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Peck, Jordan S. (Jordan Shefer). "Using prediction to facilitate patient flow in a health care delivery chain." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/79504.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Engineering Systems Division, 2013.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 163-178).
A health care delivery chain is a series of treatment steps through which patients flow. The Emergency Department (ED)/Inpatient Unit (IU) chain is an example chain, common to many hospitals. Recent literature has suggested that predictions of IU admission, when patients enter the ED, could be used to initiate IU bed preparations before the patient has completed emergency treatment and improve flow through the chain. This dissertation explores the merit and implications of this suggestion. Using retrospective data collected at the ED of the Veterans Health Administration Boston Health Care System (VHA BHS), three methods are selected for making admission predictions: expert opinion, naive Bayes conditional probability and linear regression with a logit link function (logit-linear regression). The logit-linear regression is found to perform best. Databases of historic data are collected from four hospitals including VHA BHS. Logit-linear regression prediction models generated for each individual hospital perform well based on multiple measures. The prediction model generated for the VHA BHS hospital continues to perform well when predictive data are collected and coded prospectively by nurses. For two weeks, predictions are made on each patient that enters the VHA BHS ED. This data is then summarized and displayed on the VHA BHS internet homepage. No change was observed in key ED flow measures; however, interviews with hospital staff exposed ways in which the prediction information was valuable: planning individual patient admissions, personal scheduling, resource scheduling, resource alignment, and hospital network coordination. A discrete event simulation of the system shows that if IU staff emphasizes discharge before noon, flow measures improve as compared to a baseline scenario where discharge priority begins at 1pm. Sharing ED crowding or prediction information leads to best patient flow performance when using specific schedules dictating IU response to the information. This dissertation targets the practical and theoretical implications of using prediction to improve flow through the ED/IU health care delivery chain. It is suggested that the results will have impact on many other levels of health care delivery that share the delivery chain structure.
by Jordan Shefer Peck.
Ph.D.
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Heslop, Liza. "An ethnography of patient and health care delivery systems : dialectics and (dis)continuity." Monash University, Faculty of Education, 2001. http://arrow.monash.edu.au/hdl/1959.1/8764.
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Recame, Michelle Ashley. "Exploring Women's Lived Experiences and Expectations with In-Patient Maternity Care within the U.S. Military Healthcare System." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2755.
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Satisfaction with in-patient maternity care within the Military Healthcare System (MHS) continues to score significantly below national benchmarks when compared to civilian hospitals and doctors. Lack of independent, qualitative research in this area has left the MHS with few answers as to why patients are satisfied, but still unhappy, with specific aspects of care. Discrepancy theory was used in conjunction with grounded theory as the foundation and framework for understanding the expectations and experiences of women who have given birth in the MHS within the past year. Using grounded theory and a hermeneutical approach to interview participants, qualitative data were collected to understand these women's expectations, experiences, and satisfaction. Participants were active duty dependents who had given birth within the last year at a local hospital and used TRICARE as their only insurance. They were recruited through the base's local community online network and 12 women total participated. Data were carefully analyzed using transcriptions and were subsequently grouped into common patterns, and then into themes. Findings revealed 3 key themes: (a) participants had one or more complaints or complications with their maternity care; (b) previous experiences on standard care were mostly negative, and (c) differences in satisfaction may be seen when a patient's personal experiences and beliefs about an occurrence are met or excused. This study contributes to social change by adding previously unexplored qualitative data to the military healthcare community in a population that had not been investigated in this manner and has the potential to increase understanding about the population, as well as how experiences, expectations, and satisfaction coexist.
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Kuperstein, Janice M. "TIKKUN OLAM A FAITH-BASED APPROACH FOR ASSISTING OLDER ADULTS IN HEALTH SYSTEM NAVIGATION." Lexington, Ky. : [University of Kentucky Libraries], 2008. http://hdl.handle.net/10225/799.
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Thesis (Ph. D.)--University of Kentucky, 2008.Title from document title page (viewed on August 25, 2008). Document formatted into pages; contains: viii, 152 p. : ill. (some col.). Includes abstract and vita. Includes bibliographical references (p. 140-149).
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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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Micski, Erik. "CO2 Flow Estimation using Sidestream Capnography and Patient Flow in Anaesthesia Delivery Systems." Thesis, KTH, Skolan för kemi, bioteknologi och hälsa (CBH), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-261664.
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Volumetric CO2 data from patients in anaesthesia delivery systems are sought after by physicians. The CO2 data obtained with the commonly used sidestream sampling technique are not considered adequate for volumetric CO2 estimation due to distortion and desynchrony with patient flow. The purpose of this thesis was to explore the possibility of using signal enhancing methods to the sidestream data to accurately estimate CO2 flow using a Flow-i anaesthesia delivery system. To evaluate sidestream performance, experimental data was acquired using a mainstream and a sidestream capnograph connected in series to a FRC test lung with known CO2 content, ventilated by a Flow-i anaesthesia machine. The data was then enhanced and analysed using signal processing methods including sigmoid modelling and neural networks. A Feed Forward Neural Network achieved results closest resembling the mainstream capnogram of the evaluated signal processing methods. The mainstream capnogram, considered the benchmark, produced large internal scattering and approximately 25 % offset from actual CO2 flow while using the inherent patient flow data produced by the Flow-i anaesthesia system. When using patient flow data from a Servo-i ventilator, the resulting CO2 flow estimates were drastically improved, producing estimates within 10 % error. This thesis concludes that there are several potential processing methods of the sidestream data to approximate the mainstream signal, however the patient flow of the Flow-i system are a suspected source of error in the CO2 flow estimation.
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Cloud-Buckner, Jennifer M. "Managing Patient Test Data in Primary Care: Developing and Evaluating a System for Test Tracking to Enhance Processes, Safety, and Understanding of Performance." Wright State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=wright1348258363.
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Pinkoane, Martha Gelemete. "Incorporation of the traditional healers into the national health care delivery system / Martha Gelemete Pinkoane." Thesis, North-West University, 2005. http://hdl.handle.net/10394/1725.
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Myers, Robert A. "Engineering Healthcare Delivery: A Systems Engineering Approach to Improving Trauma Center Nursing Efficacy." Wright State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=wright1482419145222356.
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Gilliam, Patricia. "Transitional Care for Adolescents with HIV: Characteristics and Current Practices of the Adolescent Trials Network Systems of Care." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0002840.
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Henteleff, Harry J. A. "Developing an information system to monitor the delivery and outcome of care in patients undergoing lung cancer surgery in Nova Scotia." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/mq24853.pdf.
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Tamirepi, Farirai. "HIV and AIDS within the primary health care delivery system in Zimbabwe : a quest for a spiritual and pastoral approach to healing." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85760.
