Dissertations / Theses on the topic 'Hospital care'
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1
Piterman, Hannah, and Hannah Piterman@med monash edu au. "Tensions around introducing co-ordinated care a case study of co-ordinated care trial." Swinburne University of Technology, 2000. http://adt.lib.swin.edu.au./public/adt-VSWT20050418.092951.
Abstract:
The aim of the research was to analyse the organisational dynamics surrounding a health care reform implementation process associated with the introduction of coordinated care, which is an Australian Government initiative to introduce structural changes to the funding and delivery of health-care in response to rising health care costs. A longitudinal case study of an implementation team was studied. This included the perceptions and experiences of individuals and institutions within hospitals, the general practice community and Divisions of General Practice. Furthermore, the case study explored organisational structures, decision-making processes and management systems of the Project and included an examination of the difficulties and conflicts that ensued. The broader context of health care reform was also considered.
The study found that an effective change management strategy requires clarity around the definition of primary task in health care delivery, particularly when the task is complex and the environment uncertain. This requires a management and support structure able to accommodate the tensions that exists between providing care and managing cost, in a changing and complex system. The case study indicated that where tensions were not managed the functions of providing care and managing costs became disconnected, undermining the integrity of the task and impacting on the effective facilitation of the change process and hence, the capacity of stakeholders to embrace the model of co-ordinated care. Moreover, the micro dynamics of the project team seemed to parallel the macro dynamics of the broader system where economic and health care provision imperatives clash. Through its close analysis of change dynamics, the study provides suggestions for the improved engagement of stakeholders in health care change.
2
Bernard, Didem M. "The impact of managed care on the hospital industry." Thesis, Boston University, 2001. https://hdl.handle.net/2144/36762.
Abstract:
Thesis (Ph.D.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Managed care health plans have become an important new force in the US health care system, changing the delivery of health care and the nature of competition in the health care industry. Lower health care costs of managed care emollees have led many to see 'managed care' as the solution to rising health care expenditures. Therefore, it is important to understand the impact of managed care on the health care industry. This dissertation focuses on the impact of 'managed care' on the acute care hospital industry and physicians who work in inpatient settings, using data on hospitals in Massachusetts between 1992 and 1998. In the first essay, I investigate the impact of managed care penetration on the prices and costs of hospitals. Managed care plans provide coverage for health care through a predetermined group of providers selected by the plan. Their ability to direct demand potentially gives them power to extract lower prices from providers. However, the impact of managed care penetration on prices for the overall patient population depends on whether hospitals raise prices to non-managed care insurers. Using instrumental variables estimation, I find evidence that managed care penetration leads to significant reductions in hospital prices and costs for the overall patient population. Managed care involves methods of financing and delivering health care services that manage, or intervene, in care decisions made by patients and physicians in order to reduce costs. The second essay empirically investigates whether managed care plans are able to reduce the resource use of physicians in inpatient settings. Using instrumental variables estimation, I find evidence that managed care involvement reduces physicians' resource use not only for managed care patients but for nonmanaged care patients as well.
2031-01-01
3
Gong, Zhiping. "Developing casemix classification for acute hospital inpatients in Chengdu, China /." Access full text, 2004. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20050314.195349/index.html.
Abstract:
Submitted to the School of Public Health, Faculty of Health Sciences. Thesis (Ph.D.) -- La Trobe University, 2004.Includes bibliographical references (leaves 320-329). Also available via the World Wide Web.
4
Jeddian, Alireza. "Is critical care service relevant to Iran's hospital care?" Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5486/.
Abstract:
The numbers of acutely ill patients (AIP) are admitted in general hospital wards increased. The failing to identify, manage and deliver timely and optimal care to AIPs may lead to catastrophic outcomes. A qualitative study aimed to define the current state of AIPs in Iranian hospitals showed the flaws and shortcomings in the current services for identifying and managing AIPs. An evaluation study was designed to explore the potential impact of Critical Care Service (CCS) in an Iranian University Hospital. The study design was a Stepped-Wedge Cluster Randomized Controlled Trial. The study included, for each ward, an unexposed to the intervention, training, and an exposed to the intervention phase. The data was analyzed using three methods: all patients, matched randomized and before-after. The null-hypothesis was tested using the mixed effect logistic regression, linear mixed and the mixed effects models. The results showed that there are no significant differences in mortality, CPR, ICU admission and length of stay. A second qualitative to find the views of staffs toward the CCS indicated that the CCS had several favorable effects, however; overcoming contextual problems in the hospital, prior to implementation of CCS, may facilitate its implementation.
5
Basu, Priyam. "WIRELESS COMMUNICATION FOR HOME CARE AND HOSPITAL INTENSIVE CARE." Master's thesis, Temple University Libraries, 2013. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/216512.
Abstract:
Computer and Information ScienceM.S.
Many emerging and existing medical applications can benefit from having continuous access to the patients vitals. This paper presents the results of a set of experiments conducted in a medical setting to determine the feasibility of using wireless communication in both home care and hospital intensive care environments. The study is also done with the intention of developing a new wireless protocol for use in medical settings. This protocol will later be incorporated into different medical devices operating inside a patient room with a view that significant performance improvements should be observed.
Temple University--Theses
6
Kahnamoui, Niknaz. "After outsourcing : working collaboratively to deliver patient care? /." Burnaby B.C. : Simon Fraser University, 2005. http://ir.lib.sfu.ca/handle/1892/2035.
7
Quinlan, John. "The essence of pastoral care an investigation of patient satisfaction with pastoral care in an acute general and psychiatric hospital /." Online full text .pdf document, available to Fuller patrons only, 2000. http://www.tren.com.
8
Berwald, Sarah Moch. "The architecture of well-being creating effective design for the care and treatment of the mentally ill /." Thesis, Montana State University, 2009. http://etd.lib.montana.edu/etd/2008/berwald/BerwaldS1208.pdf.
9
Drager, Katrina A. "Inpatient psychiatric length of stay and readmission rates." Menomonie, WI : University of Wisconsin--Stout, 2007. http://www.uwstout.edu/lib/thesis/2007/2007dragerk.pdf.
10
Dixon, Jennifer. "Hospital admissions for ambulatory care conditions." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.397231.
11
Wendall, Pamela S. "Clients' spiritual perspective of care." Virtual Press, 2000. http://liblink.bsu.edu/uhtbin/catkey/1191724.
