Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: Dept. of Health Administration. Bibliography: leaves 239-260. Also available online.

El presente estudio intitulado “Calidad de las Notas de Enfermería en la Unidad de Cuidados Intensivos - Hospital Regional Moquegua I semestre año 2011” de tipo cuantitativo, prospectivo, de corte transversal; su objetivo fue determinar la calidad de las notas de enfermería en la unidad de cuidados intensivos de los profesionales de enfermería hospitalaria. La población estuvo conformada por 64 historias clínicas correspondientes al I semestre, se aplicó una Lista de cotejo, a través de observación directa y evaluación. El análisis y procesamiento de los datos se hizo en el software SPSS versión 20, estadística descriptiva, se realizó pruebas de confiabilidad utilizando el alfa de Cronbach y coeficiente de correlación. Se llegó a las conclusiones: Las notas de enfermería presentan un porcentaje significativo de regular calidad con un 54,7%. El 79,7% tienen una regular calidad en cuanto a su dimensión estructura y el 96,9% de las notas de enfermería estudiadas tienen mala calidad en cuanto a su dimensión contenido (PAE).

According to a recent study, about 30 percent of U.S. real estate projects are canceled midstream, while more than half run up to 190 percent over budget and 220 percent over the initial time estimate. The reasons for this are manifold but poor decisions during the initiation and early planning of the project can be pointed to as main causes. Most poor decisions stem from lack of information, bad judgment, and lack of communication and transparency between what the client expects and what the project team can deliver. Proper project planning procedures and methods will lead to proper contingency planning, management of partner relationships and contracts, management of dynamic change and associated risks that can, and most probably will, occur in the course of the project. The role of the owner cannot be overstated in all of these targets. Historically, the owners of healthcare facilities have a once in a lifetime involvement in the planning, design and construction (or major renovation) of their facility. The interaction with planners, public bodies, architects, engineers, and other entities is a daunting prospect for which an owner will seek help from specialized firms that represent the owner. This guide may serve as a healthcare project planning guide for owners, and in particular CEOs, to navigate the process. It will prepare the owner to recognize the major tasks and decision steps throughout project planning, while keeping the focus on the desired outcome. Any owner should recognize that the slogan: if you dont know what you want, you will not get what you need is as true today as it ever was. This guide will include research, best practices from industry experts, and a case study on the New Orleans public healthcare planning process post-Hurricane Katrina.

The main responsibility of the medical institution is to provide medical services that meet patients¡¦ needs as well as create health value in a patient¡¦s life. Hospital marketing, a type of service marketing promoting intangible products, is a way of utilizing medical service marketing to provide patients with more efficient medical service. Since the implementation of National Health Insurance, Taiwan¡¦s medical system has experienced an increased of enterprization in hospital management, the implementation of a global budget payment system, the financial crisis and the impact of rising medical right demanded by the Taiwanese. The military district hospitals that are responsible for maintaining the combat power of the military staff also pay an important role in the National Health Insurance medical system. While confronting the change in the competitive environment and the transformation of the entire medical ecology, military district hospitals should take a step further to adjust and develop a new marketing strategy. The research method of this paper adapts a case study based on information from a military district hospital located in southern Taiwan. The discussion focuses on the changes in current medical ecology and the competitive advantages of the subject hospital. Diamond Theory by Michael Porter and SWOT analysis are used to evaluate the strengths and weakness in and outside of the hospital, determine the trend choice for the hospital¡¦s new positioning, and define the right strategy to target to its market segment. All of these are based on the concept of national defense. The paper will also take into consideration the subject hospital¡¦s special features and competitive advantages, and build an 8P marketing model centering on patients in order to formulate the best combination of marketing strategies for the subject hospital. The paper has three conclusions, first of all, recognize the competitive advantages and the opportunities of the subject hospital; second, assert the new positioning of the transformed medical service; finally, establish a patient-oriented marketing strategy. In addition, this paper also suggests the best marketing strategy combination by applying innovative and pragmatic managerial thinking in order to give the military hospital a brand new image.

Thesis--University of Minnesota. / Photocopy of typescript. Ann Arbor, Mich. : University Microfilms International, 1977. -- 21 cm. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [119]-125).

Thesis (MSD (EAP))--University of Pretoria, 2003. / Includes bibliographical references.

