Thesis (Ph. D.)--University of Oklahoma, 1998. / Includes bibliographical references.

<p> This study examines methods and barriers to minority leadership recruitment in healthcare organizations. Minorities are underrepresented in healthcare organizations at the executive level, even though staff and patient demographics are becoming increasingly diverse. This disparity in minority representation presents the potential for staff and patient needs, interests, and values to be overlooked by senior management and the strategies, policies, and programs they implement. This study conducted interviews with human resources personnel at healthcare organizations identified as top performers to determine whether their organizations engaged in minority recruitment methods, what methods were successful, and what barriers existed to recruitment of minorities. These results were compared to survey data compiled by the Institute for Diversity in Health Management. The results show significant room for improvement in the implementation of comprehensive methods to recruit minority senior management, with significant variation among organizations in the amount and type of methods to recruit minority executives. These findings lead to the conclusion that more pressure needs to be placed on healthcare organizations to identify best practices in minority recruitment and implement these in formal, comprehensive human resources activities related to recruitment, retention, and professional development.</p>

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<p> A nursing shortage has resulted in hospitals seeking ways to meet their staffing needs. One strategy is the use of travel nurses (travelers) employed by staffing agencies. Hospitals are challenged with providing travelers an adequate orientation to assure their patients receive safe care while placing the travelers where they are urgently needed&mdash;at the bedside. The goals of this project are to identify best practices to provide a quality orientation and to propose an orientation program. To address these goals, pertinent literature has been reviewed, and input from travelers has been examined. As a result, an orientation program has been developed with a module for travelers to review prior to their assignments. An onsite orientation program follows with one day of didactic training and two shifts with a preceptor at the bedside. The recommendation is that organizations use the proposed program as a template when developing their orientation programs.</p>

The aim of this thesis is to develop analytic methods to support the implementation of decentralization in primary health care. Decentralization may be defined as the delegation of decision-making power from central management to middle or local management for coordinated control. To be an effective mechanism for coordinated control it needs to be implemented by systematic methods. This doctrine generally comes from the experience of implementing decentralization in the industrial sector. This thesis develops systematic methods of resource allocation to support the implementation of decentralized primary health care in Britain. The thesis also considers the transferability of methods to support the implementation of decentralization to Pakistan. The work reported in this thesis is based on case studies carried out in health districts in both Britain and Pakistan. Based on the reported work this thesis concludes that decentralization could be beneficial for both British and Pakistani primary health care systems, provided its implementation is supported by appropriate analytic methods.

No description available.

No description available.

This thesis proposes a critical, systemic and pluralist approach to evaluating health programs. It examines ways in which efforts to promote equality and plurality are undermined by the application of foundationalist and universal conceptions of social justice and evaluation. This approach is developed within the current debate taking place in the field of Critical Systems Thinking, particularly in the area of the evaluation of social and health programs. It is argued that the potential for equality and plurality in Western societies goes beyond the questions of economic exploitation, military, cultural and political oppression and encompasses the relation between power and knowledge which is inherent in rationalities governing the formulation, the implementation and the operation of health programs. The thesis offers an alternative view of social justice that conciliates equality with plurality, and promotes these values through an evaluative procedure. Using Foucault's philosophy, it is proposed that a nonfoundationalist conception of social justice should be understood in terms of the interactions between three areas of human activity, namely knowledge, morality, and techniques and technologies of government. As regards the possibilities for developing a non-foundational and non-universal evaluative judgement, the thesis assumes a decentered conception of truth in the analysis of society and morality, and acknowledges the role of power as factor of generalisation or diversification of truth. Thus complexes of power-knowledge-morality are at the centre of our evaluative judgements of social justice. In order to encourage equality and plurality, this thesis proposes a rationale for evaluation that includes three main methodological guidelines: a decentered conception of critique regarding the problems and negative effects of a health program (unfolding in reverse); the promotion of subjectivity (autonomy, diversity, solidarity) through self-knowledge and self-regulation of desires (folding); and participation in the reordering of society through an ethical and political process of decision-making (ethical and political unfolding of the situated truths of the subjects). The processes are designed to interrelate and iterate in a complex way. They should include the exploration, choice and combination of methods and/or their parts, and of the strategic positions in scientific and ethical discursivities by thinking critically and acting in a situated and participative way.

Holistic health care recognises that body, mind and spirit operate as an integrated whole yet spirituality remains a neglected element of total health care. A co-operative inquiry group, comprising staff from two cancer care centres, met for one year to explore spirituality. The aim of the inquiry was to explore participants' own spirituality with a view to how that affected their work. The eight health care professionals involved in the co-operative inquiry brought varied religious and non- religious perspectives as well as different professional roles. A church based journey into faith group also contributed to the research. A significant outcome of the co- operative inquiry group was the development of a continuing professional education module for health care staff about spiritual care. Although spirituality is a word used increasingly today, there seems little clarity about the concept. Confusion between spirituality and religion aggravates this lack of clarity. Significant influences in the development of the post modern, western world have marginalised the spiritual to the extent that it can be argued that people have lost a cohesive voice with which to discuss spirituality. For those contributing to this research, the experience of talking about spirituality with others in a safe but challenging environment was both enlightening and encouraging. From this experience emerged a greater clarity about spirituality which influenced both personal and professional experience. Clearer understanding led to greater confidence, enabling individuals from different professions to become more effectively involved in spiritual assessment and spiritual care. Continuing professional education about spirituality, particularly involving reflection on experience, offers an opportunity to extend this work to others.

This thesis describes and analyses the development of the health care system in Saudi Arabia, particularly in the period since 1970. Two major differences between Saudi Arabia and most other countries have to be isolated. First, as a result of its oil wealth, Saudi Arabia has experienced extremely rapid economic growth over the last twenty years. Second, a very strong value system, Islam, has a persuasive effect upon Saudi society, including the organization of its health care system. The Basic Needs approach, which is favoured here, defines 'economic development' a the satisfaction of certain basic material human needs. Health care is important because it is one such basic need. The principal characteristics of health and health care in poor countries are examined. Patterns of mortality and morbidity are discussed as are the different health systems, and financial and health care planning arrangements, which are to be found. Trends in mortality, morbidity and life expectancy in Saudi Arabia are then discussed, bringing together data not previously assembled. The framework of the Saudi health sector is described. For the first time, the roles of health service providers, other than the Ministry of Health itself, are comprehensively documented. Regression contributions of rising living standards and the development of the health services to improvements in health status. Although some positive results are obtained, inadequate data prevent firm conclusions from being drawn. This crucial issue is therefore pursued on a more analytical level, employing comparative evidence on the experience of other countries. The final judgement is that economic growth, rather than the expansion of the health services, is the principal explanation of better standards of health in Saudi Arabia.