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Spiritual dimensions are an important focus for nursing care and nurses can be catalysts for spiritual care. The purpose of this descriptive comparative analysis is to examine the spiritual care needs as perceived by terminally ill clients, non-terminally ill clients, and well adults. The theoretical framework for this study is Leininger's "Cultural Care Theory" that supports the notion that spiritual care needs to be culturally congruent.Participants were obtained from a 225-bed hospital, hospice, home care, and a wellness program in a midwestern city. Permission was obtained from the hospital President, Vice President of Nursing, the directors of Hospice and Home Care, and the community's Wellness Program. The number of participants was 76. The process for the protection of human rights was followed.Findings were that terminally ill, non-terminally ill, and well-adults all agree that receiving spiritual care that is congruent with beliefs is important. The terminally ill clients rated spiritual needs higher than both non-terminally ill and well-adults. All groups rated the same in the persons from whom it was wished to receive spiritual care. Common themes of spiritual care desired from these persons for the terminally ill group was: pray for/with me and talk to me. For the non-terminally ill group it was: give me information, The understanding, and provide emotional and spiritual support. Finally, for the well-adults it was: listen to me, talk to me, be confident, and support me.No statistical difference between groups (.940) on the SPS. On the SPC, the terminally ill group was more satisfied (5.20) with spiritual support they were receiving than the non-terminally ill group or well-adults.It was concluded that regardless of the stage of illness, the same spiritual needs are prominent, all individuals have spiritual needs, and several types of interventions are preferred. It has been demonstrated in this study that prayer is the most sought after component of spiritual care among all three groups. Second to that would be someone to talk to and someone to listen to them.Implications call for nurses to facilitate spiritual care from family, friends, minister or priest, and hospital chaplain. This could be written into the plan of care by having the client describe the type of spiritual care they want to receive. Nursing Administration needs to work with nursing staff to define spirituality and religion and what they mean to the nurse.School of Nursing
12
Bucknall, Christine E. "Contrasts in asthma care." Thesis, University of Edinburgh, 1989. http://hdl.handle.net/1842/23760.
13
O'Reilly, Glenda. "Families in today's health care system : the experience of families during pediatric admission." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=78189.
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The purpose of this study was to explore the experiences and needs of families during the admission of a child to a paediatric ward in an acute care hospital. Qualitative research methods were used to access the caregivers' and professionals' perceptions of the culture that families experience in a paediatric in-patient setting. For this project, data collection methods included a review of the literature in the area, individual interviews with caregivers, and focus groups with paediatric health care professionals.In the study, both parents and paediatric professionals described a multitude of experiences and needs of families during a child's admission to a paediatric ward in an acute care setting. Understanding the experiences and needs of families is important for professionals. The information collected in this study provides some insight into the culture that families experience when their child is admitted to a paediatric ward in an acute care hospital.
14
Bechel, Diane Lynn. "The effect of patient-centered care on hospital inpatient cost and quality outcomes the experience in southeast Michigan." Ann Arbor, Mich. : University of Michigan, 1998. http://books.google.com/books?id=bhUvAAAAMAAJ.
15
Lemaire, Diana C. "The effect of home care utilization on acute care hospital readmission." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ28607.pdf.
16
Chana, Navtej. "Quality of care amongst hospital nursing staff." Thesis, University of Oxford, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.531831.
17
Sinha, Sidhartha. "Quantifying outcomes after hospital care in England." Thesis, St George's, University of London, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.677183.
Abstract:
There is increasing interest in outcomes assessment in modern surgical research and the applicability of outcomes research to everyday clinical practice. Improving healthcare quality is a current political priority and since outcomes are the most visible and quantifiable end points of clinical care pathways, they are most frequently publicised. Standardised mortality metrics such as the Hospital Standardised Mortality Ratio are of particular interest given their current media spotlight following recent infamous failings in the quality of NHS care. Specialised mortality metrics such as the "failure-to-rescue" rate are of particular interest to clinicians given their theoretical superiority in identifying failings in standards of care but derivation of such metrics from administrative data requires identification of complications of care. However, a number of unanswered questions remain including the utility of Hospital Episode Statistics (the national administrative dataset) for providing outcomes data such as mortality and complication rates. Additionally the validity of hospital wide summary mortality measures remains incompletely defined given the lack of data on the inter-dependencies of outcomes between disparate patient groups within English hospitals. Methods Hospital Episode Statistics were used to provide national patient level data on various defined cohorts including patients undergoing emergency medical, emergency surgical, elective general surgical and elective vascular surgical care in England from 2000 - 2010. Outcomes included in hospital and longer term mortality as well as non-mortality metrics such as emergency readmission, length of stay, complication rates and "failure-to-rescue" rates. Complications data validation was performed through case note review for matched patients undergoing cholecystectomy. Novel methods were developed to manipulate the HES data, to analyse inter-provider variability in outcomes and to evaluate evidence of intra-provider inter-dependencies in outcomes amongst different clinical groups. A number of statistical methods were employed including systematic review for evidence base synthesis and multi-level regression modeling for risk-adjustment. Results 60.8% of published studies using HES data were on surgical specialties and the most common analytic theme was of inequalities and variations in treatment or outcome (27%). The volume of published studies has increased with time (r = 0.82, P < 0.0001) as has the length of study epoch (r = 0.76, P <0.001) and the number of outcomes assessed per study (r = 0.72, P = 0.0023). Generic methodologic data were better reported than those specific to HES data extraction. For the majority of parameters, there were no improvements with time. 2,406,709 admissions across 20 emergency groups, 116,596 emergency and elective vascular surgical admissions across 5 groups and 418,214 cholecystectomy procedures were considered in three separate analyses. Clinically and statistically significant variations in outcome were observed between providers (p
18
Wahl, Grendi Heidi. "Measuring Patient Experience in Hospital Maternity Care." Thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-281290.
