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Applying management principles of successful businesses towards the survival of non-profit organisations in the Western CapeBarnard, Dewald 30 April 2020 (has links)
Non-profit organisations serve disadvantaged people by fulfilling their social needs, promoting social inclusion and building economies. Non-profit organisations are confronted with a tightening funding environment, growing competition for donors and grants, rising demand for services and increasing calls for accountability. The objective of the study was to investigate the way in which non-profit organisations in the Western Cape province apply fifteen management factors of the Lussier Business Success Versus Failure Model. This model was successfully used in various parts of the world to predict the success or failure of a business.
A descriptive research design, using a qualitative case-study research approach was used in this study. A purposive non-probability sampling method was applied, and convenience sampling was used to identify twelve participants from four non-profit organisations. Semi-structured interviews were conducted with founders, managers and staff. Descriptive and thematic analysis techniques were utilised, and a deductive coding approach was used to develop thematic areas.
Thematic analysis showed three broad themes, namely people, management, and finance. The research established that the non-profit organisations applied nine success factors of the Lussier Business Success Versus Failure Model. Non-profit organisations keep accurate records and adequate financial controls. They do have staff with management experience, while the staff have limited NPO experience. The non-profit organisations make use of professional advisors and networks. The research also revealed that non-profit organisations experience challenges with income-generating activities. They do not plan for the long term and find it difficult to retain staff. Non-profit organisations also lack critical skills, such as strategic planning, marketing management, and administrative management. Non-profit organisations need to build and maintain relationships with government bodies, support organisations and other non-profit organisations. Enhanced information sharing and relationships will reduce the dependence on government grant funding. Applying management principles will enhance the long term survival of non-profit organisations. / Business Management / M. Com. (Business Management)
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Hranice globální daňové spolupráce: Neúspěšná vyjednávání na půdě OSN / Limits to Global Tax Cooperation: Unsuccessful Negotiations in the United NationsBřezovská, Romana January 2017 (has links)
In view of the adopted SDGs in 2015 and their focus on domestic resource mobilisation, this diploma thesis attempts to fulfil two main objectives. First, it aims to describe and analyse the current tax system often labelled not only by developing states as unfit for the 21st century's globalized economy. Second, it tries to provide deeper understanding of reasons that lead certain countries not to support the creation of a UN Tax Body, the only platform where all countries could participate in the negotiating of tax harmonization on an equal footing. Three hypotheses based on a neorealist, liberal and functional regime theory are put forward. Using data obtained from interviews conducted with delegates at the UN, it can be concluded that the organisational infrastructure is the power reflection. While the OECD BEPS mechanism is recognised by many as efficient and sufficient, this is possible due to the enabling power relations that exclude more than hundred developing countries from the negotiation of international tax rules. It can thus be concluded that the current OECD mechanism does not address existing policy loopholes that cause losses to developing countries. To match the SDGs' rhetoric with reality, policy-makers should create a more inclusive and universally agreed on standard-setting...
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Understanding adult education: Case-studies of three university-based adult education certificate programs.January 2000 (has links)
Doctor Educationis / By the mid-1980s, the Nationalist Party had sought to salvage almost four decades of apartheid
policies that were based on white supremacy. In this regard, it engaged in dual strategies of
repression and reform. The state's strategies were challenged by organizations and movements
within civil society. In this regard, many community-based organizations mushroomed
both nationally and regionally. These organizations were coordinated by adult political activists
most of whom were perceived to lack the necessary skills to manage organizations more
effectively. In this conjuncture, the Adult Education Departments at five South African
universities developed certificate-level programs to address this gap. This study focuses on
three such programs, the Community Adult Education Programme, based at the University of
Cape Town, the Certificate for Educators of Adults at the University of the Western Cape, and
the Community Adult Educators Training Course based at the University of NatalPietermaritzburg.
This study investigates the social and political conditions that gave rise to the three certificate
programs. It also investigates the relationship between the external social and political
conditions and the internal curriculum practices of the certificates. This process analyses the
nature of the relationship and identifies shifts in the programs and the curriculum practices
between 1986 and 1996. The study uses a qualitative approach and draws on elements of critical
theory and social constructionism to understand the data gleaned from interviews and
documents.
