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1
MELO, ALEXANDRE CUNHA LOBO DE. "HOSPITAL MANAGEMENT: THE CASE OF PRIVATE HOSPITALS IN RIO DE JANEIRO." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2007. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=11057@1.
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Este trabalho tem por objetivo identificar quais são os
fatores críticos de
sucesso na gestão de um hospital e propor um modelo de
gestão baseado nas
melhores práticas de mercado. Partiu-se da proposição que
muitos destes fatores
estariam relacionados aos desafios enfrentados atualmente
pelos hospitais, às
estratégias adotadas, à forma de implementação dessas
estratégias e às tecnologias
de gestão empregadas. Assim sendo, foi feita uma revisão
da literatura sobre estes
temas e foram elaboradas perguntas de pesquisa sobre este
fundo teórico. Em
campo, foram pesquisados cinco hospitais particulares
situados na região
metropolitana do Rio de Janeiro. Todos eles têm as
cirurgias como uma de suas
principais atividades, a despeito de, também, realizarem
outros tipos de
atendimento. Assim, esses hospitais têm o médico como um
de seus principais
clientes na medida em que utilizam a estrutura hospitalar
para realizarem seus
procedimentos cirúrgicos. Os resultados revelam um mercado
hospitalar cheio de
espaços, com gestão predominantemente amadora e familiar e
com estratégias
informais. Na conclusão, é proposto um modelo de gestão
hospitalar que pode
ajudar os hospitais a se prepararem para a
profissionalização do mercado que está
por vir.This study`s objective is to identify the success critical factors in hospital management and to propose a management model based on the best practices in the market. It was presumed that many of these factors would be related to the challenges faced by the hospital in the market, to the strategies adopted, to the way these strategies are implemented and to the management technologies used. So, a literature review was made and the field questions were created focusing on these topics. In the field, five Rio de Janeiro metropolitan area private hospitals were studied. All of them have the surgeries as one of their main activities, despite of doing many other procedures. So, the doctors are one of their main clients, as far as they need the hospital structure to make their surgeries come to true. The results reveal a spacefull market, a lack of professional management as well as informal strategies. In the end, a hospital management model is proposed. This model may help the hospitals to make themselves ready to the market professionalization that must come soon.
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Nasr, Joseph Antoine. "Hospital governance in Lebanon : corporate and clinical governance in non-profit private hospitals." Thesis, University of Brighton, 2017. https://research.brighton.ac.uk/en/studentTheses/b678a511-2cda-46a6-982b-8f87bca20980.
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There are multiple internal and external governance mechanisms intended to ensure the functioning of corporations, while maintaining the interests of stakeholders. Although corporate governance is a growing area of research, empirical research is restricted. This research study critically examines historical definitions of corporate governance. It explains the relationship of corporate and clinical governance and explores clinical governance as a subset of hospital governance. It aids an understanding of hospital governance through an examination of the governance of a sample of nonprofit Lebanese hospitals. It examines the relationship of governance with performance. It explores how managers and clinicians are incentivized and the relationship of this to performance. It compares the governance processes between three hospitals and examines the influence of external factors. Mixed methods are used, including quantitative surveys that are developed and explored using factor analysis, and qualitative semi-structured interviews. The findings are used to critically examine major corporate governance theories and their relevance to understanding hospital governance, by understanding the perspectives of those employed in the hospitals. Using critical realism as a theoretical framework, the findings show how the mechanisms of hospital governance are perceived. The survey data from 207 participants were subjected to principal components analysis which resulted in a single factor solution representing individual perceptions of hospital governance for all respondents. The results of perceptions differed according to differences in managerial role, management experience, management education, leadership role, number of years working at the hospital, current role, and the hospital studied. Differences in age and gender had no significant effect. Findings also revealed that clear methods of performance measurement were perceived to be in used in each of the three hospitals, with a good knowledge of the used performance measurement. Hospitals have a good mission, and clear structures. There is a good knowledge of the external stakeholders to the hospitals and their roles, and the involvement of external stakeholders in hospitals is proven to be core to their overall ability to function. The hospitals have good clinical performance and governance systems in terms of quality and safety. On the other hand, there are management deficits. There is an absence of monetary incentives which was mainly caused by corporate governance events represented by a conflict of interest case. This appeared to be caused by the minor role of the board of directors, accompanied with the lack of adequate background, knowledge, and education of its members, resulting in a lack of control over the CEO. These corporate governance events were shown to change interviewees‘ perception of hospital governance. The hospitals also had problems with the internal reporting systems. The contribution of this study lies in illuminating the employees‘ perspectives of corporate governance in the hospital settings. It questions and informs theoretical approaches to the traditional principal-agent and stakeholder models. It creates tools for measuring clinicians‘ and managers‘ perceptions of hospital governance where they work. It shows how corporate governance ̳events‘ affect both clinical and corporate governance. It provides evidence of the importance of the stakeholder approach to hospital governance and demonstrates the influence of external factors on internal hospital governance.
3
Amin, Mohammad Ahsanul. "An analysis of private hospital markets in Bangladesh." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289877.
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Cherry, Jacqueline Helen. "The feasibility of the Uitenhage provincial hospital private initiative." Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1508.
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The South African Health Care environment is in state of reform. Government strategy and change in legislation have been the catalyst for the development of new business models in South Africa. This report deals with the feasibility of a proposed model which is to be implemented by the Eastern Cape Department of Health at the Provincial Hospital in Uitenhage. The fundamental challenge in South Africa is the shortage of resources to support the health care industry from a public perspective. The point of departure for this research was to understand the complexity of this industry and investigate models that have evolved in South Africa and internationally. The literature research covers funding mechanisms from both a public and private perspective and takes into account the role the government plays in providing equitable health care for all. The literature provided the foundation to develop the model which is to be piloted at the hospital in Uitenhage. In terms of the research objective, a single case study methodology approach was conducted. Triangulation technique was used to gain insight from different perspectives and to test the model for validity. The core of this research focuses on the viability of the proposed model and the integration of this into the government health reform plan. The research revealed that in comparison to the existing PPP models in South Africa, this model is feasible. As a result of the analysis and the development of the proposed model, the research is concluded by offering suggestions for further research.
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Unawunwa, F. O. "Ways to improve the efficiency of private hospital business administration." Master's thesis, Сумський державний університет, 2021. https://essuir.sumdu.edu.ua/handle/123456789/87228.
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Однією з найважливіших галузей будь-якої економіки є охорона здоров’я. Повільне економічне зростання загрожує країні з поганими системами охорони здоров’я та політикою. Протягом останніх років приватна медична галузь швидко зросла і зараз є ключовим джерелом медичної допомоги для багатьох людей. Однак ефективність деяких із цих установ знижувалася через такі фактори, як неналежне медичне обслуговування, медична халатність, недбалість, зростання медичних витрат та найм некваліфікованих працівників. Ці занепокоєння призвели до поганого надання послуг, негативного суспільного іміджу та скорочення клієнтів, що призвело до падіння ефективності приватних лікарень. Основною метою цього дослідження є пошук шляхів підвищення ефективності бізнес-адміністрування приватних лікарень. Для цього дослідження були використані підручники, журнали, відповідна література та Інтернет. Дослідження зробило висновок, що недостатнє фінансування та недостатній внутрішній дохід пов’язані з неправильним веденням обліку, чітко визначеними цілями та ефективним керівництвом. Бюрократія та втручання уряду в управлінські рішення додають до проблем, які постають адміністратори лікарень. У більшості лікарень навчання та розвиток робочої сили неефективні. Крім того, у цьому дослідженні було рекомендовано, щоб прозорість, підзвітність та процес прийняття рішень вимагали оцінки ефективності для покращення за допомогою впровадження найкращих практик. Лікарні повинні бути оцінені на предмет їх ефективності та ефективності, щоб забезпечити довгострокову підтримку. Огляд цих двох характеристик сприяє оптимізації розподілу ресурсів у сфері охорони здоров’я, що покращує економічний та соціальний добробут.One of the essential industries in every economy is health care. Slow economic growth risks a country with lousy health systems and policies. The private health industry has risen rapidly in recent years and is now a key source of health care for many people. However, the performance of several of these institutions has been declining due to factors such as inadequate medical care, medical malpractice, carelessness, rising medical costs, and the employment of unqualified workers. These concerns have resulted in poor service delivery, a negative public image, and customer attrition, leading to a drop in private hospital performance. The primary purpose of this study is to look into ways to improve the efficiency of private hospital business administration. Textbooks, journals, related literature, and the internet were used for this research. The study concluded that inadequate financing and insufficient internally generated revenue are due to improper record keeping, clearly defined objectives, and effective leadership. Bureaucracy and government meddling in management decisions add to the challenges posed by hospital administrators. In most hospitals, workforce training and development are ineffective. Furthermore, this study recommended that Transparency, accountability and the decision-making process all require performance evaluation to improve through the adoption of best practices. Hospitals must be evaluated for their effectiveness and efficiency to secure long-term support. The review of these two characteristics contributes to resource allocation optimization in healthcare, which improves economic and social well-being.
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Vides, Maria Lucia Pontes Capelo. "Identificação dos fatores que influenciam o médico no processo de tomada de decisão quando da indicação de um hospital para a internação de um paciente: proposição de um instrumento e estudo de caso." reponame:Repositório Institucional do FGV, 2018. http://hdl.handle.net/10438/24046.
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A gestão da competitividade nas organizações tem por prerrogativa a entrega dos melhores resultados de forma que se possa garantir o crescimento e a sustentabilidade de uma instituição. Para tanto, conhecer o cenário em que se está inserido e a dinâmica do setor é essencial para que se possa lograr êxito nesta caminhada. Vários e importantes atores compõem o mundo hospitalar, mas está na figura do médico o poder pela decisão da internação de um paciente, quando essa se faz necessário. Nesse momento, o médico exerce grande influência sobre a definição da instituição hospitalar na qual o paciente será internado. A oportunidade que se apresentou aqui, portanto, foi sobre a perspectiva de ouvir o médico de maneira estruturada, para poder entender o que é importante para esse profissional quando ele analisa uma instituição hospitalar, bem como a avaliação empreendida ao hospital que foi o objeto da pesquisa. Assim, propusemos um instrumento de avaliação da opinião do médico sobre fatores importantes na decisão de um hospital para a internação de um paciente. Adicionalmente, tal instrumento foi aplicado em estudo de caso, em um hospital privado de grande porte da Zona Sul do munícipio de São Paulo. O instrumento proposto mostrou-se eficaz na detecção de fatores importantes. Notou-se que esses fatores de importância podem ser avaliados em casos específicos, como o hospital em estudo. E nesse caso pode-se afirmar que os fatores 'Excelência no atendimento ao paciente', 'Sistema que garanta o exercício médico de forma ética' e 'Foco na segurança do paciente' são os que interferem na tomada de decisão pelo médico no momento da indicação ao paciente de um hospital para internação. Recomenda-se, então, que o presente instrumento de pesquisa possa ser aplicado em outros hospitais privados para aumento de competitividade, benefício da gestão hospitalar e sustentabilidade econômica.
