility’ distinction, but incorporates concepts of value creation and interdependencies within a PSS and between a PSS and its environment. This novel characterisation scheme contributes to the development of a PSS classification scheme for engineering design and also to the literature of PSS classifications.
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Gombera, Peter Pachipano. "A risk management system for healthcare facilities service operators." Thesis, University of Derby, 2003. http://hdl.handle.net/10545/202349.
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Jia, Hao. "A web application for Medasolution Healthcare Company customer service system." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2612.
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Medasolution is a virtual company designed by the author to handle Medicare insurance business. The web application (which uses ASP.net and SQL Server 2000) facilitates communication between Medasolution and all its clients: members, employers, brokers, and medicare providers through separate web pages based on their category levels. The program incorporates security so that it follows government privacy rules regarding client information.
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Afrasiabi, Rad Amir. "Business process modeling in Web service-based healthcare systems." Thesis, University of Ottawa (Canada), 2009. http://hdl.handle.net/10393/28422.
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Web services composition is an emerging paradigm for enabling inter and intra organizational integration, and a landscape of languages and techniques for modeling business processes in web service based environments has emerged and is continuously being enriched. With the advent of modeling standards, different business sectors are investigating the options for modeling their workflows. In terms of business process modeling, healthcare is a rather complex sector of activity. Indeed, modeling healthcare processes presents special requirements dictated by the complicated and dynamic nature of these processes as well as by the specificity and diversity of the actors involved in these processes. Little effort has been dedicated to evaluating the capabilities and limitations of modeling languages based on healthcare requirements. This thesis presents a set of healthcare requirements and proposes an evaluation framework for process modeling languages based on these requirements. The suitability of three major process-based service composition languages, namely BPEL, BPMN and WS-CDL, is evaluated.
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Rust, Tom. "Dynamic Analysis of Healthcare Service Delivery: Application of Lean and Agile Concepts." Digital WPI, 2013. https://digitalcommons.wpi.edu/etd-dissertations/456.
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Hospitals are looking to industry for proven tools to manage increasingly complex operations and reduce costs simultaneously with improving quality of care. Currently, €˜lean€™ is the preferred system redesign paradigm, which focuses on removing process waste and variation. However, the high level of complexity and uncertainty inherent to healthcare make it incredibly challenging to remove variability and achieve the stable process rates necessary for lean redesign efforts to be effective. This research explores the use of an alternative redesign paradigm €“ €˜agile€™ €“ which was developed in manufacturing to optimize product delivery in volatile demand environments with highly variable customer requirements. €˜Agile€™ redesign focuses on increasing system responsiveness to customers through improved resource coordination and flexibility. System dynamics simulation and empirical case study are used to explore the impact of following an agile redesign approach in healthcare on service access, care quality, and cost; determine the comparative effectiveness of individual agile redesign strategies; and identify opportunities where lean methods can contribute to the creation of responsive, agile enterprises by analyzing hybrid lean-agile approaches. This dissertation contributes to the emerging literature on applying supply chain management concepts in healthcare, and opens a new path for designing healthcare systems that provide the right care, at the right time, to the right patient, at the lowest price.
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Marval-Peck, Luisa. "Exploring Women's Experiences Obtaining Medication Abortion Outside of the Formal Healthcare System." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42372.
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Despite legal and technological advances, women still face barriers to abortion care in legally restricted or low-resource settings. The advent of medication abortion using misoprostol with or without mifepristone, has enabled women to self-manage their abortions outside of the formal healthcare system. Self-managed abortions are often assisted by telemedicine services, which provide women with evidence-based guidance on managing the abortion process on their own. This thesis explores two separate abortion telemedicine services operating in legally restricted and/or low resource settings – a global online telemedicine service and an abortion support hotline in Venezuela – and evaluates the outcomes associated with each. By interviewing counsellors at a Venezuelan abortion support hotline and the women who used the service, we gained a stronger understanding of the hotline’s successes, barriers, and areas for improvement. We conclude that abortion telemedicine services provide effective and acceptable care, in general, and we recommend greater access to misoprostol in Venezuela.
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Chakrabarty, Nayan. "A Methodology for Supply Inventory Management for Hospital Nursing UnitsConsidering Service Level Constraint." Ohio University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1596192804676873.
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Eriksson, Albert. "Reducing waste from healthcare in a society of mass consumption : Applying PSS for personal protective equipment." Thesis, Blekinge Tekniska Högskola, Institutionen för maskinteknik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-21088.
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Background. The amount of waste generated each year is increased, research indicates that 79 % of plastic waste is dumped in landfills, 12% to incinerated and 9% of the plastics are recycled. At the beginning of the year 2020, an increase in personal protective equipment (PPE) was noted as a direct result of the Covid-19 pandemic that spread around the world. As a foundation to the waste problem in society, VolvoGroup presented its zero mission goals. The zero missions goals were to be captured in a problem space provided by Volvo. A problem space that students at Blekinge Institute of Technology and Stanford University were set out to find a solution to. Objectives. The objectives of this thesis were through the Design Thinking strategy to find solutions that are circular and applied as a PSS. The goal is to apply a circular system of which Volvo Group can apply in their line of work, also to transition this solution into other areas, e.g. healthcare. Methods. For research measures, the Design Research Methodology was used to frame the research and Design Thinking to frame the design process. Results. The result presented is a machine that can provide Volvo Group or healthcare with circular single-use gloves. The circular aspects are enabled by a certain material, allowing the created system to be circular. The system is applied as a product-service system, enhancing the availability of gloves in either healthcare or inside Volvo Group. Conclusions. The circular system applied as a PSS satisfies the goals by Volvo Group by reducing waste generated, increasing availability of protective equipment, thus increasing the safety of users in need of PPE. The created circular system has the potential to be applied in other areas than waste management and healthcare, which can be proved through future research.Bakgrund. Mängden sopor som slängs ökar för vart år som går. Forskning visar att79% av all plast som slängs går till deponi, 12% går till förbränning och resterandemängd plast (9%) återvinns. Under år 2020 har förbrukningen av skyddsartiklar av engångstyp ökat på grund av den Covid-19-pandemi som bröt ut i början av året. Den ökade förbrukningen har sin tur medfört nedskräpning av skyddsartiklar i naturen i en ökad omfattning. Till följd av detta har Volvo Group utformat ett uppdrag i syfte att få hjälp med att nå sin nollvision. Visionen innebär att utsläpp, olyckor och produktionsstopp ska upphöra helt och hållet. Uppdraget tilldelades en gruppstudenter på Blekinge Tekniska Högskola och Stanford University. Studenterna fick i uppgift att angripa problemet och komma med en lösning som uppfyller företagets nollvision. Syfte. Syftet med denna rapport är att genom design thinking- strategin finna en lösning som kan skapa ett cirkulärt system och appliceras som ett produkt-servicesystem (PSS). Målet är att kunna applicera detta system inom Volvo koncernen, men att även kunna presentera möjligheten att göra systemet tillämpningsbart inom sjukvården. Metod. I rent forskningssyfte användes Design Research Methodology för att rama in forskningen som skedde parallellt med utvecklingsprocessen. Utvecklingsprocessen följde ramarna för Design Thinking som presenterar olika typer av verktyg för design och utveckling av en produkt. Resultat. Det resultat som presenteras i denna rapport är ett cirkulärt system applicerat i en form av en PSS. Det som möjliggör detta system är ett material som tillåter reproduktion av engångshandskar som går att applicera inom sophanteringsindustrin. Detta indikerar även på att ett likande system kan medföra att sjukvården kan bli självständig i sitt användande av skyddsutrustning. Slutsatser. Ett cirkulärt system som uppfyller Volvos nollvision genom att skydda deras arbetare sluter ett kretslopp för en typ av skyddsutrustning. Det leder även tillökad tillgänglighet av utrusning. Detta system har potentialen att appliceras inom sjukvården i form av ett centraliserat system på sjukhus som tillför mindre enheter med tillverkade handskar.
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Falenius, Erik, and Mikael Jarl. "Lean – En utveckling från produktion till välfärd och service : En litteraturstudie av hur Lean utvecklats från produktion till välfärds- och servicebranschen." Thesis, Mittuniversitetet, Institutionen för informationssystem och –teknologi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-36335.
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This study consists of two studies around Lean. The studies are limited to two databases and three different sectors, the industry sector where Lean originated from, and the welfare and service sectors. The first study is a quantitative pilot study on published articles. The purpose was to get an understanding of what extent the different sectors get published, compared to each other. The result was illustrated in a graph where 40 articles per year were proportionally divided between the three sectors. The main study is a literature review where a scoring matrix was used to cull the selected articles. The remaining articles where compared to the “Toyota house” to answer the research questions: In what way has the definition of Lean changed from the manufacturing-based improvement philosophy it originated as, to the concept that is used in different sectors today? How does the specific sector affect the implementation of Lean, is there a difference in the Lean that is described in the literature compared to the Lean that is used in the welfare or service sectors? The study found in the chosen literature is that the sectors that are new at using Lean are using less of the tools available and in a smaller part of the organization, instead of using it on the whole organization. Many case studies where found that describes what tool was used, but not how they were used. One sector with many published articles was the construction sector, but they were overlooked due to the limitations of the study.Denna studie består av två undersökningar kring Lean. Undersökningarna är begränsade till två databaser samt tre branscher, industribranschen där Lean grundades samt välfärds- och tjänstebranschen. Först gjordes en kvantitativ förstudie av publicerade artiklar för att få en uppfattning kring hur många andelar av de olika branscherna artiklarna bestod av. Resultatet visades i form av en graf där 40 artiklar från varje år delades upp i de tre branscherna. Efter det gjordes en litteraturstudie med en bedömningsmatris för en utgallring av artiklar. Utvalda artiklar jämfördes därefter mot ”toyotahuset” för att svara på forskningsfrågorna: På vilket sätt har definitionen av Lean förändrats från den produktionsbaserade förbättringsfilosofin det ursprungligen var, till det uttryck som används i flera olika branscher idag? Hur påverkar branschen implementeringen av Lean, skiljer sig det Lean som beskrivs i litteraturen mot det Lean som används i välfärds- eller tjänstesektorn? Det vi kunde hitta i den utvalda litteraturen var att de branscher som är nya med Lean använder färre verktyg och på mindre delar av sin organisation istället för att göra implementeringen på hela organisationen. Vi hittade många ”case studies” som berättar att det använt verktyg men inte hur verktygen har använts. En bransch som det hittades mycket artiklar om men som sållades bort på grund av avgränsningen var Lean construction.
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Jung, S. J. (Sang-Joong). "Personal machine-to-machine (M2M) healthcare system with mobile device in global networks." Doctoral thesis, Oulun yliopisto, 2013. http://urn.fi/urn:isbn:9789526203164.