This study argues that all three certificate programs have directly been tied into the sociopolitical context in South Africa between 1986 and 1996. In this decade the study argues, there
are three distinct political periods, namely repression/reform, negotiations, and fragile
democracy. It argues that distinct features from each period have shaped the certificates in
different ways. Along with the national political conditions as manifest at the level of the state,
the private sector, and civil society, there are local and institutional dynamics that contribute to the
different forms assumed by these certificates. The study further argues that the external social -
political conditions from each period have demarcated and fixed the boundaries for the
certificates as a social practice. In this process, the curriculum practices for each period permitted
certain words and practices in preference to others. Consequently, it argues that the external and
internal social and political dimensions together construct the certificates as a discourse.
This study is based on a belief that the role of a certified practitioner is to creatively locate the
day-to-day practices within different theoretical frameworks to advance studies into sites
of adult education practices. This study represents a step in such a direction.
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Cause Related Marketing ve vztahu k veřejnému sektoru / Cause Related Marketing in relationship to the public sectorJurásková, Radka January 2008 (has links)
Diploma thesis "Cause Related Marketing in relationship to the public sector" deals with new phenomenon in area of marketing of companies, which is based on connection of business and public welfare activity. This type of marketing teaches big companies how to be responsible to social issues in certain country and society, how not to be indolent to minorities, interest groups, diseases and to other aspects of social need. Cause Related Marketing asserts on the base of connection of private and non-state non-profit sector by profiting on both of them. Company can on its base differ from competition and enhance the sale of their goods and services. For non-profit organizations it can be the contributions seen from new financial sources and in promoting their cause, which they are trying to solve. Otherwise, Cause Related Marketing is connected with concrete risks and the intervention of private sector into the public sector that can bring problems with definition of public interest. Then in consequence problems with selection of actual public and social issues to solve. Thanks to Cause Related Marketing grows the influence of corporations on the national state policies, what brings higher pressure on political decision-making sphere as a result of expectation of companies that this sphere will decide...
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Ochrana před diskriminací podle Evropské úmluvy o ochraně lidských práv / Protection against Discrimination under the European Convention on Human RightsKonoplia, Oleksandra January 2020 (has links)
The thesis is focused on the examination of the scope of Article 14 of the European Convention of Human Rights, theoretical framework, and legal basis of the concept of discrimination. The paper presents an analysis of the caselaw of the European Court on Human Rights, how the latter operationalises the issue of inequality, and which inaccuracies of interpretation it leaves. The primary aim is to challenge the system of protection against discrimination under the Article 14 as well as the role of the national actors in its development. The thesis examines the level of compliance among signatories of the Convention with its anti- discriminatory provisions and focuses on the individual capacities of the states to satisfy judgements of the European Court on Human Rights. The usage of the comparative approach also helps to analyse the role of local non-governmental organisations in the process of compliance with human rights obligations under the Convention among signatories. The thesis aims to show why the level of protection against discrimination differs from the one country to another and which obstacles they face on the path towards the respect for human rights.
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An archival collecting framework for the records generated by South Africa's Portuguese community-based organisations in GautengDa Silva Rodrigues, Antonio 11 1900 (has links)
South African institutions of preservation, such as archives, have often focused their collecting efforts on records of national significance and documenting the perspectives of the more dominant communities that represent power and government. This has resulted in the underrepresentation of certain communities in the archival heritage of the nation, such as the South African Portuguese community, whose contemporary history and experiences have not been adequately reflected in the country’s archival collections, including in those of government and other mainstream archival institutions and non-public institutions. Since South Africa has a number of Portuguese community-based organisations - and because the records they have created may be a potential resource for safeguarding the social history of this under-documented group - this study aimed to investigate the management of these records with a view of proposing a best practice model that would assist in their future management and guide their inclusion in any intended archival collection initiatives. Utilising a generic interpretive qualitative research design, the study revealed that the selected study population, namely the Portuguese community-based organisations in Gauteng, create and hold diverse types of records that may show important aspects of the community’s history that are worthy of systematic management and preservation. However, it became evident from the empirical findings that the recordkeeping practices of these organisations were performed inadequately, with records often being misplaced or discarded after their administrative use had expired. The findings also showed that, although these organisations had never thought of establishing an archival programme for themselves or depositing their records in any mainstream archives, they were willing to contribute their records to a planned archival collecting initiative of the community.
