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Tesi sul tema "Health services administration"

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1

Waddington, Catriona Jane. "Health economics in an irrational world - the view from a regional health administration in Ghana". Thesis, University of Liverpool, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317275.

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2

Paulo, Cynthia Ann. "Validation of criteria for use in health and safety program administration". CSUSB ScholarWorks, 1992. https://scholarworks.lib.csusb.edu/etd-project/3034.

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3

Holmberg, Leif. "Health-care processes a study of medical problem-solving in the Swedish health-care organization /". Lund : Lund University Press, 1997. http://books.google.com/books?id=1jNrAAAAMAAJ.

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4

Peoples, Paula Beth. "Pay-per-visit for Home Health Agency nurses". CSUSB ScholarWorks, 1997. https://scholarworks.lib.csusb.edu/etd-project/1410.

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5

Zhakata, Chikomborero. "The sustainability of health committees in Nelson Mandela Bay". Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1019704.

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Primary health care is pivotal to the growth of a country’s economy by improving the health and social well-being of its people. Several efforts and structures have been put in place to ensure that all South Africans have access to health facilities as well as representation in the health facilities, just as community members are represented in schools and other boards. Health committees play an important and integral role to the community and health facilities by being mediators between the community and the health facility (Padarath &Friedman, 2008). The Eastern Cape is one of the provinces that has health committees that are fully functional and a number of factors including the collaboration of key stakeholders (facility managers, community members, clinic staff and ward councillors) contribute to why health committees have been operational in the Eastern Cape(Padarath &Friedman , 2008). It becomes critical to investigate factors that sustain health committees in Nelson Mandela Bay. This chapter introduces the research topic, purpose, rationale and background as well as the objectives of the study. The research focuses on investigating the sustainability of health committees in Nelson Mandela Bay therefore making it critical to define the term sustainability. Conceptualizing sustainability has been ongoing with various definitions from learners from different backgrounds. Sustainability as a concept emanates from different dimensions namely, scientific, political economic and indigenous dimension. Sustainability has been described by scholars as a state of well-being and as an evolutionary process (Dimitrov, 2010). Sustainability is regarded as a state of well being whereby humans can live in co-exist with the natural world, this definition takes into account issues to do with good health , cultural identity, personal security and freedom of choice. Sustainability- well being brings out a lot of questions and problems in identifying the fundamentals values of sustainability. It is continuously debated amoung scholars if sustainability of well being pertains only to the health conditions of human beings or it should be extended to others (Dimitrov, 2010) “Sustainability that is restricted to the well being of humans is related to Notions about security of individual/community health together with financial security together with financial security; the planet is regarded as a resource to further this end (Dimitrov, 2010:4) If however well-being definitions of sustainability are construed to preserving and protecting the environment as well as biodiversity of other species (plant and animals) then the normative definitions of sustainability from this viewpoint are tendered with notions of global Environmental stability, ecological considerations and security of ecosystems” (Dimitrov, 2010:4).
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6

Al-Haque, Shahed. "Responding to traveling patients' seasonal demands for health care services in the Veterans Health Administration". Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/81112.

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Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, 2013.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 60-62).
The Veterans Health Administration (VHA) provides care to over eight million Veterans and operates over 1,700 sites of care distributed across twenty-one regional networks in the United States. Health care providers within VHA report large seasonal variation in the demand for services, especially in healthcare systems located in the southern U.S. that experience a large influx of "snowbirds" during the winter. Since the majority of resource allocation activities are carried out through a single annual budgeting process at the start of the fiscal year, the seasonal load imposed by "traveling Veterans," defined as Veterans that seek care at VHA sites outside of their home network, make providing high quality services more difficult. This work constitutes the first major effort within VHA to understand the impact of traveling Veterans. We found a significant traveling Veteran population (6.6% of the total number of appointments), distributed disproportionately across the VHA networks. Strong seasonal fluctuations in demand were also discovered, particularly for the VA Bay Pines Healthcare System, in Bay Pines, Florida. Our analysis further indicated that traveling Veterans imposed a large seasonal load (up to 46%) on the Module A clinic at Bay Pines. We developed seasonal autoregressive integrated moving average (SARIMA) models to help the clinic better forecast demand for its services by traveling Veterans. Our models were able to project demand, in terms of encounters and unique patients, with significantly less error than the traditional historical average methods. The SARIMA model for uniques was then used in a Monte Carlo simulation to understand how clinic resources are utilized over time. The simulation revealed that physicians at Module A are over-utilized, ranging from a minimum of 92.6% (June 2013) to maximum 207.4% (January 2013). These results evince the need to reevaluate how the clinic is currently staffed. More broadly, this research presents an example of how simple operations management methods can be deployed to aid operational decision-making at other clinics, facilities, and medical centers both within and outside VHA.
by Shahed Al-Haque.
S.M.in Technology and Policy
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7

Veenstra, Gerry. "Social capital and regional health governance in Saskatchewan, Canada /". *McMaster only, 1998.

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8

Lehaney, Brian. "Simulation modelling in administration-by-consensus organisations". Thesis, Brunel University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286696.

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9

Frantz, Allison E. "The impact of the growing elderly population on health care". Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1992. http://www.kutztown.edu/library/services/remote_access.asp.

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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1992.
Source: Masters Abstracts International, Volume: 45-06, page: 2940. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 147-158).
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10

McCollum, Denise M. "The Structural Response and Performance of General Hospitals in a Managed Care Environment". VCU Scholars Compass, 1998. https://scholarscompass.vcu.edu/etd/4943.