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Abstract This thesis describes the development of a personal machine-to-machine (M2M) healthcare system that is both flexible and scalable. Based on the IPv6 protocol, the system can be used over a low-power wireless personal area network (6LoWPAN). Since a hierarchical network structure offers excellent accessibility, the system is applicable both to local and international healthcare services. To further enhance scalability and reliability, the proposed system combines 6LoWPAN with mobile techniques, depending on whether the sensor is located inside or outside the range of a wireless sensor network (WSN). Employing wearable low-power sensors, the system measures health parameters dynamically. For wireless transmission, these sensors are connected to an M2M node either through the internet or through an external IPv4/IPv6-enabled network. The applicability of the IEEE 802.15.4 and 6LoWPAN protocols to wide area networks were verified in practical tests using an M2M gateway. To assess the physical health of an individual, the system uses heart rate variability analysis in time and frequency domains. Acquired data are first stored on a server for analysis. Results of the analysis are then automatically sent to Android-based mobile devices carried by the individual or appointed healthcare providers. In this way, mobile techniques are used to support remote health monitoring services. This personal M2M healthcare system has the capacity to accurately process a large amount of biomedical signals. Moreover, due to its ability to use mobile technology, the system allows patients to conveniently monitor their own health status, regardless of locationTiivistelmä Tutkimuksessa kehitetään henkilökohtainen mobiililaitteden välillä toimiva (M2M) terveydenhoitojärjestelmä, joka mahdollistaa joustavan ja skaalautuvan potilaan terveyden monitoroinnin. Perustuen IPv6-protokollaan, sovellusta voidaan käyttää matalatehoisen langattoman 6LowPAN-verkon yli. Koska hierarkkinen verkkorakenne tarjoaa erinomaisen saavutettavuuden, järjestelmän kapasiteetti riittää paitsi kaupungin sisäisten myös kansainvälisten terveyspalvelujen järjestämiseen. Skaalattavuuden ja luotettavuuden vuoksi ehdotettu järjestelmä yhdistelee 6LowPAN-tekniikkaa mobiiliteknologiaan riippuen siitä onko sensori langattoman sensoriverkon kuuluvuusalueella vai sen ulkopuolella. Puettavia matalatehoisia sensoreita käyttävä järjestelmä kykenee mittaamaan terveysparametreja dynaamisesti. Langatonta siirtoa varten nämä sensorit on kytketty M2M-solmuun joko internetin tai ulkoisen IPv4/IPv6-verkon kautta. Käytännön testeissä IEEE802.15.4- ja 6LowPAN-protokollien soveltaminen laajaverkossa mahdollistettiin tähän soveltuvalla M2M-yhdyskäytävällä. Yksilöiden fyysisen terveyden arvioinnissa järjestelmä käyttää sydämen sykevaihtelun analysointia aika- ja taajuustasossa. Data tallennetaan palvelimelle analysointia varten. Analyysin tulokset lähetetään automaattisesti henkilöiden omiin tai heidän lääkäriensä mobiililaitteisiin. Näin mobiiliteknologiaa käytetään tukemaan terveyden etämonitorointipalveluja. Tämä henkilökohtainen M2M-kommunikointiin perustuva terveydenhoitojärjestelmä kykenee käsittelemään tarkkaan suuriakin määriä 6LowPAN-verkon ja internetin kautta tulevia biolääketieteellisiä signaaleja. Lisäksi kyky käyttää mobiiliteknologiaa tekee järjestelmästä potilaille miellyttävän tavan monitoroida omaa terveydentilaansa sijaintipaikasta riippumatta
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Rodríguez, Lina María Garcés. "A reference architecture of healthcare supportive home systems from a systems-of-systems perspective." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/55/55134/tde-16102018-111654/.
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Population ageing has been taking place all over the world, being estimated that 2.1 billion people will be aged 60 or over in 2050. Healthcare Supportive Home (HSH) Systems have been proposed to overcome the high demand of remote home care for assisting an increasing number of elderly people living alone. Since a heterogeneous team of healthcare professionals need to collaborate to continually monitor health status of chronic patients, a cooperation of pre-existing e-Health systems, both outside and inside home, is required. However, current HSH solutions are proprietary, monolithic, high coupled, and expensive, and most of them do not consider their interoperation neither with distributed and external e-Health systems, nor with systems running inside the home (e.g., companion robots or activity monitors). These systems are sometimes designed based on local legislations, specific health system configurations (e.g., public, private or mixed), care plan protocols, and technological settings available; therefore, their reusability in other contexts is sometimes limited. As a consequence, these systems provide a limited view of patient health status, are difficult to evolve regarding the evolution of patients health profile, do not allow continuous patients monitoring, and present limitations to support the self-management of multiple chronic conditions. To contribute to solve the aforementioned challenges, this thesis establishes HomecARe, a reference architecture for supporting the development of quality HSH systems. HomecARe considers HSH systems as Systems-of-Systems (SoS) (i.e., large, complex systems composed of heterogeneous, distributed, and operational and managerial independent systems), which achieve their missions (e.g., improvement of patients quality of life) through the behavior that emerges as result of collaborations among their constituents. To establish HomecARe, a systematic process to engineer reference architectures was adopted. As a result, HomecARe presents domain knowledge and architectural solutions (i.e., architectural patterns and tactics) described using conceptual, mission, and quality architectural viewpoints. To assess HomecARe, a case study was performed by instantiating HomecARe to design the software architecture of DiaManT@Home, a HSH system to assist at home patients suffering of diabetes mellitus. Results evidenced HomecARe is a viable reference architecture to guide the development of reusable, interoperable, reliable, secure, and adaptive HSH systems, bringing important contributions for the areas of e-Health, software architecture, and reference architecture for SoS.O envelhecimento da população é um fenômeno mundial e estima-se que no ano 2050, 2,1 bilhões de pessoas terão 60 anos ou mais. Sistemas de casas inteligentes para o cuidado da saúde (em inglês Healthcare Supportive Home - HSH systems) têm sido propostos para atender a alta demanda de serviços de monitoramento contínuo do número cada vez maior de pacientes que vivem sozinhos em suas residências. Considerando que o monitoramento do estado de saúde de pacientes crônicos requer a colaboração de equipes formadas por profissionais de várias especialidades, é fundamental que haja cooperação entre sistemas eletrônicos de saúde (por exemplo, sistemas de prontuário eletrônico ou sistemas de atenção de emergência), sendo eles externos ou internos à residência. Entretanto, as soluções de HSH existentes são comerciais, monolíticas, altamente acopladas e de alto custo. A maioria delas não considera a interoperabilidade entre sistemas distribuídos e exteriores ou internos à residência dos pacientes, como é o caso de robôs de companhia e monitores de atividade. Além disso, os sistemas de HSH muitas vezes são projetados com base em legislações locais, na estrutura do sistema de saúde (por exemplo, público, privado ou misto), nos planos de cuidados nacionais e nos recursos tecnológicos disponíveis; portanto, a reusabilidade desses sistemas em outros contextos é não é uma tarefa trivial. Em consequência, os sistemas de HSH existentes oferecem uma visão restrita do estado de saúde do paciente, são difíceis de evoluir acompanhando as mudanças no perfil de saúde do paciente, impossibilitando assim seu monitoramento contínuo e limitando o suporte para o paciente na autogestão de suas múltiplas condições crônicas. Visando contribuir na resolução dos desafios apresentados, esta tese estabelece a HomecARe, uma arquitetura de referência para apoiar o desenvolvimento de sistemas de HSH de qualidade. A HomecARe considera os sistemas de HSH como Sistemas-de-Sistemas (do inglês Systems-of-Systems - SoS) (ou seja, sistemas grandes e complexos formados por outros sistemas heterogêneos, distribuídos e que apresentam independência em seu gerenciamento e operação), que cumprem suas missões (por exemplo, melhoria da qualidade de vida do paciente) mediante o comportamento que emerge resultante da colaborações entre seus sistemas constituintes. Para estabelecer a HomecARe, foi adotado um processo sistemático que apoia a engenharia de arquiteturas de referência. Como resultado, a HomecARe contém o conhecimento do domínio, bem como soluções arquiteturais (por exemplo, padrões arquiteturais e táticas) que são descritas usando os pontos de vista conceitual, de missão e de qualidade. A HomecARe foi avaliada por meio da condução de um estudo de caso em que a arquitetura de referência foi instanciada para projetar o DiaManT@Home, um sistema de HSH que visa apoiar pacientes diagnosticados com diabetes mellitus na autogestão de sua doença. Os resultados obtidos evidenciaram que a HomecARe é uma arquitetura de referência viável para guiar o desenvolvimento de sistemas de HSH reusáveis, interoperáveis, confiáveis, seguros e adaptativos, trazendo importantes contribuições nas áreas de saúde eletrônica, arquitetura de software e arquiteturas de referência para SoS.
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De, Castri Andrea. "Sistemi di supporto alle decisioni in ambito clinico: predizione del rischio "as a service"." Master's thesis, Alma Mater Studiorum - Università di Bologna, 2017. http://amslaurea.unibo.it/14733/.
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L'evoluzione tecnologica e l'ampliamento dei canali di comunicazione stanno giocando un ruolo fondamentale nelle aziende che hanno intenzione di evolvere la propria infrastruttura IT in un modello as a service. Il cloud sta svolgendo una funzione principale nel business aziendale portandone il mercato ad una crescita che oscilla tra il 18% e il 21%, nel solo 2017, e spingendo migliaia di aziende a integrare la vecchia IT con la nuova.
Si deve inoltre tener conto dell'enorme volume di dati prodotto dai processi aziendali nell'ultimo ventennio, in quanto la richiesta di utilizzo di tali dati, per scopi aziendali, ha reso necessaria la creazione di tecniche avanzate per l'analisi degli stessi; ne sono un esempio la ricerca clinica e alcune pratiche mediche. Queste, infatti, stanno subendo un cambiamento radicale attraverso l'introduzione di algoritmi di apprendimento che facilitano l'analisi di una enorme mole di dati relativa alle informazioni dei pazienti.
Una delle tecniche utilizzate per la costruzione di algoritmi in grado di imparare da eventi passati e di predire eventi sconosciuti è il machine learning.
La sfida che ci si pone e di cui si tratterà in questo documento è la creazione di un sistema di supporto alle decisioni as a service che utilizzi una base di conoscenza elaborata da tecniche di machine learning. Nel mondo sanitario queste tecnologie trovano applicazioni sia nella formulazione di diagnosi, sia nella predizione del rischio di un paziente affetto da determinate malattie.
La predizione del rischio può essere intesa come: probabilità di un paziente di entrare in ricovero nei successivi 30 giorni, probabilità di peggioramento oppure possibilità di morire.
Lo scopo che ci si prefigge di raggiungere con questo lavoro è quello di fornire un primo prototipo funzionante di un Clinical Decision Support System, focalizzandosi sulla costruzione di un'architettura di sistema che guidi l'analisi delle migliori tecnologie da utilizzare.
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Renner, Anna-Theresa. "Inefficiencies in a healthcare system with a regulatory split of power: a spatial panel data analysis of avoidable hospitalisations in Austria." Springer Berlin Heidelberg, 2019. http://dx.doi.org/10.1007/s10198-019-01113-7.
