A role description for a medical coordinator in extended and long term care facilities in British Columbia has been defined using a Delphi method. Also obtained during the study was a long term care philosophy. Three groups - nurses, administrators, and physicians took part in three rounds of the Delphi study. Thirty-five respondents were interviewed in the first round. During this interview the researcher obtained from the respondents the statements that they considered should be included in this role and philosophy description. During the second round the respondents rated the responses of the first round and in the third round those of the second round were revised after seeing the mean scores of the whole group and the three separate groups. The description of the role of a medical coordinator developed describes the role as it applies to: resident care; private physicians; planning, development and evalution of care; staffing of a facility; education; administration; and the training, experience, skills and attitude of a medical coordinator. When the description created was compared with that for the medical director in a long term care facility in the United States it was found that this study had described additional dimensions of the role, in particular the multi-disciplinary approach and the physician's knowledge, training, experience, skills and attitude. The results of the study show where there was agreement and where there were differences of opinion between the three professional groups. A long term care philosophy which was considered very important for a medical coordinator to promote, has been defined during the study. It focuses on the resident reaching his full potential, the creation of a special environment, as well as acceptance of disability, dying and death. Recommendations from the study are made for facilities which might be considering employing a medical coordinator, for planners deciding whether to provide funds for medical coordinators, for geriatric medical education and for the acceptance of a long term care philosophy in all parts of the health care system where there are long term care clients. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

abstract: ABSTRACT Academic literature and industry benchmarking reports were reviewed to determine the way facilities benchmarking reports were perceived in the healthcare industry. Interviews were conducted through a Delphi panel of industry professionals who met experience and other credential requirements. Two separate rounds of interviewing were conducted where each candidate was asked the same questions to determine the current views of benchmarking reports and associated data in the healthcare industry. The questions asked in the second round were developed from the answers to the first-round questions. The research showed the panel preferred changes in the data collection methods as well as changes in the way the data is presented. The need for these changes was unanimous among the members of the panel. The main recommendations among the group were: 1. An interactive method such as a member portal with the ability to customize, run scenarios, and save data is the preferred method. 2. Facilities Management (FM) teams are often not included in the data collection of the benchmark reports. Including FM groups would allow more accuracy and more detailed data resulting in more accurate and in-depth reports. 3. More consistency and “apples to apples” comparisons need to be provided in the reports. More categories and variables need to be added to the reports to offer more in depth comparisons and assessments between buildings. Identifiers to help the users compare the physical condition of their facility to others needs to be included. Suggestions are as follows: a. Facility Condition Index (FCI)- easily available to all participants and allows an idea of the comparison of upkeep and maintenance of their facility to that of others. b. An indicator on whether the comparison buildings are Centers for Medicare and Medicaid Services (CMS) accredited. 4. Gross Square Footage (GSF) is not an accurate assessment on its own. Too many variables are left unidentified to offer an accurate assessment with this method alone. / Dissertation/Thesis / Masters Thesis Construction Management 2020

Thesis (M. Arch.)--University of Hong Kong, 2001. / Includes bibliographical references.

published_or_final_version / Architecture / Master / Master of Architecture

Thesis (M.Arch.)--University of Hong Kong, 2001. / Includes bibliographical references. Also available in print.