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Thesis (PhD)--Stellenbosch University, 2013.ENGLISH ABSTRACT: This qualitatively oriented Practical Theological research journey, informed by the philosophical ideas of postmodern, contextual, participatory and feminist theologies, postmodern and social construction epistemologies was based on a participatory action research through the therapeutic lens of narrative inquiry. The thesis is about the spiritual problems and spiritual needs of people living with HIV and AIDS and how they can be addressed as part of a holistic approach to their care within the primary healthcare delivery system in Zimbabwe. The research curiosity was prompted by the HIV and AIDS policy in Zimbabwe that advocates for a holistic approach to the care of HIV and AIDS patients within the primary health care delivery system. The recognition that healthcare has to be holistic for the best outcome for patients creates an expectation that spiritual care will also be incorporated into clinical practice. However there is a puzzling blind spot and a strange silence about the spiritual problems and spiritual needs of people living with HIV and AIDS within the HIV and AIDS policy. This has had the effects of reducing intervention programmes to purely medical, psychological and sociological. This research sought to correct such an approach by highlighting the role of spiritual care in the healing process of people living with HIV and AIDS as part of the holistic approach to their care. The core information, on which this research is based, comes from the experiences of people living with HIV and AIDS who are receiving care within the primary health care delivery system in Zimbabwe. It sweeps away statistics and places those questing for spiritual healing at the core of the study. All the participants in the study affirmed that the why me questions as a summation of their indescribable and unimaginable spiritual pain felt in the spirit were directed to God. They confirmed that their spiritual problem was spiritual pain and their spiritual need therefore was spiritual healing from the spiritual pain of which God is believed to be the healer. The belief that God is the ultimate healer of the spiritual pain stood out from the midst of problem saturated narratives of spiritual pain and suffering as the unique outcome to reconstruct the alternative problem free stories of healing. The research opted for an approach that is informed by the experiences of people living with HIV and AIDS. In the light of the stories shared by the participants in this study, it became evident that there is an existing need within the Primary Health Care delivery system in Zimbabwe to provide spiritual care to people living with HIV and AIDS. The research aimed at co-creating a spiritual care approach in which those living with HIV and AIDS as well as those working with them can be empowered to re-author the stories of patients‟ lives around their self preferred images. The narrative approach was explored in this research as a possible therapeutic approach that could be used to journey pastorally with people living with HIV and AIDS in a non-controlling, non-blaming, non-directive and not knowing guiding manner that would permit the people living with HIV and AIDS to use their own spiritual resources in a way that can bring spiritual healing to their troubled spirits. The research also emphasizes the position of the people living with HIV and AIDS which they can inhabit and lay claim to the many possibilities of their own lives that lie beyond the expertise of the pastoral caregiver. The strong suggestion emerging from this study is that a spiritual care approach to healing must of necessity be integrated into the holistic approach to the care of people living with HIV and AIDS in Zimbabwe. The wish of participants that their spiritual well-being be considered in their health care adds momentum to this suggestion. Hence the research argues for the inclusion of a spiritual and pastoral approach to spiritual healing which links the patient‟s spirituality and pastoral care. The research does not claim to have the solutions or quick fix miracle to the complicated spiritual pain of people living with HIV and AIDS and neither claims to have the power to bring any neat conclusions to the spiritual healing of people living with HIV and AIDS. However, the research has the potential to stimulate a new story of spirituality as a vital resource in the healing process of people living with HIV and AIDS and ignoring it may defeat the purpose of a holistic approach to the care of people living with HIV. The re-authoring of alternative stories is an ongoing process but like in all journeys, there are landmarks that indicate achievements, places of transfer or starting new directions or turning around. Hence this research process may be regarded as a landmark that indicated a new direction in the participants‟ journey towards spiritual healing.
AFRIKAANSE OPSOMMING: Hierdie kwalitatief-georiënteerde Praktiese Teologie navorsingsreis, geïnformeer deur die filosofiese idees van postmoderne, kontekstuele, deelnemende en feministiese teologie, postmoderne en sosiale konstruksie epistemologie, is gebaseer op deelnemende aksie-navorsing deur die terapeutiese lens van narratiewe ondersoek. Die tesis handel oor die spirituele probleme en navorsingsbehoeftes van mense wat met MIV en vigs leef en hoe dit aangespreek kan word as deel van ʼn holistiese benadering tot hul sorg binne die primêre gesondheidsorg-diensleweringstelsel in Zimbabwe. Die navorsing-belangstelling het ontwikkel na aanleiding van die MIV en vigs beleid in Zimbabwe wat ʼn holistiese benadering tot die sorg van MIV en vigs pasiënte in die primêre gesondheidsorg-diensleweringstelsel bepleit. Die erkenning dat gesondheidsorg holisties moet wees om die beste uitkoms vir pasiënte te bied, skep ʼn verwagting dat spirituele sorg ook by kliniese praktyk ingesluit sal word. Daar is egter in die HIV en vigs beleid ʼn raaiselagtige blinde kol, ʼn vreemde stilte oor die spirituele probleme en spirituele behoeftes van mense wat met MIV en vigs leef. Die gevolg is dat intervensie-programme gereduseer word tot slegs mediese, sielkundige en sosiologiese programme. Hierdie navorsing streef om dié benadering reg te stel deur die beklemtoning van die rol van spirituele sorg in die heling-proses van mense wat met MIV en vigs leef as deel van die holistiese benadering tot hul sorg. Die kerninligting waarop hierdie navorsing gegrond is, vloei voort uit die ervarings van mense wat leef met MIV en vigs en sorg ontvang binne die primêre gesondheidsorg-diensleweringstelsel in Zimbabwe. Dit vee statistiek van die tafel af en plaas diegene wat soek na spirituele heling, in die hart van die ondersoek. Al die deelnemers aan die ondersoek het bevestig dat hul “Waarom ek?” vrae, as opsomming van hul onbeskryflike, ondenkbare geestelike pyn, aan God gerig is. Hulle het bevestig dat hul spirituele probleem spirituele pyn is, en dat hul spirituele behoefte dus spirituele genesing is van die spirituele pyn, die pyn waarvan geglo word dat God die geneser is. Die geloof dat God die opperste geneser is, het uitgestaan te midde van die probleem-deurdrenkte narratiewe van spirituele pyn en lyding as die unieke uitkoms om alternatiewe probleem-vrye verhale van heling te herkonstrueer. Die navorsing het ʼn benadering gekies wat geïnformeer is deur die ervarings van mense wat leef met MIV en vigs. In die lig van die verhale wat die deelnemers aan die studie gedeel het, het dit duidelik geword dat daar ʼn behoefte is dat spirituele sorg ook aan mense wat leef met MIV en vigs verskaf word in die primêre gesondheidsorg-diensleweringstelsel in Zimbabwe. Die doel van die navorsing was om saam ʼn spirituele sorg benadering te skep waarin diegene wat met MIV en vigs leef, sowel as diegene wat met hulle werk, bemagtig kan word om die stories van pasiënte se lewens te herskryf in terme van pasiënte se verkose beelde. Die narratiewe benadering is in hierdie studie ondersoek as ʼn moontlike terapeutiese benadering wat gebruik kan word om pastoraal te reis met mense wat leef met MIV en vigs op ʼn manier wat nie kontroleer, beskuldig, voorskryf of weet nie, maar wat mense wat met MIV en vigs leef eerder begelei en toelaat om hul eie spirituele bronne te gebruik op ʼn manier wat spirituele genesing vir hul gekwelde siele kan bring. Die navorsing beklemtoon ook die posisie van mense wat leef met MIV en vigs waarin hulle spirituele moontlikhede, areas van hul lewens kan eien en bewoon, moontlikhede wat buite die bereik van pastorale versorgers lê. Uit hierdie studie vloei ʼn sterk suggestie dat ʼn spirituele benadering tot genesing noodwendig geïntegreer moet wees in die holistiese benadering tot die sorg van mense wat leef met MIV en vigs in Zimbabwe. Deelnemers se wens dat hul spirituele behoeftes ook in hul gesondheidsorg oorweeg word, gee aan dié suggestie verdere momentum. Derhalwe argumenteer hierdie navorsing ten gunste van die insluiting van ʼn spirituele en pastorale benadering tot spirituele genesing wat die pasiënt se spiritualiteit en pastorale sorg verbind. Die studie maak nie daarop aanspraak dat dit antwoorde of ʼn wonderbare kits-oplossing bied vir die gekompliseerde spirituele pyn van mens wat leef met MIV en vigs nie, of spirituele genesing netjies afsluit nie. Die navorsing het egter wel die potensiaal om ʼn nuwe verhaal te stimuleer van spiritualiteit as ʼn deurslaggewende bron in die genesingsproses van mense wat leef met MIV en vigs. Om spiritualiteit te ignoreer, mag dalk die doel verydel van ʼn holistiese benadering tot die sorg van mense wat met MIV en vigs leef. Die herskryf van alternatiewe verhale is ʼn voortdurende proses, maar soos alle reise, is daar landmerke wat prestasies aandui, en ook punte van verplasing, rigtingverandering of selfs ommekeer. Hierdie navorsing kan beskou word as ʼn landmerk van ʼn verandering van rigting in deelnemers se reis na spirituele genesing.