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Despite generous universal social health insurance with little formal restrictions of outpatient utilisation, Austria exhibits high
rates of avoidable hospitalisations, which indicate the inefficient provision of primary healthcare and might be a consequence
of the strict regulatory split between the Austrian inpatient and outpatient sector. This paper exploits the considerable regional
variations in acute and chronic avoidable hospitalisations in Austria to investigate whether those inefficiencies in primary
care are rather related to regional healthcare supply or to population characteristics. To explicitly account for inter-regional
dependencies, spatial panel data methods are applied to a comprehensive administrative dataset of all hospitalisations from
2008 to 2013 in the 117 Austrian districts. The initial selection of relevant covariates is based on Bayesian model averaging.
The results of the analysis show that supply-side variables, such as the number of general practitioners, are significantly
associated with decreased chronic and acute avoidable hospitalisations, whereas characteristics of the regional population,
such as the share of population with university education or long-term unemployed, are less relevant. Furthermore, the spatial
error term indicates that there are significant spatial dependencies between unobserved characteristics, such as practice style
or patients' utilization behaviour. Not accounting for those would result in omitted variable bias.
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Maximo, Tulio P. dos Santos. "Not just the right for a wheelchair but the right wheelchair : a multi-site study of the wheelchair public service provision in Belo Horizonte city, Brazil." Thesis, Loughborough University, 2018. https://dspace.lboro.ac.uk/2134/31843.
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For decades the care of disabled population in Brazil has been neglected by the government and was provided largely by the charitable institutions. It was as only recently, as in the year 2011 that Brazilian government created the national plan for the rights of the disabled people. The plan articulates policies regarding social inclusion, access to education, accessibility and health care. The last section of the plan includes the provision of wheelchairs free of cost to the Brazilians citizens, who are in need of a wheelchair. It is common knowledge that a wrong wheelchair specification can lead to physical damage for the user and the carer; the abandonment of device, and wastage of time and resources involved in the wheelchair provision. The World Health Organization has propounded several good practices and training material with reference to wheelchair services towards enabling of right wheelchair fit to the user characteristics. Though, there is no evidence that the service provided in Brazil adheres to these guidelines or any other wheelchair service good practice. This research reviews the wheelchair service provision in Belo Horizonte city, Brazil with the aim to understand the functionality of these services in order to provide context-specific interventions and recommendations to improve the design of current services. Herein, three main studies were conducted using a mix of methods: A first exploratory study was conducted to assess the Belo Horizonte assistive technology services and identify a research focus. A second study was conducted to develop an in-depth insight on the understanding of the wheelchair service provided and to collect the necessary information towards creating a context-based and collaborative designed intervention. A third study was conducted to evaluate and improve the proposed interventions. A total of sixty-six interviews were conducted (n=66) with service stakeholders and two hundred and fifty user care observed (n=250) from which ninety-five (n=95) tested the proposed interventions.
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Oosthuizen, Louzanne. "A location science model for the placement of POC CD4 testing devices as part of South Africa's public healthcare diagnostic service delivery model." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96972.
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Thesis (MEng)--Stellenbosch University, 2015.ENGLISH ABSTRACT: South Africa has a severe HIV (human immunodeficiency virus) burden and the management of the disease is a priority, especially in the public healthcare sector. One element of managing the disease, is determining when to initiate an HIV positive individual onto anti-retroviral therapy (ART), a treatment that the patient will remain on for the remainder of their lifetime. For the majority of HIV positive individuals in the country, this decision is governed by the results of a CD4 (cluster of differentiation 4) test that is performed at set time intervals from the time that the patient is diagnosed with HIV until the patient is initiated onto ART. A device for CD4 measurement at the point of care (POC), the Alere PIMA™, has recently become commercially available. This has prompted a need to evaluate whether CD4 testing at the POC (i.e. at the patient serving healthcare facility) should be incorporated into the South African public healthcare sector's HIV diagnostic service provision model. One challenge associated with the management of HIV in the country is the relatively large percentage of patients that are lost to follow-up at various points in the HIV treatment process. There is extensive evidence that testing CD4 levels at the POC (rather than in a laboratory, as is the current practice) reduces the percentage of patients that are lost to follow-up before being initiated onto ART. Therefore, though POC CD4 testing is more expensive than laboratory-based CD4 testing, the use of this technology in South Africa should be investigated for its potential to positively influence health outcomes. In this research, a multi-objective location science model is used to generate scenarios for the provision of CD4 testing capability. For each scenario, CD4 testing provision at 3 279 ART initiation facilities is considered. For each facility, either (i) a POC device is placed at the site; or (ii) the site's testing workload is referred to one of the 61 CD4 laboratories in the country. To develop this model, the characteristics of eight basic facility location models are compared to the attributes of the real-world problem in order to select the most suitable one for application. The selected model's objective, assumptions and inputs are adjusted in order to adequately model the realworld problem. The model is solved using the cross-entropy method for multi-objective optimisation and the results are verified using a commercial algorithm. Nine scenarios are selected from the acquired Pareto set for detailed presentation. In addition, details on the status quo as well as a scenario where POC testing is used as widely as possible are also presented. These scenarios are selected to provide decision-makers with information on the range of options that should be considered, from no or very limited use to widespread use of POC testing. Arguably the most valuable contribution of this research is to provide an indication of the optimal trade-off points between an improved healthcare outcome due to POC CD4 testing and increased healthcare spending on POC CD4 testing in the South African public healthcare context. This research also contributes to the location science literature and the metaheuristic literature.
AFRIKAANSE OPSOMMING: Suid-Afrika gaan gebuk onder `n swaar MIV- (menslike-immuniteitsgebreksvirus-) las en die bestuur van die siekte is `n prioriteit, veral in die openbare gesondheidsorgsektor. Een element in die bestuur van die siekte is om te bepaal wanneer `n MIV-positiewe individu met antiretrovirale- (ARV-)behandeling behoort te begin, waarop pasiënte dan vir die res van hul lewens bly. Vir die meeste MIV-positiewe individue in die land word hierdie besluit bepaal deur die uitslae van `n CD4- (cluster of differentiation 4-)toets wat met vasgestelde tussenposes uitgevoer word vandat die pasiënt met MIV gediagnoseer word totdat hy of sy met ARV-behandeling begin. `n Toestel vir CD4-meting by die punt van sorg (\POC"), die Alere PIMA™, is onlangs kommersieel beskikbaar gestel. Dit het `n behoefte laat ontstaan om te bepaal of CD4-toetsing by die POC (met ander woorde, by die gesondheidsorgfasiliteit waar die pasiënt bedien word) by die MIV-diagnostiese diensleweringsmodel van die Suid-Afrikaanse openbare gesondheidsorgsektor ingesluit behoort te word. Een uitdaging met betrekking tot MIV-bestuur in die land is die betreklik groot persentasie pasiënte wat verlore gaan vir nasorg in die verskillende stadiums van die MIV-behandelingsproses. Heelwat bewyse dui daarop dat die toetsing van CD4-vlakke by die POC (eerder as in `n laboratorium, soos wat tans die praktyk is) die persentasie pasiënte wat verlore gaan vir nasorg voordat hulle met ARV-behandeling kan begin, verminder. Daarom, hoewel CD4-toetsing by die POC duurder is as toetsing in `n laboratorium, behoort die gebruik van hierdie tegnologie in Suid-Afrika ondersoek te word. In hierdie studie is `n meerdoelige liggingswetenskapmodel gebruik om scenario's vir die voorsiening van CD4-toetsvermoë te skep. Vir elke scenario word CD4-toetsvermoë by 3 279 ARV-inisiasie fasiliteite oorweeg. Vir elke fasiliteit word toetsvermoë verskaf deur (i) die plasing van POC-toestelle by die fasiliteit, of (ii) verwysing vir laboratoriumgebaseerde toetsing by een van die 61 CD4-laboratoriums in die land. Die kenmerke van agt basiese fasiliteitsliggingsmodelle is met die kenmerke van die werklike probleem vergelyk om die mees geskikte model vir toepassing op die werklike probleem te bepaal. Die doelwitte, aannames en insette van die gekose model is daarna aangepas om die werklike probleem voldoende te modelleer. Die model is opgelos met behulp van die kruis-entropie-metode vir meerdoelige optimering, waarna die resultate deur middel van `n kommersiële algoritme bevestig is. Nege scenario's uit die verworwe Pareto-stel word uitvoerig aangebied. Daarbenewens beskryf die studieresultate die besonderhede van die status quo sowel as `n scenario waar POC-toetsing so wyd moontlik gebruik word. Hierdie scenario's word aangebied om besluitnemers van inligting te voorsien oor die verskeidenheid moontlikhede wat oorweeg kan word, wat wissel van geen of baie beperkte tot wydverspreide gebruik van POC-toetsing. Die mees beduidende bydrae van hierdie navorsing is stellig dat dit `n aanduiding bied van die optimale kompromie tussen `n verbeterde gesondheidsorguitkoms weens CD4-toetsing by die POC, en verhoogde gesondheidsorgbesteding aan CD4-toetsing by die POC, in die konteks van Suid-Afrikaanse openbare gesondheidsorg. Die navorsing dra ook by tot die ligingswetenskapliteratuur sowel as tot die metaheuristiekliteratuur.
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Ottosson, Ulrika, and Siri Rönnlund. "Implementation of a Mobile Healthcare Solution at an Inpatient Ward." Thesis, KTH, Medicinteknik och hälsosystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279145.
Full textAbstract:
Healthcare is a complex system under great pressure for meeting the patients’ needs. Implementing technology at inpatient wards might possibly support healthcare professionals and improve quality of care. However, these technologies might come with issues and the system might not be used as intended. This master thesis project investigates how healthcare professionals communicate at an inpatient ward and how this might be affected by implementing a Mobile Healthcare Solution (MHS). Further, it sought to question why healthcare professions might, or might not, use the MHS as a support of their daily work and what some reasons for this might be. Research methods were of qualitative approach. Field studies were performed at an inpatient ward and further, two healthcare professionals were interviewed. Grounded Theory (GT) was chosen as a method to process the data and obtain understanding for communication at the inpatient ward. The results showed that healthcare professionals communicate verbally, written and by reading, using different tools. The most prominent ways of communication were verbally, where it was common to report or discuss about a patient. The means for communication did not get drastically affected by implementing the MHS and reasons for this were of social, technical and organizational types. Some reasons for not using the MHS were habits and due to healthcare professionals perceiving the MHS as more time consuming than manual handling. However, a specific investigation of whether this might affect the usage of the MHS is yet needed
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Memon, Ally Raza. "Management in collaborative and integrated healthcare service systems : concept and practice." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/21998.
Full textAbstract:
This study explores how managers are coping within a changing public healthcare service context and how the role of service managers and the nature of Management Development are being transformed. With the public healthcare sector in the UK facing complex challenges including financial constraint and increasing service demand, it is inevitable that collaborative partnership working and service integration are viewed as a means of addressing such challenges. Using the views and experiences of service managers from Scottish Community Health Care Partnership cases, the study highlights the experiences of managers in relation to partnership working and service integration and explores the potential implications of this for managerial learning, training and development. The research evidence establishes the importance of changing roles, responsibilities and relationships for managers in a changing healthcare service environment and takes on board a Service-Dominant approach and propositions from New Public Governance theory to explain these and to address attendant issues. Specifically, the challenges surrounding the learning, training and development of managers in an increasingly integrated services environment are explored and reconceptualised through a Services-as-Systems approach. The outcomes of this study allow for a better understanding of the changing nature of work that managers do and attempts to reframe Management Development in such a context for the future.