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The study purpose is to link hospital structure, represented by each hospital’s professional contingent, service mix, and inpatient capacity; and its environment, characterized by the penetration of managed care enrollees. The secondary purpose is to test the relationship between hospital structural change and subsequent hospital performance. The study employs a non-experimental panel design, with a sample of 1882 community hospitals (service type: general medical and surgical). Environmental variables are measured for the base year 1989. Hospital structural variables are measured for 1989 and 1994, with change variables computed. Performance variables are measured for 1989 and 1995, with change computed for cost measures. Hospital structural change is viewed as a dependent variable related to the environment, as well as an independent variable related to performance. Descriptive data are extracted from the American Hospital Association Annual Survey of Hospitals. Hospital cost performance data are from the Health Care Financing Administration Prospective Payment System Minimum Data Sets. Hospital mortality data for 1989 are from Medicare Hospital Mortality Information. HMO enrollment data are extracted from the Interstudy Edge and aggregated to metropolitan statistical area (MSA) level. Market competition data are from the 1989 Area Resource File. A Herfindahl-Hirschman index (HHI) is calculated for each hospital’s MSA. Analytical hypotheses are tested using ordinary least squares (OLS) technique. Results from Part 1 suggest that where HMO penetration was relatively high, sample hospitals tended to contain growth in their registered nurse (RN) staff between 1989 and 1994. Higher HMO penetration is also associated with more stabilization in occupancy rates, preventive services, and ambulatory workload. In contrast, market competition is associated with changes to a higher Medicare case-mix index (CMI), and increase in ambulatory visits. Results from Part 2 indicate positive associations between increased RN staff and hospital cost growth between 1989 and 1995. Hospitals which did not experience an increased CMI are similarly linked with cost growth. Alternatively, reduction in hospital bedsize is associated with more controlled growth in hospital cost per patient day. Several control variables display noteworthy associations with the variables of interest. Theoretical and management implications for community hospitals are discussed.
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11

Pai, Chih-Wen. "Determinants of the New Entry of HMOs into A Medicare Risk Contract: A Resource Dependence-Diversification Model". VCU Scholars Compass, 1996. https://scholarscompass.vcu.edu/etd/4946.

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The purpose of this study is to examine the determinants of the new entry of an HMO into a Medicare risk contract using a resource dependence—diversification model. This study is conducted through a non-experimental, panel design With one year time lag. An HMO’s market is defined as the service area. The primary sample for this study is composed of 440 HMOS that do not have a Medicare risk contract as of January 1994. Data for the variables are extracted from the 1994 and 1995 InterStudy and Group Health Association of America (GHAA) directories, the 1996 Area Resource File, the 1994 County and City Data Book, the 1993 County Business Patterns. Additional supplementary data on adjusted average per capita cost (AAPCC) and county-level Medicare beneficiaries are obtained from the Health Care Financing Administration. The dependent variable is discrete indicating an HMO’s market entry. Independent variables are grouped into four categories: market structure, resource munificence, market price, and organizational attributes. Twelve hypotheses are tested using multivariate logistic regression. This analysis reveals that HMO enrollment size is a predominant, positive factor in predicting a new market entry. HMOs are also sensitive to the level of AAPCC rates in making a market entry decision. Results from hypothesis testing suggest that competition encourages a new market entry. The importance of resource munificence is not statistically supported. This study demonstrates the appropriateness of a panel design to verify a cause-effect relationship and the applicability of the service area as an HMO’s market. This study also contributes to the theoretical understanding of an HMO’s market entry.
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12

Lee, Jae Chul. "Health disparities in access to health care for older people with disabilities". Diss., Connect to online resource - MSU authorized users, 2008.

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Thesis (Ph.D.)--Michigan State University. Rehabilitation Counselor Education , 2008.
Title from PDF t.p. (viewed on July 2, 2009) Includes bibliographical references (p. 128-144). Also issued in print.
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13

Greene, Joseph Harrison. "Development of a social service program for college health services". CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/1869.

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The initial development of a social services program in a college health setting is presented, with discussion regarding causes, methods, and outcomes. Both empirical and anecdotal data which were influential in the initial formation of the program are reviewed, in the context of an examination of the research literature relating to this area. The actual development and implementation of the program is followed through its first year of existence. Outcomes are presented in the form of qualitative data analysis and case studies. Discussion of the results and recommendations for both future research and improvements to the program are presented.
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14

Donato, Francis A. "Reforming health care through managed care". Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1995. http://www.kutztown.edu/library/services/remote_access.asp.

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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995.
Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).
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15

Catena, Rodolfo. "Essays on health care operations management". Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:3c2035a6-b5d0-43b7-9b12-4883e5db4526.