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This thesis concerns Patient Experience (PX), in hospital maternity care in Sweden. The focus lies in the development of a measure to describe the current state of PX. The thesis uses a semi-sequential mixed-methods study design; exploration of the patient journey, through qualitative methods, informs the adaptation of an existing maternity care experience survey instrument. The resulting survey instrument is tried in a pilot study and renders a composite measure of PX. Part of the analysis is dedicated to understanding the e!ect of information and communication in PX; Exploratory Factor Analysis is used to test the model and attempt an answer. The results show that it is possible to describe PX using the proposed survey instrument. The composite measure preserves di!erences in perceptions better than an arithmetic average of two discrete VAS-1 type measurements, and is more appropriate when measuring attitudes, and opinions using Likert-type measures. A three component solution describes 65.44% of the total sample variance. Determining to what degree PX is influenced by information and communication remains di"cult to quantify, but these initial results indicate that the manner of the attending sta! during aftercare and the respondent’s mastery of information during discharge are important dimensions of patients’ total PX (ANOVA R .695, R Square .483). The model’s three components are almost entirely built from items that address interpersonal skills and information assimilation. These correspond to two of the three Service Quality Dimensions, namely Interaction Quality and Outcome Quality. Most important of the three is the component “Chemistry in aftercare”. The predictive strength of the model shows merit under the context of the study and could advise further e!orts to develop measurements for PX in maternity care in a Swedish hospital setting. Lastly, this study contextualises Service Design in hospital maternity healthcare; the study therefore o!ers ample opportunity for innovation.Arbetet handlar om Patientupplevelse (PU), i förlossningsvården i Sverige. Fokus ligger på utvecklingen av ett mätvärde att beskriva den nuvarande patientupplevelsen. Arbetet använder kvalitativa och kvantitativa metoder (mixed-methods), i en semi-sekventiell design; utforskning av patientresan ligger till grund för anpassningen av ett existerande mätinstrument. Det nya mätinstrumentet testas i en pilotstudie och ger ett kompositmätvärde av PU. En del av analysen ägnas åt att förstå vilken e!ekt information och kommunikation har på PU; Explorativ faktoranalys används för ändamålet. Resultaten visar att det är möjligt att beskriva PU genom det föreslagna mätinstrumentet. Det resulterande kompositvärdet är bättre på att beskriva skillnader i uppfattning än ett medelvärde av två diskreta variabler av VAS-1 typen, och är också lämpligare när attityder och åsikter mäts med hjälp av Likert-skalor. En trekomponentslösning beskriver 65.44% av den totala stickprovsvariansen. Att avgöra hur mycket PU påverkas av information och kommunikation förblir svårt att kvantifiera, men dessa inledande resultat visar att patientbemötande under eftervårdstiden och patientens förmåga att bemästra information under utskrivningen är viktiga dimensioner av patienters totala PU (ANOVA R .695, R Square .483). Modellens tre komponenter är nästan uteslutande uppbyggda av variabler som fångar upp personliga relationer och assimilering av information. Dessa motsvarar två av de tre dimensionerna i Servicekvalitetsmodellen, nämligen Interaktionskvalitet och Utfallskvalitet. Viktigaste komponenten är Personlig kemi under eftervården. Modellens förutsägningsstyrka visar förtjänst under studiens kontext och kunde informera framtida ansträngningar att utveckla mätvärden för förlossningsvården inom svensk sjukhusmiljö. Till sist kan nämnas att studien kontextualiserar Service Design inom förlossningsvården; studien erbjuder därför omfattande möjligheter för innovation.
19
Sheppard, Sasha. "A randomised controlled trial comparing hospital at home with in-patient hospital care." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.284587.
20
Hsieh, Hui-Min. "The Impact of Medicaid Disproportionate Share Hospital Payment on the Provision of Hospital Uncompensated Care and Quality of Care." VCU Scholars Compass, 2010. https://scholarscompass.vcu.edu/etd/2058.
Abstract:
Medicaid Disproportionate Share Hospital (DSH) payment is one of the major funds supporting health care providers as they treat low-income patients. However, Medicaid DSH payments have been targeted for major budget cuts in many health policy reforms. This study examines the association between the changes in Medicaid DSH payments resulting from the BBA policy changes and hospital outcomes, in terms of hospital provision of uncompensated care and quality of care. Economic theory of non-profit hospital behavior is used as a conceptual framework, and longitudinal data for California short-term, non-federal general acute care hospitals for 1996-2003 are examined. California was especially affected by DSH changes because it is one of the states with highly concentrated DSH payments and high uninsured rate. Economic theory suggests that hospitals would change their uncompensated care provision as well as quality of care when confronted with a reduction in public payments. Hospital uncompensated care costs and percent of operating costs devoted to uncompensated care are used to measure the provision of hospital uncompensated care. Six AHRQ’s Patient safety indicators (PSIs) and one composite measure are selected to measure hospital quality of care provided for Medicaid and uninsured patients as well as privately insured patients. The key independent variable is Medicaid DSH payments received by individual hospitals. This study also includes control variables such as other governmental financial subsidies, market characteristics, and hospital characteristics. The primary data sources include the detailed hospital annual financial data and Medicaid annual report data at the county level from California Office of Statewide Health Planning and Development, Healthcare Cost and Utilization Project (HCUP) state inpatient data (SID), American Hospital Association Annual Survey, Area Resource File, Interstudy HMO Data and Medicare cost report data. After controlling for different factors, the study findings suggest that not-for-profit hospitals may reduce their provision of uncompensated care in response to reductions of Medicaid DSH payments. The results, however, do not support the hypotheses that for-profit hospitals may reduce uncompensated care by a smaller degree than not-for-profit hospitals for a comparable DSH decline. With respect to quality of care model, the overall study findings do not strongly support there is an association between net Medicaid DSH payments and patient adverse events for both Medicaid/uninsured and privately insured.
21
Glover, Gloria. "Relationships Between Nursing Resources, Uncompensated Care, Hospital Profitability, and Quality of Care." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7142.
Abstract:
The value-based purchase requirement of the Patient Protection and Affordable Care Act puts pressure on hospital leaders to control cost while improving quality of care. The resource dependency theory was the theoretical framework for this correlational study. Archival data from the Centers for Medicare and Medicaid Services collected from 166 acute care urban hospitals for the Fiscal Year 2016. Multiple linear regression analysis was used to determine the relationship between nursing salaries per patient day, cost of uncompensated care as a percentage of net patient revenue, percentage of net income from patient services, and overall patient satisfaction for quality of care received. The multiple regression analysis results indicated the model as a whole to significantly predict overall patient satisfaction for quality of care for the Fiscal Year 2016, F (3,162) = 13.788, p = .000, and R2 = .203. In the final model, all 3 independent variables significantly predicted overall patient satisfaction for quality of care. Nursing salaries per patient day and percentage of net income from patient services were significant positive predictors of overall patient satisfaction for quality of care. Nursing salaries per patient day (� = .366, t = 5.120, p = .000) accounted for a higher contribution to the model than percentage of net income from patient services (� = .169, t = 2.374, p = .019). The cost of uncompensated care as a percentage of net patient revenue displayed a significant negative relationship with overall patient satisfaction for quality of care (� = .176, t = 2.458, p = .015). The implications of this study for positive social change include the potential to enhance the quality of care for patients while maintaining local hospitals' financial viability.
22
Busca, Erica. "Nursing care models in primary care and hospital settings: implementation and evaluation." Doctoral thesis, Università del Piemonte Orientale, 2021. http://hdl.handle.net/11579/128002.
Abstract:
In the last year, the COVID‑19 pandemic has made clear how vulnerabilities in health systems can have profound implications for the health of people. Thus, organizations are taking in place significant changes which are also influencing nursing staff and the nursing care model.
This dissertation aims to: 1) explore the effects of primary nursing on patient, -staff,-organizational-related outcomes in hospital settings; 2) identify barriers and facilitators of nursing role implementation in primary care; and 3) assess the effects of the family and community nursing (FCN) practice model on patient-, organizational-related outcomes.
Method. To reach aim 1 a multi-centre, prospective before-after study is performed. Primary outcome are healthcare-associated infections. Also, staff-related outcomes are included. To reach aim 2 an integrative literature review was conducted. It combines data from quantitative and qualitative studies from two databases searches (Medline and CINAHL) up to 09 June 2020. Data extraction and identification of emerging themes are performed using the Consolidating Framework for Research Implementation (CFIR).