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Zhang, Jing Kai. "An investigation on system interoperability in healthcare information systems based on the web services." Thesis, University of Surrey, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442674.
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Pereira, Vera Lisa dos Santos Baptista. "Gestão integrada "Ambiente e Qualidade" aplicada a uma unidade de saúde." Master's thesis, Universidade de Évora, 2017. http://hdl.handle.net/10174/21048.
Full textAbstract:
A presente dissertação insere-se na realização do Mestrado em Qualidade e
Gestão do Ambiente e tem como principal objetivo a integração das
componentes de qualidade e ambiente na gestão global de uma unidade de
saúde.
Dada a dimensão e complexidade inerentes às atividades desenvolvidas foi
selecionado o serviço de Anatomia Patológica, já certificado no âmbito da
qualidade, pela Norma ISO 9001.
De modo a conhecer as consequências, a nível ambiental, inerentes à
atividade desenvolvida foi realizada observação dos processos de trabalho e
análise da documentação existente, tendo sido utilizados os princípios
orientadores da Norma de Gestão Ambiental ISO 14001:2015.
O trabalho resultou numa análise crítica da situação atual deste serviço,
pretendendo-se que a aposta futura em políticas de gestão integrada
(qualidade e ambiente) possibilite uma maior interação entre as atividades
desenvolvidas, os impactes ambientais gerados e a qualidade no acesso aos
cuidados de saúde; INTEGRATED “ENVIRONMENTAL AND QUALITY” MANAGEMENT
APPLIED TO A HEALTHCARE UNIT
Abstract:
This dissertation is part of the Master in Quality and Environmental
Management. Its main objective is the integration of environmental and quality
components in the global management of a healthcare unit.
The Anatomic Pathology Service, already having a Quality certification (ISO
9001), was selected due the dimension and complexity of the activities
developed.
In order to know the environmental consequences inherent to the activity
developed, work processes and existing documentation were analysed,
following the guiding principles of the ISO standard 14001:2015.
The work resulted in a critical analysis of the current situation of the service.
The intention is that a future investment in integrated management policies
(quality and environment) will improve the interaction between the activities
developed, the environmental impacts generated and the quality of the
healthcare service.
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Klahn, Erin J. "Debating identity urban Indians in the healthcare system /." CONNECT TO THIS TITLE ONLINE, 2008. http://etd.lib.umt.edu/theses/available/etd-05272008-202310/.
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Marufu, Masiya Passmore Alex. "ICT-based innovation using service dominant logic in healthcare : a design thinking perspective." Thesis, University of Pretoria, 2017. http://hdl.handle.net/2263/64294.
Full textAbstract:
Health professionals in the developing world face the twin challenge of growing populations requiring services and dwindling resources in the face of reduced funding. Developments in information and communication technologies (ICT) present an opportunity to streamline service offering in a way that maximises the available meagre resources. Such innovations require the input and support of the public that these institutions serve. Design thinking has over the last 20 years developed into a “design paradigm” that can assist service providers to craft solutions to problems that take into account the views of the stakeholders involved.
This work explored how information technology can be used to improve service delivery. Adopting a pragmatic philosophical paradigm and a design science research approach, the researcher used concepts underlying the theory of service dominant logic, coupled with technology capability concepts, to develop a conceptual framework for use in design thinking projects. The development of the Technovation Framework continued over three design cycles, in which a number of design teams focused their efforts on how ICT could be used to improve post-natal care services. The empathy input for these workshops was derived from an eight-week-long in-depth study into the lives of new mothers, using journals and interviews. Interviews with midwives and doctors provided a healthcare perspective of the provision of post-natal care.
The first design workshop was made up of four teams, each consisting of two midwives, two mobile developers and two mothers in a design thinking workshop. The workshop resulted in the development of four prototypes of mobile applications aimed at assisting midwives in educating mothers as well as providing off-site monitoring. Two further workshops were conducted, providing two more iterations of the design process and resulting in further prototypes of potential solutions for use in healthcare. A final evaluation workshop was conducted to validate the fully developed Technovation Process.
This study contributes to knowledge in a number of ways. The first is a deep understanding of the lives of new mothers and challenges they face in a low-resource environment as they struggle with raising their babies in the first eight weeks after giving birth. The second contribution is a framework and an enhanced design thinking process that streamlines the process of consolidating empathy output while providing a mechanism to apply technology capabilities to proposed solutions. A third contribution is the set of lessons that arise from observing design teams at work. The final contribution is in the form of a number of prototypes that could be developed into solutions for use in a developing environment healthcare setting.
Keywords: ICT in healthcare, e-Health, innovation, co-creation, design thinking, developing country, post-natal care, design science research, Technovation, technology capabilitiesThesis (PhD) - University of Pretoria, 2017.
Informatics
PhD
Unrestricted
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Tyali, Sinovuyo. "An integrated management system for quality and information security in healthcare." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1006670.
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Health service organizations are increasingly required to deliver quality healthcare services without increasing costs. The adoption of health information technologies can assist these organizations to deliver a quality service; however, this again exposes the health information to threats. The protection of personal health information is critical to ensure the privacy of patients in the care of health service organizations. Therefore both quality and information security are of importance in healthcare. Organisations commonly use management system standards to assist them to improve a particular function (e.g. quality or security) through structured organizational processes to establish, maintain and optimise a management system for the particular function. In the healthcare sector, the ISO 9001, ISO 9004 and IWA 1 standards may be used for the purpose of improving quality management through the establishment of a quality management system. Similarly, the ISO 27001 and ISO 27799 standards may be used to improve information security management through the establishment of an information security management system. However, the concurrent implementation of multiple standards brings confusion and complexity within organisations. A possible solution to the confusion is to introduce an integrated management system that addresses the requirements of multiple management systems. In this research, various standards relevant to the establishment of management systems for quality and security are studied. Additionally, literature on integrated management systems is reviewed to determine a possible approach to establishing an IMS for quality and information security in healthcare. It will be shown that the quality management and information security management standards contain commonalities that an integration approach can be based on. A detailed investigation of these commonalities is done in order to present the final proposal of the IMSQS, the Integrated Management System for Quality and Information Security in healthcare.
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Lee, Seung Yup. "Proactive Coordination in Healthcare Service Systems through Near Real-Time Analytics." Thesis, Wayne State University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10839804.
Full textAbstract:
The United States (U.S.) healthcare system is the most expensive in the world. To improve the quality and safety of care, health information technology (HIT) is broadly adopted in hospitals. While EHR systems form a critical data backbone for the facility, we need improved 'work-flow' coordination tools and platforms that can enhance real-time situational awareness and facilitate effective management of resources for enhanced and efficient care. Especially, these IT systems are mostly applied for reactive management of care services and are lacking when they come to improving the real-time "operational intelligence" of service networks that promote efficiency and quality of operations in a proactive manner. In particular, we leverage operations research and predictive analytics techniques to develop proactive coordination mechanisms and decision methods to improve the operational efficiency of bed management service in the network spanning the emergency department (ED) to inpatient units (IUs) in a hospital, a key component of healthcare in most hospitals. The purpose of this study is to deepen our knowledge on proactive coordination empowered by predictive analytics in dynamic healthcare environments populated by clinically heterogeneous patients with individual information changing throughout ED caregiving processes. To enable proactive coordination for improved resource allocation and patient flow in the ED-IU network, we address two components of modeling/analysis tasks, i.e., the design of coordination mechanisms and the generation of future state information for ED patients.
First, we explore the benefits of early task initiation for the service network spanning the emergency department (ED) and inpatient units (IUs) within a hospital. In particular, we investigate the value of proactive inpatient bed request signals from the ED to reduce ED patient boarding. Using data from a major healthcare system, we show that the EDs suffer from severe crowding and boarding not necessarily due to high IU bed occupancy but due to poor coordination of IU bed management activity. The proposed proactive IU bed allocation scheme addresses this coordination requirement without requiring additional staff resources. While the modeling framework is designed based on the inclusion of two analytical requirements, i.e., ED disposition decision prediction and remaining ED length of stay (LoS) estimation, the framework also accounts for imperfect patient disposition predictions and multiple patient sources (besides ED) to IUs. The ED-IU network setting is modeled as a fork-join queueing system. Unlike typical fork-join queue structures that respond identically to a transition, the proposed system exhibits state-dependent transition behaviors as a function of the types of entities being processed in servers. We characterize the state sets and sequences to facilitate analytical tractability. The proposed proactive bed allocation strategy can lead to significant reductions in bed allocation delay for ED patients (up to ~50%), while not increasing delays for other IU admission sources. We also demonstrate that benefits of proactive coordination can be attained even in the absence of highly accurate models for predicting ED patient dispositions. The insights from our models should give confidence to hospital managers in embracing proactive coordination and adaptive work flow technologies enabled by modern health IT systems.
Second, we investigate the quantitative modeling that analyzes the patterns of decreasing uncertainty in ED patient disposition decision making throughout the course of ED caregiving processes. The classification task of ED disposition decision prediction can be evaluated as a hierarchical classification problem, while dealing with temporal evolution and buildup of clinical information throughout the ED caregiving processes. Four different time stages within the ED course (registration, triage, first lab/imaging orders, and first lab/imaging results) are identified as the main milestone care stages. The study took place at an academic urban level 1 trauma center with an annual census of 100,000. Data for the modeling was extracted from all ED visits between May 2014 and April 2016. Both a hierarchical disposition class structure and a progressive prediction modeling approach are introduced and combined to fully facilitate the operationalization of prediction results. Multinomial logistic regression models are built for carrying out the predictions under three different classification group structures: (1) discharge vs. admission, (2) discharge vs. observation unit vs. inpatient unit, and (3) discharge vs. observation unit vs. general practice unit vs. telemetry unit vs. intensive care unit. We characterize how the accumulation of clinical information for ED patients throughout the ED caregiving processes can help improve prediction results for the three-different class groups. Each class group can enable and contribute to unique proactive coordination strategies according to the obtained future state information and prediction quality, to enhance the quality of care and operational efficiency around the ED. We also reveal that for different disposition classes, the prediction quality evolution behaves in its own unique way according to the gain of relevant information. (Abstract shortened by ProQuest.)
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Nhavoto, José António. "Integration of Mobile Technologies with Routine Healthcare Services in Mozambique." Doctoral thesis, Örebro universitet, Handelshögskolan vid Örebro Universitet, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-56948.