INTRODUCTION Exclusive breastfeeding (EBF) for the first six months of an infant‟s life is recognized by the World Health Organisation (WHO) and the United Nations Children‟s Fund (UNICEF) as the most effective and essential strategy for optimal growth and prevention of infant mortality. One of the factors that influences a mothers choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa (SA) has voluntarily adopted the ICMBS in 1981 to help protect and promote EBF, the exclusive breastfeeding rates in SA remain very low (<8%). In a renewed attempt to protect and promote exclusive breastfeeding in SA, the code has been legislated in December 2012 to ensure compliance. AIM To assess the extent of ICMBS violations in health facilities in four Provinces in SA. DESIGN This was cross-sectional study. A purposive stratified cluster sample of eight to twelve health facilities was drawn in four Provinces (Gauteng, North-West, Free-State and Eastern Cape) in SA. Fixed structured interviews were conducted by trained fieldworkers with three health workers from each of the 40 health facilities to determine the extent of ICMBS violations as well as awareness of the ICMBS. The receipt of free gifts, free/low cost supplies/samples of formula milk, bottles or teats, and free materials or equipment from companies who sell breast-milk substitutes (BMS), infants foods/drinks and bottles or teats (violation of articles 6.2, 6.3, 6.6, 6.8, 7.3 and 7.4 of the ICMBS) were determined. RESULTS A total number of four violations were reported by four health workers from three of the 40 health facilities (7.5%). ICMBS violations were reported only in Gauteng Province with no violations in North West, Free State or Eastern Cape Province. All four violations involved the receipt of free gifts for personal use (including a pen, booklet, calendars and booklet/poster) from a BMS company (Nestlé), violating article 7.3 of the ICMBS. Health workers from four health facilities also reported the receipt of information materials and/or equipment for use in the facility, including leaflets, maternal and infant feeding product booklets and water bags from Nestlé. However, since the brand name of a product within the scope of the ICMBS was not visible on any of the materials or equipment, none of these gifts constituted a violation. In terms of ICMBS awareness, 46 health workers (38%), including the four health workers who received gifts, from 19 health facilities situated mainly in Eastern Cape and Gauteng Province were familiar with the ICMBS. CONCLUSIONS Violations were reported in 7.5% of health facilities, including the health facilities where health workers were aware of the code. Implementation and training of the ICBMS in health facilities is there for warranted. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

INTRODUCTION Exclusive breastfeeding (EBF) for the first six months of an infant‟s life is recognized by the World Health Organisation (WHO) and the United Nations Children‟s Fund (UNICEF) as the most effective and essential strategy for optimal growth and prevention of infant mortality. One of the factors that influences a mothers choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa (SA) has voluntarily adopted the ICMBS in 1981 to help protect and promote EBF, the exclusive breastfeeding rates in SA remain very low (<8%). In a renewed attempt to protect and promote exclusive breastfeeding in SA, the code has been legislated in December 2012 to ensure compliance. AIM To assess the extent of ICMBS violations in health facilities in four Provinces in SA. DESIGN This was cross-sectional study. A purposive stratified cluster sample of eight to twelve health facilities was drawn in four Provinces (Gauteng, North-West, Free-State and Eastern Cape) in SA. Fixed structured interviews were conducted by trained fieldworkers with three health workers from each of the 40 health facilities to determine the extent of ICMBS violations as well as awareness of the ICMBS. The receipt of free gifts, free/low cost supplies/samples of formula milk, bottles or teats, and free materials or equipment from companies who sell breast-milk substitutes (BMS), infants foods/drinks and bottles or teats (violation of articles 6.2, 6.3, 6.6, 6.8, 7.3 and 7.4 of the ICMBS) were determined. RESULTS A total number of four violations were reported by four health workers from three of the 40 health facilities (7.5%). ICMBS violations were reported only in Gauteng Province with no violations in North West, Free State or Eastern Cape Province. All four violations involved the receipt of free gifts for personal use (including a pen, booklet, calendars and booklet/poster) from a BMS company (Nestlé), violating article 7.3 of the ICMBS. Health workers from four health facilities also reported the receipt of information materials and/or equipment for use in the facility, including leaflets, maternal and infant feeding product booklets and water bags from Nestlé. However, since the brand name of a product within the scope of the ICMBS was not visible on any of the materials or equipment, none of these gifts constituted a violation. In terms of ICMBS awareness, 46 health workers (38%), including the four health workers who received gifts, from 19 health facilities situated mainly in Eastern Cape and Gauteng Province were familiar with the ICMBS. CONCLUSIONS Violations were reported in 7.5% of health facilities, including the health facilities where health workers were aware of the code. Implementation and training of the ICBMS in health facilities is there for warranted. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

The incidence of Heath Care Associated Infection is a major patient safety concern in the United Kingdom and reducing the morbidity and mortality associated with this has become a National Health Service priority. It is generally accepted that this objective will require a multi-factorial approach where infection prevention and control is seen as everybody’s business. However, some strategies receive greater exposure than others and hand hygiene is widely touted as a common sense solution to a complex problem. This discourse based study combined the techniques of Corpus Linguistics with Critical Discourse Analysis to explore the Textual, Discursive and Sociocultural features of hand hygiene discourse. This took place across three language domains, the Academy, the Newspaper Media and Organisational Policy Makers. These three cultural elites take a consistent account of the problem and the solution. Broadly hand hygiene is portrayed as effective, compliance is basic, performance is poor and Health Care Workers should be held to account through zero tolerance policies and if necessary disciplinary action. However, not only does this background the messy, contextual factors of implementing a hand hygiene policy it imposes a one size fits all approach and measurement programme on compliance that hides the true nature of performance and this ultimately impacts on patient care. This study calls for junior clinicians for whom policy has the greatest impact to become more engaged in the policy making process. In a spirit of openness trusts should adopt linguistic devices that recognise the dynamic nature of practice and a more educational, sophisticated approach to audit.