Based on these findings, recommendations were made with regard to these organisational records in order to improve their management and to facilitate their potential inclusion in an archival collecting plan. The study also suggested an archival collecting framework and a model for these records. The proposed model followed an integrated approach, taking into account the community’s divergent collecting and custody preferences, such as the mainstream institutional acquisition of these records or these being preserved within community structures. / Information Science / D. Litt. et Phil. (Information Science)
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Effectiveness of nonprofit organisations in the City of Tshwane: an evaluation of the poverty alleviation and sustainable livelihoodsKekana, Kerotse Marilyn 06 1900 (has links)
The roles of non-profit organisations in South Africa have evolved, leaving these organisations with an increased role to play in service delivery and community development. The purpose of the current research was to assess the effectiveness of non-profit organisations in the City of Tshwane to render services to communities by evaluating the Poverty Alleviation and Sustainable Livelihood Programme for the
period of 2015 to 2018. This research adopted a qualitative approach. Purposive sampling was used to identify participants in the study according to time in the programme and the number of years
non-profit organisations have been receiving funding from government. Using semistructured interviews and document analysis, this study found that, despite the efforts of the Gauteng Department of Social Development to decentralise services, poverty levels in South African communities remain high. This study further found that, although national, provincial and local poverty alleviation or sustainable livelihood programmes have been established, these programmes have been insufficient in making an impact in job placements and poorly reflect poverty reduction challenging communities. While non-profit organisations still face a plethora of challenges with regard to limited funding, capacity challenges and a lack of meaningful training and support, these organisations have however shown to be effective in achieving poverty alleviation in terms of the Sustainable Livelihood
Programme outcomes in addition to meeting the needs of the poor. This success has been achieved through the offering of skills development programmes to the youth, implementing government food security interventions, fostering entrepreneurship skills, and promoting access to information on social development opportunities in communities.
This study recommends that, for government to see considerable results and a change in the fight against poverty alleviation, there is a need to establish one national and uniform poverty alleviation programme that could be implemented across all spheres of government. In addition, this study concluded that, in strengthening the usefulness of non-profit organisations, there is a need to extend the current role played by the NPO Directorate, not only where staff capacity is concerned but also to introduce a functional model for managing the funding of all NPOs in South Africa. / Public Administration and Management / M. Admin (Public Adminitration)
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The motives of South African female perpetrators for becoming drug mulesKlein, Lucy Pearl Mpho 01 July 2020 (has links)
Summary in English, Tswana and Zulu / The researcher aimed to examine female perpetrator motives for becoming drug mules. The aim was accomplished through the use of a qualitative study, case research. Collection of data occurred via semi-structured interviews with seven participants. Purposive sampling was employed to aid with the selection of participants, and thematic analysis used as a means to analyse the data collected. The study found that motivations differed amongst all participants; nonetheless, the primary findings indicate that participants chose to become drug mules mainly due to financial strain. The other themes identified included monetary rewards and the influence of social networking relationships. The most common finding was the involvement of Nigerians in all participants becoming drug mules. Further research, and the need for intensive educational drives in communities and schools regarding drug mules, formed the recommendations derived from the study. / Boikaelelo jwa patlisiso eno ke go tlhatlhoba mabaka a a dirang gore basadi ba ikamaganye le go tsamaisa diokobatsi tse di seng kafa molaong. Boikaelelo jono bo fitlheletswe ka go dirisa patlisiso e e leng kaga boleng,, go dirisiwa boemo jo go ithutiwang ka jone ka ntlha ya gore ke jone bonang le dintlha tse di tlhokegang, tse di maleba mme di re naya dintlha tse di feletseng kaga se go batlisisiwang ka sone. Patlisiso eno e kaga basadi ba le supa bao re kgonneng go batlisisa ka bone. Patlisiso eno e sekaseka kafa batsayakarolo ba tshelang ka gone go ya kafa ba tlhalositseng ka gone,, go akareletsa le tsela eo ba neng ba tshela ka yone fa ba sale bannye le ka moo ba godileng ka gone, ga mmogo le botshelo jwa bone jwa jaanong le ka moo ba tshelang ka gone jaaka batsamaisi ba diokobatsi tse di seng kafa molaong. Patlisiso eno gape e sekaseka le kwa ba tswang teng, seemo sa bone sa loago le ikonomi, ba lelapa ga mmogo le ditsala tse ba ikopanyang le tsone, patlisiso eno e batlisisitse le gore a go na le dilo dipe tse dingwe tse di bakang gore ba tsamaise diokobatsi tse di seng kafa molaong.