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The aim of operations management in health care is to enhance the provision of services to patients and to decrease costs. Overall worldwide health care expenditures represent around 10.5% of the global GDP and are projected to increase at an annual rate of 5.3% from 2015 to 2017 [74]. In order to investigate how to curb health care costs, I study the English NHS, a health care system that provided universal care to around 54 million people in 2014 [243]. The NHS has launched many initiatives to improve the performance of hospital operations such as the "QIPP" program, which has the objective to save £20 billion of costs by 2015 [98]. Given this framework, this research aims to contribute to the theory that is guiding these operational changes, using data on all admissions to hospitals and focussing on the inguinal hernia, one of the most common surgical procedures [86]. In the next chapters, this research describes inguinal hernia care delivery in the English NHS, examines the impact of spillovers and complementarities on costs, and investigates the effects of length of stay reduction on risk of re-admission and risk of death. The findings of this thesis indicate that one of the possible problems in the delivery of inguinal hernia care in the NHS is the decrease in the number of elective operations performed and the increase in readmission rates. They also clarify how decisions on allocation of resources can affect hospital expenditures by showing that loss in focus can increase health care costs and by pointing out that there is little evidence to support the theory of spillovers and complementarities in the surgical context. Finally, the results of this research can be used to suggest the logic of a policy to decrease length of stay that can inform hospital decisions and can decrease hospital costs.
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16

Garske, Gary L. "Continuity planning for local public health agencies in northern Wisconsin : providing essential public health services after displacement /". Connect to online version, 2009. http://digital.library.wisc.edu/1793/37472.

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17

Cota, Luis Quihui. "Prevalence of intestinal parasites in school children from two Mexican states after 7 years of albendazole administration". Thesis, University of Glasgow, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268339.

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18

Gray, Ann Marie. "Government and the administration of hospital services in Northern Ireland 1948 - 1973 : the Northern Ireland Hospital Authority". Thesis, University of Ulster, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.359543.

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19

Aronson, Edward. "Ethics and leader integrity in the health sector". Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=82823.

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This thesis examines the determinants of ethical leadership and the manner in which they are associated with the directive, transactional, and transformational leadership styles, as well as their effects on organizational followers. A review is first conducted of the major theories of leadership and ethics, and current perspectives on ethical leadership are discussed. The determinants of ethical leadership are postulated to be altruism, manifested through some combination of teleological and deontological values, intellectual integrity, and moral integrity. A framework is then presented which integrates ethics and leadership by illustrating the proposed linkages among the ethics variables, leadership styles and effects on followers. This is followed by a series of hypotheses concerning the suggested relationships among the variables. The empirical investigation to test the hypotheses was conducted in a series of Canadian hospitals. Leaders were heads of various departments and services while followers were individuals who reported directly to the leader. Leader altruism was measured by a self-report questionnaire completed by the leaders themselves. Since leadership style and integrity are conceptualized as attributions by followers, all other variables were assessed via a self-report questionnaire having subordinates as respondents. The main findings of the thesis are the significant relationships between intellectual integrity and the three leadership styles compared with insignificant associations observed for moral integrity, as well as the stronger, although indirect, effects of leader intellectual integrity on subordinates compared with those for moral integrity. The thesis concludes with suggestions for future research and practical implications for management.
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20

Salsberry, Pamela J. "The distribution of health care in a just society /". The Ohio State University, 1987. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487585645577798.

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21

Severance, Jennifer Jurado Eve Susan Brown. "A survey of collaborative efforts between public health and aging services networks in community health centers in Texas". [Denton, Tex.] : University of North Texas, 2009. http://digital.library.unt.edu/permalink/meta-dc-10984.

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22

Pereira, Jocelene Batista. "Hipertensão arterial : avaliação da assistencia na otica da integralidade". [s.n.], 2005. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310543.