The management of competitiveness in organizations has the prerogative to deliver the best results in a way that guarantees the growth and sustainability of an institution. To do so, knowing the scenario in which it is inserted and the dynamics of the sector is essential for the success of this journey. Several and important actors make up the hospital world, but it is in the figure of the doctor the power by the decision of the hospitalization of a patient, when this becomes necessary. At that moment, the doctor exerts great influence on the definition of the hospital institution in which the patient will be hospitalized. The opportunity presented here, therefore, was about the perspective of listening to the doctor in a structured way, to be able to understand what is important for this professional when he analyzes a hospital institution, as well as the evaluation made to the hospital that was the object of the research. Thus, we have proposed here an instrument for evaluating the doctor's opinion on important factors in the hospital decision for the hospitalization of a patient. Additionally, this instrument was applied in a case study, in a large private hospital in the southern part of the municipality of São Paulo. The proposed instrument was effective in detecting important factors. It was noted that these factors of importance can be evaluated in specific cases, such as the hospital under study. In the hospital under study, the factors 'Excellence in patient care', 'System that guarantees ethical medical practice' and 'Focus on patient safety' are those that interfere in decision making by the physician in the moment of the patient’s indication of a hospital for hospitalization. It is therefore recommended that this research instrument be applied in other private hospitals to increase competitiveness, benefit of hospital management and economic sustainability.
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Belkin, Markus, and markus belkin@rmit edu au. "An Assessment of Information Systems Effectiveness in Private and Hospital Pathology." RMIT University. Business Information Technology, 2009. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20090513.160738.
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This research investigates the role of laboratory information systems on business outcomes in medical pathology in Australia. Pathology information systems are inherently large-scale systems handling large numbers of data daily to service not only the pathology laboratory itself, but also referring medical practitioners. Patient results are often required in a
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Bosch, Annette. "An effective nursing staffing model for a private hospital / Annette Bosch." Thesis, North-West University, 2008. http://hdl.handle.net/10394/3631.
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Healthcare organisations in South-Africa are constantly looking for cost containment strategies, while providing and delivering effective healthcare and managing risk. Private hospitals must develop a cost effective staffing strategy to plan and meet present and future nursing needs. The need for safe and adequate nursing staffing levels is becoming more critical every day. Nursing shortages, combined with the increased workload it causes have to be addressed by nursing managers. The right number of nursing staff members with the right level of training and experience must be employed and retained to provide consistent high quality nursing care and guarantee patient safety.
Nursing workforce management is a major responsibility of nursing management. This research study identified, investigated and evaluated significant factors and trends that contribute to, or influence the determining of the staff component in nursing units in the South-African private hospital environment. Criteria for an effective nursing staffing model to assist nursing managers in workforce management were developed.
The study was conducted in two phases. A literature review and an empirical study were conducted. Information and the identification of factors influencing nurse staffing was obtained through the literature study. An empirical investigation was done to understand nursing staffing practices. Information was gathered through a questionnaire that was compiled as part of the qualitative research design. The various factors influencing the determining of nursing teams were empirically investigated and analysed. The including of factors in nursing staffing models was empirically tested.Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2009.
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Ahlström, Mandy, and Valles Carmelle Fajutrao. "Hand hygiene compliance among nursing staff in a Philippine private hospital." Thesis, Sophiahemmet Högskola, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-1585.
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Background Healthcare-associated infections constitute a threat to patient safety and an economic burden on health systems worldwide. The most effective way to prevent healthcare-associated infections is through proper hand hygiene practice, but studies show that compliance is low. In 2009, the World Health Organization released hand hygiene guidelines and tools to address the issue. Aim The aim of the study was to measure the compliance to the WHO Guidelines on Hand Hygiene in Health Care among nursing staff in a private hospital in the Philippines using the evaluation framework of the World Health Organization. Method The method used to assess compliance was structured direct observations using the World Health Organization’s observation form. Data was collected in 15 days, during full shifts, and analyzed quantitatively based on overall compliance, according to indication, ward, week day/weekend and shift. Results A total of 1920 opportunities were recorded, of which 336 were hand rub performances, 168 hand wash and 1416 missed opportunities, giving an overall compliance of 26.25 percent. The ward with the highest compliance rate was the Neonatal Intensive Care Unit (45.40 percent) and the lowest was Nursing Station 1 (22.26 percent). Conclusion The overall compliance rate of 26.25 percent is lower compared to most published studies and healthcare workers were more compliant to indications that protect themselves than to indications that protect patients. The results can be useful in improving quality of care and patient safety.
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McKnight, David. "Medication incidents in a private hospital : frequency, type, causes and outcomes." Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/1254.
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Background: Medication Safety has become a major health issue in Australia and internationally. Medication use is a part of most people lives with around seven in ten Australians and nine in ten older Australians having taken at least one medication over a two week period. But the taking of medications is not devoid of risk to the patient and a subsequent cost to society. This risk of an adverse outcome can be due to a predictable or idiosyncratic direct effect of the medication (adverse drug reaction) or a breakdown in the systems involved in the management of medications (medication incident). Although the risk of an adverse outcome is low and most medication incidents do not cause any harm, the volume of medications in use dictates that the problem when quantified is still significant. Following the publication of major patient safety studies it has become possible to estimate that almost 2 to 3 per cent of all hospital admissions are related to problems with medicines with an annual cost of $380 million.In 2002, following the publication of the Second National Report on Patient Safety ―Improving Medication Safety‖ it became apparent that despite medication safety issues growing in awareness in public hospitals, the same could not be said for private hospital practice which catered for about one third of all admitted patient episodes in Australia. Later that year a first step was taken with the Private Health Industry Quality and Safety workshop with representatives from most private hospitals attending. This meeting highlighted that medication safety practices at St John of God Hospital Subiaco was not aligned very well with public sector hospitals and that a number of deficiencies existed requiring urgent attention.Aims: This study had a broad range of aims. These were as follows: 1. To chronicle the development of medication safety procedures at St John of God Hospital Subiaco, nationally and internationally. 2. To quantify and uniformly classify, medication incidents reported from different sources in a private hospital. 3. To develop and assess a range of contributing factors as to why the medication incidents occurred. 4. To quantify the clinical significance of reported medication incidents. 5. To develop strategies to minimise/reduce the incidence of medication incidents in the future. 6. To investigate the influence of pharmacy ownership, location and employment of clinical pharmacists on medication incident reporting practices in Australian private hospitals.Method: The study was conducted in different phases. Initially the focus was a retrospective review of reported medication incidents in the hospital based on the date of occurrence of the medication incident rather than the date of review by a pharmacist. Secondly all incidents were then classified using a standardised format using the origin of the error. These included prescribing errors by medical practitioners, dispensing error by pharmacists and administration errors by nursing staff. Standard sub-categories were devised by St John of God Health Care, the national body coordinating the practices of all St John of God Hospitals, but in some instances they were noted to be too general. This led as part of this study to the development of more specific and sensitive categories for dispensing errors.Due to the realisation that medication error was now seen as a systems failure it was appropriate then to assess the risk to the patient and/or the organisation for a particular incident as well as determine some measure of harm to the patient. The level of risk associated with a medication incident was ranked according to the consequence of the incident and the likelihood of it recurring. Allied to this, a determinant of harm suffered by a patient following an incident or error was devised and promoted which differentiated harm into potential and actual harm.To further gauge private hospital medication safety practices, a national survey was undertaken of Australian private hospitals to gain an insight into the methodology used to collect and collate medication incidents and the roles played by pharmacy services in that process. In particular the survey sought to determine the influence of the ownership and location of the pharmacy service on those practices along with the employment or not of clinical pharmacists.Results: The classification of medication incidents by the date of occurrence aided in the assessment of why an incident occurred as it now became possible to study whether the ward location and day or time of an incident contributed in any way to causing that error. The classification of medication incidents by their origin in the medication cycle, highlighted that most incidents were reported by nursing staff and were therefore heavily weighted towards administration errors, which embodied their core medication function.The development of knowledge and understanding surrounding the causes and contributing factors associated, in particular with administration and dispensing medication errors, has helped to retrain caregivers to seek ways to avoid the incident in the future rather than focusing on any individual blame for what is a system failure.The clinical significance of a particular incident both to the patient and to an organisation can be more adequately assessed if a risk stratification and harm model is in place. This is apparent when dispensing errors were assessed as clinically significant to the pharmacy department but from a hospital perspective were noted only to have a potential for harm. In contrast, while the majority of administration errors had the potential for harm, some did cause actual harm.With the awakening of the need to improve our medication practices, the Pharmacy Department and the Hospital have committed to embracing more fully those practices more commonplace in public hospitals. These included having an active Drug and Therapeutics Committee and the implementation of clear medication polices and guidelines. Other initiatives have been embraced such as the use of standardised medication charts and ensuring a strong focus on medication reconciliation at the transitions of care. This included the employment of more clinical pharmacists to service areas such as preadmission and high risk areas such as Intensive Care and Oncology.The survey, with a response rate of 43%, highlighted that pharmacy services in private hospitals in Australia were either located On Site (52.8%) or Off Site (47.2%) and were either Hospital Owned (22.2%) or Contracted Out (77.8%). On Site pharmacy respondents were significantly more likely to be involved in the review of medication incidents (p = 0.047), have a policy on medication safety (p = 0.024), employ more clinical pharmacists (p = 0.006) and have a higher mean number of medication incidents reported (p = 0.001) as compared to Off Site pharmacies. Pharmacy providers who employed clinical pharmacists were more likely to be involved in the review of medication incidents (p = 0.02). Hospital Owned services were more likely to report a higher number of medication incidents (p = 0.011) and be On Site whilst Contracted Out services were more likely to be Off Site (p = 0.026).Medication safety has grown to become an international phenomenon. Two of the World Health Organisations top five priority areas to improve patient safety worldwide involve medication usage. In Australia, the formation of an active Australian Commission on Safety and Quality in Health Care, has provided leadership to all hospitals both private and public whilst at state level Medication Safety Groups drive more local state based issues. The willingness of some private hospitals to embrace fully the concept of medication safety is very evident at St John of God Health Care where a national medication reference group was set up to lead all their hospitals along a common path and this has been complemented recently by the formation of a medication safety committee at the Subiaco campus.Conclusion: The safe use of medicines is still a major issue. Medication errors are now recognised to be a system failure. Great progress has been made to improve the system of how we manage medications in our hospitals, but the system must continue to evolve. Gaps still exist that need addressing to make our hospitals safer. The various private hospital models that exist lend themselves to differing levels of service and participation in medication safety. It is vital that the Australian Council for Health Care Standards, the private health insurers and the Commonwealth Health Department develop a higher expectation from all private hospitals to ensure systems are in place so that patients are safe regardless of the health care environment they enter.