Go kgobokanya tshedimosetso go dirilwe ka go dira dipotsolotso le batsayakarolo ba supa. Setlhopha se se tlhophiwang se dirisiwa go tlhopha batsayakarolo. Ka ntlha ya gore setlhogo seno ke kaga batsamaisi ba diokobatsi, mokgwa ono o ne o le maleba go tlhatlhoba batsayakarolo ba ba oketsegileng. Mmatlisisi o akanyeditse gore a botsolotse batho ba ka nna lesome, kwa bofelong go ile ga nna le basadi ba ka nna sometlhano ba ba ileng ba kopiwa go tsenela patlisiso eno mme ba le supa ke bone fela ba dumetseng go tsenela patlisiso eno. Go ile ga dirisiwa tlhatlhobo ya thematic e le go tlhatlhoba tshedimosetso e e kgobokantsweng. Le fa gone patlisiso e ne e le ka ga boemo jo go ithutiwang ka jone, tlhatlhobo ya thematic e nnile yone e e thusang thata ka gonne e ne e le bonolo go ka dirisiwa ka ntlha ya gore ke yone eo e nang le dintlha tse dintsi tseo di batlegang.
Mabaka a a dirang gore ba tlhophe tiro ya go tsamaisa diokobatsi a ne a sa tshwane go batsayakarolo botlhe le fa go ntse jalo go bonagetse gore lebaka la konokono leo le ba dirang ba tlhophe tiro eno ke ka ntlha ya mathata a madi/maemo a ikonomi a a sa tlhomamang. E re ka mathata a madi le maemo a ikonomi a a sa tlhomama di aname seo se ama motho yo o mo maemo ao fela thata, ke ka moo patlisiso e bontshitsheng gore maemo ao e ka nna a nako e telele kana a nako e e khutshwane. Mathata a tsa madi a nako e e telele a bakwa ke go tlhoka tiro nako e e telele le ditshono tse di tlhaelang tsa go bona tiro ka ntlha ya go sa nne le bokgoni jwa tiro, mme mathata a tsa madi a nako e khutshwane a bakwa ke ditiragalo tse di sa bonelwang pele tseo maemo a tsone a ka baakangwang ka bonako. Patlisiso e ne e bontsha lebaka le lengwe la go bo basadi bano ba dira tiro eno e ne e le ka gonne tiro eno e dira madi ka bonako ga e tshwane le tiro ya nako e e tletseng. Ba bontshitse gore ba tlhotlhelediwa le ke balosika, batho ba ba ratanang le bone ga mmogo le ditsala. Lebaka le lengwe le le kgatlhang le le fitlheletsweng go batsayakarolo botlhe ke go nna le seabe ga Ma-Nigeria mo go direng gore ba tsamaise diokobatsing tse di seng kafa molaong. Patlisiso eno e tlhomamisitse gore Ma-Nigeria ke one a a tshamekang karolo e kgolo mo tirong eno e re ka e le bone badiri ba diokobatsi tseno le gore ke bone ba ba nayang tiro eno ya go tsamaisa diokobatsi. Basadi botlhe ba ba dumetseng go tsenela patlisiso eno ba bontshitse bosupi jwa seno.