To reach aim 3 a prospective controlled study was designed. The study will recruit older and frail residents in municipalities belonging to Community Health Centres (CHC) of Santhià and Gattinara (Local Health Authority of Vercelli). The Intervention is the FCN and it is allocating in one of the CHC. Primary outcome is hospitalization.
Results. In this dissertation, the results of the integrative literature review are listed. 56 papers met the inclusion criteria. The major barriers identified are related to: i) the limited availability of nursing special education, ii) legislations and regulations, iii) organizational setting in which nurse’s role implementation is embedded; and iv) lack of nurse’s role clarity among stakeholders.
Major facilitators include: i) prior planning for role introduction and nurses’ involvement in the early stage of role implementation, ii) job satisfaction and nurses’ access to high-quality education, iii) successful doctor-nurse collaboration.
Finally, the two study protocols were submitted to the Local Ethics Committee. The before-after study has begun in 2019 with 10 Centres enrolled. Actually, the study has recruited 422 patients and 94 nurses.
Discussion. Implementation and evaluation of the nurse’s role in primary care and hospital settings are complex interventions due to several components which interact with each other. In this regard, the Medical Research Council framework has been used to guide the development and evaluation of complex interventions, related to nursing research and practice. Despite using this framework, two different studies have been designed to explore how the nursing care model works and its effects. The studies are still suspended due to restrictions imposed by the ongoing COVID-19 pandemic.
23
Lee, Wing-yee Wendy, and 李穎怡. "Hospital as playground." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31985294.
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Omérov, Majda. "Violence in psychiatric inpatient care /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-850-5/.
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Smeets, Wim. "Spiritual care in a hospital setting : an empirical-theological exploration /." Leiden [u.a.] : Brill, 2006. http://www.loc.gov/catdir/toc/fy0711/2006047517.html.
26
Kula, Nokuseni. "Challenges faced by professional nurses in implementing the six Ministerial priority standards of care in a Health care institution in O R Tambo Region in the Eastern Cape province." Thesis, Walter Sisulu University, 2016. http://hdl.handle.net/11260/699.
Abstract:
The objective of this research study was to describe and explore challenges faced by professional nurses in implementing six ministerial priority standards of care in selected units of an identified institution in O.R. Tambo region. Nurses are trained and employed to provide nursing care to patients according to scope of practice set by their statutory body (South African Nursing Council). Setting of standards forms part of quality improvement in nursing care and standards need to be monitored and evaluated (Muller 2006:206). In South Africa, the Minister of Health has identified six priority areas to fast-track improvement and ensure quality in health services. These priority areas are as follows: attitudes and values of health workers, cleanliness of the facility, waiting times, patient safety and security, infection prevention and control, and availability of medicines (National Health Plan: Strategic plan 2010/2013). Standard of nursing care in OR Tambo region according to available statistics, is lower than the expected ministerial standards, regardless of continued monitoring and evaluation. Staff attitudes is an ongoing problem, long queues, linen shortages, low standards of cleanliness as well as shortage of medication remain a challenge in health care institutions. This study is a qualitative, descriptive, exploratory, and contextual study that explored challenges faced by professional nurses in implementing the six ministerial priority standards of care. A purposive sampling of 10 professional nurses, meeting the selection criteria was utilised. In depth, semi structured interviews were used as a method of data collection. A digital voice recorder was used to record the interviews and consent from participants was obtained. Ethical considerations were adhered to. The interview question was: “What challenges are you facing in implementing expected standards of care with reference to the six ministerial priority standards of care?” Data was analysed using content thematic analysis approach. An independent coder with a Master’s degree and studying towards a doctorate helped with coding the results of the interviews. The Theory for Health Promotion in nursing as propounded by Botes (2006) was used to analyse the findings. The approach used was based on the external environment and its dimensions – social, physical and intellectual. v The findings of the research revealed the following themes: Lack of resources, demotivation of nurses, attitude of nurses, lack of monitoring and evaluation, environment and overcrowding, lack of patient safety, negligence, availability of policy and procedure manuals, and incompetency of health care professionals. The findings of this study revealed that nurses faced many challenges with regard to improving the standard of nursing care. According to Botes (2006), the purpose of nursing research is functional by nature, it provides guidelines for practice. Therefore in this study, a description of guidelines to improve nursing care has been done. Trustworthiness of the findings was ensured by utilising Lincoln and Guba’s model of trustworthiness. Limitations of the research are highlighted and recommendations for further and related studies are made.
27
Morrow, Karen. "An analysis of stakeholder perceptions of health care reform for strategic planning at an Indiana hospital." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/864900.
Abstract:
This thesis applied the decision support mechanism, Q-Methodology, to an integrated model of issues management and strategic planning. This approach was applied at Riverview Hospital in Noblesville, Indiana in order to respond to the health care reform issue.The research approach involved the three primary stakeholder groups of the hospital: Board of Directors, physicians and managers. The three groups, representing 56 people, attended a planning retreat and identified Riverview's planning options in the form of 77 statements representing future program or service options. These 77 statements were then ranked using Q-methodology.The findings of the study included a QMETHOD computer and researcher analysis of the statements from the perspective of the total group and also the three factors.The final result was a list of statements that comprised Riverview's response to the reform issue in the form of corporate goals and objectives. The conclusions of the study show that:--The integrated approach did provide focus to the strategic planning process. The final list of objectives were all related to the health reform proposal.--Q-Methodology was an appropriate decision support mechanism. It not only provided the final list of corporate objectives but clearly identified potential support and resistance.--A viable set of corporate objectives was developed to respond to the health reform proposal.--All of the stakeholder groups unanimously approved the final list of statements (objectives) in a formal voting process.Department of Journalism
28
Beattie, Michelle. "Measuring the patient experience of hospital quality of care." Thesis, University of Stirling, 2016. http://hdl.handle.net/1893/23410.
Abstract:
The primary motivation of this PhD by publication has been the apparent disconnect between the metrics of hospital quality of care at national and board level and patients’ experiences. Exploration of the gap led to the realisation of two key points. Firstly, the concept of healthcare quality continually evolves. Secondly, the NHS Scotland Measurement Framework does not include a measure of patient experience at the microsystem level (e.g. hospital ward). This is needed to counterbalance easier to obtain metrics of quality (e.g. waiting times). Resource tends to follow measurement. Papers 1 and 2 were exploratory, investigating theoretical and practical aspects of measuring quality of hospital care at the clinical microsystem level. With the associated Chapters, they highlighted both the necessity and the possibility of measuring the patient experience at the micro level of the healthcare system. They also drew attention to the inadequacy of “satisfaction” as a metric, leading to closer examination of “experience” as the decisive metric. This required the development of a systematic review protocol (Paper Three), then a systematic review (Paper Four). The review (Paper Four) examined the utility (validity, reliability, cost efficiency, acceptability and educational impact) of questionnaires to measure the patient experience of hospital quality of care, with a newly devised matrix tool. Findings highlighted a gap for an instrument with high utility for use at the clinical microsystem level of healthcare. Paper Five presents the development and preliminary psychometric testing of such an instrument; the Care Experience Feedback Improvement Tool (CEFIT). The thesis provides, as well as the matrix tool and CEFIT, theoretical and methodological contributions in the field of healthcare quality. It contributes to an aspiration that the patient’s voice can be heard and acknowledged, in order to direct improvements in the quality of hospital care.
