<p><strong>Background:</strong> Organ donation in India is a complex issue due to the country’s large population, diverse religious beliefs and myths surrounding organ donation, varying literacy rates, nation-wide focus on disease control, and the commercialization of organs. India has only made marginal steps to address the significant obstacles in order to ensure adequate supplies of organs are available to meet the demand.</p> <p><strong>Purpose: </strong>The purpose of this study is to analyze the feasibility of implementing an organ donor registry in Mumbai, India. This is achieved by reviewing current organ donation policies and processes in Mumbai, exploring perceptions of key informants about Indian government health priorities, and identifying possible reasons why the Indian government has not made efforts to increase the deceased donor rate.</p> <p><strong>Methods:</strong> This qualitative policy analysis employs semi-structured interviews with physicians, transplant coordinators, and representatives of organ donation advocacy groups in Mumbai to explore key informants’ perceptions about the feasibility of developing and implementing an organ donor registry. The 3-I framework (ideas, interests, and institutions) is used to analyze the results and frame the discussion and their implications.</p> <p><strong>Results:</strong> Key informants cite various barriers to the implementation of an organ donor registry in Mumbai, including public misconceptions about organ donation, competing health priorities on the government agenda, and limited hospital infrastructure.</p> <p><strong>Conclusion: </strong>In the absence of a focusing event or a policy entrepreneur who is able to push the issue of organ donation onto the health policy agenda, both central and state governments may have little incentive to aggressively pursue the implementation of a donor registry in more than a superficial way. Moreover, even if the issue reached the government’s policy agenda, current barriers may be too overwhelming to overcome. This suggests that implementing an organ donor registry in Mumbai as a means of enhancing organ availability is not feasible in the current environment. Instead, efforts to enhance the transplant system should focus on alternate strategies, such as public education, until the policy environment becomes more amenable to change.</p> / Master of Science (MSc)

Thesis (M. Soc. Sc.)--University of Hong Kong, 1986.

Thesis (M.P.A.)--University of Hong Kong, 1991.

Thesis (M.P.A.)--University of Hong Kong, 1991. / Also available in print.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1986. / Also available in print.

No description available.

An Enterprise Culture, which looks to replicate improvements to quality and efficiency demonstrated in the private sector, has evolved from health care policy in the English NHS. The aims of this research were to explore the theory underpinning the application of the policy and to challenge and test if the Enterprise Culture has provided a framework for performance improvement in a rural District General Hospital (DGH). The evolution and characteristics of the Enterprise Culture resulting from the convergence of political policy relating to health care revealed a centralised command and control approach to performance expectations and a decentralised means of achieving them through managers and competitive markets. Using a mixed methodology with a dominant quantitative, less dominant qualitative emphasis, this research examined the theory through a critical comparison of the Enterprise Culture present in a single case study of a rural DGH with the Purpose, Process, People (PPP) framework which has led to private sector success. Firstly, the study looked to understand the nature of the central Enterprise Culture target for hospital emergency care: that patients spend less than four hours in the Emergency Department. A quantitative analysis of service demand from patients found that attendance patterns offered opportunity to use PPP techniques to meet the four hour target, but that greater data availability would be necessary to make detailed calculations. A quantitative analysis of the resources provided revealed that capacity was not calculated, planned or monitored to meet demand. Furthermore, an ethnographic study of the operational activities of the hospital’s emergency care system uncovered a lack of defined process and competent actors, departmental barriers and reactionary decisions leading to poor performance against the four hour wait target. Secondly, an intervention was introduced to examine the Enterprise Culture’s ability to generate efficiency and quality improvements. The intervention (care plans and drug chart provision for patients who required clinical observation) addressed a need, specific to the case site and was identified and implemented by clinicians and managers within the hospital’s emergency care system. Practical barriers to conducting research in rural a DGH were encountered during the intervention and its evaluation. The intervention 2 also revealed that although the Enterprise Culture enabled an improvement intervention to meet local needs, pressure from the central target and the competence of people enacting the process did not support its continued efficacy. In conclusion, in my contributions to subject knowledge, I argue that the Enterprise Culture present in the case site does not support the policy aims for generating quality and efficiency. The central four hour target remains too influential and causes reactionary operational activities. Processes and staff competent in following them are not adequate to meet the demands placed on the service of the emergency care system studied. Finally, the whole emergency care system has a great influence on the Emergency Department’s performance and should be considered when evaluating its performance and decisions about service structure.