Go tlile go dirwa patlisiso e e tseneletseng ka ga batsamaisi ba diokobatsi. Go na le tshedimosetso e ntsi malebana le batsamaisi ba diokobatsi, segolobogolo jang mo basading. Ntle le seo, go tshwanetswe ga rutiwa batho mo go tseneletseng kaga batsamaisi ba diokobatsi mo baaging ga mmogo le kwa dikolong, thuto eno e tla lebisediwa thata kwa malapeng, ba ba tlhokomelang malapa ka tsa madi ga mmogo le go ba thusa gore ba kgone go dira ditshwetso tse di siameng. / Injongo yalolu cwaningo ukuhlola izimbangela ezenza abantu besifazane bashushumbise izidakamizwa. Le njongo iye yafezwa ngokusebenzisa uhlobo lokucwaninga lokuhlola ngokucophelela, kanye nocwaningo olumba lujule ngoba lushaya ngqo kulokho okucwaningwayo, lunembile futhi lunikeza isithombe esicacile sendaba ecwaningwayo. Leli phepha locwaningo lusekelwe ocwaningweni olwenziwe kwabesifazane abayisikhombisa. Lolu cwaningo luye lwahlola izindaba zokuphila zababambiqhaza njengoba babezilandisela bona ngokwabo, kuhlanganise isikhathi beseyizingane nendlela abakhuliswe ngayo, impilo yabo bengabantu abadala nokuphila kwabo njengabashushumbisi bezidakamizwa. Ucwaningo lugxile nasekuphileni kwabo kwangaphambili, izimo zomnotho nezenhlalo, umndeni nabangane, ucwaningo luye lwahlola ukuthi zikhona yini ezinye izinto okungenzeka ziyingxenye yezimbangela ezenza bashushumbise izidakamizwa.
Ukuqoqwa kwedatha kwenziwa ngezingxoxo ezihleliwe nababambiqhaza abayisikhombisa. Abacwaningi baye bazikhethela ngokwabo abantu abazobamba iqhaza. Ngenxa yokuthi isihloko sigxile kulabo abashushumbisa izidakamizwa, le ndlela ibifaneleka ukuze kuxoxwe nababambiqhaza abengeziwe. Umcwaningi obehlose ukuxoxa okungenani nababambiqhaza abayishumi, ekugcineni kuyiwe kwabayishumi nanhlanu okuthe kubo kwaba nabayisikhombisa abavume ukubamba iqhaza. Indlela ehlakaniphile yokuhlaziya isetshenzisiwe ukuhlaziya idatha eqoqiwe. Nakuba ucwaningo belugxile ocwaningweni olumba lujule, ukuhlaziya okuhlakaniphile kube usizo ngoba bekuvumelana nezimo okusizile ekunikezeni idatha enemininingwane eminingi.
Izimbangela bezihlukile kubo bonke ababambiqhaza, noma kunjalo okuyinhloko okutholakele kulolu cwaningo kubonisile ukuthi ababambiqhaza bakhetha ukushushumbisa izidakamizwa ngenxa yokuthwala kanzima ngokwezomnotho nangokwezimali. Ngenxa yokuthi ukuthwala kanzima ngokwezimali nangokwezomnotho kuyinto ebanzi futhi kuhlobana nomuntu othwele kanzima, kuye kwatholakala ukuthi ukuthwala kanzima ngokwezimali/ngokwezomnotho kungachazwa ngokuthi ukuthwala kanzima ngokwezezimali okuthatha isikhathi eside nokuthwala kanzima ngokwezimali kwesikhashana. Ukuthwala kanzima ngokwezimali okuthatha isikhathi eside kwenziwa ukuhlala isikhathi eside ungasebenzi kanye nokuntuleka kwamathuba emisebenzi ngenxa yokungabi namakhono, kuyilapho ukuthwala kanzima ngokwezemali kwesikhashana kudalwa izimo ezingalindelekile ezenza kudingeke isisombululo esisheshayo. Okunye futhi okutholakele ukuthi ababambiqhaza babekhuthazwa izinzuzo ezingokwezimali ukuthi bangaceba ngokushesha ngokungafani nokusebenza isikhathi esigcwele. Abantu abaphila nabo nsuku zonke bayingxenye yembangela ebagqugquzele ukuba bashushumbise izidakamizwa, kulaba kungabalwa umndeni, ophathina babo nabangane abadlale indima ebalulekile ekuthonyeni abanye ababambiqhaza ukuba bashushumbise izidakamizwa. Okuthakazelisayo okutholakale kubo bonke ababambiqhaza ukuthi abantu abadabuka eNigeria babe nesandla ekubeni kwabo abashushumbisi bezidakamizwa. Ucwaningo luqinisekisile ukuthi abase-Nigeria badlale indima enkulu ekubeni abaxhasi noma abagcini bezidakamizwa ezithuthwa ababambiqhaza. Lokhu bekufakazelwa yibo bonke ababambiqhaza okuxoxwe nabo.