Isolation of those ill with contagious disease has been a fundamental infection control concept for hundreds of years. However, recent studies suggest that fewer than 50% of health—care workers comply with their hospitals' isolation precaution policies and that efficacy of some of those policies is questionable. In response, two new systems, based upon fundamentally different goals, were promoted. The Centers for Disease Control, prompted by health—care worker& concerns about occupational risk of human immunodeficiency virus (HIV) from a growing number of patients with acquired immunodeficiency disease syndrome (AIDS), issued formal guidelines in 1987. This formed the basis for Universal Precautions (UP), a unifying strategy for precautions with all patients regardless of diagnosis intended to reduce risk to hospital staff members. Also in 1987, one hospital issued guidelines for Body Substance Isolation (BSI), hygienic precautions to be used with all patients based on recognition that colonized body substances are important reservoirs for cross—infection to both patients and staff members. These new strategies have been promoted widely, but there have been no formal assessments to reconcile controversies they raised nor to confirm their effectiveness. Further, necessary assessment tools have not been validated. This thesis provides new tools and new information to address three vital questions: Have hospitals adopted Universal Precautions or Body Substance Isolation? Do their staff members use the new system of precautions in daily practice? Has reliable use of a new system led to decreased risk of infection? A confidential mailed survey of all acute—care Canadian hospitals was conducted to measure rates of guideline receipt and adoption. It also obtained information on motivations for and perceived effectiveness of strategies adopted. A self—selected group of responding hospitals subsequently participated in standardized covert observation of their nurses infection control practices, then had the observed nurses complete a test examining their knowledge and beliefs. Employee health records were also examined to determine whether needlestick injury rates had changed since adoption of a new infection control strategy. Most Canadian hospitals adopted and modified new strategies based upon reasonable but unproven extensions of logic to protect health—care workers from HIV. 74% claimed UP (65%) or BSI (9%) but only 5% of 359 claiming UP and 0 of 50 claiming BSI adopted all policies expected. Many hospitals had not received key guideline publications. Guideline source, hospital size, and other variables were significantly associated with receipt. Nurses in 35 hospitals were observed to wear gloves during only z60% of procedures in which gloving was expected; rates varied widely among hospitals. Direct examination of sharps disposal containers confirmed compliance with a policy to not recap used needles (taken as recapping rate of 25%) in only 47% of 32 hospitals. Paired analysis of needlestick injury rates in 11 hospitals during comparable 90—day periods before versus after implementing UP/BSI showed no significant difference. 489 nurses completing a written test achieved their highest scores and least discordance among questions regarding procedural issues established long before UP/BSI, and lower scores or greater discordance on UP/BSJ concepts of philosophy, risk recognition and newer procedures. Positive correlation between knowledge and practice was not evident. UP and BSI now mean different things in different hospitals and have not been effective in harmonizing health—care workers’ infection control practices. Carefully standardized assessment methods are needed to guide their evolution to cost—effectiveness.

This study examines the underutilization of rural hospitals in Kentucky. The authors study hospital and patient characteristics to determine why and how rural patients bypass local rural hospitals and how they make their decision in the hospital choice. A Health Care Service Survey conducted in rural Kentucky and hospital data drew from American Hospital Directory are used. A binary probit model and a conditional logit model are applied. The results suggest that the hospital quality, prior experiences and the satisfaction of the local hospital, along with patients’ value of hospital size, reputation and patients’ insurance coverage influence rural patients’ hospital choice. The study offers seven policy implications to better utilize rural health care institutions.

The U.S. Army Medical Department (AMEDD) has used the interstitial building system (IBS) as a design component for some of the hospitals in its healthcare infrastructure portfolio. Department of Defense (DoD) leadership is aware of increases in healthcare costs and understands the importance of safely reducing costs, which may be possible through design initiatives. An analysis was performed on facility maintenance metrics for ten different U.S. Army hospitals, including IBS design and conventional / non-interstitial building system (NIBS) design. Statistical analysis indicated a significant difference in cost and time data between IBS and NIBS for most of the building systems considered (HVAC, electrical, plumbing, and interior). Scheduled maintenance for the plumbing building system was not found to have a significant difference in costs; scheduled maintenance for the HVAC and plumbing building system was not found to have a significant difference in time expended. The data in this study showed that facility maintenance cost and time were generally lower for IBS than NIBS. Time spent (and associated cost) for scheduled maintenance of the electrical and plumbing building systems were slightly higher in IBS, though not significantly higher for plumbing. It may be easier to reach the plumbing and electrical building systems due to the greater accessibility afforded by IBS design. While a cost premium is estimated for integrating IBS design, the savings provided by life cycle facility maintenance is estimated to be up to three and a half times the initial cost premium.

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