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Orientador: Luiz Carlos de Oliveira Cecilio
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-07T00:32:05Z (GMT). No. of bitstreams: 1 Pereira_JoceleneBatista_D.pdf: 38372542 bytes, checksum: 4bb3070c799aff463c9e2d4d0f4156f2 (MD5) Previous issue date: 2006
Resumo: O presente trabalho estudou a assistência aos portadores de hipertensão arterial, sob a ótica da integralidade do cuidado, na região de abrangência da Coordenação de Saúde de São Miguel Paulista, no município de São Paulo-SP. Foram realizadas entrevistas estruturadas com 804 usuários do serviço de urgência/emergência do Hospital Municipal Tide Setúbal, referência hospitalar da região, identificando potenciais hipertensos e investigando suas referências para a assistência, possíveis complicações, adesão ao tratamento e eventuais mudanças no estilo de vida em decorrência da doença. Os resultados mostraram prevalência de 18% de potenciais hipertensos no pronto-socorro, utilizando-se como critério de corte os valores de 140x90mmHg (associados ou isolados), segundo recomendações do protocolo da Sociedade Brasileira de Hipertensão Arterial, sendo que metade desconhecia sua condição de risco para hipertensão arterial.Também foram realizados grupos focais com médicos e gerentes das unidades de saúde da região, visando fazer uma caracterização da visão dos mesmos com relação à doença, ao comportamento dos pacientes e às dificuldades para se tratar a hipertensão arterial. Os pacientes que fizeram o diagnóstico na UBS/PSF mencionaram maior adesão aos medicamentos (80%) e menor proporção de internações (19,5%), quando comparados com aqueles que fizeram diagnóstico no pronto-socorro ou outro serviço Só houve associação estatística significante entre o local de diagnóstico UBS/PSF e hábitos que adotou após saber da HA, com os itens ir ao médico regularmente e fazer exames complementares de controle. Não se encontrou uma associação estatística significante entre local de diagnóstico e outros hábitos, como diminuição do sal, diminuição de gorduras, prática de exercícios físicos regulares, emagrecimento e controle do estresse Mas diminuir sal e gorduras na alimentação, emagrecer, ir ao médico regularmente e fazer exames complementares de controle da HA, apareceram como associadas estatisticamente a menores índices de internação No entanto, 10% dos hipertensos entrevistados durante a pesquisa declararam que não farão seguimento ambulatorial. Nos grupos focais, a necessidade de vínculo, escuta e equipe multidisciplinar é reconhecida pelos profissionais de saúde, mas prevalece uma marcada opinião de que os pacientes são "rebeldes", "resistentes" e não "obedecem" ao tratamento proposto, o que denota uma visão ainda muito normativa e autoritária dos profissionais em relação aos usuários que são acompanhados nos serviços de saúde, possivelmente dificultando o reconhecimento de suas necessidades singulares Os profissionais reconhecem a dificuldade de integração da equipe para o trabalho coletivo, mostrando contradição entre a prática efetiva cotidiana e o discurso idealizado da necessária integração e complementariedade do trabalho dos profissionais de saúde. O estudo permite afirmar que não há integralidade na atenção prestada aos hipertensos da região estudada, não havendo a configuração de uma rede articulada de serviços que assuma, efetivamente, a responsabilização e acompanhamento dos hipertensos
Abstract: This paper deals with the attendance to the hypertensive people, from the point of view of the care integrality, in the area of São Miguel Paulista Health Coordination, São Paulo city. State of São Paulo. Structured interviews were accomplished with 804 users of the urgency and emergency service of the Municipal Hospital Tide Setúbal, a reference hospital in the region, in order to identify potential hypertensive people and to investigate their references about the attendance, any possible disease complications, their adhesion to the treatment and occasional lifestyle changes resulted from the disease The results showed prevalence of 18% potential hypertensive people in the hospital emergency room - using the reference value of 140x90mmHg (associated or isolated), according to the protocol of the Brazilian Society of Arterial Hypertension recommendations - half of them ignoring their risk condition for the disease. The methodology also accomplished focal groups with doctors and managers of the health units in the area, focusing to characterize their vision about the disease, about the patients' behavior and about the difficulties of treating arterial hypertension The patients diagnosed by UBS/PSF mentioned larger adhesion to the medicines (80%) and smaller proportion of hospitalization (19,5%), when compared with those that were diagnosed in the emergency room or other services. There only was significant statistical association between the diagnosis place (UBS/PSF) and the habits adopted after knowing that they have HA, such as going regularly to the physician office and doing complementary control exams. There was no significant statistical association between the diagnosis place and other habits, such as salt and fat decreasing, regular exercising, loss of weigh and stress control. But, decreasing salt and fat, losing weight, attending regularly the physician and doing complementary control exams are events statistically associated to smaller hospitalization indexes. However, 10% of the hypertensive people interviewed during the research declared that they won't submit themselves to ambulatory follow up. The members of the focal groups recognized the necessity of the linkage between patients and physicians, the importance of hearing them and the existence of a multidisciplinary equip, but it prevailed the opinion that the patients are "rebellious", "resistant" and do not "obey" the proposed treatment, what denotes a still very normative and authoritarian vision of the professionals towards the patients attended by the health services, what may difficult the recognition of their singular needs. The professionals recognized the difficulty to integrate the team for collective tasks, showing contradiction between the daily effective practice and the idealized speech about the work integration. The results of this paper allows to affirm that there is no integrality in the attention offered to the hypertensive people of the studied area, and also that there is no articulate net of services that effectively should assume the responsibility on and the accompaniment of the hypertensive people
Doutorado
Saude Coletiva
Doutor em Saude Coletiva
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23

Buckley, L. C. "Going through changes : a single point of access for health and social care". Thesis, Coventry University, 2013. http://curve.coventry.ac.uk/open/items/7345dede-9192-4dad-827e-9b4ddd4503fa/1.

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Background: Integrated working between health and social care services within England has been encouraged by Government policy in the last decade, and has been argued to provide a seamless, joined up experience for service users (Department of Health 2011). One way of integrating care is through the use of a single point of access to health and social care services. A single point of access to services has been trialled in mental health and learning disability services to improve access, and following on from policy (e.g. Department of Health 2007) and support from literature (Rogers, Entwistle & Pencheon 1998; Lovell & Richards 2000; Raine, Carter, Sensky & Black 2005) a single point of access to health and social care for older adults has been implemented in parts of the UK. This thesis examines the implementation of one such single point of access. Objectives: The aim of the study was to examine the single point of access and whether it had any impact upon integrated working within a county in England, UK. Methods: An ethnographic approach was taken, using a combination of methods including interviews, focus groups and observations. This was complemented by a grounded theory approach to analysis. Findings: The single point of access had an adverse effect upon integration. The poor management of change and lack of communication led to issues within the single point of access such as failure of IT systems and duplication. Staff became frustrated and disengaged from the process, and consequently reported feeling disempowered, retreating back to their professional 'tribes'. Conclusion: Firm conclusions about the efficacy of a single point of access with regard to its effect upon integrated working could not be reached. However, the findings suggest that clear communication, continued change management and recognition of professional culture are decisive factors when attempting to integrate health and social care. Further research into the impact of a single point of access upon integration as well as outcomes for service users is recommended.
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24

Hayes-Burrell, Ingrid Monique. "Financing School-Based Health Centers: Sustaining Business Operational Services". ScholarWorks, 2015. http://scholarworks.waldenu.edu/dissertations/1684.