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Sousa, Jorge Humberto Vasques de. "Os enfermeiros e as dimensões motivacionais : estudo não experimental, descritivo, analítico e transversal, baseado na técnica de inquérito." Master's thesis, Universidade Nova de Lisboa. Escola Nacional de Saúde Pública, 2012. http://hdl.handle.net/10362/9706.
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RESUMO - A profissão de enfermagem é definida por Virgínia Henderson (1966), como tendo por objeto "ajudar o indivíduo, saudável ou doente, na execução das atividades que contribuem para conservar a sua saúde ou a sua recuperação, de tal maneira, devendo desempenhar esta função no sentido de tornar o indivíduo o mais independente possível, ou seja, a alcançar a sua anterior independência".
A atenção à saúde ao longo da história da humanidade vem sendo desenvolvida de muitos modos e por diversos atores sociais. O trabalho em saúde é essencial para a vida humana e envolve atividades realizadas por profissionais e equipas multidisciplinares que dominam os conhecimentos e técnicas essenciais para assistir o indivíduo com problemas de saúde ou em risco de adoecer, em atividades de investigação, de prevenção, curativo e de reabilitação.
À Enfermagem tal como a outras profissões, são cada vez mais exigidos requisitos de eficiência, eficácia e polivalência na sua atividade, tendo a motivação um papel fundamental na atitude, postura e desempenho do profissional.
Este trabalho descreve o estudo da motivação profissional, numa população de enfermeiros portugueses numa instituição privada. A versão adaptada de um inquérito como instrumento de autopreenchimento representa vários construtos implicados no processo motivacional, em contexto profissional.
Pretendo com este estudo identificar a dimensão da motivação mais relevantes no processo motivacional dos enfermeiros, assim como as suas variações face a variáveis de características pessoais, profissionais e institucionais.
A partir dos resultados obtidos pretendo ainda apresentar sugestões de maneira a oferecer oportunidade de transformação do seu ambiente organizacional em instituições similares.ABSTRACT - NURSES – AND THE MOTIVATIONAL FACTORS The nursing profession is defined by Virginia Henderson (1966), as "helping the individual, healthy or sick, in carrying out activities that contribute to maintain its health or its recovery, so, should perform this function in order to make the individual as independent as possible, to reach its previous independence.” The health care throughout the history of mankind is being developed in many ways and by various social actors. Health work is essential to human life and involves activities conducted by multidisciplinary teams and professionals who have mastered the essential knowledge and skills to assist individuals with health problems or at risk of becoming ill, in research, prevention, curative and rehabilitation. In nursing as other professions are increasingly required requirements of efficiency and effectiveness in its work. Motivation plays a key role in attitude, posture and professional performance in the company. This paper describes the study of professional motivation, in a Portuguese population of nurses at a private institution. The adapted version of a survey as a self-fulfilling represents various constructs involved in the motivational process in a professional context. I intend to make this study a comparative analysis of the level of motivation and the identification and correlation of the most important needs that affect their motivational process. From de results obtained still want to make suggestions in order to offer the opportunity to transform their organizational environment in similar institutions.
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Lynch, F. J. "Acute hospital services in Ireland : a contribution to the public-private debate." Thesis, Queen's University Belfast, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.437846.
Full text
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Kruger, Daniel Frederik. "Evaluation of primary non-compliance with discharge medication at a private hospital." Thesis, University of Limpopo ( Medunsa Campus), 2009. http://hdl.handle.net/10386/203.
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Thesis (MSc. (Med.)(Pharmacy))--University of Limpopo, 2009.ABSTRACT Background: When a patient is discharged from the hospital, the doctor may prescribe medication to be used at home which is called TTO (To Take Out) medication. Failure by the patient to collect TTO medication might be intentional or may indicate a lack of appropriate structures and procedures at the hospital to provide such care on discharge, and/or failure by the health care professionals to reach concordance with the patient to ensure that he/she continues to take medications as prescribed. Objectives: The purposes of this study were to examine the prevalence of primary non-compliance with medication in this private hospital and to explore its association with various factors contributing to its existence. Methodology: The study was conducted at a private hospital in Gauteng, South Africa. The study focused on discharged patients who did not redeem their TTO medication. Thus only patients discharged from the hospital within a thirty day period between 25 May 2009 and 23 June 2009 were included in the study. For each subject the discharge medication prescription was reviewed and the following determined: number of items prescribed, number of items dispensed at the hospital pharmacy, whether any items were non-dispensed, whether any items were partially dispensed and reason for any item non-dispensed or partially dispensed. A telephone call was made to those subjects for whom a discharge medication script was prescribed, but no medication was dispensed at discharge. Information was collected from the patients to identify possible reasons for not redeeming discharge medication. Results: In total 1365 records were evaluated. TTO medication was prescribed for 1161 (85%) patients discharged. All items were redeemed in full by 854 (74%) of the patients, 118 (10%) patients redeemed no discharge medication, 101 (9%) patients redeemed only some items prescribed, 74 (6%) patients redeemed all items partly, 14 (1%) patients redeemed some items partly and some not at all and for seven v patients details were not known. Four reasons and five types of medication together accounted for 54% of the total value not redeemed. The four reasons include the following: medical aid TTO rules, patient unaware of TTO being prescribed, ward stock given, patient still had stock at home, and the types of medication included: blood and haematopoietic agents, analgesics, antimicrobials, agents of the gastrointestinal tract and unclassified. Conclusion: Some patients reported that they took own decision not to redeem the medication and some still had stock at home, a fact that should lead healthcare providers to ensure that they reach concordance with their patients.
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Kotze, Frederika Jacoba. "A historical perspective : private nursing institutions in South Africa (1946-2006) / Frederika Jacoba Kotze." Thesis, North-West University, 2012. http://hdl.handle.net/10394/8436.
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During the twentieth century, Nursing Education in South Africa was
traditionally provided by the public sector and religious orders. Sr
Henriëtta Stockdale played a major role in the development of nursing
education and the governing thereof.
In 1914, the establishment of the South African Trained Nurses’ Association (SATNA)
marked the drive for an improved system of education for professional nurses. Medical
practitioners and members of the Colonial Medical Council supported this initiative. The
Provincial Medical Councils recommended a uniform system of education, to abolish the
apprenticeship system of training and that students should be supernumerary. However, it
was difficult to persuade authorities to accept the recommendations. The apprenticeship
system prevailed, except for Groote Schuur Hospital where a block system was introduced
(Searle, 1965b:287).
Nursing training at university level has been advocated by SATNA since 1914. Due to
financial responsibilities and the limited number of recruits that met the entry requirements of
tertiary institutions, it was unsuccessful. Furthermore, university training of nurses restricted
the placement of student nurses at large hospitals linked to universities. In 1933, the
University of Cape Town and the University of the Witwatersrand became the first two
universities in South Africa to have nurses on campus (Potgieter, 1984:1).
In 1916, the training of male nurses in the mining industry was allowed for the first time. All
training interventions were funded by mining houses and could therefore be regarded as the
first Private Nursing Education Institution (PNEI). In 1946, a small nursing school was
established on the East Rand under the Simmer and Jack Native Hospital. The purpose was
to train white male orderlies for medical stations at mines. This was the beginning of PNEI in
South Africa. PNEI are still functioning presently. The role and contribution of these
institutions to nursing education in South Africa are often ignored.
The researcher strove to answer the following question: What is the history and
development of PNEI and their contribution with regard to nursing education in South Africa
from a historical perspective? The objectives of the study were to explore, describe and
record the history of the development of PNEI and their contribution to nursing education in
South Africa. The motivation for the private health care industry to embark on the
establishment of Nursing Education Institution (NEI) was investigated and described. A qualitative research design and an explorative, descriptive, contextual, historical research
approach were applied. Explorative research involves the exploration of the phenomenon to
divulge its core components. A descriptive study design aimed to find more information on
the topic within this particular field of study was also used. The topic and context of this
study is PNEI in South Africa between 1946 and 2006. The purpose of the study is to
preserve the history of the development and contribution of PNEI including Gold Fields
Nursing College, Netcare Training Academy, Life Nursing College, Medi-Clinic Learning
Centres and Gandhi Mandela Nursing Academy between 1946 and 2006. This research
study is presented as a chronological narrative report (Objective 1).
Data collection was done by individual oral history semi-structured interviews with
information-rich individuals as well as document analysis. Oral history semi-structured
interviews had been recorded after which each interview was transcribed verbatim. Data
analysis was done by narrative and document analysis. Scientific rigour was ensured
throughout the study. Objective 2 and Objective 3 were achieved through data collection and
analysis.
Recommendations based on the findings are made for nursing research, nursing education
and nursing practice.Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2012
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Al-Shekh, A. A. A. "Perceptions of hospital experiences in Riyadh City, Saudi Arabia : a comparison of service quality in public and private hospitals." Thesis, Swansea University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.635728.
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This study is about patients’ and doctors’ perceptions of services provided by hospitals in Riyadh City, Saudi Arabia. To the best of the researcher’s knowledge, this is the first study, at PhD level, that includes Saudi private sector hospitals, and consequently it compares the public and private sectors, using variations of SERVQUAL, an instrument developed by Parasuraman et al (1988). This study included 531 patients and 172 doctors selected from two Ministry of Health and two private hospitals. The findings include the discovery that hospitals in both sectors pride themselves in doing what patients value least, and doctors and patients have wholly different constructions of what constitutes a satisfactory hospital experience. Generally, hospitals owned by the Ministry of Health perform worse than private hospitals, as perceived by their patients. This may explain why those who can afford it have been seeking healthcare services in the private sector even though they are eligible for the free-of-charge public services. Moreover, patients of both sectors have the same priorities and expectations. What differentiates patients of the two sectors is their perceptions of the actualisations of aspects related to those dimensions, and their satisfaction with the delivery of these important dimensions by their hospitals. Significant differences were detected between patients who propose to stay and those who propose to switch, and between patients who intend to recommend and those who intend not to do so. In addition, significant differences, in service quality perceptions, exist between patients who reported complaints and patients who did not, and between patients whose complaints were resolved and those whose complaints were not. Also, significant negative relationships were found between the reporting of complaints by patients and future behavioural intentions to reuse and recommend their current hospital. Also, significant relationships were found between the resolving of complaints by hospitals and patients’ future behavioural intentions to reuse and recommend their current hospital. It is argues here that managers of Saudi hospitals should put forth all efforts to satisfy patients and meet their needs in order to keep them and ensure that they spread positive, rather than negative word-of-mouth advertising. And, if dissatisfaction still occurs, it should be kept at a minimum level by encouraging dissatisfied patients to express their dissatisfaction and report their complaints.
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Chilongani, Joseph Elieza. "The private practice within public hospitals in Tanzania : an exploratory study at Muhimbili national hospital and Bugando medical centre." Master's thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/9443.