Izincomo zalolu cwaningo zihlanganise ucwaningo olwengeziwe oluzokwenziwa kulabo abashushumbisa izidakamizwa. Alwanele ulwazi olukhona mayelana nabashushumbisi bezidakamizwa, ikakhulukazi kubantu besifazane. Ngaphandle kwalokho, kufanele kube nemikhankaso yokufundisa emiphakathini nasezikoleni ngokuphathelene nokushushumbisa izidakamizwa, le mikhankaso yokufundisa izogxila kakhulu emndenini, ezikhungweni ezinikeza kanye nasekwenzeni ukukhetha okufanele. / Criminology and Security Science / M.A. (Criminology)
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Kvalitetssäkring i agila team : Hur balanseras kundnytta mot ökad risk för instabil mjukvara? / Quality Assurance in Agile Teams : How is customer value balanced against increased risk of unstable software?Holmgren, Nils-Ivar, Bergström, Nils January 2022 (has links)
Agile software development aims to minimize risk by using a short and iterative process, a test-centric development approach by continuous integration, and test automation. Scrum aims to maximize collaboration and collective responsibility for quality by using a team approach. Regardless of this, the risk of project failure due to budget and time overruns is still a severe problem in software development projects. Despite the power that testing offers to mitigate these risks, testing remains a challenge to implement in agile teams regarding a test first or a test early context. This qualitative case study of two agile teams with differing approaches to agile methodology aims to provide some clarity on what driving forces contribute to an agile teams’ possibilities or what impediments contribute to an agile teams’ challenges pertaining to “why do we test software”.
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Building safer health systems : strategies used in the institutionalization of patient engagement for patient safetyAho-Glele, Ursulla 05 1900 (has links)
Contexte : Quatre patients sur dix qui reçoivent des soins de santé en milieu hospitalier sont victimes d’évènements indésirables et 80 % de ces évènements auraient pu être évités (OMS, 2019). Des données récentes montrent que 15 % des dépenses et activités hospitalières totales dans les pays de l'OCDE sont le résultat direct d'événements indésirables, ce qui représente des milliards de dollars US chaque année (Slawomirski, 2017). Selon un rapport de l'Institut canadien pour la sécurité des patients publié en 2016, les incidents survenus dans les établissements de soins de courte durée et à domicile ont entraîné des coûts supplémentaires de 2,75 milliards de dollars chaque année. Il n'est donc pas surprenant que l'investissement dans le coût de la prévention soit bien inférieur au coût des soins dus aux préjudices. Aujourd'hui, la recherche suggère que l'engagement des patients (EP) peut contribuer à améliorer les résultats et à réduire la charge des établissements de santé. Cependant, l'utilisation de l'EP dans diverses stratégies de gestion des risques et de promotion de la sécurité des patients n'est pas encore totalement intégrée dans les organisations et systèmes de soins de santé au Canada, aux États-Unis et dans de nombreux pays de l'OCDE.
Objectifs : L'objectif de cette étude de recherche est d'identifier les mécanismes et stratégies d'EP émergents et innovants mis en place par les dirigeants des principaux établissements de santé dans la province du Québec (Canada) après la mise en œuvre de la loi 10 en 2015, qui permettraient l'institutionnalisation de l'EP dans le système de santé pour la sécurité des patients (SP). Deux questions spécifiques ont été posées.
Question de recherche 1 : Quels sont les différents mécanismes/stratégies d'EP mis en place par les dirigeants des établissements de santé (CISSS et CIUSSS) pour institutionnaliser l'EP pour la SP?
Question de recherche 2 : Quelles sont les pratiques émergeantes et innovatrices (stratégies, mécanismes) ainsi que les facteurs limitatifs et habilitants mis en place par les leaders institutionnels dans un des centres de santé intégrés du Québec (étude de cas) qui permettraient d'institutionnaliser complètement l'EP dans la gestion des risques pour l'amélioration de la SP?