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Walden University College of Management and Technology This is to certify that the doctoral study by Ingrid Hayes-Burrell has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Ify Diala, Committee Chairperson, Doctor of Business Administration Faculty Dr. Anne Davis, Committee Member, Doctor of Business Administration Faculty Dr. Yvette Ghormley, University Reviewer, Doctor of Business Administration Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 â?? School-based health centers (SBHCs) have faced challenges in securing adequate funding for operations and developing sound business systems for billing and reimbursement. Specifically, administrators often lack strategies to develop and sustain funding levels to support appropriate resources for business operations. The focus of this descriptive study was to explore best practice strategies to develop and sustain funding through the experiences of SBHC administrators. The conceptual framework included Elkington's sustainability theory, which posits that corporate social responsibility, stakeholder involvement, and citizenship improve manager's effect on the business system. Twenty full-time SBHC administrators working in separate locations throughout the state of Maryland participated in semistructured telephone interviews. The van Kaam process was used to cluster descriptive experiences in data analysis that resulted in the development of thematic strategies for implementing best practices relevant to developing and sustaining funding for SBHC business operations. Major themes provided by the participants were interagency communications, creating marketing plans, and disparities in the allocation of funding for programs and professional staff. Findings indicated SBHC administrators continue to face challenges in developing and sustaining adequate funding for operations in the state of Maryland. Suggestions for future research include how administrators can develop marketing plans and explore long-range funding for SBHC services. The findings in this study may contribute to positive social change by demonstrating to officials in the Maryland State Department of Education the significance of SBHCs, and the need to increase mental health services.
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Rorie, Terri. "Rural Environmental Factors and Lesbian, Gay, Bisexual, and Transgender Mental Health Services Utilization". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6659.

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The rates of mental health issues in the lesbian, gay, bisexual, and transgender (LGBT) communities are twice that of individuals who identify as heterosexual. Research in urban communities show lower mental health services utilization rates for LGBT individuals compared to their heterosexual counterparts. The purpose of the study was to examine how rural environmental factors affect the use of mental health services by LGBT individuals and provide information to improve mental health outcomes. Andersen's healthcare utilization model and the minority stress theory were the foundations of this study. This study examined the association of mental health providers' availability/characteristics and utilization of mental health services and the association of perceived sexual discrimination and mental health services utilization in rural LGBT communities. Questionnaires were used to collect data from a random sample of 121 LGBT participants in Virginia, and linear and multiple regression was used to analyze the data. The findings for the associations between environmental factors and mental health service use were p < .84 for perceived discrimination, p < .04 for fear of provider insensitivity, p < .02 for provider availability, p < .000 for provider insensitivity and hostility, and p < .003 for provider insensitivity and ridicule. The results showed a need for specialized and sensitivity training in the health community and the need for improved access for LGBT health consumers in rural communities. The results of this study might lead to social change by encouraging improvement in mental health services and mental health outcomes for the LGBT community.
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Dixon, Decia N. "Perceptions of school based mental health services by directors and supervisors of student services". [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002079.

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Papadakis, Sophia. "Economic evaluation of cardiac rehabilitation and secondary prevention services". Thesis, University of Ottawa (Canada), 2004. http://hdl.handle.net/10393/26737.

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Little is known about the relative cost-effectiveness (CE) of different cardiac rehabilitation (CR) program designs and how CE is influenced by a patient's clinical and demographic characteristics. The aim of this study was to assess the 2-year incremental cost-utility of a distributed (12-month, 33-session) CR program to that of a standard (3-month, 33-session) CR program as assessed from the perspective of the cardiac health care system. 306 Patients (mean age = 58.4 years, SD+/-9.7) with CAD were randomized to either standard or distributed CR. Program delivery costs, cardiac health care use, QALYS were tracked over a two-year period. The standard CR intervention was found to be dominant, resulting in both a cost saving and larger gains in QALYs in the 2-years following initiation of CR. Important differences were noted in CE of CR across cardiac risk strata and diagnosis groups, suggesting patients may benefit from triage to available CR models.
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28

Matthews, Jean Isabel. "Power, management and complexity in the NHS : a Foucauldian perspective". Thesis, University of South Wales, 2009. https://pure.southwales.ac.uk/en/studentthesis/power-management-and-complexity-in-the-nhs(bb92809f-944d-4bfd-8502-7ffd0791a35a).html.

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This thesis is a critical and post-structural exploration of the discourse of managerialism in the NHS secondary care sector in Wales. Its central intent is to destabilise the dominant thinking about NHS management practice and to evoke intellectual debate about alternative discourses of management that ontologically perceive the organisation as a complex adaptive human system. The emergent theoretical framework conjoins the discipline of Complexity with post-structural conjecture, posing a novel conceptualisation of a fractal self where relations of power are seen as essential for harmonising diverse influences and legitimising a local discourse that informs and regulates practice. Using Foucault’s insights on power and knowledge the thesis critiques the strategic nature of NHS discourse, exposing the discursive dominance of managerialism and its inherent relations of power and debates what this predicates for a local negotiation and a flexible, safe and innovative environment. The methodological approach employs a reflexive and micro-level interpretative strategy to emphasise the singularity of agents and to explore the way in which the discursive constitution of the self influences agent practice. My profound experience of the secondary care system requires I situate my self reflexively within the context where I explore and liberate my own voice in conjunction with my participants. The research adopts a biographical narrative method of data collection and uses Foucauldian discourse analysis as a framework for exploring the underlying discourse in agent stories. The findings demonstrate the polyphonic nature of the secondary care context and reveal the demonstrate the polyphonic nature of the secondary care context and reveal the diverse ways in which agents legitimise, negotiate or resist the conflicting truth claims of various discourse in order to strategically sustain an image of health care historically constituted in their self. The results portray a web of discourses that endorse conformity or complicity through oppressive mechanisms of disciplinary control and surveillance, perpetuating authoritative and dualist structures, dissipating relations of trust and removing intellectual thinking from the front-line. The conclusion asserts that this significantly jeopardises the ability of agents to legitimise local ‘discourse’, severely limiting their capacity for adaptive practice and the generation of new order.
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29

Carney, Philip Sheridan. "Managed healthcare and integrated delivery systems: A model for getting ahead of the change curve". CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2103.