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Bibliography: leaves 50-51.In the late 1980s, many governments in the low-income countries could not fund their health care budgets adequately due to poor availability of fmancial resources. This resulted into deterioration of the public health sectors in general. Inadequacy of consumables and other supplies, and low payment for health workers were among the problems faced. Governments in some of these countries introduced public private mix (PPM) to address these problems. In 1996, the government of Tanzania allowed private practice in public hospitals called 'the fast track' service. This study investigated the organizational and management system of this type of PPM, its impacts and the factors determining people's demand for the fast track service. Data was collected through interviews with health care providers and patients, and document reviews. Systematic and random sampling methods were used to select participants. Data was analysed using STAT A package. The study found that the executive directors of the hospitals headed the fast track management teams, with the executive committees coordinated by the executive secretaries. The committees included specialist doctors involved in the PPM. The study findings also show that about 85% of health care providers reported that the practice played an important role in supplementing the hospitals' budgets as well as health workers' incomes. In one of the study hospitals, the "fast track" services contributed more than 26% of the total income during a 5-year period. Likewise, it has significantly improved the access to health care services. This was achieved through retaining health workers, improving the infrastructure, adequate supply of consumables and drugs, and raising funds to subsidise treatments for poor patients. However, the fast track services resulted in specialists spending less time with public patients. In addition, the standards of private care were still lower in the "fast track" when compared to what is expected in a private health care setting, and private patients were offered very poor diagnostic tests and investigation services. Concerns were also raised about the poor management of the funds generated from private services.
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Hansen-Salie, Nasieba. "Professional nurses' perceptions of newly qualified professional nurses competency and factors influencing competency." University of the Western cape, 2011. http://hdl.handle.net/11394/5406.
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Magister Curationis - MCurIn our constantly changing healthcare system and with large numbers of staff shortages in hospitals, newly qualified professional nurses are expected to be competent and work unsupervised in leadership capacities soon after they have completed their nursing programs. The study was aimed at determining the perceptions of professional nurses of newly qualified professional nurses' competency as well as factors that influence competency. A quantitative approach using a descriptive survey design was employed, using 34 experienced professional nurses working in selected private hospitals in the Western Cape. Data was collected by means of a peer evaluation questionnaire, namely the Competency Inventory for Registered nurses. Data was analyzed, using IBM SPSS 19 with the assistance of a statistician. The results of the 55-item Competency Inventory for Registered Nurses indicate that newly qualified nurses were perceived as highly competent in clinical care, leadership, interpersonal relation, legal/ethical and professional development. Newly qualified nurses were perceived as low in competency in teaching/coaching, critical thinking and research aptitude. All the factors identified using literature, were perceived as having an influence on competency. Recommendations were made to the institutions to assist newly qualified nurses in competence development.
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Theunissen, Dirkie Petra. "Improving service quality and operations at a South African private healthcare clinic through the implimentation of lean principles." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1020654.
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Although open to debate, it is something of an undisputed fact and has been since the days of Florence Nightingale, that hospital management is frustrated with recurring problems - many of them due to broken processes. Hospitals are places of phenomenal healing and heroic care. However, as with any human-led endeavour, there are problems. (Grunden (2009)) A first time use of the word ‘lean’ generally begs some explaination as it is not a commonly used word. The simplest way to explain the word is by way of the introduction of the concept known as ‘lean management’. Lean management is a methodology which allows hospitals to advance the quality of patient care by reducing errors and waiting times. Lean is a system of reinforcement of hospital business for the long term thereby reducing costs and risk. Kanban (2009) states that lean is a toolset; a management system and a viewpoint that can change the way hospitals are structured and managed. Lean helps managers to comprehend and identify broken systems and to improve these in small parts, while employees aid in finding solutions for broken systems. This proposal analyses the effect lean tools have had within Arwyp Medical Centre in Kempton Park, South Africa.
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Theunissen, Dirkie Petra Stephanie. "Improving service quality and operations at a South African private healthcare clinic through the implimentation of lean principles." Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/d1019943.
Full textAbstract:
Although open to debate, it is something of an undisputed fact and has been since the days of Florence Nightingale, that hospital management is frustrated with recurring problems - many of them due to broken processes. Hospitals are places of phenomenal healing and heroic care. However, as with any human-led endeavour, there are problems. (Grunden (2009)). A first time use of the word ‘lean’ generally begs some explaination as it is not a commonly used word. The simplest way to explain the word is by way of the introduction of the concept known as ‘lean management’. Lean management is a methodology which allows hospitals to advance the quality of patient care by reducing errors and waiting times. Lean is a system of reinforcement of hospital business for the long term thereby reducing costs and risk. Kanban (2009) states that lean is a toolset; a management system and a viewpoint that can change the way hospitals are structured and managed. Lean helps managers to comprehend and identify broken systems and to improve these in small parts, while employees aid in finding solutions for broken systems. This proposal analyses the effect lean tools have had within Arwyp Medical Centre in Kempton Park, South Africa.
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Mendes, Natália Freitas. "Modelo de financiamento alternativo às Parcerias Públicas-Privadas na Saúde para a construção do Hospital Oriental de Lisboa." Master's thesis, Instituto Superior de Economia e Gestão, 2012. http://hdl.handle.net/10400.5/10428.
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Mestrado em Economia e Políticas PúblicasEm Portugal, em 2001, foi anunciada a construção de 10 novos hospitais em regime de PPP com a inovação de incluírem a gestão clínica durante 10 anos. Estes hospitais de 1.ª vaga (apenas 3 em funcionamento - Cascais, Braga e Loures - e o de Vila Franca Xira a concluir a sua construção) representam um encargo no ano de 2012 de 300,5 milhões de euros e continuarão a constituir encargos para o Orçamento Estado nos próximos 30 anos em amortizações e juros, pelo que se tem questionado se a contratação tradicional (construção e gestão pública) não será financeiramente mais adequada. No presente trabalho pretende-se estudar uma alternativa, com financiamento público resultante da venda do património dos hospitais substituídos e gestão pública tradicional. O caso em estudo é a construção do Hospital Oriental de Lisboa. Para identificar a necessidade deste novo investimento e, por isso, quais os hospitais a substituir, foi utilizado o Plano Diretor Regional (2002), único instrumento de planeamento regional conhecido. O trabalho valoriza o património daqueles hospitais, atribuí um custo à construção do novo hospital pelo modelo tradicional, considera o seu custo em PPP e compara o orçamento de exploração deste com o dos hospitais substituídos. Ficou assim evidenciada dentro de um conjunto de pressupostos, a vantagem da reorganização da rede hospitalar substituindo 5 antigos hospitais pelo Hospital Oriental de Lisboa e neste caso, a vantagem na substituição do atual modelo PPP pelo modelo de contratação pública tradicional com financiamento público.
In 2001, the Portuguese Government announced the construction of 10 new hospitals under a Public-Private Partnership (PPP) regime with the innovation of including private clinical management for a period of 10 years. This first wave of hospitals represents a financial commitment of 300.5 million Euros in 2012 and it will continue to burden the Portuguese state budget over the next 30 years in amortization and interest payments. This methodology has drawn criticism from opinion-makers from different political and social persuasions - including from those who initially advocated for such a model. The purpose of this study is to present an alternative based on traditional public management financed by public funding resulting from the sale of assets from the replaced hospitals. The case study presented pertains to the construction of the Lisbon Eastern Hospital. The present study evaluates the assets of those hospitals, assigns a cost to the construction of the new hospital using the traditional model, considers its total cost within the PPP logic and compares its operating budget with that of the replaced hospitals. This study aims to show that there is an advantage in the reorganization of the hospital network by replacing the 5 older hospitals with the new Lisbon Eastern Hospital. It also shows that it is more advantageous for the State to replace the current PPP model with the traditional public financing model.
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Linden, Andrew. "Measuring hospital efficiency using DEA an investigation into the relationship between scale and efficiency within the South African private hospital environment." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/5811.
Full textAbstract:
Includes abstract.Includes bibliographical references.
This paper investigates the relationship between scale and efficiency through the application of Data Envelopment Analysis (DEA) to a set of South African private hospitals over the three year period from 2007 to 2009. As part of the investigation, this paper provides a description of the current research into scale and efficiency with a focus on definition and measurement. It also provides an introduction to DEA as a tool for measuring the relationship between hospital scale and efficiency. Based on the underlying set of private hospitals, this investigation found that scale efficiency improvements are likely to be possible.
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Batuka, Nabawesi Jennifer. "Pre and post computerized radiography film reject analysis in a private hospital in Kenya." Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/1574.
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The production of good quality radiographs is a complex process, given the high level of image quality required (Sniureviciute & Adliene, 2005: 260). Exposure of patients to x-rays, a factor in the production of quality radiographs also entails a risk of radiation injury. In 2006, computerized radiography (CR) was introduced at The Nairobi Hospital to try and reduce the film reject rate, decrease repeats, reduce financial costs of consumables like x-ray films and processing chemicals. However, to date, no formal film reject analysis has been conducted at The Nairobi Hospital. Four years after the incorporation of CR, there is apparently, still a significant number of film rejects, implying operational costs may still be high. The cause of film rejects and overall reject cost is not known. This has led to the research question: “Has the film reject rate in the A & E x-ray unit at The Nairobi Hospital reduced following incorporation of CR?” A quantitative, retrospective, descriptive study involving a reject film analysis of rejected radiographs in the Accident and Emergency (A&E) x-ray unit in the Nairobi Hospital, Kenya was conducted. The researcher collected data for a period of 6 months between 2/12/07 and 28/05/08 using a purpose-designed data collection form. All rejected x-ray films during the study period were included. Capture and analysis of the collected data was completed by the researcher using SPSS 10 and EPINFO computer packages. Permission to conduct the study was obtained from The Nairobi Hospital Education Committee and due consideration to patient and radiographer confidentiality was maintained throughout the study. A total of 851(2.5 percent) x-ray films were collected during the study period. Four hundred and fourteen (2.6 percent) radiographs and 437 (2.5 percent) radiographs were rejected prior to and after the incorporation of CR respectively. Chest radiographs were the most frequently rejected accounting for 277(66.9 percent) and 123 (28.1 percent) prior to and after the incorporation of CR respectively. The most frequently rejected film size was 35x35cm prior to the incorporation of CR (61.6 percent) and 26x35cm film size after the incorporation of CR (91.3 percent). The most frequent cause of film rejects was radiographer causes both prior to and after the incorporation of CR accounting for 496 (58.3 percent). The film reject rate did not significantly reduce after the incorporation of CR, suggesting that there are other factors which contribute to reject rate, other than CR. The study also shows that higher film consumption does not necessarily lead to high reject rates. The percentage value on annual rejects did not change after the incorporation of CR and a demonstrated increase in the annual cost of purchasing x-ray films was attributed to an increase in annual consumption after the incorporation of CR, and also to the higher cost of digital x-ray films. Despite some identified limitations to this study, some recommendations, which included conduction of regular reject analyses and regular continuing professional development with respect to radiographic technique amongst others, were suggested.