Méthodes : Le projet d’étude est une recherche descriptive longitudinale avec des niveaux d'analyse imbriqués (stratégique, organisationnel et clinique) séparés en deux phases.
Phase 1 : La phase 1 se divise en deux sous-étapes. La première sous-étape est le développement d'un outil pour les dirigeants afin d'identifier et d’évaluer les stratégies émergentes d'intégration de l'EP et leurs mises en œuvre dans les établissements de santé pour améliorer la SP (article 1 des résultats de la thèse). Suite à ce développement d’outil, la deuxième sous-étape est une collecte de données sur les stratégies émergentes et innovantes d'EP pour la SP dans les établissements de santé (N= 24 : 9 CIUSSS, 11 CISSS, 2 établissements de santé universitaires non intégrés) à travers le Québec (Canada) qui a été complétée en envoyant le questionnaire aux différents établissements participants. De plus, pour approfondir les réponses apportées par les participants, une collecte de données qualitative a été complétée en appui par le biais d'entretiens semi-structurés de 1 heure avec les dirigeants de ces établissements de santé (responsables de la qualité et de la gestion des risques, dirigeants ou équipes en charge de l'EP dans leur établissement (intégrant un patient partenaire (PP)) (article 2 des résultats de la thèse).
Phase 2 : La phase 2 est une analyse d'une étude de cas, qui a commencé à mettre en œuvre des stratégies visant à faire participer un PP à la SP (analyse d'un projet pilote de prévention et de réduction des chutes par une équipe clinique intégrant un PP) dans leur établissement de santé, a été menée dans un établissement de soins de longue durée. Une approche de collecte de données qualitatives a été utilisée pour mener des entretiens semi-structurés de 40 min à 2 h 30 min chacun avec des responsables stratégiques, organisationnels et cliniques (N = 7) (article 3 des résultats de la thèse). Pour ces deux phases, l'observation, ainsi que l'analyse de documents internes et externes ont également été menées.
Résultats: En phase 1 : 1) (Article 1 des résultats de la thèse), un outil d'évaluation des stratégies d'intégration de l’EP et leurs mises en œuvre dans les établissements de santé pour améliorer la SP a été créé, composé de 82 questions. 2) (Article 2 des résultats de la thèse), sept sous-stratégies émergentes/innovantes de l'EP pour la SP ont été identifiées et discutées à travers le processus d'acquisition, de partage et de préservation des connaissances aux trois niveaux de gouvernance : clinique, organisationnel et stratégique. Sept sous-stratégies principales ont été identifiées.
Dans la phase 2 : (Article 3 des résultats de la thèse), une étude de cas mettant en œuvre une stratégie de processus d'analyse des chutes par l'équipe clinique intégrant un PP pour la prévention et la réduction des chutes, a été sélectionnée pour participer. Trois sous-stratégies principales ont été révélées ici.
