M.Cur. / Quality health service delivery is a necessity in any health care service and is the responsibility of the management, but it is often not accomplished due to a variety of reasons. The most important determinant is the personnel of the health care service and their level of motivation to provide quality service. The aim of this study was the describing of motivation guidelines for the delivery of quality health service. The study was qualitative and contextual. The research strategy was explorative and descriptive. The study is based on the Botes research model and the Nursing Theory of Wholeness. Several measurements were taken to increase credibility. It is regarded as a prerequisite to explore, describe and implement a quality improvement programme for the specific health service, before motivation guidelines could be described for quality health service delivery. The quality improvement programme was based on literature, with recognition of the context of the health service. The determinants of quality health service delivery were discussed as well as the aim, reasons, prerequisites, contents and principles of the quality improvement programme and the quality improvement process. The realisation of the quality improvement programme was also discussed. The exploring, description and implementation of the quality improvement programme in the health care service is followed by the exploring and describing of factors which motivate and/or demotivate personnel to deliver quality health care service, by means of naive sketches obtained from open questionnaires of two samples. It was verified for accuracy during a feedback interview. The results are used to describe motivation guidelines which is confirmed by literature.

The aim of this master s thesis is to establish continual program of health care quality improvement in a private multi-specialty medical facility Nebolejka based in Ukrainian city Kharkov. Thesis is divided into several parts. Theoretical part is focused on quality examination from the healthcare system point of view, deals with the analyses of Ukrainian healthcare system actual state. Practical part is focused on health care quali-ty evaluation in a private clinic Nebolejka. With a use of patient satisfaction survey a program of health care quality improvement was established. Its effectiveness was also verified via repeated patient satisfaction survey in short- term time period. This thesis is primarily useful for medical facility Nebolejka, because improvement of health care quality not surprisingly constitute to better competitive market position.

Background: The United States health care system faces two fundamental challenges: a high growth rate of health care spending and deficiencies in quality of care. The growth rate of health care spending is the dominant driver of our nation’s long-term federal debt, while the inconsistent quality of care hinders the ability of the health care system to maximize value for patients. To address both of these challenges, public and private payers are increasingly changing the way they pay providers—moving away from fee-for-service towards global payment contracts for groups of providers coming together as accountable care organizations. This thesis evaluates the change in health care spending and in quality of care associated with moving to global payment for accountable care organizations in Massachusetts in the first 4 years. This thesis studies the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), a global payment contract that provider organizations in Massachusetts began to enter in 2009. The AQC pays provider organizations a risk-adjusted global budget for the entire continuum of care for a defined population of enrollees insured by Blue Cross Blue Shield of Massachusetts. It also awards substantial pay-for-performance incentives for organizations meeting performance thresholds on quality measures. This work assesses its effect on spending and quality through the first 4 years of the contract. Methods: Enrollee-level claims data from 2006-2012 were used with a difference-in-differences design to evaluate the changes in spending and quality associated with the Alternative Quality Contract over the first 4 years. The study population consisted of enrollees in Blue Cross Blue Shield of Massachusetts plans (intervention group) and enrollees in commercial employer-sponsored plans across 5 comparison states (control group). Unadjusted and adjusted results are reported for each comparison between intervention and control. Changes in spending for all 4 AQC cohorts relative to control were evaluated. In adjusted analyses of spending, I used a multivariate linear model at the enrollee-quarter level, controlling for age, sex, risk score, indicators for intervention, quarters of the study period, the post-intervention period, and the appropriate interactions. For analyses of quality, an analogous model at the enrollee-year level was used. Process and outcome quality were evaluated. Results: Seven provider organizations joined the AQC in 2009, with a total of 490,167 individuals who were enrolled for at least 1 calendar year in the study period. The control group had 966,813 unique individuals enrolled for at least 1 year during the study period. Average age, sex, and risk scores before and after the AQC were similar between the two groups. In the 2009 cohort, claims spending grew on average $62.21 per enrollee per quarter less than control over 4 years (p<0.001), a 6.8% savings. Analogously, the 2010, 2011, and 2012 cohorts had average savings of 8.8% (p<0.001), 9.1% (p<0.001), and 5.8% (p=0.04), respectively, by the end of 2012. Savings on claims were concentrated in the outpatient facility setting, specifically procedures, imaging, and tests (8.7%, 10.9%, and 9.7%, respectively, p<0.001). Organizations with and without risk-contracting experience saw similar average savings of 6.3% and 7.7%, respectively, over 4 years (p<0.001). About 40% of savings were explained by lower volume. Pre-intervention trends were not statistically different between intervention and control (-$4.57, p=0.86), suggesting savings were not driven by inherently different trajectories of spending. No differences in coding intensity were found. In sensitivity analyses, estimates were robust to alterations in the model, variables, and sample. Notably, claims savings were exceeded by incentive payments to providers (shared savings and quality bonuses) in 2009-2011, but exceeded incentives payments in 2012, generating net savings. Improvements in quality among intervention cohorts generally exceeded New England and national comparisons. Quality performance on chronic care measures increased from 79.6% pre-intervention to 84.5% post-intervention in the 2009 cohort, compared to 79.8% to 80.8% for the HEDIS national average, a 3.9 percentage-point relative increase over the 4 years. Analogously, preventive care and pediatric care measures increased 2.7 and 2.4 percentage points relative to control, respectively. On outcome measures, achievement of hemoglobin A1c, LDL cholesterol, and blood pressure control grew by 2.1 percentage points per year in the 2009 cohort after the AQC, while HEDIS averages remained largely unchanged (Figure). Conclusion: After 4 years, physician organizations in the AQC had lower spending growth relative to control and generally outperformed national averages on quality measures. Shared savings coupled with quality bonuses can exceed savings on claims in initial years, but over time, savings on claims may outgrow incentive payments. Incentive payments themselves may serve meaningful purposes, as quality measures may protect against stinting and shared savings may help ease providers into risk contracts. Changes in utilization suggest that this payment model can help modify underlying care patterns, a likely prerequisite for sustainable reform. The AQC experience may be useful to policymakers, insurers, and providers embarking on payment reform. Combining global budgets with pay-for- performance may encourage organizations to embark on the delivery system reforms necessary to slow spending and improve quality.