This thesis applies a conceptual framework to determine the key insights that complex adaptive system theories provide to the novel challenges facing the introduction of clinical governance in two English Primary Care Trusts (PCTs). It presents empirical research on governance through qualitative case studies of the implementation of clinical governance arrangements within two North West PCTs, during a time of flux and change. The study is located within the English National Health Service (NHS) between 1999 and 2005. The Department of Health (DH) describes clinical governance as an evolving organisational structure and process that: "Provides NHS service organisations and individual health professionals with a framework within which to build a single, coherent local programme for quality improvement." (Department of Health, 1998a p.33). The thesis reviews the literature on governance models, quality improvement frameworks and complexity-based approaches to establish an appropriate theoretical base to the study. The literature relates to the nature of PCTs as a networked structure with autonomous parts. This approach contextualises the origins of clinical governance and related quality concepts. The study encompasses the introduction of the most recent contractual arrangements for primary care in 2004 (NHS, 2004). The research question posed is: "How can governance of quality improvement programmes be managed in a way that is appropriate to the characteristics of English PCTs?" Detailed evidence demonstrates the nature of local clinical governance programmes and the implementation within two North West PCTs, from the perspective of those involved. The results of the analysis show that multiple perspectives were taken into account in the decisions made about the content and delivery of clinical governance programmes. It is suggested that the application of a complex adaptive system conceptual framework helped to provide insight and interpretation of the accounts of those involved in the two case studies. The variation in clinical governance approaches across the two PCTs is explained in part by the strategic and policy orientation of each PCT. The results are consistent with the argument that the characteristics of quality improvement programmes in two PCTs go beyond linear based concepts, and can be thought of as real-world exemplars of the emergent properties of complex adaptive systems. In practice, the lessons learned provide opportunities to inform future management approaches to quality improvement programmes in PCTs.

Background: Antimicrobial resistance (AMR) is a widely recognized threat to global health that has been accelerated by the overuse of antimicrobials. Policy and regulatory interventions offer a useful approach to bring about widespread change in antimicrobial use. Objectives: This dissertation aims to investigate and characterize the role of policy interventions on antimicrobial use, to understand which policy levers have been used, which interventions have proven to be effective, and to identify analytic strategies that assist researchers and policymakers in developing evidence-informed approaches to address human AMR. Methods: To investigate effectiveness of policy interventions, I developed a systematic review and evidence map and appraised the quality of research on government policies to reduce antimicrobial use. To evaluate the extent of policy action on AMR in the Canadian context, I conducted an environmental scan of AMR action between 2008-2018. Finally, to facilitate advances in the scientific evidence base on antimicrobial resistance policy, I developed a framework for planning, conducting, and disseminating AMR intervention research. Findings: Governments have a variety of policy options at their disposal to respond to the growing threat of AMR, however, most of these policy options have not been rigorously evaluated and their effectiveness is unknown. Some regulatory, communication, guidelines, and fiscal interventions have been effective in particular settings, however, the interventions were too disparate to generalize about the effectiveness of any particular policy approach and reporting gaps in pose challenges for interpreting and replicating study results. In Canada, policy interventions have been too few, too small and too uncoordinated to achieve our AMR goals. Building on these findings, I developed a framework for planning, conducting, and disseminating AMR intervention research that identifies challenges, areas for increased coordination with policymakers, and best-practices for overcoming common limitations in AMR research. Discussion: Governments around the world have committed to respond to AMR, however, rigorous evidence to inform their policy and regulatory strategies is lacking. As the threat posed by AMR grows, it is increasingly important to strengthen the scientific evidence base on AMR policy interventions, to learn from existing policies and programs, and integrate scientific evidence into the global AMR response.

Thesis (D.P.H.)--University of Michigan, 1995.