29
Gihwala, Raina Tara. "Out-of-hospital assessment and management of rape survivors by pre-hospital emergency care providers in the Western Cape." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21186.
Abstract:
South African incidence of rape ranks amongst the highest worldwide. No direct policy exists for the emergency care provider management of rape victims in the pre-hospital setting. The pre-hospital exposure to rape cases is unknown as its health information system is not gender-based violence sensitive. In the absence of a clearly defined protocol, indiscretion in the emergency care treatment of rape victims remains undocumented. As a particularly vulnerable group globally, victims of rape are deserving of focused intervention. A qualitative, descriptive approach guided the research in which nine semi-structured voluntary interviews were held with emergency care providers, forensic medical practitioners and emergency consultants. Through a critical theory lens thematic content analysis was employed. University of Cape Town ethics approval was attained. The study found that pre-hospital providers lack knowledge and skills of rape victim identification and management but are desirous of evidence-informed guidelines for treatment and referral in a multidisciplinary approach. Educational and policy deficiencies are documented. The recommendations support a community of practice that is mutually inclusive of specialist rape-care centres, emergency department and pre-hospital providers in the interest of forensic emergency medicine. Due regard must be had for needs of practitioners at risk of vicarious traumatization from sexual assault management. Transformative curricula and responsive clinical guidelines are likely to redress any complicity of the health sector non-response to rape/sexual assault. This study is likely to benefit emergency care regulators, educators and researchers whose professional interest is to promote responsivity of the health system to rape.
30
Karnas, Diana Maria Girardi. "The psychology of the environment in children's health care setting : James Whitcomb Riley Hospital for Children - Cancer Unit." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/845987.
Abstract:
Hospitals are constantly evolving to keep pace with the latest medical technologies. Whether it is a refurbishment of an existing facility or the addition of a new unit, the design process usually focuses on the technological requirements rather than the human elements of such an undertaking. The Riley Hospital for Children in Indianapolis presents an architectural opportunity to incorporate psychology of the environment into the design and construction of a new Cancer Unit. By balancing the technological requirements with the physical and psychological needs of the pediatric bone marrow transplant and hematology/oncology patients, one can create a healing environment more conducive to a rapid recovery.Department of Architecture
31
Boyd, Sheree S. "Hospital Administrators' Strategies for Reducing Delayed Hospital Discharges and Improving Profitability." Thesis, Walden University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10640911.
Abstract:
Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, direct observation, and a review of discharge documents. Data analysis took place using the modified van Kaam method. Two emergent themes were identified relating to strategies for efficient communications and facilitating effective leadership. Implications for positive social change include the potential to improve health services within the community where access to health care is limited or the need exists for additional hospital beds. Positive leadership strategies in hospitals tend to contribute to the success and wellbeing of employees, patients, communities, and the economy.
32
Stokes, Zwitter Miriam. "Nursing organizational structures in acute care hospital settings." Case Western Reserve University School of Graduate Studies / OhioLINK, 1992. http://rave.ohiolink.edu/etdc/view?acc_num=case1059758111.
33
Chang, Ting-Huan. "Determinants of hospital affiliation with health care networks." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2007. https://www.mhsl.uab.edu/dt/2008r/chang.pdf.
34
Gorgon, Edward James. "Improving back pain care in the hospital setting." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29414.
Abstract:
Redesigning how care is structured and delivered has been identified as a potential solution to enable implementation of best practice care for back pain. Redesigning care requires a deep understanding of local needs and context, and participation of stakeholders in the process to promote relevance, acceptance, and uptake. This thesis includes studies that have contributed toward defining the problem, identifying potential solutions, and proposing a new service to improve care for people with chronic back pain.
The aim of the thesis was to complete the design phase of a new service for chronic back pain in a hospital setting.
This thesis used different methods of research to conduct needs assessment and service design guided by an intervention mapping approach. Needs assessment was conducted through quantitative and qualitative evaluations of current care (Chapter 2 and Chapter 3). Service design was undertaken by creating a logic model of the health problem and a logic model of change, and identifying key components of a new service using information from the needs assessment and stakeholder feedback (Chapter 4, Chapter 5, and Chapter 6). As part of service design, a feasibility study protocol was designed to test key components of a new service for chronic back pain (Chapter 7).
The needs assessment studies demonstrated that current service delivery is largely not structured to provide patients with timely and coordinated, long-term management. Whilst the clinical record review showed that existing practice involved good uptake of guideline recommendations, the focus groups and interviews suggested that many patients might be disengaging due to misaligned care expectations and a pathoanatomical focus. The service design process with stakeholder participation showed overall agreement with the needs assessment findings and proposed key components of a new service. This participatory process also revealed potential barriers related to clinician sensitivities and challenges with reimagining traditional roles which could adversely impact progress in the next steps of the service development process.
This thesis has contributed to achieving the aim of completing the design phase of a new service for chronic back pain in a hospital setting. Moreover, this thesis provided new insights into the structures and processes that would need to be created to enable and support best practice care for chronic back pain.
35
Meissner, Melanie R. "Decreasing Hospital Admission Rates in Long-Term Care." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6925.
Abstract:
Each year, hospitalizations from long-term care (LTC) settings occur, in part, due to underdeveloped nursing assessment skills, ineffective communication with primary care providers (PCPs), and delayed intervention. Through staff development nursing education, the quality and timeliness of care can be improved. The practice question that guided this doctoral project focused on whether evidence-based research information would assist in decreasing LTC-to-hospital admission rates through improved nursing assessment skills and better communication with PCPs. Using the logic model, the effectiveness of a program was evaluated and the impact of interventions on a predicted outcome was determined. Sources of evidence included obtaining best practice research information from scholarly nursing journals and official nursing websites. Analytical strategies included a review of the literature to examine data from nursing journals, websites, and other publication sources in addition to the use of a synthesis matrix that classified different ideas rated by the Cochrane Consumer Network. The findings of this project might contribute to positive social change by fostering improved patient assessments, enhanced communication with PCPs, early intervention, and decreased LTC-to-hospital admission rates through the improvement of nursing practice policy.
36
Matshikiza, Wonga. "Barriers to acute stroke care at a tertiary hospital in the Western Cape." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30928.