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Chukmaitov, Askar S. "Variations in Quality Outcomes Among Hospitals in Different Types of Health Systems." VCU Scholars Compass, 2005. https://scholarscompass.vcu.edu/etd/1414.
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Although prior research has found differences in costs and financial performance across different types of hospital systems, there has been no systematic study of variations in patient quality of care or safety indicators across different systems. Our study examines whether five main types of health systems - centralized (CHS), centralized physician/insurance (CPIHS), moderately centralized (MCHS), decentralized (DHS), and independent (IHS) - as well as other hospital characteristics are associated with differences in quality of patient care. Data were assembled for 6 years (1995 - 2000) from multiple sources. We used 4 AHRQ risk adjusted inpatient quality indicators (IQIs) and 5 risk-adjusted patient safety indicators (PSIs) as dependent variables. Random effects models were used in the analysis.It was found that the IQI and PSI models have different patterns. In the IQI models, CHS hospitals have lower AMI, CHF, Stroke, and Pneumonia mortality rates than hospitals in other system types. The PSI models did not indicate any systems' effects on adverse event rates. It was also found that system hospitals' compliance with the JCAHO performance area indicator for availability of patient specific information was associated with lower rates of CHF, Stroke, Pneumonia, and Infection due to medical care.The findings suggest that centralization of hospital structures may improve internal clinical processes by enhancing coordination of activities, communication between providers, timely adjustments of processes of care delivery and structures to external pressures. A lack of systems' effect on adverse events may be explained by a newness of the patient safety issues for hospitals and possible changes in reporting patterns of medical errors after the Institute of Medicine report of 1999. A system hospitals' compliance with the JCAHO performance area indicator may indicate improvements in information and clinical record systems.Hospital systems hold much potential for hospitals in improving patient quality of care and safety because they provide a laboratory for studying the health care process and sharing lessons across multiple institutions. Based on our findings, we recommend that future studies use a combination of IQIs and PSIs when examining institutional quality of care because both provide different and complementary information.
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Fryer, Ashley-Kay. "Improving Health Care Delivery: Patient Care Integration and Manager Commitment." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493267.
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This dissertation investigates how patient-perceived integrated care and manager commitment influence the improvement and integration of health care delivery. Using survey instruments, across three studies I examine potential mechanisms for improving health care delivery: patient perceptions of integrated care, a physician organization care management program, and manager commitment to a quality improvement program.
In Chapter Two, I examine how patient-perceived integrated care relates to utilization of health services. I assess relationships between provider performance on 11 domains of patient-reported integrated care and rates of emergency department (ED) visits, hospital admissions, and outpatient visits. I find better performance on two of the surveyed dimensions of integrated care are significantly associated with lower ED visit rates: information flow to other providers in doctor’s office and responsiveness independent of visits. Better performance on three dimensions of integrated care is associated with lower outpatient visit rates: information flow to specialist, post-visit information flow to the patient, and continuous familiarity with patient over time. No dimension of integration is associated with hospital admission rates.
In Chapter Three, I use the same patient sample to evaluate the achievement of integrated care by a care management program (CMP) from the perspective of older patients with multiple chronic conditions. Survey results suggest that patient perceptions of integrated care vary substantially among survey items and domains. CMP enrollment is significantly associated with greater patient perceptions of care integration in two domains: connecting patients to home services and being responsive independent of visits, domains that were targeted for improvement by the CMP. Enrollment in the CMP is not significantly associated with other domains of integration.
In Chapter Four, I assess whether and how senior and middle manager commitment to a falls reduction quality improvement (QI) program is associated with the successful implementation of the program. Survey results suggest managers’ affective commitment to the program is positively associated with program implementation success across all manager levels surveyed (senior managers, middle managers, and assistant middle managers). Stronger frontline worker support for the falls QI program partially mediates the relationship between manager affective commitment and falls program implementation success for middle managers and assistant middle managers, but not for senior managers. Manager affective commitment to the falls program mediates the relationship between organizational support for the falls program and program implementation success across all manager levels.
Together, these studies advance our understanding of how patient-perceived integrated care, care management programs, and manager commitment to a quality improvement program influence the integration and improvement of health care delivery. Findings demonstrate how patient reports of integration can be useful guides to improving health systems. Dissertation results also provide empirical evidence of a relationship between manager commitment—at both the middle and senior manager levels—and successful QI program implementation. In addition, these studies provide practical implications for physicians and hospital managers seeking ways to improve the quality and integration of health care delivery.Health Policy
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Siemens, Annette Cecile. "Improving Patient Care Delivery in a Small Alaska Native Health Care Organization." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/1937.
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Chronic diseases impose heavy burdens on the United States health care system, particularly among some ethnic/racial groups such as American Indian and Alaska Natives who experience higher incidence of these diseases than non-Native population. In an effort to improve the health status of its patients, the Ukudigaunal Wellness Center (UWC) partnered with the Improving Patient Care (IPC) Collaborative to implement changes designed to improve chronic disease care for Native Alaskans through intensive monitoring of screening for chronic disease and selected chronic disease outcomes. For this program evaluation, the units of analysis were the changes in health service delivery and the resulting patient clinical outcomes. The data source was the Registration and Patient Management System (RPMS), repository for the data collected over the 14 months of the collaborative. The findings showed that the process measures that met IPC goals were due to improvements in service delivery by UWC. Goals for other services, such as diagnostic screenings, were not met because these clinical components had to be coordinated with facilities outside UWC. Outcome measures for BP and HgbA1c control were not met as these depended on the patients' abilities to self-manage the required procedures. The implications for social change included: (a) Positive outcome in managing chronic diseases is possible by combining chronic care models with Deming's model for improvement; (b) Increased patient awareness of chronic conditions and their long term consequences tended to support more responsible and successful patient self-management; (c) Use of external medical resources should be considered when patient privacy and confidentiality are concerns.
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Nagula, Prasad. "Redesigning the patient care delivery processes at an emergency department." Diss., Online access via UMI:, 2006.
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Maneejiraprakarn, Phattharamanat. "Effects of patient delivery models on nurse job satisfaction, quality of care and patient safety." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/404586/.
