The purpose of this study was to explore and describe the perceptions of registered nurses about patient-friendly health services rendered within an ambulatory care setting in the King Abdulaziz Medical City, Riyadh (KAMC-R), Kingdom of Saudi Arabia. A qualitative, explorative, descriptive and contextual design was used. Fifteen registered nurses (one male and 14 female) voluntarily participated in this study. The data collection process comprised of semi-structured individual interviews with the participants to explore what they perceived to be patient-friendly health services. The obtained data were analysed using Van Mannen’s thematic analysis method. The emerging empirical data identified four themes, three categories and nine subcategories; a literature control was incorporated to validate the findings. The study findings revealed that the participants identified cultural differences as a quintessential obstacle in rendering patient-friendly health services in the study context. Professional yet patient-friendly communication proved to be a challenge as did ambulatory care flow. This had the potential to compromise patient-friendly health services. Meeting the patients’ needs was acknowledged. However, the needs, goals and values of patientfriendly healthcare services were perceived differently by the patients on the one hand and the registered nurses on the other and this affected the process of interaction and delivery of patient-friendly care. Despite the fact that the registered nurses daily experienced ongoing challenges which compromised patient-friendly health services, they were aware and committed to deliver patient-friendly health services. The process of scientific inquiry concluded with the limitations of the study and recommendations were made based on the findings. / Health Studies / M.A. (Heath Studies)

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)

The purpose of this study was to explore and describe the perceptions of registered nurses about patient-friendly health services rendered within an ambulatory care setting in the King Abdulaziz Medical City, Riyadh (KAMC-R), Kingdom of Saudi Arabia. A qualitative, explorative, descriptive and contextual design was used. Fifteen registered nurses (one male and 14 female) voluntarily participated in this study. The data collection process comprised of semi-structured individual interviews with the participants to explore what they perceived to be patient-friendly health services. The obtained data were analysed using Van Mannen’s thematic analysis method. The emerging empirical data identified four themes, three categories and nine subcategories; a literature control was incorporated to validate the findings. The study findings revealed that the participants identified cultural differences as a quintessential obstacle in rendering patient-friendly health services in the study context. Professional yet patient-friendly communication proved to be a challenge as did ambulatory care flow. This had the potential to compromise patient-friendly health services. Meeting the patients’ needs was acknowledged. However, the needs, goals and values of patientfriendly healthcare services were perceived differently by the patients on the one hand and the registered nurses on the other and this affected the process of interaction and delivery of patient-friendly care. Despite the fact that the registered nurses daily experienced ongoing challenges which compromised patient-friendly health services, they were aware and committed to deliver patient-friendly health services. The process of scientific inquiry concluded with the limitations of the study and recommendations were made based on the findings. / Health Studies / M. A. (Heath Studies)

A temática deste estudo trata da prática de enfermagem de trabalhadores de nível superior que atuam em serviços da rede de Atenção Básica à Saúde, em especial, na Estratégia de Saúde da Família (ESF). Foi desenvolvido com o objetivo de analisar como os enfermeiros identificam e intervêm nas necessidades de saúde, apresentadas pelos usuários que demandam os serviços de saúde de três Unidades de Saúde da Família, localizadas no município de Marília, São Paulo, além de conhecer as dificuldades e facilidades dos enfermeiros, ao desenvolverem a prática de enfermagem, na perspectiva da produção do cuidado em saúde. Constitui-se em um estudo de natureza descritiva e de abordagem qualitativa. Na coleta de dados, optamos pela observação livre e entrevista semiestruturada. A observação livre se deu durante os atendimentos agendados e eventuais, ocorridos na unidade e também na visita domiciliária. Participaram deste estudo três enfermeiras pertencentes à ESF da zona norte do município citado. Para a análise dos dados obtidos, utilizou-se a Análise de Conteúdo Temático. No decorrer da análise, foi possível apreender uma unidade temática relacionada às identificações e intervenções realizadas pelas enfermeiras, sujeitos desta pesquisa, e duas subunidades: eventos episódicos e problemas anteriores e eventos episódicos e problemas atuais. Os resultados da pesquisa apontaram o predomínio da identificação de necessidades de saúde como sinônimo de queixas, e nas intervenções prevaleceu a fundamentação no conhecimento biológico. Quanto às facilidades apontadas pelas enfermeiras observadas, observaram-se o vínculo e a autonomia em relação a alguns procedimentos, já as dificuldades destacadas foram a falta de recursos humanos, a não adesão dos usuários em relação às atividades coletivas, dentre outras. Dessa forma, concluímos que são necessários investimentos na formação e na qualificação dos enfermeiros para modificarem a prática em saúde, hoje focada na doença, para uma prática fundamentada em um conceito ampliado do processo saúde-doença, para que a satisfação das necessidades, anseios e dúvidas dos usuários passem a se constituir em foco de atenção da prática dos enfermeiros. Consideramos necessário utilizar a Educação Permanente no cenário do trabalho em saúde na atenção básica e assim possibilitar uma escuta qualificada dos trabalhadores, em especial, dos enfermeiros que atuam nos serviços de saúde. / This study deals with the practice of graduated nursing professionals who work in services of Primary Health Care Network, especially in the Family Health Strategy (FHS). It aims to analyze how nurses identify and intervene in health needs presented by the users who demand the health services of three Family Health Units, located in the city of Marilia, state of São Paulo, besides to understand the difficulties and facilities of nurses to develop nursing practice, in view of the production of health care. It consists of a descriptive and qualitative study. For data collection, free observation and semi-structured interview were used. The free observation was during the scheduled and possible attendances occurred in the unit and also at the home visit. Participants were three nurses form the FHS in the north zone of the city. For data analysis, the Thematic Content Analysis was used. During the analysis it was possible to identify a thematic unit related to the identification and interventions performed by nurses, who were subjects of this research, and two subunits: episodic events and previous problems and episodic events and current problems. The results showed predominance of the identification of health needs as a synonym of complaints, and in the interventions, the reasoning in biological knowledge prevailed. Regarding the facilities mentioned by the nurses are the bond and autonomy for some procedures, and the difficulties highlighted were the lack of human resources, non-compliance of users in relation to collective activities, among others. Thus it is concluded that investments are needed in training and qualification of nurses to change their practice in health, nowadays focused on the disease, for a practice based on an expanded concept of health-disease process, so that the satisfaction of needs, desires and doubts of the users becomes the focus of nursing care. It is necessary to use the Continuing Education in the setting of health work in primary care and thus provide a qualified listening of workers, especially nurses, who work in health services.