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Mobile technologies are emerging as one way to help address health challenges in many countries, including in Least Developed Countries. Mobile technology can reach a large share of the population but in order to provide effective support to healthcare services, technology, information collection and dissemination, and work processes need to be well aligned. The thesis uses a design science methodological approach and mixes qualitative and quantitative data analysis to address the question of, How can mobile technologies be effectively integrated with routine healthcare services? The study concerns the design, implementation, and evaluation of a mobile technology-based system, called SMSaúde, with the aim of improving the care of patients with HIV/AIDS and tuberculosis in Mozambique. The work started with the elicitation of functional and user requirements, based on focus group discussions. An important challenge, as in many mHealth interventions, was the integration with routine healthcare services and the existing IT systems, as well as developing a scalable technical structure. The system has now been in routine use since 2013 in more than 16 healthcare clinics in Mozambique. Evaluation was done by a randomised controlled study. Analysis of patient records showed that retention in care in urban areas was significantly higher in the intervention group than in the control group. In a user study both patients and health professionals were very positive to the system. The thesis contributes to research by demonstrating how information system artefacts can be constructed and successfully implemented in resource-constrained settings. The practical contributions include the designed artefact itself as well as improved healthcare practices and mHealth policy recommendations.
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Ibrahim, Abdul Razak. "An integrated performance measurement system of healthcare services : an empirical study of public and private hospitals in Malaysia." Thesis, University of Strathclyde, 2002. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=23752.
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The purpose of this study is to explore performance measurement systems in the healthcare services in Malaysia. This study postulates a framework based on an analysis of the existing literature in the field and on the empirical evidence collected during fieldwork. This framework provides a useful perspective for studying performance measurement in developing countries such as Malaysia. Moreover, identification of gaps in the field enables both academics as well as practitioners to improve the existing systems, thereby creating more robust and better surveillance in the healthcare industry. The findings show that in order for systems to operate efficiently, three major components must work together, namely strategy formulation and deployment, internal control systems, and managing processes. The empirical framework developed in the study represents an amalgamation of approaches used in organisations. One of the findings is that top management commitments, people involvement, and structure to accommodate change process are the catalyst for measurement systems to work. Further analysis reveals (survey) that 80% of users are not satisfied with their measurement system. This means that there is a need for further research in the future. Performance measurement is in its embryonic stage in Malaysia as the survey reveals domains accomplishment of less than 50%. The healthcare industry is inevitably growing and the Malaysian government needs to address the importance of measuring performance in the long run. Learning from another country's experience is the best way forward. The thesis also provides a context in which performance measurement works. There are two contexts applied: healthcare industries and Malaysia. Both contextual elements are important; healthcare has special attributes that make it different from other industries, while Malaysia has unique properties that provide a fresh look at healthcare. The key to successful performance measurement is to ensure congruence in all elements of the systems: context (Malaysia and healthcare) and content (organisations where systems exist). Then integration can be accomplished.
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McLoughlin, Robert. "Healthcare Disparities and Noncompliance in Children and Young Adults with Crohn’s Disease." eScholarship@UMMS, 2019. https://escholarship.umassmed.edu/gsbs_diss/1026.
Full textAbstract:
Objective:
Treatment compliance in children with Crohn’s disease is associated with higher levels of symptom remission. We hypothesized that the management, comorbidities, and complications for children with Crohn’s disease would differ based on a diagnosis of noncompliance.
Methods:
Using the Kids’ Inpatient Database for 2006-2012, we identified young patients (<21 >years) with a diagnosis of Crohn’s disease. Diagnoses and procedures were analyzed according to a recorded diagnosis of noncompliance. Multivariable logistic regression analysis was performed to examine the association between noncompliance and the outcomes of interest.
Results:
There were 28,337 pediatric Crohn’s disease hospitalizations identified with 1,028 (3.6%) hospitalizations having a diagnosis of both Crohn’s disease and noncompliance. The mean age of the study population was 15.9 years and 48.9% were girls. Black patients ( multivariable adjusted odds ratio, aOR,2.27; 95% CI:1.84-2.79) and those in the lowest income quartile (aOR 1.57; 95% CI:1.20-2.05) had an increased likelihood of a noncompliance diagnosis than respective comparison groups. Noncompliant patients had an increased likelihood of concurrent depression, nutritional deficiency, and anemia. Patients with a diagnosis of noncompliance had lower rates of intestinal obstruction (4.0% vs 6.3%), intraabdominal abscesses (2.0% vs 4.2%,), and underwent fewer major surgical procedures (aOR 0.40; 95% CI:0.31-0.53) and large bowel resections (aOR 0.44; 95% CI:0.31-0.64) than patients without this diagnosis.
Conclusions:
We found significant differences in socioeconomic status and race among hospitalized children with Crohn’s disease with, as compared to those without, a diagnosis of noncompliance. Children with noncompliance have different comorbidities, disease-related complications, and are managed differently. Possible explanations for observed treatment differences include a reluctance to offer surgery to those with a diagnosis of noncompliance, a refusal of intervention by noncompliant patients, or implicit bias. Further investigation is warranted to better define noncompliance in this population and to determine the implications of this diagnosis.
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Stolarik, Ladislav Udomslip Phuwadol Sangsub Suriya. "A feedback perspective of healthcare demand/supply relationship and behavior /." Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2003. http://library.nps.navy.mil/uhtbin/hyperion-image/03Jun%5FStolarik.pdf.
Full textAbstract:
Thesis (M.B.A.)--Naval Postgraduate School, June 2003."MBA professional report"--Cover. Advisor(s): Tarek Abdel-Hamid and Bill Gates. Includes bibliographical references (p. 61-64). Also available online.
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Tao, Li. "Understanding the performance of healthcare services: a data-driven complex systems modeling approach." HKBU Institutional Repository, 2014. https://repository.hkbu.edu.hk/etd_oa/89.
Full textAbstract:
Healthcare is of critical importance in maintaining people’s health and wellness. It has attracted policy makers, researchers, and practitioners around the world to .nd better ways to improve the performance of healthcare services. One of the key indicators for assessing that performance is to show how accessible and timely the services will be to speci.c groups of people in distinct geographic locations and in di.erent seasons, which is commonly re.ected in the so-called wait times of services. Wait times involve multiple related impact factors, called predictors, such as demographic characteristics, service capacities, and human behaviors. Some impact factors, especially individuals’ behaviors, may have mutual interactions, which can lead to tempo-spatial patterns in wait times at a systems level. The goal of this thesis is to gain a systematic understanding of healthcare services by investigating the causes and corresponding dynamics of wait times. This thesis presents a data-driven complex systems modeling approach to investigating the causes of tempo-spatial patterns in wait times from a self-organizing perspective. As the predictors of wait times may have direct, indirect, and/or moderating e.ects, referred to as complex e.ects, a Structural Equation Modeling (SEM)-based analysis method is proposed to discover the complex e.ects from aggregated data. Existing regression-based analysis techniques are only able to reveal pairwise relationships between observed variables, whereas this method allows us to explore the complex e.ects of observed and/or unobserved(latent) predictors on waittimes simultaneously. This thesis then considers how to estimate the variations in wait times with respect to changes in speci.c predictors and their revealed complex e.ects. An integrated projection method using the SEM-based analysis, projection, and a queuing model analysis is developed. Unlike existing studies that either make projections based primarily on pairwise relationships between variables, or queuing model-based discrete event simulations, the proposed method enables us to make a more comprehensive estimate by taking into account the complex e.ects exerted by multiple observed and latent predictors, and thus gain insights into the variations in the estimated wait times over time. This thesis further presents a method for designing and evaluating service management strategies to improve wait times, which are determined by service management behaviors. Our proposed strategy for allocating time blocks in operating rooms (ORs) incorporates historical feedback information about ORs and can adapt to the unpredictable changes in patient arrivals and hence shorten wait times. Existing time block allocations are somewhat ad hoc and are based primarily on the allocations in previous years, and thus result in ine.cient use of service resources. Finally, this thesis proposes a behavior-based autonomy-oriented modeling method for modeling and characterizing the emergent tempo-spatial patterns at a systems level by taking into account the underlying individuals’ behaviors with respect to various impact factors. This method uses multi-agent Autonomy-Oriented Computing (AOC), a computational modeling and problem-solving paradigm with a special focus on addressing the issues of self-organization and interactivity, to model heterogeneous individuals (entities), autonomous behaviors, and the mutual interactions between entities and certain impact factors. The proposed method therefore eliminates to a large extent the strong assumptions that are used to de.ne the stochastic properties of patient arrivalsand servicesinstochasticmodeling methods(e.g.,thequeuing model and discrete event simulation), and those of .xed relationships between entities that are held by system dynamics methods. The method is also more practical than agent-based modeling (ABM) for discovering the underlying mechanisms for emergent patterns, as AOC provides a general principle for explicitly stating what fundamental behaviors of and interactions between entities should be modeled. To demonstrate the e.ectiveness of the proposed systematic approach to understanding the dynamics and relevant patterns of wait times in speci.c healthcare service systems, we conduct a series of studies focusing on the cardiac care services in Ontario, Canada. Based on aggregated data that describe the services from 2004 to 2007, we use the SEM-based analysis method to (1) investigate the direct and moderating e.ects that speci.c demand factors, in terms of certaingeodemographicpro.les, exert onpatient arrivals, whichindirectly a.ect wait times; and (2) examine the e.ects of these factors (e.g., patient arrivals, physician supply, OR capacity, and wait times) on the wait times in subsequent units in a hospital. We present the e.ectiveness of integrated projection in estimating the regional changes in service utilization and wait times in cardiac surgery services in 2010-2011. We propose an adaptive OR time block allocation strategy and evaluate its performance based on a queuing model derived from the general perioperative practice. Finally, we demonstrate how to use the behavior-based autonomy-oriented modeling method to model and simulate the cardiac care system. We .nd that patients’ hospital selection behavior, hospitals’ service adjusting behavior, and their interactions via wait times may account for the emergent tempo-spatial patterns that are observed in the real-world cardiac care system. In summary, this thesis emphasizes the development of a data-driven complex systems modeling approach for understanding wait time dynamics in a healthcare service system. This approach will provide policy makers, researchers, and practitioners with a practically useful method for estimating the changes in wait times in various “what-if” scenarios, and will support the design and evaluation of resource allocation strategies for better wait times management. By addressing the problem of characterizing emergenttempo-spatial waittimepatternsinthe cardiac care system from a self-organizing perspective, we have provided a potentially e.ective means for investigating various self-organized patterns in complex healthcare systems. Keywords: Complex Healthcare Service Systems, Wait Times, Data-Driven Complex Systems Modeling, Autonomy-Oriented Computing(AOC), Cardiac Care
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Adeogun, Oluseun. "Informatics for devices within telehealth systems for monitoring chronic diseases." Thesis, Cranfield University, 2011. http://dspace.lib.cranfield.ac.uk/handle/1826/6493.