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Background; a patient care delivery model describes a method of allocating work at hospital ward level. Four classical models are articulated which involve different work allocation paradigms. Research findings are varied in regard to the association between these models of care and outcomes. This study aimed to (1) describe current approaches to the delivery of nursing care to hospital based patients and (2) examine the association between patient care delivery models and nurse job-satisfaction, quality of care and patient safety. Method: a cross-sectional survey was conducted in two phases: (1) a pilot study and a preliminary survey; and, (2) the main study. Data were collected from general medical and surgical wards in 11 regional hospitals in Thailand from July 2013 to October 2014. Findings: The pilot study (9 wards, 1 hospital) demonstrated that the chosen data collection procedures are feasible and confirmed the reliability of the instruments. The preliminary survey (42 wards, 6 hospitals) suggested that there was a degree of incongruence between the models of care reported by the ward managers and the actual patterns of care delivery as well as dissonance with the classical model‘s characteristics derived from the literature. A revised classification, using the ward managers‘ reported current methods of care delivery was made. The majority of the wards (62%) can be classified as team nursing. However, all characteristics of the classical task allocation, and the patient allocation model existed in wards classified as following the team nursing paradigm. The main study (1,193 staff nurses and their 76 ward managers; 83% and 95% response rate) confirmed that current approaches to care delivery are not based on any single classical model; instead, the approaches observed are eclectic, combining the classical team nursing model with a hybrid assignment of tasks as well as patients, and the duration of responsibility lasting for one shift. Hierarchical modelling was performed. After controlling for nurse-to-patient ratio, skill mix ratio and work environment, it was demonstrated that work allocation patterns derived from the team nursing and patient allocation models were found to be independently significant associated with a likelihood of nurse reported good quality of care (odds ratio 3.1 and 1.5, 95% confidence interval: 1.4-6.7 and 1.1-2.1). No supportive evidence for any benefits of implementing work allocation patterns derived from the primary nursing and task allocation models has been found. Conclusion: The results provided both more accurate knowledge and a better understanding of work allocation mechanisms, at the micro level, within the nursing team. Shifting the emphasis from an evaluation of the patient care delivery model to the components of work allocation is suggested, as the pure classical model no longer exists. However, work allocation patterns that emphasise the formation of explicit nursing sub-teams with the ward compliment (elements of ?team nursing‘) and explicit assignment of nurses to individual patients (elements of ?patient allocation‘) based on nurses skills and patient need appear to be associated with better outcomes than patterns that involve task allocation or those which emphasise continuity of nurse to patient assignment.
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Liu, Yazhuo. "Patient Populations, Clinical Associations, and System Efficiency in Healthcare Delivery System." Thesis, University of South Florida, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3714134.
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The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes’ perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease’ correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.
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Bosire, Joshua. "Designing an integrated surgical care delivery system." Diss., Online access via UMI:, 2007.
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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.
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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.
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Whelan, Amanda Rebecca. "Measuring quality of health care delivery : maternal satisfaction in the South Wales valleys." Thesis, Cardiff University, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337715.
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Olsson, Lars-Eric. "Patients with acute hip fractures motivation, effectiveness and costs in two different care systems /." Göteborg : Institute of Health and Care Sciences and The Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, 2006. http://hdl.handle.net/2077/716.
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Koritor, Christine N. "A study comparing two health care delivery systems, for gerontological patients, and the incidence of hospitalization /." Staten Island, N.Y. : [s.n.], 1994. http://library.wagner.edu/theses/nursing/1994/thesis_nur_1994_korit_study.pdf.
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Phiri, Jane. "Socioeconomic inequalities in Zambia's public health care delivery system." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/9458.
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Includes bibliographical references.In this thesis, equality is considered as the absence of differences in utilization among individuals of different socioeconomic status while equity is taken to mean that individuals in equal need of health care should use the same amount of care, irrespective of their socioeconomic status. Using the above definitions, this thesis, examines equity/inequality in the utilization of public health care in Zambia. Concentration curves, concentration indices and horizontal equity indices were used for this purpose. This thesis focuses specifically on public health care that is subsidized by the Government. It is anticipated that the findings of this thesis will broaden the knowledge base on health care utilization inequities in Africa.
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McErlain, Louise. "The impact of an alternative hospital meal delivery system on patient satisfaction." Thesis, Manchester Metropolitan University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.392565.
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Ndlovu, Sibusiso. "Comparison of patient experiences in three differentiated antiretroviral delivery models in a public health care facility." University of the Western Cape, 2020. http://hdl.handle.net/11394/7262.
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Master of Public Health - MPHBackground: HIV remains a global concern. Consequently, global institutions such as the World Health Organisation (WHO) and United Nations Programme on HIV and AIDS (UNAIDS) continue to work towards ending HIV/AIDS by facilitating innovative strategies to improve service delivery of antiretroviral therapy (ART). In 2016 WHO issued the ‘test and treat’ policy recommendation in line with the UNAIDS 2020, 90-90-90 target of reaching 90% people to know their HIV status, get 90% of these on ART treatment and to have 90% of those on treatment virally suppressed. Differentiated Care Models (DCMs) has been put in place for all stakeholders, from global, institutes, government departments and civil society to improve patient access to treatment and retention in care. While various evaluation studies have shown that DCMs improve the retention in care and adherence to medication behaviours of patients on ART, little is known about the patients’ experiences and preferences. The aim of the current study was to explore and compare the experiences of patients in three DCMs (Facility Adherence Clubs [FAC], Community Adherence Club [CAC] and Quick Pharmacy Pick-up [QPUP]) in a community health care facility in a township in Cape Town, South Africa. Methods: An exploratory qualitative study design was used. Data were collected through semi-structured interviews (12) and focus group discussions (6) with purposively selected participants from six DCMs. Thematic analysis was done using Atlas.ti version 8.0. Results: Patients found DCMs easily accessible and convenient and presented positive experiences in relation to the National Health Services (NHS) patients experience principles. FACs and CAC presented attributes of patient-centeredness as prescribed by the NHI. We found that the QPUP model fell short on attributes of patient-centeredness such as coordination and integration of care, information sharing, communication and education, and emotional/psychological support. Conclusions: The principles of DCMs acknowledge the diversity and preference of PLHIV in addressing the barriers they face in accessing ART while empowering these patients to self-manage their disease. Understanding the experiences of patients using DCMs could improve our understanding of how DCMs promote self-management among PLHIV (or not) and some of the challenges faced by the patients using these care models. This understanding could inform strategies to tailor ART delivery services that suit the patients’ needs and enhance their abilities to achieve optimal retention in care and viral suppression.
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Xu, Aidi. "How Design Thinking Can Improve The Patient Experience and Provide Innovation in Hospital Care Delivery." University of Cincinnati / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470740642.
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Granholm, Hanna, and Linda Axwik. "Patients and care providers perception of the current heart failure health care system : A survey within Stockholm County." Thesis, KTH, Skolan för teknik och hälsa (STH), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-149273.