This dissertation examines how perceptions of competence affect the care of older persons, and the values ​​and vocational conceptions of care work and care recipients that are tied to the perceptions of what skills that are needed and why. Competence is defined by three parts with relevance for the content of care work: what knowledge the care workers should have, what tasks they should perform and how they should respond to care recipients. The aim of this dissertation is to analyse how the care managers' and care workers' perceptions of competence form the direction of the care work and how that direction relates to the care recipients’ perceptions of and expectations on the care work.   The care work is characterised by what is analysed as an activation of the recipients - that the recipients themselves should perform as much of the care work as possible. The activation aims at managing the decay of the aging body and is motivated by a vocational conception of the care recipients as different from others, with designations as grateful and passive. This conception is analysed as generation character based on an idea among the care managers and care workers that the society in which the recipients grew up gave them certain cognitive prerequisites that have to be managed in the practical care work.   The care recipients in the study have opposing conceptions and perceptions of care work compared with the care managers and care workers. The recipients’ central objective with the care work is to prevent what has been interpreted as the disrepair of the home. The care recipients’ position in the organisation raises the problem of loyalty towards the care workers and in some sense the care managers. Their loyalty reduces their ability to complain and to influence their situation to the better.   Keywords: care of older persons, care needs, care work, care relationship, care receivers, care workers, care managers, competence, technologies, activation, generation character

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)

A temática deste estudo trata da prática de enfermagem de trabalhadores de nível superior que atuam em serviços da rede de Atenção Básica à Saúde, em especial, na Estratégia de Saúde da Família (ESF). Foi desenvolvido com o objetivo de analisar como os enfermeiros identificam e intervêm nas necessidades de saúde, apresentadas pelos usuários que demandam os serviços de saúde de três Unidades de Saúde da Família, localizadas no município de Marília, São Paulo, além de conhecer as dificuldades e facilidades dos enfermeiros, ao desenvolverem a prática de enfermagem, na perspectiva da produção do cuidado em saúde. Constitui-se em um estudo de natureza descritiva e de abordagem qualitativa. Na coleta de dados, optamos pela observação livre e entrevista semiestruturada. A observação livre se deu durante os atendimentos agendados e eventuais, ocorridos na unidade e também na visita domiciliária. Participaram deste estudo três enfermeiras pertencentes à ESF da zona norte do município citado. Para a análise dos dados obtidos, utilizou-se a Análise de Conteúdo Temático. No decorrer da análise, foi possível apreender uma unidade temática relacionada às identificações e intervenções realizadas pelas enfermeiras, sujeitos desta pesquisa, e duas subunidades: eventos episódicos e problemas anteriores e eventos episódicos e problemas atuais. Os resultados da pesquisa apontaram o predomínio da identificação de necessidades de saúde como sinônimo de queixas, e nas intervenções prevaleceu a fundamentação no conhecimento biológico. Quanto às facilidades apontadas pelas enfermeiras observadas, observaram-se o vínculo e a autonomia em relação a alguns procedimentos, já as dificuldades destacadas foram a falta de recursos humanos, a não adesão dos usuários em relação às atividades coletivas, dentre outras. Dessa forma, concluímos que são necessários investimentos na formação e na qualificação dos enfermeiros para modificarem a prática em saúde, hoje focada na doença, para uma prática fundamentada em um conceito ampliado do processo saúde-doença, para que a satisfação das necessidades, anseios e dúvidas dos usuários passem a se constituir em foco de atenção da prática dos enfermeiros. Consideramos necessário utilizar a Educação Permanente no cenário do trabalho em saúde na atenção básica e assim possibilitar uma escuta qualificada dos trabalhadores, em especial, dos enfermeiros que atuam nos serviços de saúde. / This study deals with the practice of graduated nursing professionals who work in services of Primary Health Care Network, especially in the Family Health Strategy (FHS). It aims to analyze how nurses identify and intervene in health needs presented by the users who demand the health services of three Family Health Units, located in the city of Marilia, state of São Paulo, besides to understand the difficulties and facilities of nurses to develop nursing practice, in view of the production of health care. It consists of a descriptive and qualitative study. For data collection, free observation and semi-structured interview were used. The free observation was during the scheduled and possible attendances occurred in the unit and also at the home visit. Participants were three nurses form the FHS in the north zone of the city. For data analysis, the Thematic Content Analysis was used. During the analysis it was possible to identify a thematic unit related to the identification and interventions performed by nurses, who were subjects of this research, and two subunits: episodic events and previous problems and episodic events and current problems. The results showed predominance of the identification of health needs as a synonym of complaints, and in the interventions, the reasoning in biological knowledge prevailed. Regarding the facilities mentioned by the nurses are the bond and autonomy for some procedures, and the difficulties highlighted were the lack of human resources, non-compliance of users in relation to collective activities, among others. Thus it is concluded that investments are needed in training and qualification of nurses to change their practice in health, nowadays focused on the disease, for a practice based on an expanded concept of health-disease process, so that the satisfaction of needs, desires and doubts of the users becomes the focus of nursing care. It is necessary to use the Continuing Education in the setting of health work in primary care and thus provide a qualified listening of workers, especially nurses, who work in health services.