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Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.
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30

Jackson, Pulver Lisa Rae. "An argument on culture safety in health service delivery towards better health outcomes for Aboriginal peoples /". University of Sydney. Public Health and Community Medicine, 2003. http://hdl.handle.net/2123/609.

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The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.
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31

Lee, Fock Choy. "A quantitative performace measurement framework for health care systems". Diss., Columbia, Mo. : University of Missouri-Columbia, 2006. http://hdl.handle.net/10355/4583.

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Thesis (M.S.) University of Missouri-Columbia, 2006.
The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file viewed on (June 26, 2007) Includes bibliographical references.
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32

Yeritsyan, Sargis. "Just Culture Consulting, LLC| Cultural Competency Services for Healthcare Providers". Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10839096.

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The U.S. healthcare industry seeks to improve patient satisfaction as the national trend of increasing diversity and ethnic representation continues. The provision of culturally sensitive health care will not only increase patient satisfaction and outcome metrics but also allow healthcare organizations to thrive financially by meeting patient needs and payer requirements. Just Culture Consulting, LLC. is a start-up, for-profit healthcare consulting firm that will provide cultural competency and language training services for healthcare professionals. Just Culture Consulting, LLC. aims to build a regionally and potentially a nationally recognized brand in specialty healthcare consulting by capitalizing on the growing need for culturally competent providers in healthcare. The Firm will retain a large client base through aggressive marketing and by leveraging the skills of its multicultural staff who possess significant career and native exposure to language, cultural sensitivity, healthcare delivery, and administration.

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Heinritz, Debbie. "A study to determine the need for lean training by the health care employers of Northeast Wisconsin". Menomonie, WI : University of Wisconsin--Stout, 2006. http://www.uwstout.edu/lib/thesis/2006/2006heinritzd.pdf.

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34

Flad, Jennifer. "Advocating work an institutional ethnography of patients' and their families' experiences within a managed care health system /". Related electronic resource: Current Research at SU : database of SU dissertations, recent titles available full text, 2009. http://wwwlib.umi.com/cr/syr/main.

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35

Jackson, Pulver Lisa Rae. "An argument on culture safety in health service delivery: towards better health outcomes for Aboriginal peoples". Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/609.

Testo completo
Abstract (sommario):
The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.
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36

Obenauer, Irina. "Fit4Life, LLC, corporate wellness, fitness, and nutrition services| A business plan". Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10142966.

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Over one-third (78.6 millions) of U.S. adults are obese. Weight management in the typical health care practice is inadequate with fewer than half of primary care physicians consistently providing guidance on diet, physical activity, or weight control. Because 60 percent of Americans get their health insurance through their jobs, employers often bear the bulk of the obesity costs, but are also well-positioned to implement effective lifestyle interventions. The Patient Protection and Affordable Care Act (PPACA) of 2010 included provisions for the incentives and penalties employers and health plans can impose on employees’ health insurance premiums based on the participation and goal completion in wellness programs giving a major boost to a now rapidly-growing multi-billion dollar workplace wellness industry. Fit4Life, LLC intends to offer on-site wellness, fitness, and nutritional services to medium- to large-size employers with fitness facilities in the Los Angeles Metropolitan area. The company’s unique combination of fitness, nutritional, and medical expertise rarely offered by other providers in the Los Angeles area and the convenience of the on-site service model, paired with low start-up and overhead costs are the major strengths likely to contribute to Fit4Life, LLC’s success.

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37

Callicott, Cecelia Antoinette. "The revitalization of rural health care in Big Bear Lake, California". CSUSB ScholarWorks, 1989. https://scholarworks.lib.csusb.edu/etd-project/552.

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38

Duro, Charles. "Effects of Lifestyle Changes on the Health of African Americans With Type 2 Diabetes". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4362.

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African Americans are adversely affected by Type 2 diabetes at a greater rate than their European American counterparts; however, research on the effects of Type 2 diabetes on African Americans is limited. Lifestyle modifications that include the incorporation of physical activity and dietary changes can help patients with Type 2 diabetes better manage their disease and improve their overall quality of health. The purpose of this phenomenological study was to explore the experiences of African Americans with Type 2 diabetes who incorporated these self-management behaviors, discerning if they had improved health and quality of life. The self-efficacy framework was applied to understand the research problem and interpret study results. An in-depth interview protocol was used to explore participants' perspectives and lived experiences in disease management. Interview transcripts and participant data were analyzed using a thematic-content-analysis approach. According to study findings, participants experienced physical activity and dietary changes, and their self-efficacy directly correlated with their experience of positive changes in their health status. Providing programs that support the adoption of healthy lifestyles for this population will help mitigate the later effects of diabetic complications. Implications for social change include the provision of strategies that will help in formulating programs and policies that will reduce diabetic complications and deaths due to complications.
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39

Sandu, Adriana Iuliana. "Poverty, institutions and child health in post-communist rural Romania a view from below /". Related electronic resource: Current Research at SU : database of SU dissertations, recent titles available full text, 2006. http://proquest.umi.com/login?COPT=REJTPTU0NWQmSU5UPTAmVkVSPTI=&clientId=3739.