In the UK the National Health Service (NHS) faces the challenge of securing £20 billion in savings by 2014. Improving healthcare productivity is identified by the state as essential to this endeavour, and critical to the long-term future of the NHS. However, healthcare productivity remains a contentious issue, with some criticizing the level of professional engagement. This thesis explores how contemporary UK policy discourse constructs rights and responsibilities of healthcare professionals (HCPs) in terms of productive healthcare, how this is made manifest in practice, and the implications for professional autonomy/identity. Using analytical lenses from the sociology of professions, identity formation and the Foucauldian concept of governmentality, it is proposed that policy discourse calls for a new flavour of professionalism, one that recognises improving healthcare productivity as an individualised professional duty, not just for an elite cadre but for all healthcare professionals. Adopting an ethnographic approach (participant observation, semi-structured interviews, focus group and document analysis), data is presented from a large UK Emergency Department (ED), exploring the extent to which this notion of self-governance is evident. The study elucidates the ways in which: professional notions of productivity are constructed; productive work is enacted within the confines of the organisational setting; and tensions between modes of governance are negotiated. The findings of this study suggest that HCPs perform identity work via their construction of a multidimensional notion of healthcare productivity that incorporates both occupational and organisational values. Whilst responsibility for productivity is accepted as a ‘new’ professional duty, certain ethical tensions are seen to arise once the lived reality of ‘productive’ work is explored within the organisational field. The complex interplay of identity work and identity regulation, influenced by the co-existence of two differing modes of governance, results in a professional identity which cannot be represented by a static occupational/organisational hybrid, but rather one that is characterised by continual change and reconstitution. Understanding healthcare productivity from this perspective has implications for professional education, patient care, service improvement design and the academic field of the sociology of professions.

Studies were conducted in Nottingham, UK to assess quality of discharge summary communication sent from secondary to primary care using updated processing methods. Objectives (1) Assess available evidence on effectiveness of interventions aiming to improve discharge information communication specifically introducing computerised discharge summaries (2) Assess differences in discharge summary quality using new processing methods (3) Obtain perspectives of secondary care on discharge communication issues, identifying points of weakness and primary care views on discharge information communicated from hospital. Methods (1) Systematic review of literature on effectiveness of interventions aiming to improve discharge summary information communication (2) Before and after studies of two different discharge summary types in three departments within Nottingham University Hospitals NHS Trust (3) Qualitative interviews with key stakeholders (N=27) and observations in 3 sites. Results The systematic review returned 21 interventions with emphasis on the introduction of computerised systems to improve quality (timeliness and completeness of discharge summaries). Nine studies significantly improved the completeness of the discharge summary. Ten studies significantly increased the timeliness of the generation of the document and the transfer of information. The three before and after studies produced varying results; the HCOP findings suggested improvements post-intervention in completeness of summaries; this was not statistically significant. In Nephrology, computerisation significantly speeded up the timeliness of discharge summaries but there was no significant difference in completeness between the two types. In Paediatrics, computerisation increased the number of summaries not completed, and the handwritten summary was significantly faster. Computerised discharge summaries contained more information- this was statistically significant. The qualitative study identified issues with understanding the concept of discharge, the purpose and importance of the discharge summary, and organisational issues around the ability to balance the demands for completeness and timeliness, a lack of leadership and user-centred design of the electronic discharge system. Conclusions The literature reviewed found examples of the potential computerisation has on discharge documentation quality. The research studies conducted showed that the introduction of computerisation into the discharge documentation process produced mixed results in quality (completeness and timeliness) of discharge summaries communicated from secondary to primary care. Slight improvements were found in the before and after studies and staff feedback was positive. The success of such interventions depends largely on increased clinical leadership and user-centred design. An established link to patient safety is needed to increase awareness of the importance of discharge summary communication and justify major system change.