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Van, Heerden Johannes Francois. "Customer service at a private hospital in the North–West Province / Johannes van Heerden." Thesis, North-West University, 2010. http://hdl.handle.net/10394/4503.
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The South African private healthcare industry is a very competitive market. The three
key role players in this industry all market themselves as institutions that provide
quality care and service. As a result of this marketing, customers attend these private
institutions with the expectation that they will receive quality service.
This study centres around the research of customer service at a private hospital or
private healthcare institution. The objective was to measure the expectations and
perceptions of customers who made use of the services at the private healthcare
institution. Thereafter, the gaps between the expectations and perceptions were also
analysed in order to determine the practically significant areas for management to
focus their improvements on with regards to the quality of service system.
The literature review revealed that the SERVQAUL model is the optimal instrument to
be used to measure the expectations and perceptions of customers at a service
institution of this nature. The model also provides a way of measuring the gaps that
exist between the customers? expectations and perceptions, by adapting an instrument
of 22 statements to the specific industry. The 22 statements measure the quality of
services across the five SERVQUAL dimensions, namely tangibles, reliability,
resposiveness, assurance and empathy. This provides valuable data for effect size
analysis in all five of the SERVQUAL service quality dimensions.
The results revealed that customers? expectations of the service quality at the private
healthcare insittution were high. The average score for the 22 expectation statments
was 6.56 out of 7.0. The customers' perceptions of the service quality at the private
healthcare institution, were high, but, however, lower than the expectations average.
The average score for the 22 perception statements was 6.17 out of 7.0. This
indicated that there was a difference between the perception of healthcare services
and that which was expected of the healthcare institution.
The reliability of the SERVQUAL instrument, was done by the calculation of a
Cronbach Alpha for each of the five dimensions of the instrument and an average of
0.875 was achieved. This indicated a high reliability of the data.Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2011.
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Lang, Andreas Michael. "Healthcare infrastructure Public-Private Partnerships in Developing Countries : the Queen 'Mamohato Hospital in Lesotho." Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104519.
Full textAbstract:
Thesis: S.M. in Management Studies, Massachusetts Institute of Technology, Sloan School of Management, 2016.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 83-86).
Over the past decade, Public-Private Partnerships (PPPs) have increasingly found their application in the sector of health infrastructure. The objective of this paper is to determine whether PPPs are a viable option for health infrastructure projects in developing countries. For this purpose, the author discusses and describes PPPs in general and specifies features of PPPs, which may be relevant for the healthcare sector and developing countries. In a next step, the author extensively analyses the Lesotho New Hospital PPIP case study and establishes key learnings from the undertaking. The combined evidence suggests that the PPP model for health infrastructure projects in developing countries is not recommended as a result of its high complexity and wide spectrum of underlying obstacles. Therefore, the author suggests developing countries' governments to engage in smaller and less demanding PPP projects in order to acquire the skills and expertise that are required for large-scale health infrastructure PPP projects. Keywords: Public-Private Partnership, PPP, 3P, integrated, PPIP, healthcare, infrastructure, finance, new hospital, Queen 'Mamohato Hospital, Queen Elizabeth II Hospital, developing countries, emerging markets, World Bank Group, International Finance Corporation, IFC, Oxfam, Tsepong, Netcare, Maseru, Lesotho, Bloemfontein, South Africa.
by Andreas Michael Lang.
S.M. in Management Studies
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Osman, Sharina. "Building reputation through organisational values : a case study of a private hospital in Malaysia." Thesis, University of Exeter, 2017. http://hdl.handle.net/10871/29017.
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Theories within organisation and management studies have offered several concepts and models which indicate that organisational values are important factor for organisational success, including reputation building. Nevertheless, existing theory is still inadequate to explain the link between organisational values and organisation’s reputation because it does not account for the enabling factors that underlies the two concepts. This study argues that the implementation of organisational values is an important organisational action for acquiring positives perceptions of organisational values which influences employee behaviour and shapes organisational reputation. It specifically shows and elucidates the enabling mechanisms that reinforce organisational values to impact on employee perceptions and behaviour. This is important because when employees share and exemplify the values in their work, they are likely to behave in ways that support the organisation’s strategy which impacts on external perceptions and build reputation. This study employed a qualitative approach through a single in-depth case study. It reflects that the understanding of ‘what is going on’ within organisation is most appropriately achieved by building concepts and constructs from empirical studies. By using semi-structured interviews, focus groups and non-participant observations, the data develops and evolves through the responses and behaviours of participants. Employees were selected through purposive sampling and the snow-balling technique was used to reach customers. The data were structured and coded using thematic analysis. The findings revealed that the process of aligning organisational values and employee values is significant for understanding how organisational values influence employee behaviours, which in turn enable the organisation to build its reputation. The data suggest that four remediation phases: aware, articulate, accept and act, are important for explaining how a gap between organisational values and employee values can be reduced. This remediation process enabled the senior management team and employees to understand how their perceptions and reactions towards the implementation of organisational values impact upon attitudes and behaviours. The findings suggest that organisational values can be reinforced through various social influences. Social interactions can occur in different forms including the involvement of leaders of the management team in creating, exampling and communicating values as well as through expanding the employee’s role in enacting values through empowerment and trust building. However, the findings emphasise that the process of cascading and instilling values through a top-down or hierarchical is no feasible. Instead, it is a hybrid approach that requires employee buy-in and involvement especially in communicating and enacting organisational values. This is an important insight because employees regularly interact with each other which provide a valuable platform to persuade and influence other colleagues to embrace organisational values. Additionally, the findings also build on the reputation literature by demonstrating the role of reciprocity and mimicking in behaviour as the consequences of social interactions within the organisation. The opportunity to regularly interact with colleagues enables employees to want to reciprocate in return for what they have received in the workplace. This tacit understanding of reciprocity for mutual benefit and the tendency to imitate other’s behaviour improves employee perceptions of organisations which in turn contribute towards reputation building. The study advances current understandings in the organisational reputation literature by providing a unique theoretical and empirical insight into how organisational values can impact on reputation building. It also highlights the important role of internal mechanisms for shaping both internal perceptions and behaviour as well as external perceptions of organisations.
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Du, Preez Monique. "Implementation of a blood conservation program in the private hospital setting in South Africa." Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/24886.
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Although blood products are a great deal safer these days than in the past, patients receiving allogeneic blood transfusions are still exposed to potential hazards such as infectious diseases and immunomodulatory reactions. Therefore it is important to consider alternatives to allogeneic blood use. This can be done by means of blood conservation alternatives. A successful blood conservation program consists of three integrated phases, namely pre-operative, intra-operative and post-operative stages of patient care. The main objective of this study was to create a transfusion medicine database in order to evaluate the effect of a blood conservation program on the length of hospital stay of patients and the costs incurred in such a program. Five pilot hospitals who had implemented a blood conservation program were compared to five non-pilot hospitals (no blood conservation program). The results show that the average cost related to allogeneic blood usage in pilot hospitals amounted to R 473 274.13, compared to R 777 646.22 for the non-pilot hospitals. Length of hospital stay was also significantly lower in patients receiving blood conservation alternatives compared to patients receiving allogeneic blood. The total costs related to patients of blood conservation was lower, although not significantly, than the total costs of patients using allogeneic blood or both. In this study it was seen that the outcomes were positively associated with the implementation of blood conservation techniques. The efficacy of two leukodepletion methods for allogeneic blood products namely pre-storage and post-storage filtration, were evaluated. The results revealed that the mean leukocyte count of pre-storage leukodepleted blood samples (n = 30) was 0.12 cells/μl. The mean leukocyte count of the post-storage filtered blood samples (n = 20) was 0.05 cells/μl. Both methods were shown to be successful in the efficient removal of leukocytes. CopyrightDissertation (MSc)--University of Pretoria, 2011.
Immunology
unrestricted
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Carney, Caitlin. "Clinical Simulation Laboratories: Bridging the gap between academia and the private care hospital setting." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/honors/41.
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Many academic medical programs present students with the chance to experience scenario based learning. This is often achieved through the use of clinical simulation laboratories which utilize computer-based scenarios that realistically imitate the human body and how it responds to various situations. This interactive style of learning has proven to be successful at integrating theories taught in textbooks and practice gained through clinical experience without posing any harm to human patients. Literature has shown documentation of the effectiveness of using clinical simulation laboratories in both the academic and clinical setting; however, some clinical facilities have been slow to adapt the use of this technology. The purpose of this study was to determine what factors are deterring the use of clinical simulation labs for the purpose of continuing education in the hospital setting. The study was limited to the field of respiratory therapy. The study was conducted by sending surveys to respiratory therapists and administrators working in acute care facilities in the Northeast region of Tennessee and the Southwest region of Virginia. The surveys included various questions concerning knowledge and perceptions of clinical simulation labs. The surveys were coded using a modified Likert scale, and the data was input into SPSS Version 18.0. Sample t-tests were then run where appropriate. Therapists indicated a preference for learning through the use of clinical simulation labs as opposed to learning through textbooks alone. Administrators indicated a knowledge of the benefits of clinical simulation labs even though the majority are not currently using the technology in their facilities.
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Рябоконь, О. А. "Оцінка пріоритетів населення при виборі між приватною та державною формами організації лікувальних установ." Thesis, Сумський державний університет, 2015. http://essuir.sumdu.edu.ua/handle/123456789/41910.
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Wegoye, Emmanuel. "Radiotherapy for head and neck paragangliomas: A 10 year retrospective review 2005-2014 at Groote Schuur Hospital and UCT Private academic hospital." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30840.
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Objective. Over the last two decades there has been increasing evidence that radiosurgery and radiotherapy management of skull-base paragangliomas is as effective as microsurgical resection and carries less morbidity. This 10 year retrospective review of 24 patients in a single institution, treated over 10 years assesses tumour control rates and morbidity associated with radiosurgery and radiotherapy treatment. Method. Patients with a radiological diagnosis of skull-base paragangliomas were treated with different techniques of stereotactic and image-guided radiotherapy delivering hypo fractionated irradiation. Techniques used included conventional radiotherapy or intensity modulated radiotherapy (IMRT), dynamic arc (DA) and volumetric modulated arc therapy (VMAT). Analysis of local tumour control was performed using RECIST criteria and the KaplanMeier method. 69% of patients received 14-16gy in 1-3 fractions while 31% received 48- 50gy in 25 fractions. Radiation-associated toxicity was graded according to the commonly used Radiation therapy Oncology group (RTOG) toxicity criteria. Results. 24 patients with skull-base paragangliomas were treated with a median follow up of 43 months. One patient lost to follow up and was excluded. Tumour control was achieved in 96% of patients. 76% of patients treated reported no radiation associated toxicity. 24% of patients had some radiation associated toxicity: the conventional group 12%, stereotactic radiosurgery 8% and stereotactic radiotherapy 4%. 43% of patients in the conventional group had progression of hearing loss in the affected ear. One patient in the radiosurgery group developed osteonecrosis of the temporal bone at 5 year follow up. Conclusion. Radiosurgery and radiotherapy are efficacious in achieving tumour control with minimal morbidity. Tumour control rates in the study are similar to control rates in literature. Radiation associated toxicities are mainly minor. Study is limited by the retrospective nature and limited duration of follow up.