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40

Tyali, Sinovuyo. "An integrated management system for quality and information security in healthcare". Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1006670.

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Abstract (sommario):
Health service organizations are increasingly required to deliver quality healthcare services without increasing costs. The adoption of health information technologies can assist these organizations to deliver a quality service; however, this again exposes the health information to threats. The protection of personal health information is critical to ensure the privacy of patients in the care of health service organizations. Therefore both quality and information security are of importance in healthcare. Organisations commonly use management system standards to assist them to improve a particular function (e.g. quality or security) through structured organizational processes to establish, maintain and optimise a management system for the particular function. In the healthcare sector, the ISO 9001, ISO 9004 and IWA 1 standards may be used for the purpose of improving quality management through the establishment of a quality management system. Similarly, the ISO 27001 and ISO 27799 standards may be used to improve information security management through the establishment of an information security management system. However, the concurrent implementation of multiple standards brings confusion and complexity within organisations. A possible solution to the confusion is to introduce an integrated management system that addresses the requirements of multiple management systems. In this research, various standards relevant to the establishment of management systems for quality and security are studied. Additionally, literature on integrated management systems is reviewed to determine a possible approach to establishing an IMS for quality and information security in healthcare. It will be shown that the quality management and information security management standards contain commonalities that an integration approach can be based on. A detailed investigation of these commonalities is done in order to present the final proposal of the IMSQS, the Integrated Management System for Quality and Information Security in healthcare.
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41

Lai, Tai-yee Barbara. "Pay for patient satisfaction what is the evidence for quality of improvement? /". Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B4299486X.

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42

Huonker, John Walter. "The determinants of physician practice choice and its effect on physician autonomy, satisfaction, and commitment". Diss., The University of Arizona, 1993. http://hdl.handle.net/10150/186498.

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The effective management of professionals requires achieving a balance between organizational control and professional autonomy. The problem of achieving a balance is important currently in the United States healthcare industry. This dissertation examined the antecedents and consequences of physician autonomy in both traditional fee-for-service (FFS) and non-traditional managed care settings. The population of physicians in one county were surveyed. Two models were developed arguing that physician practice choice affects autonomy. The antecedents and consequences of autonomy were compared both between FFS and managed care practice and between different types of managed care organizations (MCOs). Results indicate that most physicians in the survey area choose managed care practice, and the value physicians place on income is positively associated with the volume of patients from MCOs. FFS practice generated greater autonomy than MCO practice, and autonomy within MCOs positively affected practice satisfaction. Group practice positively affected autonomy within MCOs. Autonomy did not vary across different MCO types but was influenced by the process variables physician decision involvement and organizational formalization, thus suggesting that classifying organizations by autonomy requires knowledge of the processes used in the MCO.
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43

Agunga, Paul Wekesa. "County Health Leadership and Readiness for Noncommunicable Disease Services". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5298.

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Premature mortality resulting from the growing global burden of noncommunicable diseases (NCDs) is a contemporary development challenge. Low-income and lower-middle-income countries are disproportionately affected, with the poorest in society considered the most vulnerable. A paucity of literature exists on how leadership practices at the implementation level relate to ensuring readiness for NCD services. The purpose of this study was to investigate whether any relationship exists between leadership practices at the county level and readiness for NCD services in Kenya. Path-goal and adaptive leadership theories were used to guide this quantitative correlational study, using secondary data from a 2013 Service Availability and Readiness Assessment survey. Correlation and multiple linear regression tests were used to determine the strength and direction of any relationship between the independent variable of leadership practices (annual work planning, therapeutic committees, and supportive supervision), and the dependent variable of NCD readiness (county readiness score). The results indicated a statistically significant relationship between therapeutic committee (p = .002) and supportive supervision practices (p = .023) and NCD readiness. Leadership practices also had a statistically significant predictive relationship with NCD readiness (p = .009). This study may be significant to county health leaders in relation to their efforts to ensure proximal access to quality NCD services in Kenya. The results of this study may help to promote the development of capacity-building programs targeting health leadership and prioritization of actions to ensure access to NCD prevention and treatment services at the county level in Kenya.
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44

Bash, Camille Rose. "The influence of community support services in reducing potentially preventable readmissions". ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1099.

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Recently, the Centers for Medicare and Medicaid Services (CMS) ranked all hospitals based on Medicare readmission rates for heart attacks, heart failure, and pneumonia. CMS offered subsidies to hospitals ranked in the 4th quartile to develop community support services to reduce the problem of potentially preventable readmissions (PPRs). CMS cited 4 of the 5 hospitals in Prince George's County in the 4th quartile. The purpose of this quantitative research study was to investigate the relationship between community support services and the reduction of PPRs in Prince George's County. The Evans and Stoddart field model of health and well-being guided this study with support from Bertalannffy's general systems theory. This study sought to relate community support services to PPRs in Prince George's County in contrast to other Maryland counties. To evaluate relationships between community support services and the reduction of PPAs, secondary data were provided by CMS in conjunction with the Robert Wood Johnson Foundation and the University of Wisconsin. The data included 26 behavioral community support factors from 53,229 Medicare paid claims in Maryland residents from July 1, 2008 to June 30, 2011. Lack of diabetes screening is a community support factor within quality of care. Using multiple regressions, there was a statistically significant relationship found between diabetic screenings and pneumonia readmission rate. The implication for social change is that reimbursement of key screening recommendations to CMS, local government, and hospitals in Prince George's County may reduce readmission rates, thereby positively affecting patients, improving community health, and decreasing health care costs in Prince George's County.
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45