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Preliminary investigation at the beginning of this research showed that informatics on point-of-care (POC) devices was limited to basic data generation and processing. This thesis is based on publications of several studies during the course of the research. The aim of the research is to model and analyse information generation and exchange in telehealth systems and to identify and analyse the capabilities of these systems in managing chronic diseases which utilise point-of-care devices. The objectives to meet the aim are as follows: (i) to review the state-of-the-art in informatics and decision support on point-of-care devices. (ii) to assess the current level of servitization of POC devices used within the home environment. (iii) to identify current models of information generation and exchange for POC devices using a telehealth perspective. (iv) to identify the capabilities of telehealth systems. (v) to evaluate key components of telehealth systems (i.e. POC devices and intermediate devices). (vi) to analyse the capabilities of telehealth systems as enablers to a healthcare policy. The literature review showed that data transfer from devices is an important part of generating information. The implication of this is that future designs of devices should have efficient ways of transferring data to minimise the errors that may be introduced through manual data entry/transfer. The full impact of a servitized model for point-of-care devices is possible within a telehealth system, since capabilities of interpreting data for the patient will be offered as a service (c.f. NHS Direct). This research helped to deduce components of telehealth systems which are important in supporting informatics and decision making for actors of the system. These included actors and devices. Telehealth systems also help facilitate the exchange of data to help decision making to be faster for all actors concerned. This research has shown that a large number of capability categories existed for the patients and health professionals. There were no capabilities related to the caregiver that had a direct impact on the patient and health professional. This was not surprising since the numbers of caregivers in current telehealth systems was low. Two types of intermediate devices were identified in telehealth systems: generic and proprietary. Patients and caregivers used both types, while health professionals only used generic devices. However, there was a higher incidence of proprietary devices used by patients. Proprietary devices possess features to support patients better thus promoting their independence in managing their chronic condition. This research developed a six-step methodology for working from government objectives to appropriate telehealth capability categories. This helped to determine objectives for which a telehealth system is suitable.
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Molinari, Wilian. "Mental models for decision-making in remote healthcare services : A case study." Thesis, Internationella Handelshögskolan, Jönköping University, IHH, Informatik, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-50216.
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Mental models are an important theme within information systems. They show how people understand reality, make decisions and how the information flows in order for them to do so. It is particularly challenging to make such decisions when it comes to determining the health of someone, making it a particularly delicate matter. In that context, this thesis takes BetterDoc as object of study. It is an organization situated in Cologne, Germany, with an increasingly positive record of providing remote healthcare services and allowing patients to have the adequate treatment for their condition. The study was based on the theory of mental models to bring to light the implicit patterns present in making decision in that context. That was done by conducting qualitative interviews with the staff of the organization, across different teams, and synthetizing the findings in a common model that shows points of decision and the supporting information. Those findings are useful for identifying points that need to be structured to provide clarity and understanding, increasing the synergy and transparence of a socio-technical system that can influences the outcomes of healthcare for many people.
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Henriksen, Eva. "Understanding in Healthcare Organisations- a prerequisite for development." Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3072.
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This study proposes that poor understanding of the structures, processes and outcomes of organisations seriously hampers collaboration between professional groups in care organisations. Three care settings were investigated: follow-up of patients with heart disease, an intensive care unit and care services for older people.
The overall aim was to investigate how people understand structures, processes and outcomes in care organisations. The participants were patients, patient representatives, healthcare professionals, managers and politicians.
A qualitative approach was used. Thematic analysis and grounded theory were employed in analysing the data.
Despite considerable efforts, no major changes took place over a 7-year period as to how cardiac follow-up services were understood. The system of cardiac follow-up services was found fragmented in its organisation and in the way individuals understood it. The results indicate that care professionals, patients and leaders have dissimilar understandings. The data suggest that care is organised from a professional-centred perspective rather than from a holistic worldview of the patients’ total context. Leaders in intensive care perceive their organisation as a learning organisation. However, in daily work healthcare tends to function to what can be described as a mass production approach to care. This state of conflict caused confusion and chaos among the leaders. The municipal elderly care services and the county council’s geriatric organisation had difficulties in co-ordination. Older people were perceived as passive recipients of healthcare, rather than as consumers whose well being and outcome were a reflection to the quality of the service.
The study concludes that despite the major changes that have taken place in the Swedish health and elderly care organisations over the past years, healthcare professionals’ understanding of their work has gone largely unchanged. Their understanding of care structures and processes did not change despite outside pressures. Lack of understanding of what others understand hampers development with the result that care organisations risk stagnation.
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Andersson, Anna. "Management information systems in process-oriented healthcare organisations." Licentiate thesis, Linköping : Univ, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5689.
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Castaneda-Avila, Maira A. "The Role of a Monoclonal Gammopathy of Undetermined Significance Diagnosis in Healthcare Utilization." eScholarship@UMMS, 2021. https://escholarship.umassmed.edu/gsbs_diss/1135.
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Background
Monoclonal Gammopathy of Undetermined Significance (MGUS) is an understudied precursor of multiple myeloma (MM), the second most prevalent hematologic malignancy in the United States. This dissertation was designed to: (1) Describe the trajectories of serum biomarkers over time in patients with an MGUS diagnosis, (2) Determine if an MGUS diagnosis is associated with changes in healthcare service utilization, and (3) explore the patient- and provider-level drivers of healthcare utilization in patients with MGUS.
Methods
Data sources include health claims and electronic health records from a community-based population of patients seeking care in central Massachusetts and primary qualitative data collected from providers and patients’ interviews. The analyses included descriptive statistics, group-based trajectory modeling, conditional Poisson regression, and qualitative data analyses.
Results
(1) Three distinct multi-trajectory groups of creatinine and hemoglobin were identified. (2) The rates of emergency room, hospital, and outpatient visits were higher for patients with MGUS than patients without MGUS. (3) Patients have a basic understanding of MGUS; however, some patients feel anxiety, which may affect other aspects of their lives. Patients primarily see hematologists for follow-up care; other providers have less knowledge about MGUS.
Conclusions
Biomarker trajectories characterize specific subpopulations of patients with MGUS over time. We found that an MGUS diagnosis is associated with higher healthcare utilization, especially during the months surrounding the diagnosis date. Finally, our study suggests that some patients with MGUS may need psychosocial support services and identifies a gap in knowledge around caring for MGUS patients among primary care providers.
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Daffue, Ruan Albert. "Applying patient-admission predictive algorithms in the South African healthcare system." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/79897.
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Thesis (MScEng)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Predictive analytics in healthcare has become one of the major focus areas in healthcare delivery worldwide. Due to the massive amount of healthcare data being captured, healthcare providers and health insurers are investing in predictive analytics and its enabling technologies to provide valuable insight into a large variety of healthcare outcomes. One of the latest developments in the field of healthcare predictive modelling (PM) was the launch of the Heritage Health Prize; a competition that challenges individuals from across the world to develop a predictive model that successfully identifies the patients at risk of admission to hospital from a given patient population. The patient-admission predictive algorithm (PAPA) is aimed at reducing the number of unnecessary hospitalisations that needlessly constrain healthcare service delivery worldwide. The aim of the research presented is to determine the feasibility and value of applying PAPAs in the South African healthcare system as part of a preventive care intervention strategy. A preventive care intervention strategy is a term used to describe an out-patient hospital service, aimed at providing preventive care in an effort to avoid unnecessary hospitalisations from occurring. The thesis utilises quantitative and qualitative techniques. This included a review of the current and historic PM applications in healthcare to determine the major expected shortfalls and barriers to implementation of PAPAs, as well as the institutional and operational requirements of these predictive algorithms. The literature study is concluded with a review of the current state of affairs in the South African healthcare system to, firstly, articulate the need for PAPAs and, secondly, to determine whether the public and private sectors provide a suitable platform for implementation (evaluated based on the operational and institutional requirements of PAPAs). Furthermore, a methodology to measure and analyse the potential value-add of a PAPA care intervention strategy was designed and developed. The methodology required a survey of the industry leaders in the private healthcare sector of South Africa to identify, firstly, the current performance foci and, secondly, the factors that compromise the performance of these organisations to deliver high quality, resource-effective care. A quantitative model was developed and applied to an industry leader in the private healthcare sector of South Africa, in order to gauge the resultant impact of a PAPA care intervention strategy on healthcare provider performance. Lastly, in an effort to ensure the seamless implementation and operation of PAPAs, an implementation framework was developed to address the strategic, tactical, and operational challenges of applying predictive analytics and preventive care strategies similar to PAPAs. The research found that the application of PAPAs in the public healthcare sector of South Africa is infeasible. The private healthcare sector, however, was considered a suitable platform to implement PAPAs, as this sector satisfies the institutional and operational requirements of PAPAs. The value-add model found that a PAPA intervention strategy will add significant value to the performance of healthcare providers in the private healthcare sector of South Africa. Noteworthy improvements are expected in the ability of healthcare provider’s to coordinate patient care, patient-practitioner relationships, inventory service levels, and staffing level efficiency and effectiveness. A slight decrease in the financial operating margin, however, was documented. The value-add methodology and implementation support framework provides a suitable platform for future researchers to explore the collaboration of preventive care and PM in an effort to improve healthcare resource management in hospitals. In conclusion, patient-admission predictive algorithms provide improved evidence-based decision making for preventive care intervention strategies. An efficient and effective preventive care intervention strategy improves healthcare provider performance and, therefore, adds significant value to these organisations. With the proper planning and implementation support, the application of PAPA care intervention strategies will change the way healthcare is delivered worldwide.