Abstract:
Background
Stroke guidelines recommend treatment of acute stroke as a medical emergency. In many countries prolonged delays occur before patients with acute stroke receive medical attention. Only a small percentage of patients are assessed in hospital within the time window for reperfusion therapy. There is limited available published data concerning barriers to acute stroke care in South African patients. The aim of this study was to determine the pre-hospital barriers and in-hospital delays to emergency care for patients presenting to Groote Schuur Hospital (GSH) with acute stroke.
Methods
Eligible patients included were those with a clinical and radiological diagnosis of acute stroke who presented to GSH Emergency Unit and required admission for more than 24 hours. The study was a prospective, observational study with two components: a semi structured interviewer administered questionnaire and a record review of ischaemic stroke patients’ clinical notes within 48 hours of admission to GSH. GSH is a tertiary/academic level hospital in Cape Town, Western Cape province, South Africa. Recruitment took place over a 6-week period.
Results
Demographics: 50 patients were included, with a median age of 61,5 (IQR 44,7 – 70,2) years; gender: females, 29 (58%). Ethnicity: Mixed African ancestry 38 (76%), Black 11 (22%).
Pre- hospital barriers: The median distance to hospital was 12,7 (IQR 10,2 – 17,6) km. Most patients 32 (64%) called for assistance immediately. Frequent reasons cited for delays: waiting for improvement, 7 (38,9%) and failure of symptom recognition 4 (22%). Most patients used their own private transport, 32 (64%) and half of the patients (25) presented directly to GSH. In- hospital delays: The median time interval from arrival at the Emergency Unit to doctor assessment for all the patients was 67,5 (IQR 19,75 – 128,5) minutes. The median door to CT brain time interval for all patients was 5,1 (IQR 1,7 – 10,2) hours and 3,1 (IQR 0,8 – 9,6) hours for those patients that arrived within the thrombolysis time window. Only 21 of 50 patients were referred and assessed by the stroke unit team. Only 3 of the 21 patients received intravenous thrombolysis and none received mechanical thrombectomy.
Conclusion: There majority of the patients who arrived at GSH early after symptom onset used their own private transport and lived close to hospital. Pre-hospital barriers were failure to recognize symptoms, patients hoping for clinical improvement, delays in ambulance transport and routing via secondary hospitals. In hospital delays were prolonged door to doctor assessment and door to CT Brain time intervals.
37
Marepula, Lindiwe Oscarine. "Patient satisfaction with the care provided in a psychiatric hospital in Cape Town." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/3698.
Abstract:
Magister Curationis - MCurBackground: Patient satisfaction is a well-researched area in general medicine worldwide, yet a full exploration of patient satisfaction amongst psychiatric patients appears to be lacking in South Africa. Patient satisfaction has become important because of the awareness of the patient’s human rights. There is an increasing practice of applying a consumer viewpoint to health care, while safeguarding patients’ rights and taking their views into account. This has been brought about by the inception of the Mental Health Care Act no. 17 of 2002.Purpose: The purpose of this study was to describe psychiatric inpatients’ satisfaction with the care provided in a psychiatric hospital in Cape Town.Objectives : (1) To describe the psychiatric inpatients’ satisfaction with the care provided in a psychiatric teaching hospital in terms of their views on the: care provided by nurses (interpersonal/nurse-patient- interaction and technical skills); care provided by doctors (interpersonal/doctor-patient interaction and technical skills; and the nature of the environment of care, and (2) to describe the psychiatric inpatients’ overall satisfaction with the care received in a psychiatric teaching hospital in terms of the: quality of care received from nurses and doctors; nature of the environment of care; and the likelihood of future utilization of the hospital serviceMethod/Design: The study made use of the quantitative descriptive design using the Primary Provider Theory of patient satisfaction and the Batho Pele Principles served as the conceptual framework. Data were collected from discharged patients using a self-administered questionnaire which was mailed to individual participants. A five and a four point Likert scales were used for different sections in the questionnaire.The study made use of 120 participants between the ages of 18 and 60.Findings: Generally respondents were satisfied with the care provided in thispsychiatric hospital. Greater satisfaction was noted on aspects of staff-patient interactions. Low satisfaction scores were observed on nurses’ technical aspects of care. The Batho Pele principles of information, openness and transparency,consultation, access and redress seem not to have been adhered to.Conclusions: General inpatient satisfaction in psychiatric hospital care was good.However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be given to the implementation of the Batho Pele Principles and the protection of the patients’ rights.
38
Dobies, Pamela A. Roffol Herman Robert D. "Organizational design issues of establishing palliative care services in an acute care hospital." Diss., UMK access, 2005.
Abstract:
Thesis (Ph. D.)--Henry W. Bloch School of Business and Public Administration and Dept. of Sociology. University of Missouri--Kansas City, 2005."A dissertation in public affairs and administration and sociology." Advisor: Robert D. Herman. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed June 23, 2006. Includes bibliographical references (leaves 194-204 ). Online version of the print edition.
39
Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
Abstract:
Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
40
Albsoul, Rania Ali Mohammad. "Investigating missed nursing care in an Australian acute care hospital: An exploratory study." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/132413/2/__qut.edu.au_Documents_StaffHome_staffgroupW%24_wu75_Documents_ePrints_Rania%2520Ali%2520Mohammad_Albsoul_Thesis%5B1%5D.pdf.
Abstract:
This thesis is a mixed methods study of missed nursing care in an Australian acute care hospital. It explores the concept so as to further understand and to build a detailed theoretical understanding of the phenomenon. The study identified a range of factors influencing missed nursing care including the number of working hours per week, interruptions, and perceived lack of management support. A conceptual and holistic understanding of the phenomenon using Complexity Theory has been constructed. The thesis recommends incorporating nursing reflective practice into healthcare organisations and informing nursing management about change theories.
41
Yao, Wei-yen Rosa. "An evaluation of the reform and quality of pharmacy service in Hospital Authority : a case study at Princess Margaret Hospital /." Hong Kong : University of Hong Kong, 1995. http://sunzi.lib.hku.hk/hkuto/record.jsp?B14035534.
42
Cartabuke, Richard Henry. "THE EVOLUTION OF CHARITY CARE OF THE UNIVERSITY HOSPITALS OF CLEVELAND." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1244056325.
43
Waters, Leland. "Factors Associated with Access to Palliative Care in a Large Urban Public Teaching Hospital with a Formal Hospital-Based Palliative Care Program." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2746.