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The prevalence of heart failure is increasing. This is affecting the health care system; thus, making it important with change to meet the new demands. Many effective ways of treating heart failure exists, but changes are required in order to implement them. Before changes can be made, it is important to find current problem areas within the existing heart failure health care system. This study aimed to present an image of current problem areas within the heart failure health care system; in order to do so, it was necessary to speak with both care providers and heart failure patients. A total of 26 heart failure patients and 27 care providers working with heart failure patients in Stockholm County participated in the study. The participants answered survey questions concerning the heart failure care. The results from the care providers were consistent; they thought the patients’ heart failure awareness and the patient education they had received were problems within the heart failure care. In addition, they thought it was necessary for the patients to be active in their care and meet with different professions within the health care. Heart failure patients showed to be a diverse group of individuals; they wanted different kind of care and showed differences in how active they wanted to be. The results also showed differences between the care providers and patients’ perception of the heart failure care. The heart failure care needs to be more individualized to meet each heart failure patients’ needs. It is important with more patient education and to actively work with self-care. In addition, it is important that care providers get sufficient heart failure knowledge and to offer the patients the opportunity to meet with different care provider professions.Utbredningen av hjärtsvikt ökar, vilket påverkar sjukvårdssystemet. För att möta de nya behoven är det nödvändigt med förändringar. Det finns idag många effektiva behandlingsmetoder för hjärtsvikt, men för att dessa behandlingsmetoder ska kunna implementeras behöver sjukvårdssystemet förändras. Innan dessa förändringar kan genomföras är det viktigt att identifiera problem inom hjärtsviktsvården. Målet med denna studie var att identifiera befintliga problemområden inom hjärtsviktsvården. För att kunna göra detta var det nödvändigt att prata med både sjukvårdspersonal och hjärtsviktspatienter. Sammanlagt har 26 patienter och 27 vårdgivare från Stockholms Län delaktigt. Alla delatagare har svarat på enkätfrågor rörande hjärtsviktsvården. Resultaten från vårdgivarna var konsekventa, de ansåg att patienternas kännedom om hjärtsvikt och den hjärtsviktsutbildning de fått var problemområden. Vårdgivarna ansåg vidare att det var viktigt för patienterna att vara delaktiga i sin vård, samt att de skulle få träffa olika typer av vårdgivare. Hjärtsviktspatienterna visade sig vara en blandad grupp, de ville ha olika typ av vård samt vara olika mycket aktiva i egenvård. Resultaten visade också att det fanns skillnader mellan vårdgivarnas och patienternas uppfattning av hjärtsviktsvården. Hjärtsviktsvården behöver bli mer individualiserad för att kunna tillgodose varje patients behov. Det är viktigt att utbilda patienterna samt att aktivt arbeta med egenvård. Det är även viktigt att vårdgivarna får tillräckligt med kunskap om hjärtsvikt, samt att patienterna erbjuds möjligheten till möten med olika typer av vårdgivare.
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Slade, Catherine Putnam. "Does Patient-Centered Care affect Racial Disparities in Health?" Digital Archive @ GSU, 2007. http://digitalarchive.gsu.edu/pmap_diss/24.
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This thesis presents a challenge to policy initiatives that presume that patient-centered care will reduce racial disparities in health. Data from the Medical Expenditure Panel Survey were used to test patient assessment of provider behavior defined as patient-centered care according to the National Health Disparities Report of the Agency for Healthcare Research and Quality of the Department of Health and Human Services. Results indicated patient-centered care improves self-rated health status, but blacks still report worse health status than whites experiencing comparable patient-centered care. Further, black-white differences in patient-centered care had no affect on health status. Rival theories of black-white differences in health, including social class and health literacy, provided better explanations of disparities than assessment of provider behaviors. These findings suggest that policies designed to financially incentivize patient-centered care practices by providers should be considered with caution. While patient-centered care is better quality care, financial incentives could have a negative effect on minority health if providers are deterred from practices that serve disproportionate numbers of poor and less literate patients and their families. Measurement of the concept of patient-centered care in future health disparities research was also discussed.
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Fumai, Nicola. "A database for an intensive care unit patient data management system." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=22500.
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Computerization has had a large impact on hospital intensive care units, allowing continuous monitoring and display of physiological patient data. Treatment of the critically ill patient, however, now requires assimilating large amounts of patient data.Computers can help by processing the data and displaying the information in easy to understand formats. Also, knowledge-based systems can provide advice in diagnosis and treatment of patients. If these systems are to be effective, they must be integrated into the total hospital information system and the separate computer data must be jointly integrated into a new database which will become the primary medical record.
This thesis presents the design and implementation of a computerized database for an intensive care unit patient data management system being developed for the Montreal Children's Hospital. The database integrates data from the various PDMS components into one logical information store. The patient data currently managed includes physiological parameter data, patient administrative data and fluid balance data.
A simulator design is also described, which allows for thorough validation and verification of the Patient Data Management System. This simulator can easily be extended for use as a teaching and training tool for PDMS users.
The database and simulator were developed in C and implemented under the OS/2 operating system environment. The database is based on the OS/2 Extended Edition relational Database Manager.
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Engle, Eugene David. "Perceptions of patients and dietitians on the quality of nutrition care service delivery in primary health care facilities of the Western Cape Metro." University of the Western Cape, 2020. http://hdl.handle.net/11394/8010.
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Magister Scientiae (Nutrition Management) - MSc(NM)The provision of quality nutrition care services is needed to address the national burden of diseases, and to reduce under- and overnutrition in South Africa. Globally, there is a lack of information and data about the perceptions, experience of, and satisfaction with the quality of nutrition care services, both from patients and dietitians. Patients and dietitians are in the best position to provide useful information pertaining to their perception and experience of nutrition care service delivery. The aim of this study was to determine the perceptions of patients and dietitians on the quality of nutrition care service delivery in the Klipfontein/Mitchells Plain Sub-Structure (KMPSS).
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Slade, Catherine Putnam. "Does patient-centered care affect racial disparities in health?" Diss., Atlanta, Ga. : Georgia Institute of Technology, 2008. http://hdl.handle.net/1853/22569.
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Thesis (Ph. D.)--Public Policy, Georgia Institute of Technology, 2008.Committee Chair: Robert J. Eger III, Ph.D.; Committee Member: Christopher M. Weible, Ph.D.; Committee Member: Gregory B. Lewis, Ph.D.; Committee Member: Monica M. Gaughan, Ph.D.; Committee Member: Valerie A. Hepburn, Ph.D.
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Johnsrud, Michael Thomas. "An analysis of the utilization of and payments for prescription drugs and related health care services for Medicaid clients in health maintenance organization (HMO) and primary care case management (PCCM) health care delivery systems in Texas /." Digital version accessible at:, 1998. http://wwwlib.umi.com/cr/utexas/main.
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Stoyanov, Joan Ellen. "South African health care practitioners’ experiences of the current health care delivery system in Uthungulu District." Thesis, University of Zululand, 2017. http://hdl.handle.net/10530/1530.