AFRIKAANSE OPSOMMING: Vooruitskattingsanalises in gesondheidsorg het ontwikkel in een van die mees belangrike fokusareas in die lewering van kwaliteit gesondheidsorg in ontwikkelde lande. Gesondheidsorgverskaffers en lewensversekeraars belê in vooruitskattingsanalise en ooreenstemmende tegnologieë om groot hoeveelhede gesondheidsorg pasiënt-data vas te lê, wat waardevolle insigte bied ten opsigte van ʼn groot verskeidenheid van gesondheidsorg-uitkomstes. Een van die nuutste ontwikkelinge in die veld van gesondheidsorg vooruitskattingsanalises, was die bekendstelling van die “Heritage Health Prize”, 'n kompetisie wat individue regoor die wêreld uitdaag om 'n vooruitskattingsalgoritme te ontwikkel wat pasiënte identifiseer wat hoogs waarskynlik gehospitaliseer gaan word in die volgende jaar en as bron-intensief beskou word as gevolg van die beraamde tyd wat hierdie individue in die hospitaal sal deurbring. Die pasiënt-toelating vooruitskattingsalgoritme (PTVA) het ten doel om onnodige hospitaliserings te identifiseer en te voorkom tem einde verbeterde hulpbronbestuur in gesondheidsorg wêreldwyd te bewerkstellig. Die doel van die hierdie projek is om die uitvoerbaarheid en waarde van die toepassing van PTVAs, as 'n voorkomende sorg intervensiestrategie, in die Suid-Afrikaanse gesondheidsorgstelsel te bepaal. 'n Voorkomende sorg intervensiestrategie poog om onnodige hospitaliserings te verhoed deur die nodige sorgmaatreëls te verskaf aan hoë-riskio pasiënte, sonder om hierdie individue noodwendig te hospitaliseer. Die tesis maak gebruik van kwantitatiewe en kwalitatiewe tegnieke. Dit sluit in 'n hersiening van die huidige en historiese vooruitskattings modelle in die gesondheidsorgsektor om die verwagte struikelblokke in die implementering van PTVAs te identifiseer, asook die institusionele en operasionele vereistes van hierdie vooruitskattingsalgoritmes te bepaal. Die literatuurstudie word afgesluit met 'n oorsig van die huidige stand van sake in die Suid-Afrikaanse gesondheidsorgstelsel om, eerstens, die behoefte vir PTVAs te identifiseer en, tweedens, om te bepaal of die openbare en private sektore 'n geskikte platform vir implementering bied (gebaseer op die operasionele en institusionele vereistes van PTVAs). Verder word 'n metodologie ontwerp en ontwikkel om die potensiële waarde-toevoeging van 'n PTVA sorg intervensiestrategie te bepaal. Die metode vereis 'n steekproef van die industrieleiers in die private gesondheidsorgsektor van Suid-Afrika om die volgende te identifiseer: die huidige hoë-prioriteit sleutel prestasie aanwysers (SPAs), en die faktore wat die prestasie van hierdie organisasies komprimeer om hoë gehalte, hulpbron-effektiewe sorg te lewer. 'n Kwantitatiewe model is ontwikkel en toegepas op een industrieleier in die private Stellenbosch gesondheidsorgsektor van Suid-Afrika, om die gevolglike impak van 'n PTVA sorg intervensiestrategie op prestasieverbetering te meet. Ten slotte, in 'n poging om te verseker dat die implementering en werking van PTVAs glad verloop, is 'n implementeringsraamwerk ontwikkel om die strategiese, taktiese en operasionele uitdagings aan te spreek in die toepassing van vooruitskattings analises en voorkomende sorg strategieë soortgelyk aan PTVAs. Die navorsing het bevind dat die toepassing van PTVAS in die openbare gesondheidsorgsektor van Suid-Afrika nie lewensvatbaar is nie. Die private gesondheidsorgsektor word egter beskou as 'n geskikte platform om PTVAs te implementeer, weens die bevrediging van die institusionele en operasionele vereistes van PTVAs. Die waarde-toevoegings model het bevind dat 'n PTVA intervensiestrategie beduidende waarde kan toevoeg tot die prestasieverbetering van gesondheidsorgverskaffers in die private gesondheidsorgsektor van Suid-Afrika. Die grootste verbetering word in die volgende SPAs verwag; sorg koördinasie, dokter-pasiënt verhoudings, voorraad diensvlakke, en personeel doeltreffendheid en effektiwiteit. 'n Effense afname in die finansiële bedryfsmarge word egter gedokumenteer. 'n Implementering-ondersteuningsraamwerk is ontwikkel in 'n poging om die sleutel strategiese, taktiese en operasionele faktore in die implementering en uitvoering van 'n PTVA sorg intervensiestrategie uit te lig. Die waarde-toevoegings metodologie en implementering ondersteuning raamwerk bied 'n geskikte platform vir toekomstige navorsers om die rol van vooruitskattings modelle in voorkomende sorg te ondersoek, in 'n poging om hulpbronbestuur in hospitale te verbeter. Ten slotte, PTVAs verbeter bewysgebaseerde besluitneming vir voorkomende sorg intervensiestrategieë. 'n Doeltreffende en effektiewe voorkomende sorg intervensiestrategie voeg aansienlike waarde tot die algehele prestasieverbetering van gesondheidsorgverskaffers. Met behoorlike beplanning en ondersteuning met implementering, sal PTVA sorg intervensiestrategieë die manier waarop gesondheidsorg gelewer word, wêreldwyd verander.
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Komashie, Alexander. "Information-theoretic and stochastic methods for managing the quality of service and satisfaction in healthcare systems." Thesis, Brunel University, 2010. http://bura.brunel.ac.uk/handle/2438/4402.
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This research investigates and develops a new approach to the management of service quality with the emphasis on patient and staff satisfaction in the healthcare sector. The challenge of measuring the quality of service in healthcare requires us to view the problem from multiple perspectives. At the philosophical level, the true nature of quality is still debated; at the psychological level, an accurate conceptual representation is problematic; whilst at the physical level, an accurate measurement of the concept still remains elusive to practitioners and academics. This research focuses on the problem of quality measurement in the healthcare sector. The contributions of this research are fourfold: Firstly, it argues that from the technological point of view the research to date into quality of service in healthcare has not considered methods of real-time measurement and monitoring. This research identifies the key elements that are necessary for developing a real-time quality monitoring system for the healthcare environment.Secondly, a unique index is proposed for the monitoring and improvement of healthcare performance using information-theoretic entropy formalism. The index is formulated based on five key performance indicators and was tested as a Healthcare Quality Index (HQI) based on three key quality indicators of dignity, confidence and communication in an Accident and Emergency department. Thirdly, using an M/G/1 queuing model and its underlying Little’s Law, the concept of Effective Satisfaction in healthcare has been proposed. The concept is based on a Staff-Patient Satisfaction Relation Model (S-PSRM) developed using a patient satisfaction model and an empirically tested model developed for measuring staff satisfaction with workload (service time). The argument is presented that a synergy between patient satisfaction and staff satisfaction is the key to sustainable improvement in healthcare quality. The final contribution is the proposal of a Discrete Event Simulation (DES) modelling platform as a descriptive model that captures the random and stochastic nature of healthcare service provision process to prove the applicability of the proposed quality measurement models.
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Nguyen, Thi Hoai Thu. "The Governance of human resources in the Vietnamese healthcare system: A critical analysis of maternity services." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/84093/1/Thi%20Hoai%20Thu_Nguyen_Thesis.pdf.
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This thesis utilised mixed-methods study design to understand the factors that influence the translation and implementation of central human resources in health policy at the district and commune health levels. It provided recommendations for changes to enhance governance approaches to human resources for health policy implementation at local and national levels. This thesis has also contributed to the evolution of the theory on health staff motivation and performance through the description and testing of a new model, using data from a survey on 262 health staff and 43 in-depth interviews conducted in two northern mountainous provinces of Vietnam.
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Peabody, Tyler Robert, and Tali Freed. "RFID TECHNOLOGY SELECTION AND ECONOMIC JUSTIFICATION FOR HEALTHCARE ASSET TRACKING." DigitalCommons@CalPoly, 2013. https://digitalcommons.calpoly.edu/theses/1041.
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Although Radio Frequency Identification (RFID) and Real-Time Location System (RTLS) technologies for inventory tracking have been growing in popularity, the healthcare industry has been reluctant to adopt these technologies. One of the primary reasons for this lack of enthusiasm has been the risk associated with electromagnetic interference between RFID/RTLS systems and medical equipment functionality. The other reason has been the substantial cost and complexity of implementing RFID/RTLS in healthcare organizations. In this study, we show that there are several ways to safely install RFID/RTLS systems to improve the inventory management processes of hospitals and clinics. We then analyze the inventory shrinkage (loss and theft) data of the Veterans Health Administration VISN 10 (the Veterans Integrated Service Network of Ohio) using a mathematical model to estimate the annual shrinkage. Finally, we develop an economic cost/benefit analysis database system in Microsoft Access that can be used to calculate the breakeven point of RFID/RTLS implementations, as well as calculate the expected reduction in inventory- related operating costs. This system can be adapted for cost/benefit analyses in similar inventory-intensive environments.
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Foli, Matilda. "nalysing Change Resistance to an Information Systems-Supported Process in a South African Public Hospital." Master's thesis, Faculty of Commerce, 2019. http://hdl.handle.net/11427/31219.
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Introducing technological change to an organization’s normal processes can potentially bring about positive or negative results, depending mostly on the manner in which the change was facilitated and integrated into the organization. However, very little research has been done on information technology (IT) investment among hospitals, its effect on the personnel, as well as how it influences patient care and financial performance. Consequently, little is known about users’ resistance to new technologies and the precedents of technology rejection in healthcare. Therefore, this study seeks to fill the gap of understanding South African hospital staffs’ perceptions towards change, caused by introducing an information system into one of the hospital’s daily processes. Where resistance towards change is identified, the study aims to understand the reasons behind such resistance. Finally, it aims to find appropriate intervention strategies to deal with and minimize resistance. In doing so, the study seeks to contribute to the body of research regarding change resistance to information systems in public South African hospitals. By adopting a descriptive and exploratory interpretivist paradigm, in conjunction with an inductive approach, the study aims to get a better understanding of hospital staffs’ perceptions through shared meaning. The study adopted a case study research strategy, as it affords the researcher the opportunity to participate in the study, and as such contributes to the subjective interpretation of the findings. Data was collected using a mixed method approach, and was used to describe the difference between the current and proposed process. In addition, it was used to explore the reasons for change resistance to information system-supported change, and to explore methods of successfully introducing change to tertiary public hospitals in South Africa. Fourteen participants (7 medical interns and 7 ward clerks) who were directly involved in the process being studied, were interviewed. Two other participants (the head of the pharmacy and the patient flow manager), who were indirectly involved in the process, were interviewed, to verify the observed and mapped process. Interview data was analyzed qualitatively, firstly through coding techniques before using sentiment and thematic analysis. While the mapped process followed Business Process Modelling Notation conventions. In addition to a mapped proposed process, a change resistance conceptual model was developed from a conjunction of the findings and extensive review of literature. The conceptual model asserts that five main factors contribute to change resistance: unclearly defined duties; fear of job security and technology usage; years of service; resource availability and resource mismatch; as well as insufficient training resulting from the lack of a learning culture. These factors can be moderated by: the existing state of affairs referred to as status quo; management involvement; and communication. The conceptual model can be used to better understand the causes of change resistance, as well as how to minimize change resistance and successfully introduce change into a health organization. Change agents should aim to understand the status quo that exists in the organization and find ways of incorporating that into the change process. Furthermore, management should aim to involve and communicate with all affected stakeholders during a change process. This research has provided a better understanding of hospital staffs’ reactions to change, their reasons for resistance, and ways to minimize change resistance while successfully introducing change into a health organization.
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Carney, Philip Sheridan. "Managed healthcare and integrated delivery systems: A model for getting ahead of the change curve." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2103.
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Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.
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Willis, Cameron David. "Measuring quality outcomes in patient care: the example of trauma services." Monash University. Faculty of Medicine, Nursing and Health Sciences. Department of Epidemiology and Preventive Medicine, 2008. http://arrow.monash.edu.au/hdl/1959.1/62206.