This project was an assessment of elderly health care needs and access. Three urban San Bernardino communities in zip codes 92405, 92410, and 92411 were targeted. The assessment was structured according to King's theoretical construction of community as a multilevel interaction between personal, interpersonal and social systems. The components of the assessment included digital photographs, web-based internet assessments, key informant interviews, and community business visits.

Den här studien görs som avslutande del av universitetsutbildning, kandidatprogram i Industriell teknik inom ämnesområdet kvalitetsteknik. Studien kan användas för vidare verksamhetsutveckling och analys av röntgenavdelningens behov av produktivitetsmått, vid Visby lasarett. På grund av restriktioner relaterade till covid-19, samt det geografiska avståndet mellan Göteborg och Visby, utfördes studien på distans genom datainsamling från intervjuer och enkätundersökning. Vidare samlades information från vetenskaplig litteratur, lagar, förordningar och dokumentanalys. I studien användes ett abduktivt arbetssätt genom att induktivt analysera insamlad data och utifrån det formulera lämplig teoretisk bakgrund som sedan på ett deduktivt sätt kunde användas för att generera ett resultat och förbättringsförslag. För att analysera och argumentera för erhållna resultat användes vetenskapliga forskningsstudier, kvantitativ data från organisationen och statistiska verktyg. Använda teorier för studien baseras på offensiv kvalitetsutveckling, processledning och Lean Healthcare. DASIAS modell användes som metod för att på ett systematiskt sätt arbeta med data från diagnostisering av problemet till implementerings- och uppföljningsförslag. Genom studien beaktades de etiska aspekter och alla inblandade subjekt informerades med hänsyn till informations-, konfidentialitets-, anonymitets-, objektivitets-, nyttjandes- och samtyckeskraven. Erhållna resultat i form av produktivitetsmått relaterar till processkartläggning, produktivitet, flödeseffektivitet, vårdbehov, kapacitetberäkning, patientsäkerhet och kötider. Analysen visar att valda indikatorer kan användas för att förbättra verksamheten men förutsättning till detta är bättre verksamhetsplanering och effektivare resursutnyttjande för att uppnå en hög flödeseffektivitet och produktivitet. Slutsatsen är att valda indikatorer kan nyttjas för förbättringsåtgärder samt att prioriteringsområden bör väljas enligt 10M analysen. Studien lämnar vissa obesvarade frågeställningar som presenteras som förslag till framtida studier.Nyckelord: / This study is conducted as a final part of the University candidate program Industrial engineering and within the field of study quality technology. This study is suitable for business development as well for the analysis of the X-ray department's needs for productivity measures, at Visby Hospital. The study was carried out at a distance by data collection from the interviews, questionnaire survey and document analysis. An abductive approach was used to generate a result and suggestions for improvement. To analyse and argue for results obtained, scientific research studies, quantitative data from the organization, statistical tools, tables and diagrams were used. The theories for this work are based on TQM, BPM and Lean Healthcare. DASIA's model was used as a method to work in a systematic way with data from diagnosing the problem to implementation and follow-up proposals. The study took into account the ethical aspects and all the subjects involved were informed regarding ethical requirements. Results obtained in the form of productivity measures relate to process mapping, productivity, flow efficiency, care needs, capacity calculation, patient safety and healthcare waiting time. The analysis shows that selected indicators can be used to improve the business, but a condition for this is better business planning and more efficient resource utilization. The conclusion is that selected indicators can be used for improvement measures and that priority areas should be selected according to the 10M analysis. The study leaves some unanswered issues that are presented as proposal for future studies in the discussion chapter.

One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway. Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation. This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.