Implanting of leadless pacemakers is an innovative alternative to conventional implants. Of important benefit for patients is the minimally invasive approach, the minimalisation of risk of infection in the system and the reduced impact on quality of life when compared with conventional implants. The aim of this work is to review how patients rate their quality of life pre and post implant of the leadless pacemaker. For our research, we opted for a qualitative research method in the form of a standardized questionnaire about the Leadless pacemaker. The questionnaire survey will be conducted from December 2016 until the end of August 2017. The research sample consists of patients who were implanted with the Leadless pacemaker during a four-year period from December 2, 2012 to October 31, 2016 and who attend our hospital's cardiac pacemaker clinic. We would like to present the results obtained in a peer-reviewed journal and in professional cardiology conferences in the nursing section. We present one aspect of treatment (quality of life) at our institution, which has the largest number of implants of Leadless pacemakers in the Czech Republic. keywords: leadless pacemaker, nursing care, pacemaker implant, quality of life

Background: The evaluation of care strategies at the end of life is particularly important due to the globally increasing proportion of very old people in need of care. The ICECAP-Supportive Care Measure is a self-complete questionnaire developed in the UK to evaluate palliative and supportive care by measuring patient’s wellbeing in terms of ‘capability’. It is a new measure with high potential for broad and international use. The aims of this study were the translation of the ICECAP-Supportive Care Measure from English into German and the content validation of this version. Methods: A multi-step and team-based translation process based on the TRAPD model was performed. An expert survey was carried out to assess content validity. The expert panel (n = 20) consisted of four expert groups: representative seniors aged 65+, patients aged 65+ living in residential care, patients aged 65+ receiving end-of-life care, and professionals in end-of-life care. Results: The German version of the ICECAP-Supportive Care Measure showed an excellent content validity on both item- and scale-level. In addition, a high agreement regarding the length of the single items and the total length of the questionnaire as well as the number of answer categories was reached. Conclusions: The German ICECAP-SCM is a valid tool to assess the quality of life at the end of life that is suitable for use in different settings. The questionnaire may be utilized in multinational clinical and economic evaluations of end-of-life care.