Abstract:
Hospital-based specialist palliative care services are designed to address the needs of critically ill patients by psychosocial and spiritual support, improving symptoms management, and offering discussions on goals of care. Integrating palliative care upstream in the care continuum for patients who eventually die in the hospital will help to address the many individualistic needs of the critically ill patient. The diffusion of specialist hospital-based palliative care services requires an understanding of patterns of utilization by patients. The purpose of this study was to examine the population characteristics of decedents who may or may not have utilized specialist palliative care services in a hospital setting in order to develop a model of predictors of access to specialist palliative care services. The basic constructs of this study are grounded in the Behavioral Model of Health Services Use. Potential access is measured in terms of population characteristics, which include predisposing characteristics, enabling resources, and evaluated need. Building on this theoretical model, the study sought to better understand equitable and inequitable access to specialized palliative care services and to define which predictors of realized access were dominant. The research question asked was: What are predictors of access to specialized palliative care within a large urban public teaching hospital? A model of access to a palliative consult and a predictor of access to a palliative care unit were explored. Findings from this study revealed that factors encouraging access to a palliative care consult include older age, White non-Hispanic ethnic membership, a diagnosis with solid cancer and insurance. Factors encouraging access to a palliative care unit include older age, gender (female), insurance, and either a solid cancer or hematologic malignancy diagnosis.
44
Quosdorf, Ashley. "Connecting with Adolescent Mothers: Perspectives of Hospital-Based Perinatal Nurses." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/38838.
Abstract:
Background: Adolescents are more likely to be dissatisfied with perinatal care than adults. Adolescents’ perspectives of their perinatal care experiences have been explored; however, there are few studies exploring adolescent-friendly inpatient care from nurses’ perspectives.
Purpose: To explore adolescent-friendly care from the perspective of hospital-based adolescent-friendly perinatal nurses.
Research Questions: (1) How and why do perinatal nurses in inpatient settings adapt their practice when caring for adolescents? (2) What are the individual nursing behaviours and organizational characteristics of adolescent-friendly care in inpatient perinatal settings, from the perspective of perinatal nurses?
Methods: I report the qualitative component of a mixed methods study. Open-ended interviews were conducted with twenty-seven purposively-sampled expert nurses. Data were analyzed using Interpretive Description.
Findings: Nurses described being mother-friendly to adolescents by being nonjudgmental, forming connections, individualizing care, and employing behavioural strategies that facilitate relationship-building.
Implications: These findings will inform the development of interventions to facilitate connections between nurses and adolescent mothers.
45
Elo, Jyrki A. I. "The impact of surgical day care on hospital inpatient utilization in a paediatric population." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/27876.
Abstract:
Day care surgical services have been marketed as a cost saving alternative for inpatient care. There is evidence that the cost per episode of day care surgery is 50-70 percent less than a comparable episode in an inpatient ward. In addition, avoiding hospitalization has particular relevance for paediatrics, because of the undesirable effects of hospital stay on children. However, both cost savings and the quality-based need to decrease hospitalizations of children will be fullfilled only if each patient cared for in a day care surgery unit would otherwise have been an inpatient and the bed vacated by day care surgery use would not be filled in by other patients.
In a previous B.C. study based on the total population a significant component of day care surgery was found to augment total utilization, suggesting generation of surgical activity rather than substitution. The present study was designed to examine the substitution/generation issue in the paediatric (0-14 years) population, both because experts questioned the generalizability of the findings to the paediatric population, and because of the dramatic reduction in paediatric utilization in Canada during the period since the mid-1960s. The contention was that the introduction of day care surgery may have been an important factor in this downtrend.
The relationship between paediatric day care surgery use and hospital inpatient utilization was analyzed in B.C. in each of the years 1968-1976 and 1981/82-1982/83 and using a time series/cross-section study design. The data frame consisted of all B.C. school districts, in each of the study years, yielding 825 data points. Using a multivariate regression analysis, it was possible to estimate what hospital utilization patterns would have been in the absence of day care surgery capacity, and hence isolate estimates of the net impact of day care surgery on paediatric inpatient use.
Findings on the relationship between day care surgery use and paediatric medical/surgical and surgical inpatient utilization strongly support the view that paediatric day care surgery has been largely an add-on to the total hospital care system. Statistically significant substitution effect was revealed only for the most narrowly defined inpatient surgery category which more closely resembled day care surgery-type cases, after controlling for potential confounding effects of age and sex, paediatric bed capacity, different socioeconomic characteristics and time- and district-specific factors. Even here, less than 10 percent of day care surgery represented substitution for inpatient surgery and over 90 percent appeared to be generation of new activity to the hospital system as a whole. Furthermore, paediatric beds which were "saved" by day care surgery use were filled with increased utilization by non-day care surgery eligible surgical patients and by medical cases. The main driving force behind hospital utilization in the 0-14 year age group was paediatric bed availability even after standardization for age, sex, physician stock, measures of socioeconomic status, and other district- and year-specific effects.
According to this study paediatric day care surgery has not been a cost saving alternative for inpatient care in B.C. in 1968-1982/83. Neither has it reduced overall hospitalizations in the paediatric population.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
46
Ygge, Britt Marie. "Parental Involvement in Pediatric Hospital Care-Implications for Clinical Practice and Quality of Care." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4010.
47
Abrahamsen, Grøndahl Vigdis. "Patients’ perceptions of actual care conditions and patient satisfaction with care quality in hospital." Doctoral thesis, Karlstads universitet, Avdelningen för omvårdnad, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-9023.
Abstract:
There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis. Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of care, and patient satisfaction with care in hospital. Methods. Quantitative and qualitative methods were used. In the quantitative study (I-III), 528 patients (83.7%) from eight medical, three surgical and one mixed medical/surgical ward in five hospitals in Norway agreed to participate (10% of total discharges). Data collection was conducted using a questionnaire comprising four instruments: Quality from Patients’ Perspective (QPP); Sense of Coherence scale (SOC); Big Five personality traits – the Single-Item Measures of Personality (SIMP); and Emotional Stress Reaction Questionnaire (ESRQ). In addition, questions regarding socio-demographic data and health conditions were asked, and data from ward statistics were included. Multivariate statistical analysis was carried out (I-III). In the qualitative study 22 informants were interviewed (IV). The interviews were analysed by conventional content analysis. Main findings. Patients’ perceptions of quality of care and patient satisfaction ranged from lower to higher depending on whether all patients or groups of patients were studied. The combination of person-related and external objective care conditions explained 55% of patients’ perceptions of quality of care (I). 54.7% of the variance in patient satisfaction was explained, and the person-related conditions had the strongest impact, explaining 51.7% (II). Three clusters of patients were identified regarding their scores on patient satisfaction and patients’ perceptions of quality of care (III). One group consisted of patients who were most satisfied and had the best perceptions of quality of care, a second group of patients who were less satisfied and had better perceptions, and a third group of patients who were less satisfied and had the worst perceptions. The qualitative study revealed four categories of importance for patients’ satisfaction: desire to regain health, need to be met in a professional way as a unique person, perspective on life, and need to have balance between privacy and companionship (IV). Conclusions. Patients’ perceptions of quality of care and patient satisfaction are two different concepts. The person-related conditions seem to be the strongest predictors of patients’ perceptions of quality of care and patient satisfaction. Registered nurses need to be aware of this when planning and conducting nursing care. There is a need of guidelines for handling over‑occupancy, and of procedures for emergency admissions on the wards. The number of registered nurses on the wards needs to be considered. Healthcare personnel must do their utmost to provide the patients with person‑centred care.