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A dissertation submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor of Philosophy (Community Psychology) in the Department of Psychology at the University Of Zululand, 2017Health is a human need and considered to be a human right across all societies. Access to health care services is not a problem for those who can afford it, but, for those who cannot provide for themselves, legislation needs to protect their rights. Although there is legislation in place to protect these vulnerable populations, it is ultimately the health care practitioners’ job to protect and improve the health of their communities. It is these health care practitioners who were the inspiration for and focus of the present study. The present study emerged as a separate, but expanded version of the researcher’s limited 2011 study, which specifically focused on medical practitioners’ experiences of the current health care delivery system. Results from this 2011 study suggested that a broader spectrum of health care practitioners may be similarly affected by the current health care system and that their experiences may ultimately contribute towards a better understanding of the dynamics within which health care practitioners work and function. Therefore, the present phenomenologically-oriented study aimed to describe, explicate, interpret and analyse the experiences of a broad sample of health care practitioners through their lived, day-to-day realities in both the public and private health care sectors. Data were collected from a non-probability, purposive, convenience sample of 30 adult registered health care practitioners in public and private hospitals, clinics and private practices in the uThungulu District of Kwa-Zulu Natal, South Africa. There were 15 participants from the public and 15 from the private sector. An open-ended questionnaire was used to ascertain and understand their experiences, knowledge and exposure to the relatively new national health insurance (NHI) system, what they perceived as key objectives for effective transformation of the South African health care system, possible reasons for considering emigration in light of the current staff shortages and their views on the new NHI policy, in order to find solutions to problems. The overall data analysis consisted of three levels of subsidiary data analysis, descriptive, social constructionist and interpretive paradigms, each contributing to the whole, both “vertically and horizontally”, where participants’ experiences were described, explicated and interpreted. Research findings indicated persisting large divisions and fragmentation in and between the public and private health care sectors. Yet there was unity in responses concerning the poor and disadvantaged members of society and the challenges of their access to health care services. Sensitivity to human rights standards, past socio-political influences and awareness of health as a human right and need were evident in all participant responses. Valuable solutions to improve the health care delivery system were offered by health care practitioners as key stakeholders in the future of health care delivery in South Africa. Public health care practitioners’ experiences were dominated by overall expressions of unhappiness, anger and frustration related to poor service delivery, lack of resources, inadequate management structures, wages, inadequate consultation, fear for personal (and family) safety and the future of health care. Concern for the poor, vulnerable and the majority of citizens who use health care services, coupled with the burgeoning burden of disease, were perceived as a major stressor and source of anger towards the government and bureaucracy in general. Chronic stress and anxiety, suggestive of burnout and other negative psychological states, were also apparent. The inability to service long patient queues, inadequate communication structures/channels and lack of cohesive team practices, ethics and standards created a sense of emotional overburden and other negative affective states. These, and the uncertain future of health care under the new NHI, exerted extra stress on already overworked health care personnel. Education and effective consultation about the NHI were expressed as being inadequate and incomplete. Despite these factors, health care practitioners offered various valuable solutions and suggestions for the improvement of health care service delivery. Despite also being stressed, participants who work in the private sector were generally happier and they evinced less negative psychological states. Although a stressful environment with its own problems, within the private sector the NHI was considered to be a good concept in principle, although many participants doubted its feasibility and felt that regulatory changes often took place without adequate consultation. Given the nature and transparency of the present study, across multidisciplinary teams of health care practitioners, the researcher is of the opinion that the present study created a platform for discussion and debate around the context of a changing health care system within South Africa’s culturally diverse society. In conclusion, a critical review of the present study and recommendations for management structures, health care practitioners themselves and future research is provided.
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Chang, Andrew Yee. "A web accessible clinical patient information networked system." CSUSB ScholarWorks, 2006. https://scholarworks.lib.csusb.edu/etd-project/2980.
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Developed with the intention to make the patient data storage system in the clinical outpatient area more efficient, this system stores all pertinent and relevant patient data such as lab results, patient history and X-ray images. The system is accessible via the internet as well as operable over a local area network (LAN). The intended audience for this program is essentially the clinical staff (e.g., physicians, nursing staff, secretarial staff). The computer program was developed using Java Server Pages (JSP) and utilizes the Oracle 9i database.
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Havaei, Farinaz. "The effect of mode of nursing care delivery and skill mix on quality and patient safety outcomes." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/59936.
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Aims: This study examined the effect of various components of a model of nursing care delivery, the mode of nursing care delivery and nursing skill mix on (a) quality of nursing care (i.e., nurse reported quality of nursing care and nursing tasks left undone), (b) patient adverse events, and (c) nurse outcomes (i.e., job satisfaction and emotional exhaustion) after controlling for nurse demographic characteristics, work environment and workload factors. This study also explores the moderating effects of mode of nursing care delivery and skill mix on the relationship between workload factors and the five outcome variables.
Background: Research into redesigning care delivery has typically focused on only one care delivery component at a time (e.g., skill mix). There exists little research focusing on both components, and controlling for one factor while the other is investigated to determine quality of nursing care delivery and nurse and patient outcomes.
Method: This cross-sectional exploratory correlational survey study drew upon secondary data from 416 direct care registered nurses (RNs) from medical-surgical settings.
Results: Nurses working in a team-based mode of care delivery reported a greater number of nursing tasks left undone compared to those working in a total patient care mode of delivery. Nurses working in a skill mix with licensed practical nurses (LPNs) reported a higher frequency of patient adverse events compared to those working in a skill mix without LPNs. Two moderating effects were found. At higher levels of acuity, nurses in a team-based mode of care delivery reported a higher frequency of patient adverse events than did nurses in a total patient care mode of delivery. At higher levels of acuity, nurses working in a skill mix with LPNs reported lower levels of emotional exhaustion than nurses in a skill mix without LPNs.
Conclusion: Models of nursing care delivery components influenced quality and safety outcomes.
Implications: To be effective, a team-based mode of care delivery requires collaborative teamwork. Policy makers, administrators and healthcare providers should work together to clarify and optimize the scopes of practice for RNs and LPNs.Applied Science, Faculty of
Nursing, School of
Graduate
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Docherty, Andrea Catherine. "Evaluating the delivery of breast care services and their compatibility with the psychological needs of the patient." Thesis, Coventry University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.396471.
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Watts, Stewart Ian. "Development of thin film oral drug delivery devices for use in paediatric and palliative care patient populations." Thesis, University of Strathclyde, 2016. http://digitool.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=27503.
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Kairouz, Joseph. "Patient data management system medical knowledge-base evaluation." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=24060.
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The purpose of this thesis is to evaluate the medical data management expert system at the Pediatric Intensive Care Unit of the Montreal Children's Hospital. The objective of this study is to provide a systematic method to evaluate and, progressively improve the knowledge embedded in the medical expert system.Following a literature survey on evaluation techniques and architecture of existing expert systems, an overview of the Patient Data Management System hardware and software components is presented. The design of the Expert Monitoring System is elaborated. Following its installation in the intensive Care Unit, the performance of the Expert Monitoring System is evaluated, operating on real vital sign data and corrections were formulated. A progressive evaluation technique, new methodology for evaluating an expert system knowledge-base is proposed for subsequent corrections and evaluations of the Expert Monitoring System.
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Stoyanov, Joan Ellen. "South African medical practitioners’ experiences of the current health-care delivery system." Thesis, University of Zululand, 2011. http://hdl.handle.net/10530/1087.
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A thesis submitted in partial fulfilment of the requirements for the degree of Masters of Arts in Clinical Psychology at the University of Zululand, South Africa, 2011.South Africa is at a critical point in the debate about the future of health-care in the occupation-specific dispensation (OSD). It also faces the exodus of valuable human resources that was perceived as greener pastures, as medical practitioners become increasingly dissatisfied with governmental policy, wage negotiations, work-place disillusionment, lack of service delivery, expressions of corruptions, and lack of resources. This research aimed to thematically analyse the experiences, opinions and feelings of medical practitioners in both the public and private health-care sectors as well as explored international trends with the intention of drawing comparisons, highlighting problem areas, and discussion of possible solutions. It was hoped that this research would contribute towards understanding the dynamics that marked the exodus of medical practitioners from South Africa, at a time when change in the health-care system was imminent. In order for the medical practitioners to remain in the current health-care system, a new dialogue would have been opened in which their concerns could be raised and evaluated.
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Sanders, Jennifer. "The hospitalist model: remedy or new problem for a rapidly changing system?" Thesis, Boston University, 2006. https://hdl.handle.net/2144/27758.
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Boston University. University Professors Program Senior theses.PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. 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.
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Chao, Shir-Ley. "Relationships among patient characteristics, care processes, and outcomes for patients in coronary care units (CCUs)." Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/276836.