This case study investigated the quality of supervisor- employee communication and its impact on employee job satisfaction, self-esteem and trust, as well as the link to program quality in a center-based childcare setting. Three research questions guided the study with the purpose of examining communication as a means to improve job satisfaction, diminish staff turnover and strengthen program quality. Fifteen employees from a non-profit childcare center in San Joaquin County volunteered for the study. Data was collected from face to face and telephone interviews. Transcripts of the interviews revealed three themes- feedback, active listening and supervisor support. Responses were coded and categorized by theme, and then each theme was sorted into high quality supervisor communication responses and low quality supervisor communication responses. High quality supervisor communication was characterized by frequent and constructive feedback, self-motivation, openness and freedom to speak. The results of the study indicated high quality supervisor communication increased job satisfaction. Low quality supervisor communication was characterized by minimal feedback, the perception of favoritism, interference of work routine, low morale and increased absenteeism. The study found low quality supervisor communication hindered job satisfaction. The results of the study indicated that high quality communication between supervisor and employee had a positive impact on job performance, job satisfaction and organizational outcomes. Feedback, active listening and support were important communication behaviors sustaining job satisfaction. Passion for children proved to be intrinsic motivation to enhance program quality. Suggestions for developing program quality are provided.

Introduction: Amputation of lower extremity is the most common form of amputation. An amputation affects all dimensions of a human being, affects several aspects of the individuals life’s and involves great suffering. What quality of life means for these individuals is an inadequately studied area.  Purpose: To examine what factors affected quality of life in individuals that have undergone a lower extremity amputation. Method: This study is a general literature review that methodologically examined and analysed quality of life in individuals that have undergone lower extremity amputation. In this descriptive study only original articles were included and data was collected from Cinahl, PubMed and Psycinfo. Results: From the results four main categories emerged which were function and mobility, external factors, internal factors and adaption to change. Within the categories 11 subcategories surfaced which all represented factors influencing quality of life in individuals who had undergone amputation of one, or multiple, extremities. The subcategories included  factors that directly or indirectly affected quality of life such as type of amputation, comorbidity, lesser need of assistive devices, environmental adaptations, fear of discrimination, acceptance of a new identity, body image, environmental adaption, age at the time of the procedure, prosthesis fit, rehabilitation, healthcare and ability to adapt to the situation. Conclusion: An increased knowledge for healthcare providers, concerning the factors influencing quality of life of amputees, may contribute to a more individualized care and higher quality of life for the affected group. / Bakgrund: Den vanligaste typen av amputation är den av nedre extremitet. En amputation påverkar alla dimensioner av människan, påverkar flera aspekter av individernas liv samt innebär ett stort lidande.  Hur livskvaliteten ser ut för dessa personer är ett otillräckligt studerat område. Syftet: Att undersöka de faktorer som påverkar livskvalitet hos individer som genomgått amputation av nedre extremitet. Metodbeskrivning: Arbetet är utfört som en allmän litteraturstudie som metodiskt granskat och analyserat livskvaliteten hos amputerade individer. Endast originalartiklar har använts för detta beskrivande arbete där data har insamlats från sökmotorerna Cinahl, PubMed och Psycinfo. Huvudresultat: Av huvudresultaten framkom fyra kategorier vilka var funktion och mobilitet, yttre faktorer, inre faktorer och anpassning till förändring. Inom kategorierna synliggjordes 11 subkategorier som alla representerar olika faktorer vilka påverkade livskvaliteten hos individer som amputerat en eller flera nedre extremiteter. Dessa subkategorier var smärtproblematik, fysiska begränsningar, isolering, rätt hjälpmedel, socialt stöd, stigmatisering, psykisk ohälsa, självbild, målbild, rehabiliterande aktiviteter och rollbyte. Subkategorierna inkluderade faktorer som indirekt eller direkt påverkade livskvaliteten vilka var amputationsnivå, samsjuklighet, mindre behov av hjälpmedel, miljöanpassning, rädsla för diskriminering, acceptans av ny identitet, kroppsbild, sjukvård, ålder vid ingreppet, passform på protesen, och anpassning till situationen. Slutsats: En ökad kunskap hos sjukvårdspersonal gällande vilka faktorer som påverkar livskvaliteten hos amputerade kan bidra till en mer individanpassad vård och högre livskvalitet hos gruppen.