Conclusion : Cette étude est la première du genre au niveau provincial. Les travaux futurs devraient se concentrer sur (1) des études comparatives entre les provinces, les nations et leur évolution. Il existe actuellement deux projets de recherches en cours : un au niveau pancanadien et un autre au niveau brésilien, basés sur l’étude originale du Québec. En outre, la France a également mené cette étude pour décrire ses stratégies d'EP pour la SP en utilisant l'outil créé dans cette thèse. Des recherches supplémentaires devraient se concentrer sur (2) les mécanismes et stratégies de collaboration utilisés dans l'institutionnalisation d'initiatives concrètes / meilleures pratiques ou pratiques innovantes (études de cas) de l'EP pour la SP, le rôle des groupes de patients, des bénévoles, ainsi que les modèles de compensation de l'EP pour la SP dans ces mécanismes et stratégies de collaboration. Il faudra aussi mener davantage de recherches sur (3) les meilleures pratiques de leadership afin d'inculquer une culture de non-blâme au moyen d'exemples concrets (études de cas) pour mettre en œuvre une culture de sécurité fondée sur des expériences pratiques de leadership. De plus, les recherches futures devraient évoluer vers (4) l'engagement des citoyens pour la sécurité, en particulier pendant ces périodes de pandémie (ex. Covid-19). / Background: Worldwide, four out of 10 patients are harmed while receiving health care in a hospital setting, of which 80 % could have been prevented (WHO, 2009; WHO, 2002; Slawomirski, 2017; WHO, 2019). Recent evidence demonstrates that 15 % of total hospital expenditure and activities in OECD countries is a direct result of adverse events, amounting to trillions of US dollars every year (Slawomirski, 2017). According to a Canadian Patient Safety Institute report in 2016, incidents in both the acute and home care settings resulted in additional costs of $2.75 billion each year. Therefore, it is no surprise that investing in the cost of prevention is much lower than the cost of care due to harm. Today, research suggests that patient engagement (PE) can help improve outcomes and reduce the burden on health institutions. However, the use of PE in various strategies to promote PS has yet to be fully integrated across healthcare organizations and systems in Canada, the USA and many OECD countries. Objectives: The aim of this research study is to identify emerging and innovative PE mechanisms and strategies put in place by organizational leaders in leading healthcare institutions after implementation of Bill 10 in 2015, that would allow the institutionalization of PE in the health care system for patient safety (PS). Two specific questions were asked. Research question 1: What are the different PE strategies/mechanisms put in place by leaders in health institutions (CISSS and CIUSSS) to institutionalize PE for PS? Research question 2: What are the innovative practices (strategies, mechanisms) as well as the limiting and enabling factors put in place by institutional leaders in one of the integrated healthcare centers in Quebec (case study) that would allow PE to be fully institutionalized in risk management for the enhancement of patient safety? Methods: The project is a longitudinal descriptive research project by design with interwoven levels of analysis (strategic, organization and clinical) separated into two phases. Phase 1: 1) development of a tool for leaders to assess emerging PE integration strategies implemented in healthcare institutions to enhance PS (Article 1 of the thesis results); 2) collect ongoing emerging and innovative strategies of PE for PS in health institutions (N= 24: 9 CIUSSS, 11 CISSS, 2 non-integrated universities health institutions) across Quebec (Canada) by using the tool created in phase 1, and collect qualitative data through semi-structured interviews with leaders of these health institutions. Phase 2: 3) Analysis of a case study, which started implementing strategies to engage patients for PS (analysis of fall prevention and reduction pilot project by a clinical team integrating a PP) in their health institution was conducted in a long-term care facility. A qualitative data collection approach was used to conduct semi-structured interviews of strategic, organizational and clinical leaders (N = 7) of 40 min to 2 h 30 min each. Observation, as well as internal and external documents analysis was also conducted (Article 3 of the thesis results). Findings: In phase 1: 1) (Article 1 of the thesis results) a tool assessing emerging PE integration strategies implemented in healthcare institutions to enhance PS was created consisting of 82 questions. 2) (Article 2 of the thesis results), seven main emerging/innovative sub strategies of PE for PS were identified and discussed through the process of knowledge acquisition, knowledge sharing, and knowledge preservation at the three levels of governance: clinical, organizational and strategic. In phase 2: (Article 3 of the thesis results), one case study implementing a strategy of fall analysis process by the clinical team integrating a PP for prevention and reductions of falls, was selected to participate (CISSS Montérégie-Est). Three main sub-strategies were revealed in this article. Conclusion: The research study is the first of its kind at a provincial level. Future work should focus on (1) comparative studies between provinces, nations, and their evolution. There is currently an ongoing Pan-Canadian and a Brazilian research project based on the original research project from Quebec’s. In addition, France, have also conducted this study to describe their PE for PS strategies using the tool created in this thesis. Moreover, additional research should focus on (2) collaboration mechanisms and strategies used in the institutionalization of concrete initiatives / innovative practices (case studies) of PE for PS, the role of patient groups, volunteers, as well as compensation models for PE for PS in these collaboration mechanisms and strategies. In addition, more research on (3) best leadership practices to instill a no-blame culture by way of concrete examples (case studies) will be required to implement a safe culture based on practical leadership experiences. Furthermore, moving from a hospital setting, future research should evolve into (4) Citizen’s engagement for safety, especially during these pandemic periods (e.g. Covid-19).
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