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The purpose of this research was to describe the relationships among patient characteristics, care processes, and care outcomes for patients in a coronary care unit (CCU). The sample consisted of 179 CCU patients. Data collectors reviewed charts and retrieved the chart information needed to measure the operational variables of APACHE II score (Acute Physiology and Chronic Health Evaluation II), years of age, CCU length of stay, nurse to patient ratio, and mortality. Descriptive statistics were used to analyze the demographic data of the patient characteristics. Correlational statistics were used to analyze the five operational variables in the "CCU Patient Outcomes Model." Pearson correlations revealed significant positive relationships between APACHE II score and age and nurse to patient ratio. Point Biserial correlations revealed significant positive relationships between mortality and APACHE II score and nurse to patient ratio. Patient characteristics were related to care processes. Patient characteristics and care processes were related to patient outcomes.
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Singh, Jeshika. "Development of a descriptive system for patient experience." Thesis, Brunel University, 2018. http://bura.brunel.ac.uk/handle/2438/16385.
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Efficient allocation of public resources requires identification, measurement and quantification of costs and benefits of alternative programs. Patient reported outcomes (PROs) are routinely incorporated into economic evaluations of health technologies, but patient experience is often overlooked. This thesis aims to develop a descriptive system for patient experience that can be valued and used to inform economic evaluation. The generation and selection of items is key in the development of any PRO measure. The thesis provides a contemporary overview of recommended methods and those actually used by instrument developers. Frequently a staged approach is used to establish dimensions first, using exploratory factor analysis, followed by item selection using item response theory (IRT), Rasch or structural equation modelling (SEM). I demonstrate the use of different methods for item selection and its underlying mechanics, followed by comparison of the methods. An existing patient dataset, the Inpatient survey (2014) that collected information on nearly 70 aspects of healthcare delivery from NHS users was used. Logistic regression analyses were applied with respondents' rating of overall patient experience specified as dependent variable. Advanced statistical analyses focussed mostly on patients who had an operation or procedure. Latent construct or dimensions were derived and measurement model was confirmed using confirmatory factor analysis. IRT and factor analysis were employed in each one-factor model for item selection. Regression analyses identified many significant variables but most overlapped conceptually. An 11 and 8 factor model for patients with A&E and planned admissions respectively was determined. A generalised partial credit model and a factor analysis model identified different items to include in each dimension. Broadly the items identified by different methods related to respect, comfort and clear communication to patients. This thesis presents descriptive systems for patient experience that is amenable to valuation. It also demonstrates that different patient experience instruments are generated based on patient population used and item selection technique adopted.
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Wakefield, John Gregory Public Health & Community Medicine Faculty of Medicine UNSW. "Patient safety: factors that influence patient safety behaviours of health care workers in the Queensland public health system." Awarded by:University of New South Wales. Public Health & Community Medicine, 2009. http://handle.unsw.edu.au/1959.4/44598.
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ABSTRACT Objectives: To develop and validate in an Australian setting, an instrument to effectively measure patient safety culture; to survey health care workers (HCWs) in a large public healthcare system to establish baseline patient safety culture; and, using the Theory of Planned Behaviour (TPB), to use behavioural modelling to identify the factors that predict and influence Patient Safety Behavioural Intent (PSBI) Eg. Reporting clinical incidents and speaking up when a colleague makes an error. Design: Cross sectional survey analysed with multiple logistic regression (MLR). Setting: Metropolitan, regional and rural public hospitals in Queensland, Australia. Participants: 5294 clinical and managerial staff. Main outcome measures: 1) Behavioural models for high-level Patient Safety Behavioural Intent (PSBI) for senior and junior doctors, senior and junior nurses, and allied health professionals. 2) Odds ratios to compare levels of PSBI between professional groups. Results: 1) The factors that influence high-level PSBI for each professional group give rise to unique predictive models. Two factors stand out as influencing high-level PSBI for all HCWs (R2 0.21). These are: i) Preventive Action Beliefs (Adjusted Odds Ratio (AOR) 2.38) (HCWs??? belief that engaging in the target behaviour(s) will lead to improved patient safety) and ii) Professional Peer Behaviour (AOR 1.79) (HCWs??? perceptions of the safety behaviour(s) of one???s professional peers). 2) There was a six-fold difference in the level of target behaviour (PSBI) across the clinical groups with few (29.6%) junior doctors having a high-level of PSBI. When compared with the junior doctors, the senior doctors were nearly 1.5 times more likely (Odds Ratio (OR) 1.46, 95% Confidence Interval (CI) 1.01-2.13), allied health staff 2.7 times more likely (OR 2.71, 95%CI 1.91-3.73), junior nurses 3.9 times more likely (OR 3.86, 95%CI 2.83-5.26), and senior nurses 6.0 times more likely (OR 6.01, 95%CI 4.78-9.16) to have high-level PSBI. Conclusions: This is the first published study to develop behavioural models of factors that influence HCWs??? intention to engage in behaviours known to be associated with improved patient safety. The findings of this study will greatly assist in the future design and implementation of targeted and cost-effective patient safety improvement initiatives.
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Liddle, Keir. "The impact of leadership on the delivery of high quality patient centred care in allied health professional practice." Thesis, University of Stirling, 2018. http://hdl.handle.net/1893/28081.
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The Healthcare Quality Strategy for NHS Scotland, relates its overall vision of healthcare quality to six dimensions of care as: Safe, Efficient, Effective, Equitable, Timely and Patient Centred. Patient Centred Care also underpins many subsequent policies such as the management of Long Term Conditions (Scottish Government, 2008) and the Chief Medical Officers Realistic Medicine report (Barlow, et al., 2015) Leadership styles and associated policies and procedures are often assumed to inhibit or encourage the delivery of quality Patient Centred Care and the NHS invests millions of pounds per year in Leadership training. At a clinical team and management level there are behaviours and initiatives that can arguably have positive and negative impacts on the ability of individual practitioners to provide quality Patient Centred Care. However there have been no attempts to empirically test the association between (good) Leadership and quality Patient Centred Care. Without any evidence of such a relationship, NHS investment of substantial resources may be misguided. Additionally, much of the focus of research in both Leadership and Patient Centred Care has focused on medical practitioners and nurses. There is little research that focuses on the impact of allied health professionals' (a term describing 12 differing health care professional groups representing over 130,000 clinicians throughout the United Kingdom) practice on the quality of person centred care and how this is affected by Leadership structures and styles. This study aimed to explore whether there is a direct or indirect link between (transformational) Leadership and achieving the delivery of high quality Patient Centred Care (PCC) in allied health professional (AHP) practice. Aim The aim of this thesis was to explore whether it was possible to empirically demonstrate a relationship between Leadership (good or bad) and Patient Centred Care, and to do this in relation to Allied Health Professional practice. Research questions I. Is there a relationship between Transformational Leadership and Patient Centred Care in AHP practice? II. How do AHP’s conceptualise Leadership and its impact on their ability to deliver PCC? III. Do local contexts influence the ability of leaders to support Patient Centred Care? Study one Study one was designed to answer research question one: exploring the relationship between transformational Leadership and Patient Centred Care using survey design. Two groups of Allied Health Professionals were selected to take part in the study: Podiatrists and Dieticians. Clinical team leaders from across 12 Podiatry teams and 12 Dietetic teams completed a survey composed of measures of transformational Leadership and self-monitoring. Clinicians from these teams were also be asked to complete questionnaires on their perception of their clinical leaders’ transformational Leadership skills. This allowed comparison of self-assessed Leadership and team assessed Leadership. Clinicians were also asked to collect patient experience measures from 30 of their patients. Study Two Study Two was designed to answer research questions 2 and 3: how do AHPs conceptualise Leadership and how do they view the link between Leadership and their ability to deliver Patient Centred Care; and how might local context impact on professional Leadership and therefore its potential to enable or inhibit Patient Centred Care. In depth interviews were