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Sukkar, Malak, and sukkarm@stvmph org au. "Executives' Decision Making in Australian Private Hospitals: Margin or Mission?" RMIT University. Graduate School of Business, 2008. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20081031.162754.
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This thesis examines decision making at executive level in Australian private hospitals as a social phenomenon, since individuals draw meaning from their own biographical and social environmental experiences. The researcher interpreted the constructed realities of the factors influencing executives' decisions within the context of private hospitals - a field that is rarely examined through the lens of social research. Using an Interpretivist research paradigm, the researcher conducted semi- structured and in-depth interviews with sixteen executive members who are experts in their field and represent both sectors of the private hospital industry: private for-profit and private not-for-profit. The data generated was transformed into technical accounts using an abductive research strategy and adopting Schütz's notion of first-order and second-order constructs. Using Giddens' Structuration Theory, that stressed the fundamental role of the human agent, the structure and their mutual dependence, the researcher moved beyond the interpretation of individuals' meanings, to incorporate the structure as an entity that can be formed and reformed. The researcher interpreted social actors' constructed meanings of these social phenomena in their work environment to form the elements of a two-dimensional decision making model at organisational level, incorporating the present with the future and the internal with the external factors. On an individual level, three different approaches to decision making were identified, based on whether executives perceived the decision making phenomenon as intuition, as a reasoned process or as an expected outcome. While being from a limited research sample, the findings of this study suggest that the paradox of mission / economic decisions restrained executives in the not-for-profit sector from strengthening their hospitals' financial performance, putting at risk, therefore, their ability to achieve social dividends as a way to proclaim their mission. On the other hand, in the for-profit sector, shareholders' dividends appeared to be a strong catalyst for attaining profit maximisation when making decisions. In both settings, the findings suggest that the role of stakeholder theory is questionable, particularly when executives remained hesitant to involve medical specialists, whom they considered to be major stakeholders and profit generators for private hospitals. This attitude appeared to be constant, despite the changes identified in executives' individual approaches to decision making. However, early signs of shifts towards adopting more commercially and socially accountable decisions were apparent in not-for-p rofit and for-profit sectors respectively. The thesis sets out recommendations to assist executives in managing the different factors that interplay to form executives' decisions. The importance of having a mission in business longevity and the integration, as opposed to alignment, of strategic goals with business operations when making executive decisions in private hospitals was highlighted. The implications for both sectors are described and recommendations for further research are suggested.
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Azevedo, Filipa Carina Freitas de. "Estudo e avaliação do impacto financeiro da centralização dos materiais de consumo clínico dos Armazéns Privados Sul numa organização do setor da saúde : a empresa José de Mello Saúde." Master's thesis, Instituto Superior de Economia e Gestão, 2014. http://hdl.handle.net/10400.5/7660.
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Mestrado em Gestão MBAO presente trabalho tem como objetivo analisar se a centralização de stocks dos materiais de consumo clínico numa empresa de prestação privada de cuidados de saúde em Portugal, será benéfica numa perspectiva da política de gestão de stocks. A centralização da gestão de stocks tem-se vindo a assumir como uma tendência para a estratégia das organizações que pretendem reduzir custos, aumentar a eficiência do processo de compras e gestão de stocks e otimizar os processos de negócio. No entanto, na realidade das empresas de prestação de serviços de saúde, o trade-off entre o nível de serviço e a redução de custos, poderá sair caro. Este projeto de investigação foi desenvolvido em quatro Unidades privadas do setor hospitalar e suportou-se na metodologia de Estudo de Campo. Através de seis indicadores, e tendo por base os dados de 2013, foram efetuados os cálculos para determinar os valores da gestão Descentralizada efetuada em 2013, e através dos mesmos indicadores e dados, extrapolar os valores para uma gestão Centralizada. Deste modo, foram estudados dois cenários: o cenário atual de gestão de stocks Descentralizada realizada em 2013, onde a negociação e a compra foram feitas centralmente, mas com a política de gestão de stocks descentralizada, e um novo cenário possível, onde tanto a negociação, compra e gestão de stocks seriam centralizadas. O estudo destes dois cenários indicará, de acordo com os dados disponíveis, qual seria a política de gestão mais adequada.
This paper aims to examine whether the centralization of clinical consumable material stocks on a private healthcare company in Portugal, will be beneficial from the stock management policy perspective. Centralization of stock management has been acting as a tendency to the strategies of companies that are looking to reduce costs, improve purchasing process and stock management efficiency and optimize business processes. However, the reality of healthcare companies may be different, because the tradeoff between service level and cost reduction may come out expensive. This investigation project was developed in four hospital sector private Units and it?s supported on Field Study Methodology. Through six indicators, and based on 2013 data, calculations were made to determine the figures of Decentralized management conducted in 2013, and through the same indicators and data, extrapolate the figures for Centralized management. This way, two scenarios were studied: current scenario of Decentralized management of stocks held in 2013, with negotiation and purchase made centrally but with decentralized stock management policy and a new possible scenario, where both negotiation and purchase and stock management would be centralized. The study of these two scenarios will reveal, according to available data, what would be the most adequate management policy.
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Sze, Hang-chi Candice. "An evaluation of the Hospital Authority public private interface : electronic patient record (PPI-ePR)sharing /." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38478638.
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Sze, Hang-chi Candice, and 施行芝. "An evaluation of the Hospital Authority public private interface: electronic patient record (PPI-ePR)sharing." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39724591.
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Kriel, Dora Jenice. "Perceptions of nurses with regard to staffing in the operating rooms of a private hospital." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/18014.
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Despite a number of research studies showing the correlation between higher nurse staffing levels and improved outcomes, RCN members continues to report lower nurse-to-patient ratios than what research results suggests (RCN, 2011:1). This reflected a general concern within the nursing profession. The operating room requires appropriate staffing which is critical to the safety of surgical patients and quality of patient care. The research study was motivated by the researcher’s own experiences while working in an OR in a private hospital where continuous discussions were held with management about the shortage of skilled staff; and where a shortage of OR nurses resulted in the use of Central Sterilizing Department (CSD) staff to do OR duties. The objective of the study was to explore and describe the perceptions of nurses regarding staffing in the operating rooms of a private hospital in the Nelson Mandela Bay Health District. The researcher used qualitative methods and designs to explore and described the perception of nurses regarding staffing in the operating room (OR) of a private hospital in the Nelson Mandela Bay Health District. The research population of the study included all the nurses working in the OR of a private hospital. The total number of 20 OR nurses was individually interviewed by means of semi-structured interviews. Three main themes emerged that includes nurses ‘perceptions with regard to the implications of inadequate staffing in the OR; nurses experiences towards top management with regard to staffing in the OR and recommendations from participants to improve staffing in the OR. Research findings concluded that nurses have a perception that shortage of OR nurses causes lack of communication, physical, emotional and psychological strain. They also perceived OR nurses to work under unrealistic conditions and to receive added responsibilities due to staff shortages, which affect the overall delivery of quality patient care. Comments included failure of management to attend to staff complaints and the perception of high staff turnover due to a lack of recognition and acknowledgement of overworked staff.
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Balfour, Liezl. "Development of a clinical pathway for non-invasive ventilation in a private hospital in Gauteng." Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/30377.
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Despite the advantages of using NIV, healthcare professionals are not in agreement about precisely when to commence NIV (Elliott, Confalonieri& Nava 2002:1159; Lightowler, Wedzicha, Elliott&Ram 2003: [4]; Garpestad &Hill 2006:147), which adds to the underutilisation of NIV. The aim of this study was to collaboratively develop a clinical pathway for NIV. Two main objectives were identified, namely (i) to identify the components of a clinical pathway for NIV, and (ii) to develop a clinical pathway for NIV that can be implemented in the CCU. The research design utilised for this study was qualitative, contextual, explorative and descriptive in nature. The study consisted of three phases, namely Phase 1: Components of the clinical pathway, Phase 2: Literature control, and Phase 3: Development of the clinical pathway. The objectives of the study were met, and a clinical pathway for NIV was developed.Dissertation (MCur)--University of Pretoria, 2011.
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Ade-Abolade, Khadijah O. "Impact of the private sector initiative on the job satisfaction of hospital pharmacists in Lagos state." UWC, 2009. http://hdl.handle.net/11394/2665.
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Master of Public Health - MPHBackground: Hospital pharmacy practice is an important aspect of healthcare, as drugs are a key component of patient treatment in hospitals. In Lagos state, Nigeria, provision of healthcare services, including drugs, was at one time entirely free but in the face of ever dwindling resources and increasing government responsibility, the health sector has to compete with other sectors for scarce public funds. Therefore, in 2002, a private sector initiative (PSI) in hospital pharmacy was implemented in seven hospitals in Lagos state as an alternative financing system for managing drug procurement and supply to fee-paying patients. Each of these seven hospitals now has two pharmacies, one providing free drugs to certain categories of patients entitled to this service and the second providing services to all other patients. Aim: This study aimed to explore and describe the impact of this private sector initiative on the job satisfaction of the pharmacists working in these hospitals from the viewpoint of the hospital pharmacists and relevant stakeholders, and to suggest ways of improving the job satisfaction of hospital pharmacists in Lagos state. Study Design: The study utilized a qualitative research design to explore the perceptions and experiences of government-employed pharmacists and key stakeholders on the impact of the private sector initiative. Study Population and Sampling: Individual interviews were conducted with three key informants and two focus group discussions were carried out, one with hospital pharmacists from the fee-paying pharmacies and the second with pharmacists from the free pharmacies from the seven hospitals in Lagos state where the private sector initiative was in operation. Data Collection and Analysis: The audio-taped interviews and focus group discussions were transcribed and analysed to identify the key categories and themes raised by the participants. Results: The study found that most pharmacists felt that the PSI has met the main objective for which it was set up, that is, improving availability of drugs in the hospital but there were some attendant factors like inadequate funding of the free health unit, increased workload of the fee-paying unit and poor working conditions, which affect the job satisfaction of pharmacists. The study however showed that the introduction of the PSI has led to improved performance of roles and recognition of the pharmacists and better working relationships between pharmacists and other healthcare workers which have impacted positively on the job satisfaction of pharmacists. Recommendations: The study recommended that the working conditions should be improved and issues of staffing and workloads should be addressed. Also, alternative but effective means of drug financing should be sought to ensure availability of drugs to all categories of patients.
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DeBoe, Joseph Charles, and Joseph Charles DeBoe. "A Needs Assessment for a Private Practice Based Transitional Care Program for Heart Failure." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626308.