48
Wiggins, Sandra. "Utilization management of acute care services : evaluation of the SWITCH index system." Thesis, University of British Columbia, 1988. http://hdl.handle.net/2429/28355.
Abstract:
In recent years, concern about the rising costs of health care has prompted the development of programs aimed at reducing utilization of hospital services and facilities while maintaining an acceptable standard of care. One of the major strategies that has emerged in the effort to accomplish these dual objectives, is utilization management. Although there are a number of different approaches, the primary aim of all utilization management programs is to identify and eliminate unnecessary and inappropriate hospital use.
To date, most of the utilization research and program development has taken place in the United States. To a great extent, this effort has focussed on the development and use of norms for utilization based on a breakdown of length of stay data by diagnostic-related groups (DRG's). Canadian interest in this type of approach is reflected in the recent development of data bases defined by case-mix groups (CMG's). However, while continued efforts are being made to refine these schemes, they have been vulnerable to the criticism that they do not provide adequately objective criteria for establishing what constitutes appropriate patterns of hospital use. In addition, because they are based on statistically derived norms, they have been criticized as lacking sufficient clinical relevance to encourage physician support. Since hospital utilization is largely determined by the medical staff, utilization management programs that fail to obtain physician support are unlikely to succeed.
An alternative approach, which appears to be gaining in popularity, involves the formulation of criteria which can be used to determine what constitutes appropriate and necessary hospital use. Essentially, it is argued that by directly identifying the source and nature of misutilization, it should be possible to develop more effective strategies for the resolution of identified problems. The American Appropriateness Evaluation Protocol designed by Gertman & Restuccia (1981) is one of the earliest and most highly tested examples of a criterion-based system. In Canada, interest in this type of approach is more recent and, consequently, little attention has as yet been focussed on the development and use of clinical criteria in utilization review and management.
One exception, however, is the SWITCH Index System. This system, which was developed and implemented in 1984 by the Peace Arch District Hospital (White Rock, B.C.), makes a direct attempt to identify and eliminate days of hospital stay during which no appropriate acute care services are being provided. The criteria used in this system are classified under the headings Signs, Wind, Intramuscular Therapy, Tubes, Consultant, and Hospice. Patients are considered to be appropriately placed in the hospital if, on any given day, at least one of the specified criteria are met. Otherwise they are classified as Off-Index and action is taken to identify the source of the problem and to initiate corrective action.
Since a major objective of the SWITCH system is to identify and eliminate inappropriate use, an observable outcome, if the program is successful, should be a reduction in length of stay. The present study investigated this hypothesis by comparing pre- and post- intervention length of stay trends at the Peace Arch District Hospital. In addition, to take into account any general secular trends in length of stay over time, the Peace Arch length of stay was compared to the length of stay observed for a control group of three peer-group member hospitals. Although data covering the four year period 1982 to 1985, indicated that the length of stay at the Peace Arch District Hospital had been decreasing over time, no component of this general decline could be attributed to the SWITCH Index System. Time series regression analyses failed to detect changes in either the slope or the height of the estimated response curve. However, limitations in the study design do not permit any conclusions regarding the potential effectiveness of this system. Characteristics specific to the Peace Arch District Hospital may have prevented the detection of an effect. In addition, because it is likely that there would be a lag between when the program was implemented and when it might be expected to effect a reduction in length of stay, the follow-up period of eleven months may have been too short for the determination of the program's effectiveness.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
49
Au, Lai Piu. "A simulation study of dynamic customer flow control in multi-site service system /." View Abstract or Full-Text, 2002. http://library.ust.hk/cgi/db/thesis.pl?IEEM%202002%20AU.
Abstract:
Thesis (M. Phil.)--Hong Kong University of Science and Technology, 2002.Includes bibliographical references (leaves 106-108). Also available in electronic version. Access restricted to campus users.
50
Saifi, Khader M. M. Al. "The impact of information technology on hospital management of Gulf Corporation Council public hospitals." Thesis, University of Hull, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272025.
Abstract:
Information technology (m has become crucial to the functioning of modern hospitals. It includes a range of human elements, infornlation, equipment, knowledge and systems. It is important to hospitals, as these are complex environments including many systems with diversity of functions, sub-systems, and professionals. The adoption of technology can be explained by four general theories: economic, political, social and globalization theory. Based on these theories five sets of reasons can account for the adoption of IT in a hospital environnlent. They are, practical; to solve existing problems, economic/business; to achieve d profit or reduce costs or both, rational; to achieve efficienL1' and effectiveness, social; to respond to pressure from society for political reasons and to increase positive image, and supply driven forces by which IT producers seek to sell their products and services. However, no one theory or set of reasons can by itself explain the precise drive for use of IT because nluch depends on each hospital's needs and surrounding drcunlStances. The purposes of this research are to investigate the extent to which IT is being used in Gulf Corporation Council (GCC) public hospitals, why IT has been adopted, and the impact of IT on hospital managementThe methods used in conducting this research were based lllainly on three established methods for searching and collecting infomlation; a literature review, the surveyor questionnaire, intervie,,'s and case studies. Five case studies in Qatar, the United Arab Emirates (UAE) and Bahrain were undertaken to cover Gee hospitals and medical centres populations. Most health and medical services in Gee Countries are provided by public hospitals which account for approximately 64% of total hospital provision, employ most medical professionals, mainly expatriates, and contain most patient beds. In Gee hospitals, IT is still in the early stages of implementation. IT has been found to be adopted at a low level due to reasons such as lack of awareness, other priorities in health policy strategies, and the low level of funding allocated. IT can provide hospitals with many benefits, solve many problems and has many inlpacts on human and functional systems, internal power balances and on the social status of hospitals. The benefits are found to be mostly in the areas of processing work. Therefore, the areas which were given priority for IT implementation were medical records, finance, and personnel areas. No significant impacts v"ere found on hospital structure, chain of conlllland, span of control and nUlllber of employees, however, itwas found that IT increased management power, hospitals' social in1age and hospital political power, while there were disagreements about IT impacts on employees' social relations. The evaluation of IT impacts on Gee hospital management shows that the impacts were not at the same level of intensity or direction, for example, sonle impacts ,",'ere positive and some negative; some significant, moderate or nurunlal, some ambiguous or obvious, were some were slow and some fast. Some efforts at Gee States level were made to develop a model of adopting IT but no real results were detected. However, the future role of IT in Gee public hospitals will be increasing perhaps at a slower pace, but two strategic issues should be given proper consideration; first; the role of the education system, research centers, and industrictl foundation, and the second strategy concerns hospital systems and services structure. This later is related to increased privatization of medical services, economic pressure, and changes in governments' employment strategy. The importance of this thesis is to draw the attention of decisionmakers to the role of IT as an efficient managerial tool in some respects and to provide a foundation for future studies