In the wake of the New Public Management (NPM) era, the Act on System of Choice (LOV) was introduced in 2009. While implementation was voluntary, over 152 of the 290 municipalities had implemented LOV by 2022. The new act promised improvements in which care quality, user empowerment, and cost-efficiency were almost ensured.  However, despite its large implementation, little research has focused on evaluating the policy's outcome and the extent to which LOV fulfilled its three main objectives. In addressing this knowledge gap, this study positions LOV into the theory of choice and public administration, presenting a revisited mechanism. The study then sets out to understand whether LOV has increased care quality, user empowerment, and cost through regression analysis and interaction effects. Results from the study point towards the inability of LOV to fully deliver on its promises when the elderly population in a municipality is high.

Title: Spiritual Care Interventions and Quality of Life in Cancer Patients Receiving Palliative Care Background: Despite the evidence supporting spiritual care in nursing and an increased quality of life among patients, patients feel that their spiritual needs are not being supported by medical professionals. Nurses agree that the role they play is significant in addressing the needs of cancer patients; however, they feel that they lack the knowledge for addressing spirituality concerns at the end of life. The purpose of this study is to identify spiritual care interventions that nurses can implement to improve quality of life (QOL) in patients with advanced cancer receiving palliative care. Method: This literature review consisted of articles retrieved from several databases, including CINAHL, PubMED, and PsychINFO, PsychARTICLES, ATLA Religion databases using the key words "cancer'" and "quality of life" "therapeutic communication", "spirit' therapy", "relaxation therapy", and "self-care". Inclusion criteria consisted of research conducted after the year 2000, peer reviewed work and research studies written in the English language. Results: Results from this literature review include recommended nursing interventions that provide spiritual care to patients with advanced cancer receiving palliative care for the purpose of improved quality of life. Spiritual care interventions identified in this study include Meaning Centered Group Psychotherapy (MCGP), Supportive Group Psychotherapy (SGP), mental relaxation, mental images, TM, art therapy, socializing, communicative acts, aromatherapy, massage, exercise, hatha yoga, meditation, and activities such as gardening, watching TV, resting/sleeping and socializing.

The overall purpose of the essay is to, based on an anthology book with acollection of texts, reproduce voices from elderly care by describing carerelationships and what significance they can have for care recipients, care staffand the quality of the work. A second purpose of the thesis is to describe howworking conditions can affect the quality of the care relationship and the carework. When my idea was to write about care relationships and working conditionsin elderly care, I chose to start from some form of reality-based book with storiesbased on care staff and / or care recipients. The choice of empirical data landed inan anthology book consisting of thirty-five reality-based stories of experiencesand concrete knowledge about elderly care. The stories constitute the authors&amp;#39; ownperspectives and experience of elderly care. The stories reflect both urban andrural areas, as well as positive and negative experiences. The authors of theanthology are as numerous as the stories and consist of relatives who tell abouttheir mothers, thus mostly daughters, assistant nurses, care staff, who tell abouttheir work either in home care or in nursing homes. The theoretical frames ofreference I have used to gain an understanding of my results are relational theory,coping and Maslow&amp;#39;s description of a pathogenic approach. As an analysismethod, I chose to use a thematic analysis. The method takes into account partly avisible content but also an implicit content, which I thought was appropriate basedon my empirical data. The results and analysis part show that the importance ofthe care relationship between staff and care recipients is a fundamental factor forgood quality care. The care staff strives to create good and meaningful carerelationships with the care recipients, which generates a good quality of care.Furthermore, it appears that the working conditions with its control instrumentsthat are implemented affect the quality of care and generate an inadequacy of thecare staff.