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INTRODUCTION: While transitions of care (TOC) programs are known to decrease readmissions for heart failure (HF), significant policy and resource challenges inhibit the implementation of hospital based TOC programs, thus novel models of TOC are urgently needed. The purpose of this study is to evaluate the need and readiness of a private practice based TOC program led by DNP-prepared nurse practitioners.
METHODS: In this descriptive study, cardiology providers from a private practice in the Southwest (N=14) participated in a survey on HF TOC. The practice’s electronic medical records (EMR) database was queried for patient demographic data along with other HF measures (N=3175).
RESULTS: There were 1,827 females (57.5%) and 1,348 males (42.5%) with the mean age being 75.1 years +/-11.1. The 70-79 year age bracket represented 41.0% of all HF patients. The most common ICD-10 code for HF was [I50.32] Chronic Diastolic Congestive Heart Failure (N=986), which translates into 31.0% of the total HF population. Almost 30% of the providers (N=4) acknowledge that they never document their HF readmissions in the practice’s EMR. Nearly 65% percent of respondents “strongly agree,” that HF patients discharged from the hospital require a specific plan of care, while 86% of providers (N=12) either “somewhat agree” to “strongly agree” in the need for a TOC program for HF patients within their cardiology practice. Over 71% (N=10) of the providers “strongly agree” with a DNP-led TOC program for HF.
CONCLUSION: This study provides encouraging results for the future implementation of a cutting edge private cardiology practice based TOC program for HF in Tucson, AZ. The study results clearly indicate the need and readiness for the Tucson-based private practice TOC program for HF. The DNP prepared nurse practitioner is thoroughly prepared to take the lead in designing, implementing and evaluating such a program and this unique role was supported by the practice. Importantly, the results of this study may provide the foundation for future studies examining the effects of private practice based TOC programs for HF.
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Cruickshank, Deborah Claire. "Medication errors in a private hospital closed intensive care unit: a retrospective analysis of process change." Thesis, Nelson Mandela University, 2017. http://hdl.handle.net/10948/15501.
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Healthcare professionals should be concerned about the safety of the patients in their care and the references to patient safety go back as far as the Hippocratic Oath. Study of literature however shows that medical errors are still of concern and the majority of medical errors are medication errors. The aim of the study was to determine whether process changes introduced reduced both the medication prescribing and medication administration errors in the intensive care unit, thereby contributing to an increase in overall patient safety in the intensive care unit. This study retrospectively analysed the effect of the process changes on medication prescribing and administration errors. The research objectives were to: Identify the number and type of prescribing medication errors prior to the implementation of process changes; Identify the number and type of administration medication errors prior to the implementation of process changes; Identify the process changes implemented; o Determine number and type of prescribing medication errors post the implementation of process changes; Determine number and type of administration medication errors post the implementation of process changes; Assess whether the process changes affected the number and type of prescribing medication errors; and o Assess whether the process changes affected the number and type of administration medication errors. In the Phase One (1 November 2013 to 31 January 2014) 534 patient prescription charts for 172 patients were examined. Medication error rates of 57.6% (n=99) of individual patients reviewed and 18.4% of total patient prescription charts reviewed were found. A total of 69 medication prescribing errors were found in Phase One. This equates to an error percentage of 12.9% per patient chart reviewed and 40.1% per patient reviewed. Thirty medication administration errors were identified in Phase One of the study representing 17.4% of patients reviewed and 5.6% of patient prescription charts reviewed. Medication administration errors included both errors of commission, incorrect doses administered, (n=19) and omission, dose missed, (n=11). Process changes were then introduced and the results of these changes analysed in Phase Two (1 April 2014 to 31 December 2014) show an overall reduction in total medication errors with relation to number of patients reviewed from 57.6% in Phase One to 40.5% in Phase Two. In relation to number of prescription charts reviewed the medication error rate in Phase One was 18.4% and in Phase Two 14.4%. Prescribing errors in relation to number of patients reviewed reduced from 40.1% in Phase One to 26.19% in Phase Two. Overall reductions in percentage of errors were seen in all categories of prescribing errors except duplication of therapy which showed a slight increase. Based on the number of patients reviewed a reduction of prescribing errors was seen in the following categories: transcription errors (13.3% to 7.6%), anticoagulant not prescribed when indicated (3.5% to 2.4%), medication safety (5.2% to 2.9%), dose errors (9.3% to 6.6%) and duration of therapy (6.3% to 3.6%). An increase in the duplication of therapy error rate was seen (2.3% to 3.1%). There was also a reduction in administration errors in relation to number of patients reviewed with a total number of errors of 17.4% in Phase One and 15.8% in Phase Two. The number of prescribing errors per medication chart in Phase Two showed a statistically significant reduction (p=.002). A statistically significant reduction was also seen when the number of errors per patient was reviewed (p=.008). The total number of medication administration errors per medication chart showed a significant reduction (p=.042) as did the number of administration errors per patient (p=.003). When combining the total number of medication errors (both prescriobing and administration) a significant reduction was seen for both the number of charts reviewed (p=.001) and the number of patients reviewed (p=.002). These results indicate that the desired goal of increasing patient safety with regard to medication errors has been achieved but ongoing study is required to ensure the sustainability of the process changes.
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Beckenstrater, Andrea Frances. "Rehabilitate : a sub-acute facility in collaboration with Louis Pasteur private hospital in the Pretoria CBD." Diss., University of Pretoria, 2010. http://hdl.handle.net/2263/30009.
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This dissertation investigates the need for a change in popular perception of what an institutional building should and could look and feel like. This is achieved through the exploration of ways to create a therapeutic environment that houses a sub-acute facility which provides operational after care for patients discharged from Louis Pasteur Private Hospital in the Pretoria CBD. As well as providing for certain functional requirements, the architectural exploration aims to enrich and encourage the healing process of patients within the city with a rich mixture of stimulating and therapeutic experiences and qualities. Through the exploration and incorporation of various theories, these aims are set as an end goal not only throughout the design process, but are also used to guide the technical development and solutions that are used within the finalization of the facility. With a constant concept of creating a space for healing within the city of Pretoria, a Centre for Healing is created which holds these ideals at the core of its existence.Dissertation (MArch(Prof))--University of Pretoria, 2010.
Architecture
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Prinsloo, Cathrina Johanna. "Self-leadership strategies of nurses in an outreach service at a private hospital group in Gauteng." University of the Western Cape, 2018. http://hdl.handle.net/11394/6844.
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Philosophiae Doctor - PhDCritical Care Outreach Services (CCOSs) recognize early sign of deterioration in medical units, regarding the condition of the patient, by using elements of vital sign tracking namely modified early warning score (MEWS). Nurses as leaders should be proactive by using influence to obtain a desired outcome. It is unclear how nurses experience self-leadership in this outreach service in a private hospital in Pretoria. The purpose of this research was to understand nurses’ experience of their self-leadership in the current CCOS at a private hospital in Pretoria, in order to develop self-leadership strategies that could contributes to the implementation of a CCOS (for the broader population of nurses) in a private hospital group in Gauteng. In this research the steps as outlined in the self-leadership strategic framework of Neck and Milliman (1994) were adapted for this research. The theoretical assumptions furthermore informed the methodological steps followed in the research process. The theoretical assumptions of the Practice Orientated Theory of Dickoff, James and Wiedenbach (1968) were adapted and the survey lists of this theory served as a reasoning map in this research. The central statement of this research was that, nurses need to lead themselves in implementing a CCOS in general wards in a private hospital group in Gauteng.
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He, Jun. "The factors that influence private health insurance holders' choice between public and private emergency departments at the time of emergency." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/103096/4/Jun_He_Thesis.pdf.
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This is the first study to examine the issues relating to choice between public and private emergency departments in an Australian setting. This study has identified that the key factors influencing the choice were affordability and perceptions of the quality of service provided. The research provides valuable insight for future planning by identifying the factors that if addressed may help improve patient’s access to emergency care.
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Johnston, Matthew. ""We Don't Want the Loonies Taking Over": Examining Masculine Performatives by Private Security in a Hospital Setting." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23196.
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After sixteen intensive months, I quit my employed position as a security guard at a local hospital. By drawing on my autoethnographic experiences in the form of “ethnographic fiction writing”, as well as eight interviews with my former male colleagues, I explore how the guards’ constructions of masculinity intersect with their security assessment and subsequent application of force, chemical incarceration, and other coercive security tactics on involuntarily-committed mental health patients. The narratives are framed by the available literature on gender and masculinity within the security, police, prison and military institutions, as well as the theoretical notions of gendered institutions (Acker), hegemonic masculinity (Connell & Messerschmidt), doing gender (West & Zimmerman), and Dave Holmes’s application of Foucauldian biopolitical power to forensic healthcare settings. These concepts are used in tandem with a creative methodological tool to reveal the “messy”, “bloody” and “gendered” ways in which hospital life unfolds between the guard, the nurse, and the patient prisoner. By escaping more traditional forms of academic writing, I am able to weave raw, sensitive and reflexive thoughts and emotions into the research design and analysis. The analysis is divided into two narratives: “Us” and “Them”. “Us” emphasizes the gendered ways in which the hospital guard learns, reproduces, resists, lives up, or fails to live up to the masculine codes of the profession. Here, the guard must confront cultural demands to demonstrate physical prowess, authority and heroism during a patient battle. “Them” explores how hegemonic masculinity shapes the hierarchical and coercive relations between the guard, the nurse, and the patient, and reinforces psychiatrized discourses that promote punishment, pain, bureaucracy and control. Overall, these findings call for the abolition of physical restraint, chemical incarceration and other coercive security measures within our healthcare institutions, and encourage future research to give voice to the lived experiences of women guards and security management teams.
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Tsang, Hoi-ling, and 曾凱玲. "An evaluation of the ePR-PPI project in a private hospital: the implication and significance of useracceptance." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42997847.
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Bell, Janet. "An investigation into the scope of practice of a registered critical care nurse in a private hospital." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/16595.
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Thesis (MCur)--University of Stellenbosch, 2005.ENGLISH ABSTRACT: The critical care nurse works in an environment where patient need often shifts the parameters within which she or he practices. It is expected of a skilled critical care nurse to be able to make independent decisions and take action regarding patient care based on her or his knowledge and skills without discounting the parameters of her or his scope of practice. Practice experience has indicated that the critical care nurse is often uncertain about whether her or his clinical activities are protected by the regulations provided by the Nursing Council. This is more specifically true in the private hospital industry where medical advice or assistance is not always easily available. This situation led to the following research question: Do the available professional and legal guidelines provide an appropriate foundation to guide the practice of the registered critical care nurse in the private hospital sector critical care environment? A non-experimental descriptive study with a qualitative orientation was conducted in 19 private hospitals in the Western Cape. Through nonprobability, random sampling, 71 registered critical care nurses were included in the study. A questionnaire was designed and validated to collect the data. Quantitative data was analysed through Excel® while qualitative data was analysed thematically. It was found that the legal and professional guidelines in place at present do provide a foundation for the clinical activities of critical care nursing in the private hospital sector. It is suggested that it is rather the critical care nurses’ interpretation of the Scope of Practice (No.R.2598 of 30/11/1984 as amended) that limits their practice as opposed to the wording of the regulations. It is recommended that critical care nurses must determine nursing care parameters based on patient need, using the regulations as a foundation for critical, analytical and reflective practice rather than as a set of rules to be followed. Key words: Scope of practice, critical care practice, ICU nursing care, private hospital nursing practice.