Hillier, Fleur Jane School of Public Health &amp community medicine Centre for Clinical Governance Research in Health UNSW. "Managing creative and health production processes : issues, similarities and differences". Awarded by:University of New South Wales. School of Public Health and community medicine. Centre for Clinical Governance Research in Health, 2005. http://handle.unsw.edu.au/1959.4/22281.

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In this thesis I am concerned to examine the management behaviours and predilections of managers across the two settings of health and theatre considered to be divergent. To do this I explore and map methods, similarities and differences managers employ to ???manage??? workers across the industries. I also deconstruct creativity and its manifestations in both managerial behaviours and environmental contexts and map the complexity issues that managers face in different settings. Further, I explore the extent to which management activity is contextual to the identity of participant organisational aims and processes and examine the level of calculated chaos experienced by managers across the settings. Central to this approach is the utilisation of multi-method design incorporating interview, micro-ethnography, auto-ethnography and a RAND expert panel to assist with interpretation of the results. Core findings include high degrees of similarity in the roles and functions and support systems utilised by managers across the settings despite substantial differences in environmental contexts and organisational aims and processes. Differences were identified in the areas of: levels of chaos, interactions, purposes, and environmental characteristics. To account for these differences I apprehended seven metafactors grounded in the data sets. These seven metafactors can be found in each setting but emerge in different ways. The metafactors that I apprehend are order versus disorder; creativity; experimentation and change; risk; reflection; trust and respect; and time and pressure. While I discuss these seven metafactors as separate factors in reality they are fundamentally inter-related. Suggestions for future research are included.
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46

Perley, Mary Jo. "Organizational culture and social power : an analysis of a health care organization /". The Ohio State University, 1986. http://rave.ohiolink.edu/etdc/view?acc_num=osu14872675469815.

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47

Morton, Mary Elizabeth Wiedenbeck Susan McCain Katherine Wootton. "Use and acceptance of an electronic health record : factors affecting physician attitudes /". Philadelphia, Pa. : Drexel University, 2008. http://hdl.handle.net/1860/2905.

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48

Harris, Patricia Amanda. "Promoting research utilisation and evidence-based decision making amongst healthcare managers : utilising nonrecursive structural equation modelling to develop the theory of planned behaviour". n.p, 2005. http://ethos.bl.uk/.

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49

Kruthoff, Bryson. "Two canoes: a case study in organizational change failure and the implications for future population health initiatives". Thesis, University of Iowa, 2017. https://ir.uiowa.edu/etd/5541.

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Abstract (sommario):
Organizational change is undeniably difficult, and change efforts often fail to overcome the status quo processes and routines. By threatening these structures, change becomes an existential danger to organizations, who often respond with significant resistance. Organizations will look to their experiences with past change efforts to inform future changes, limiting the ability of change actors who seek to implement change beyond this narrow scope. The “Heart Failure Lite” model was a change effort that exceeded the scope of previous changes at an organization with deeply embedded routines and processes. This model threatened the traditional revenue streams that had benefited the organization for years. The resistance exhibited by the organization when presented with the change was consistent with the underlying theory. Although change failure is common, proactive efforts on the part of change actors can help break down the organizational barriers. Conceptual models like PARiHS can be utilized to identify the evidence supporting the change, the contextual environment in which the change will be introduced, and the facilitation efforts needed to guide the project to a successful conclusion. The “Heart Failure Lite” team failed to survey the organizational landscape and tailor the project accordingly. Therefore, the change effort failed. Shifting clinical practices toward a population health model presents a unique opportunity for healthcare organizations. A concerted effort from all stakeholders to find common ground will allow change agents to overcome the traditional barriers, and will help organizations to truly transform the delivery of healthcare services.
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50

Coronel, Gabriela V. "Long-Term Sustainment of Rapid Improvement Events: A Case Study in “Room Readiness”". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/honors/382.

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Shifting payment models from fee for service (FFS) to pay for performance (P4P) have fundamentally changed the environment of healthcare administration in the United States (Center for Medicaid and Medicare Services (CMS), 2011). Due to this shift, there has been an increase in demand for tracking and improving quality measures to ensure not only patient safety, but optimization of utilization. Constraints on resources and capacity, coupled with increasing safety measures has developed a new study of patient flow (Miró, Sánchez, Espinosa, et al., 2003). Decreasing patient room turnover times has the potential to maximize utilization while ensuring patient safety and quality (Dyrda, 2012). LEAN and A3 Methodology were applied to create a process improvement initiative at a 500-bed regional medical center (RMC). Using a Rapid Improvement Event (RIE), efforts were made to identify gaps and improve processes to address issues which prevented patients from being in the right place, for the appropriate amount of time, and patient rooms cleaned in a timely manner. These gaps prevented adequate patient flow in the RMC. After tracking the implemented improvements for a year, the RMC ceased following the newly designed process. This study examines the original RIE, factors that changed since the event, and additional process improvements made two years post-RIE.
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