conducted with clinicians and clinical team leaders to explore the barriers and facilitators to effective Leadership, teamwork and the provision of quality care. Interviews were conducted with 21 Podiatrists and 12 Dieticians and analysed using a framework analysis approach. Results I. Is there a relationship between Patient Centred Care and transformational Leadership in AHP practice? The theory that there is a link between transformational Leadership and Patient Centred Care was confirmed. A significant relationship was discovered for the dietetics group linking Transformational Leadership with patient centred quality of care measures. There was also a relationship in the podiatry group that was suggestive of a relationship. II. How do AHP’s conceptualise Leadership and its impact on their ability to deliver PCC? AHP’s in both groups had broadly similar conceptualisations of Leadership and both groups played down the role of Leadership in the delivery of Patient Centred Care. A far more salient factor in achieving the delivery of high quality Patient Centred Care for the AHP’s interviewed was professional autonomy. III. Do local contexts influence the ability of leaders to support Patient Centred Care? A number of contextual issues related to both Patient Centred Care and Leadership were identified from the qualitative analysis. These were centred on systemic factors, relating to management and bureaucracy, and individual factors, such as relationships within teams. In Podiatry a major shift in the context of care was ongoing during the study, namely a greater emphasis on encouraging patients to self-care. This affected the relationships between patients and Podiatrists, and Podiatrists and managers, in a way that Podiatrists felt it negatively impacted on their ability to provide quality Patient Centred Care. Conclusion A weak relationship was observed between Transformational Leadership styles and the delivery of Patient Centred Care in two Allied Health Professional groups. Professional autonomy was identified as being more likely to facilitate delivery of person centred care. Organisational issues and intervening policy directives can impact on the delivery of Patient Centred Care, regardless of Leadership. Recommendations Further work exploring the link between Leadership and Patient Centred Care is required. The concept of professional autonomy should be fostered within Leadership programs to enhance delivery of Patient Centred Care. The impact of individual policies, such as moves towards more self-care, on quality criteria need to be more fully considered. Whilst such policies may make care more efficient, there may be negative consequences for other quality care criteria, such as Patient Centred Care.
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Roger, Kathleen Mary Louise. "A nursing workload manager for a patient data management system /." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=61047.
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This thesis presents the design and implementation of a Nursing Workload Manager module for a Patient Data Management System in an intensive care unit. The Nursing Workload Manager aids in the planning and documentation of the nurse's workload. It automates the generation of the nursing care plan and automatically assigns a score to the care plan based on a nursing workload measurement system. In the thesis a literature survey of patient data management systems, nursing workload measurement systems and system evaluation methods is presented. This is followed by an overview of the work environment of an intensive care unit. The functionality of the Nursing Workload Manager is described and details of the software environment and application implementation are discussed. Finally, the results of a user evaluation of the module are presented, and future work on the module is discussed.
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Ravenscroft, Eleanor Fay. "Patient perspectives on health care system navigation : the chronic illness multi-morbidity experience." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/642.
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Meeting the health care needs of people with chronic conditions presents one of the greatest challenges for 21st century health care system renewal. Appropriate redesign of health care delivery with this complex patient population in mind requires information from many sources. Although much is known about the patient experience of chronic illness much less is understood about how patients navigate their health care delivery context.
The purpose of this qualitative study was to examine the point of view of patients dealing with multi-morbidity. These people have a unique understanding of how health care delivery links across time, place, and settings because of the care they require for their multiple chronic conditions.
An interpretive descriptive design was used to examine patient navigation from the perspective of 20 adult patients with chronic kidney disease, and co-existing diagnoses of diabetes mellitus and/or cardiovascular disease. The findings generated from iterative, constant comparative analysis add important patient perspectives about health care system navigation. From the consumer perspective health care navigation is challenging, requiring (a) ongoing discovery about the complex social structures that make up the health care system, and (b) learning how to strategically use this knowledge to manage the health care system. The findings highlight the disjunctures and misalignments in the health care delivery system, the cumulative health care-related burden of multiple chronic conditions for consumers, and consumer concerns about subtle inequities in the health care system.
As health care renewal efforts gain momentum new knowledge from the perspective of consumers, such as that captured in this research, is important. The consumer perspective provides a valuable opportunity for stakeholders in health care policy- and decision-making to contextualize and make greater sense of the information used in making decisions about health care service delivery for vulnerable populations, like patients with multiple chronic conditions.
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Haar, Michael Elmer. "A study of family system theory as a pastoral care approach to patient care within a hospital setting." Theological Research Exchange Network (TREN) Access this title online, 2005. http://www.tren.com.
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Vinneau, Justin M. "Gender Nonconforming, Transgender, and Transsexual Patient Navigation of the American Health Care System: Locating a Primary Care Provider." VCU Scholars Compass, 2016. http://scholarscompass.vcu.edu/etd/4468.
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This study explores the experiences of gender nonconforming (GNC), transgender, and transsexual (trans) people in the search for a primary care provider in the United States. The current body of literature on transgender health often discusses HIV rates, substance use, mental health/suicide, and few studies have studies primary care seeking behaviors; this study seeks to provide new insight into the primary care (pcp) seeking behaviors of GNC and trans people. The primary theoretical perspectives utilized in this study were West and Zimmerman’s (1987) “Doing Gender” and the Health Beliefs Mode (Ayers et al., 2007; Connor and Norman, 2005; Green and Murphy, 2014). In order to explore the pcp seeking behaviors among GNC and trans individuals, I designed a 45 item survey. The survey was posted on-line on three separate “sub-reddits” between March and April of 2016 and was open to all individuals who self-identified as gender nonconforming, transgender, and/or transsexual. Of 96 responses, 68 were included. Although the sample is small, the results showed that structural barriers were significantly associated with having a PCP. Those with health insurance (p=.031) and those with at least one chronic illness (p=.037) were more likely to have a regular primary care provider. Descriptive findings support the role of socio-economic factors, geographic location, and past experiences of discrimination as predictors of primary care status.
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Lauret, Fanny, and Stephanie Härdig. "Patients’ Communication with Primary Care: A Pre-study for a new communication system." Thesis, Linköpings universitet, Företagsekonomi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-131108.
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The purpose of this study is to explore patients’ experiences and preferences concerning communication with primary care, as well as their attitude towards a future digital system to manage communication. The Swedish county councils and municipalities (SKL) is developing a new digital tool as a complement in the communication between patients and physicians, thus this research is a preliminary investigation of a larger approach. The research has been based on 20 semi-structured interviews with patients in ages between 21 and 86 from 13 different health care centers in Sweden. The interviews indicate that the communication between patients and physicians needs development in numerous ways and that the system used by the primary care contributes to negative outcomes in the communication. Patients’ attitudes towards a new digital system to manage communication were investigated and a majority was positive. The study’s results pointed out the importance of the physicians’ attitudes in the physician-patient communication, and brought some possible improvements to be done in the actual primary care system; as for example implementing new communication channels to allow an easier contact of patients with their health care center. The new communication tool was overall well received and even appeared to be a suitable solution for some of the problems discovered along the patients’ journey. The overall results obtained are positive and promising towards its implementation in Sweden.