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As healthcare and health systems become increasingly complex, expectations of what constitutes high quality care continue to evolve. Stakeholders now require contemporary and meaningful measures of system performance. As such, valid healthcare quality metrics are rapidly becoming essential for those providing and receiving healthcare to assess performance and motivate change. This thesis investigates the utility of quality indicators in trauma care. Multiple in-hospital indicators have been promulgated by various bodies for assessing quality of trauma care. The properties of ideal indicators have been widely documented however few published data have reported these properties for many trauma measures. The emphasis on trauma process measures (eg. time to interventions) highlights the need for indicators with known links to patient outcomes. This process-outcome link may be viewed as a measure of an indicator’s construct validity. As this property is unknown for many trauma indicators, this thesis focuses on the construct validity of a number of routinely utilised trauma indicators. In this thesis, the available in-hospital indicators proposed by The American College of Surgeons Committee on Trauma and additional indicators used in the Victorian State Trauma System were investigated for their relationships with patient outcomes. A small number of indicators were found to have statistically significant relationships with patient outcomes, however many indicators demonstrated counter-intuitive relationships, whereby high quality care was linked with poorer patient outcomes. These results suggested that links between indicators and outcomes may not be best measured using individual indicators for individual patients. Rather, a strategy for measuring patient outcomes at the hospital level may be needed. To combine multiple indicators into a single measure of hospital level performance, a number of composite methods were explored using two trauma registries. Three composite weighting schemes were employed. As composite measures are often used for provider ranking or benchmarking, the stability of hospital ranks between providers and over time was investigated. The composites were found to have moderate to strong correlations (0.76-0.99) however variability in composite hospital rankings existed, particularly for middle ranking facilities. The construct validity of each available indicator and composite score was investigated through the relationship with hospital level risk-adjusted mortality using Poisson regression models, risk adjusting for expected deaths using the TRISS formulation. Each composite measure demonstrated a significant association with mortality, with the mortality decrease across the middle 50% of each composite score ranging from 12.06% – 16.13%. These findings suggest that complex measures such as trauma composite indices may be better able to measure the interactions between processes within complex systems that influence quality of care. This thesis adds valuable insight into the use of indicators for assessing quality of care in trauma systems. The combination of individual indicators into composite forms appears to strengthen the construct validity of these measures. By demonstrating the process-outcome link for trauma composite indices, this thesis has identified a means of utilising process measures to assess hospital level performance that may become important for future public reporting and hospital funding schemes.
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Calero, Lucero, Aracelli Maccasi, and Carlos Raymundo. "Lean model of services for the improvement in the times of attention of the emergency areas of the health sector." Springer Verlag, 2020. http://hdl.handle.net/10757/656140.
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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.In Peru, the health service has had certain problems in the attention of users. The emergency service of clinics has been saturated due to changes in the needs of people and demand, exposing the prestige of health entities that have this unit and generating risks for the health of users, this is reflected in the low level of satisfaction with regard to care. Based on the Lean philosophy, a model is developed using SMED, Kanban and pull tools to reduce waiting times. The application of this model of pilot in the Clinic reduces the waiting time for the first attention in 30% thereby reducing the number of fines imposed by the corresponding regulatory entity and the desertion in emergency, achieving an average time of 37 min.
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Mchunu, Nokubalela Ntombiyethu. "Adequacy of healthcare information systems to support data quality in the public healthcare sector, in the Western Cape, South Africa." Thesis, Cape Peninsula University of Technology, 2012. http://hdl.handle.net/20.500.11838/1387.
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Thesis submitted in fulfilment of the requirements for the degree
Master of Technology (MTech) in Information Technology
In the Faculty of Informatics and Design,
at the Cape Peninsula University of Technology (CPUT), 2013Healthcare services are vital to all human beings, as our daily lives depend on them. In South Africa approximately eighty per cent of the population uses the public healthcare services. In the current healthcare systems data corruption exists which threatens data quality in the systems. The aim of this study was to understand the existing information handling processes and factors that affect the accuracy and integrity of healthcare data. A qualitative research methodology, under the interpretive paradigm was used for this investigation. Activity theory is used to formulate an analytical framework, the “healthcare information system data quality activity theory framework”. This was very helpful for understanding the healthcare information handling process as an activity system that consists of actors with individual goals. Though the goals are varied, they are joined together by the common objective. The logic of the framework is that a realisation of goals in the activity system depends on a number of factors. At the beginning, there must be a synchronous inter-linkage between the goals of the actors, the mediating factors such as adequate tools, user skills, enabling policies, and the systematic procedures that are diligently enforced. It is assumed that any situation which prevents this inter-linkage will have a negative impact on the realisation of the sought objective. The framework therefore, was very helpful in informing questions, the data collection and ultimately, the analysis processes. The public healthcare sector is the main source of data; other sources were literature, the Internet and books. The analysis of data was done using content analysis to find what themes emerge and the relationship (s) between them in what is being analysed. The findings reveal a lack of adherence to information handling procedures and processes which lead to corrupt data in the systems. In addition, most users have limited skills, which is a hindrance to them in performing their duties as expected by the healthcare sector. In fact, the healthcare sector is also challenged by systems which are constantly slow or down, due to limited network capacity and human errors. The presence of these challenges suggests non-adherence to data handling procedures, which explains the existing corrupt data in the healthcare systems. Therefore the recommendation is that the public healthcare administration must enhance their training programs. The training must be re-designed to cater for the needs of all users, regardless of their background. It needs to improve user skills and boast their confidence in using electronic systems. Obviously, any changes and improvements need to be sustainable, and the sector is unlikely to succeed without enforcement of new procedures. Therefore, adherence to data handling procedures must be strictly enforced, with policies thoroughly communicated to the users. That way, the sector will not only have systems and related policies, but also ensure their full exploitation for improved service delivery in the public healthcare sector in South Africa.
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Kirkpatrick, Tara. "Just what the doctor ordered: reformation of the U.S. healthcare system through a dose of preventative and primary care." [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/TKirkpatrick2008.pdf.
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Moir, Mark James. "Contextual Leadership: The Social Construction of Leadership in a Comprehensive Healthcare System." [Yellow Springs, Ohio] : Antioch University, 2009. http://etd.ohiolink.edu/view.cgi?acc_num=antioch1247843733.
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Thesis (Ph.D.)--Antioch University, 2009.Title from PDF t.p. (viewed October 7, 2009). Advisor: Elizabeth Holloway, Ph.D. "A dissertation submitted to the Ph.D. in Leadership and Change program of Antioch University in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2009."--from the title page. Includes bibliographical references (p. 151-161).
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Van, der Watt Cecil Clifford. "Design considerations of a semantic metadata repository in home-based healthcare." Thesis, Cape Peninsula University of Technology, 2011. http://hdl.handle.net/20.500.11838/2300.
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Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2011.The research was conducted as part of a socio-tech initiative undertaken at the Cape Peninsula University of Technology. The socio-tech initiative overall focus was on addressing issues faced by rural and under-resourced communities in South Africa, specifically looking at Home-Based Healthcare (HBHC) primarily in the Western Cape. As research into the HBHC context in rural and under-resourced communities continued numerous issues around data and data-elements came to light. These data issues were especially prevalent in relation to the various paper forms being used by the HBHC initiatives that attempt to deliver care in these communities. The communities have the tendency to suffer from poor access to formal healthcare services and healthcare facilities. The data issues were primarily in terms of how data was defines and used within the HBHC initiatives. Within the HBHC initiatives that cater for rural and under-resourced communities there was a clear prevalence of paper-based systems, and a very low penetration of IT-based solution. Because similar and related data-elements are used throughout the paper forms and within different context these data-elements are inconsistently used and presented. The paper forms further obfuscate these inconsistencies as the paper forms regularly change due to internal and external factors. When these paper forms are changed date elements are added or removed without the changes to the underlying ontologies being considered.
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Dobrzykowski, David D. "Linking Antecedents and Consequences of Value Density in the Healthcare Delivery Supply Chain." University of Toledo / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1289833170.
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Grauers, Björn. "Digital innovation through the use of participatory design in the development of Swedish public healthcare support services." Thesis, Malmö universitet, Institutionen för konst, kultur och kommunikation (K3), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-45645.
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The Swedish public sector stands in front of great challenges, threatening the very existence of a Swedish welfare state. An aging population has increased the need for welfare support for the elderly population. At the same time, Sweden is facing a decrease in tax revenue from a shrinking percentage of work-able citizens among its population. Politicians, citizens, and service providers ask for radical innovation, and many see the opportunity to make use of digital technology to make our public services more efficient. However, it is not the lack of technical innovation that hinders public services from becoming more efficient, but rather the lack of knowledge into what is efficient and for whom. Without the understanding of user needs rather than wants it is hard, if not impossible, to know how digital technology is best utilized to increase user value. The findings show that participatory- and service design practices can answer why digital technology is needed and how and when it should be implemented. This project aims to find ways to increase accessibility, efficiency, and trust in digital healthcare support services and give insight into the opportunities for Interaction designers to bring value to healthcare development using participatory design practices.
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Coovadia, Mohamed Yusuf. "Identification and evaluation of patient satisfaction determinants in medical service delivery systems within the South African private healthcare industry." Diss., University of Pretoria, 2008. http://hdl.handle.net/2263/23094.
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The aim of the study was to identify, evaluate and compare the determinants of patient satisfaction in fee-for-service, and health maintenance organisation (HMO), medical service delivery centres. Staff at both centres, who were also patients, were surveyed to determine the congruence with patients’ quality improvement priorities. The survey was conducted using a questionnaire consisting of closed questions given to patients as they departed from the medical centres. The questionnaire was tested for convergent and divergent validity, content analysis and reliability. A rating scale was then applied to yield the scores for each determinant. The unique Patient Satisfaction Priority Index was determined using determinants that were rated low on satisfaction but high on importance. The results revealed that patients at the fee- for- service medical centre were significantly more satisfied than patients at the HMO. The priority index for patients were found to be different to that of the staff at both medical centres, proving that staff and patient priorities were incongruent. Accordingly, the recommendations were that patient satisfaction be continuously evaluated at medical service delivery centres, in order to achieve a competitive advantage, sustainability and growth in South Africa’s highly competitive private healthcare industry. CopyrightDissertation (MBA)--University of Pretoria, 2010.
Gordon Institute of Business Science (GIBS)
unrestricted
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Kanu, Alhassan Fouard. "Health System Access to Maternal and Child Health Services in Sierra Leone." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7394.
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The robustness and responsiveness of a country's health system predict access to a range of health services, including maternal and child health (MCH) services. The purpose of this cross-sectional study was to examine the influence of 5 health system characteristics on access to MCH services in Sierra Leone. This study was guided by Bryce, Victora, Boerma, Peters, and Black's framework for evaluating the scaleup to millennium development goals for maternal and child survival. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment dataset, which comprised 100% (1, 284) of the country's health facilities. Data analysis included bivariate and multivariate logistic regressions. In the bivariate analysis, all the independent variables showed statistically significant association with access to MCH services and achieved a p-value < .001. In the multivariate analysis; however, only 3 predictors explained 38% of the variance (R� = .380, F (5, 1263) = 154.667, p <.001). The type of health provider significantly predicted access to MCH services (β =.549, p <.001), as did the availability of essential medicines (β= .255, p <.001) and the availability of basic equipment (β= .258, p <.001). According to the study findings, the availability of the right mix of health providers, essential medicines, and basic equipment significantly influenced access to MCH services, regardless of the level and type of health facility. The findings of this study might contribute to positive social change by helping the authorities of the Sierra Leone health sector to identify critical health system considerations for increased access to MCH services and improved maternal and child health outcomes.
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Pawaskar, Manjiri D. "Medicaid Payment Systems: Impact On Quality Of Care, Medication Adherence And Healthcare Service Utilizations In Type 2 Diabetes Medicaid Enrollees." Columbus, Ohio : Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1206730716.
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