AFRIKAANSE OPSOMMING: Die kritiekesorgverpleegkundige werk in ‘n omgewing waar pasiëntebehoeftes gereeld die parameters waarin sy of hy praktiseer, verskuif. Dit word van ’n bekwame kritiekesorgverpleegkundige verwag dat sy of hy onafhanklike besluite en aksies met betrekking tot pasiëntesorg, gebaseer op haar of sy kennis en vaardighede, sal neem sonder om die parameters van haar of sy bestek van praktyk te oorskry. Praktykondervinding het getoon dat die kritiekesorgverpleegkundige dikwels onseker is oor watter van haar of sy optredes deur die Regulasies, soos deur die Raad op Verpleging gespesifiseer word, beskerm word. Dit is nog meer spesifiek van toepassing in die privaathospitaal-industrie waar geneeskundige advies en bystand nie altyd maklik beskikbaar is nie. Die situasie het tot die volgende navorsingsvraag aanleiding gegee: Voorsien die beskikbare professionele en wetlike riglyne ’n geskikte grondslag om die praktyk van ’n geregistreerde kritiekesorgverpleegkundige in die privaatsektor- kritiekesorgomgewing te rig? ’n Nie-eksperimentele, beskrywende studie met ’n kwalitatiewe oriëntasie is in 19 hospitale in die Wes-Kaap onderneem. Deur nie-waarskynlikheids-, toevallige steekproefneming is 71 geregistreerde kritiekesorgverpleegkundiges in die studie ingesluit. ’n Vraelys is ontwerp en gevalideer om inligting in te samel. Kwantitatiewe data is deur middel van Excel ontleed terwyl kwalitatiewe data tematies ontleed is. Daar is gevind dat die wetlike en professionele riglyne wat tans beskikbaar is, ‘n grondslag bied vir die kliniese aktiwiteite van kritiekesorgverpleegkundiges in die privaathospitaal.. Dit word voorgestel dat dit die kritiekesorgverpleegkundige se interpretasie van die Bestek van Praktyk (No.R.2598 of 30/11/1984 soos aangepas) is wat hulle praktyk beperk, eerder as die bewoording van die regulasie self.
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Dippenaar, Enrico. "Standardisation and validation of a triage system in a private hospital group in the United Arab Emirates." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/23397.
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Introduction: Upon inspection and evaluation of the Mediclinic Middle East emergency centres in the United Arab Emirates, inconsistencies related to triage were found. Of note, it was found that the use of various international triage systems within and between the emergency centres may have caused potentially harmful patient conditions. The aim of this thesis was to study the reliability and validity of existing triage systems within Mediclinic Middle East, and then to use these systems as a starting point to design, standardise and validate a single, locally appropriate triage system. This single triage system should be able to accurately and safely assign triage priority to adults and children within all of Mediclinic Middle East emergency centres. Methods: A System Development Life Cycle process intended for business and healthcare service improvement was expanded upon through an action research design. Quantitative and qualitative components were used in a five-part study that was conducted by pursuing the iterative activities set by an action research approach to establish the following: the emergency centre patient demographic and application of triage, the reliability and validity of the existing triage systems, a determination of the most appropriate triage system for use in this local environment and development of a best-fit novel triage system, establishment of validation criteria for the novel triage system, and determination of reliability and validity of the novel triage system within Mediclinic Middle East emergency centres. Results: Low-acuity illness profiles predominated the patient demographic; high acuity cases were substantially smaller in number. The emergency centres used a combination of existing international triage systems; this was found to be inappropriate for this environment. Poor reliability and validity performance of the existing triage systems led to the development of a novel, four-level triage system. This novel triage system incorporates early warning scores through vital sign parameters, and clinical descriptors. The novel triage system proved to be substantially more reliable and valid than the existing triage systems within the Mediclinic Middle East emergency centres. Conclusion: Through an initial systems analysis, it became clear that the Mediclinic Middle East emergency centres blindly implemented an array of international triage systems. Using an action research approach, a novel triage system that is both reliable and valid within this local environment was developed. The triage system is fit to be implemented throughout all the Mediclinic Middle East emergency centres and may be transposed to similar emergency centre settings elsewhere.
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Petro, Lyndsey. "Invaluable and outsourced: experiences of private company cleaners working in the public hospital sector in Cape Town." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/6829.
Full textAbstract:
In the hospital context, and in research on hospitals, cleaning staff often find themselves on the periphery. This peripheral status is exacerbated when cleaners are employed by private cleaning companies. The intersection of locations these cleaners find themselves in, as cleaners, outsourced support staff and members of the working poor means that their work-life experiences take a particular shape. In an attempt to better understand the work experiences of these staff members, I conducted qualitative interviews with 8 female private company cleaners from four different public hospitals in Cape Town. Alienation, job insecurity, working poverty and emotional labour are used as tools to unpack and understand these experiences. Here I argue that these workers perform work that is far from ancillary or non-essential, work central to the functioning of the hospital space. However, the scope of their work is unappreciated and as a result, so too are the health and safety risks they are exposed to, making them especially vulnerable. This vulnerability is compounded by insecurity and the struggle to make ends meet. Alienating conditions are evident as they are constantly reminded of their status at the bottom of the hospital hierarchy and made to feel insignificant. Engaging with the experiences of these cleaners shows how alienation, insecurity, working poverty and emotional labour manifest in interesting ways. It allows us to see the numerous challenges they face in their working lives, particularly as private company cleaners in a hospital.
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Dreyer, Kathryn Ann. "The evaluation of case-mix adjusted efficiency scores the case of the South African private hospital industry." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/5813.
Full textAbstract:
Includes abstract.Includes bibliographical references.
There is little existing South African literature relating to hospital efficiency that allows for differences in case mix across hospitals. One of the primary motivations for this dissertation is to help fill this gap in the literature by examining the impact that adjusting for differences in case mix has on efficiency scores. Data Envelopment Analysis (DEA) is chosen as the efficiency measurement method because of its exibility and ease of handling multiple inputs and outputs. A number of DEA models are applied to a sample of South African private hospitals for the years 2008 to 2011 inclusive. Three different case-mix adjustment techniques are investigated and their ability to capture differences in case mix is assessed. The three techniques investigated are: a case-mix adjustment factor (constructed using Diagnosis-Related Groups (DRGs)) to adjust outputs; including the case-mix adjustment factor as an additional output; and disaggregating hospital admissions into broad categories which are used as outputs. A comparison of the unadjusted model with the case-mix adjusted model reveals that omitting the adjustment can have a considerable impact on efficiency scores. Whilst little difference is noted in average efficiency scores for the group of hospitals, 90% for the unadjusted model and 92% for the adjusted model in 2011, there are substantial differences between the adjusted and unadjusted efficiency scores of individual hospitals. On comparison of the three different techniques investigated, it is evident that if there is sufficient data to construct a case-mix adjustment factor, case-mix adjusted admissions should be used, rather than using the factor as an additional output variable. In the case where insufficient data is available, disaggregating admissions does capture some of the differences in case mix but a substantial amount of power is lost as a result of increasing the number of output variables.
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Blackwell, Heather. "Understanding the satisfaction with nursing care from patients' perspective in a private hospital setting in South Africa." Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/2939.
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Nyandoro, Patricia. "Service quality and patient satisfaction in private hospitals: a case of a private hospital in Pretoria." 2012. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1000365.
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Pham, Mai. "Performance of Australian public and private hospitals." Phd thesis, 2008. http://hdl.handle.net/1885/110263.
Full textAbstract:
Given the importance of the Australian hospital industry, understanding the
performance of public and private hospitals is essential for interested groups including
patients, hospital staff, insurance companies and governments. Jn Australia, little
information is available on hospitals' relative performance. Hence, studies
investigating the issue are needed. This thesis addresses a part of this gap, in the
context of hospital performance, investigating how public and private hospitals in
Western Australia perform differently in terms of quality of care, and how Australian
public hospitals in different peer groups perform differently in terms of cost technical
efficiency.
The thesis consists of two main parts and the data for each part were obtained from
different sources. Data on hospital quality of care analysis are obtained from the
Department of Health, Western Australia. Hospital morbidity and mortality data in
Western Australia in the period 1995-2004 are provided by the Data Linkage Unit.
Data on hospital cost technical efficiency analysis are obtained from the Australian
Institute of Health and Welfare and information on hospital cost5 in Victoria, New
South Wales, Queensland, South Australia, Tasmania, and Northern Territory in the
period 2002-2005 is provided.
The study is structured as follows. The first chapter states the motivations and the
questions this study attempts to address. The second chapter summarizes the state of
the Australian hospital industry in the past two decades with respect to the relative
importance of public and private hospitals. Chapter three presents the literature review
including brief outlines of theoretical and empirical work concerning the performance
of public and private firms, and a critical summary of studies involving the hospital
quality of care measurement, hospital cost function and technical efficiency measures.
Chapters four and five outline the descriptive statistics, the models used for analyzing
the quality of care of public and private hospitals in Western Australia, the econometric
results obtained, and the discussion. Similarly, chapters six and seven include the
descriptive statistics, the methods of efficiency analysis for Australian public hospitals,
the regression results and the discussion. While concluding the whole study, chapter
eight also points out the study's limitations and suggestions for further research. The study uses appropriate methods to derive important results. For hospital quality of
care, this study applies multi-level random intercept logistic models. Since the data
include information on patient and hospital characteristics, multi-level models appear to
be the most suitable approach for analyzing the data. Among six quality of care
indicators, only one gives the results that public hospital perform worse than their
private counterparts. On two indicators, public hospitals' performance is superior and
on the other three, no difference in the performance of the two sectors can be found.
For hospital technical cost efficiency, the stochastic frontier approach (SFA) is applied.
Among the two main approaches of technical efficiency investigation, namely Data
Envelopment Analysis (DEA) and SFA, the later has advantages on its relaxation of
statistical noise non-existence. The results show that major and large public hospitals
are more cost efficient than small ones, and there is no evidence of a trade-off between
hospital cost technical efficiency and quality of care.
The study provides important policy implications. The results of hospital quality of
care analysis suggest policies to reduce the gap in operation between public and private
hospitals. They include private hospitals taking a larger share of more severely-sick
patients and more complicated cases, and public hospitals being provided with more
funding as part of solution for medical staff and bed availability shortage. The results
of hospital cost efficiency analysis suggest policies to reduce the heavy workload for
major public hospitals. Improving hospital quality of care policies would not damage
technical cost efficiency since no evidence of a trade-off between the two can be found.