The motivation for this study is that Health Resource Centres of the Eastern Cape ought to provide access to high quality, relevant and appropriate information that is evidence-based and responsive to the needs of health professionals thereby assisting health professionals accomplish their tasks. In order to provide access to quality information, the Health Resource Centres are expected to provide information services within an acceptable framework of service standards. This study seeks to explore the implementation of standards in the Health Resource Centres of the Eastern Cape. The study was carried out in two phases namely a literature review and a survey. The study used the quantitative method of collecting data by means of a cross-sectional survey. A self administered questionnaire was used to collect data. The questionnaire was piloted in the Queenstown Health Resource Centre, after which appropriate changes were made before the commencement of data collection. The study was conducted in the three other Health Resource Centres of the Eastern Cape, namely Umtata Health Resource Centre, East London Health Resource Centre and Port Elizabeth Health Resource Centre. Health Resource Centre managers completed the questionnaires. The overall findings of this study show that the three Health Resource Centres uphold service standards. The results show that the Health Resource Centres were compliant with the service standards relating to both services and management areas. The Health Resource Centres were more compliant with standards relating to service areas than they were to standards relating to management areas. The results of the study furthermore demonstrate that the Umtata Health Resource Centre was most compliant regarding service areas (86,20%) compared to the East London Health Resource Centre (82,75%) and the Port Elizabeth Health Resource Centre (72,41%). In regard to management areas, the results show that the Umtata Health Resource Centre and East London Health Resource were more compliant than the Port Elizabeth Health Resource Centre. However certain aspects of their service such as availability of space, health and safety, staff performance and development, quality leadership and design and financial management need further attention. The study suggests that further research is required to objectively verify implementation of standards, to solicit health professionals’ opinions and experiences about the services provided by these Health Resource Centres and to find out if there is any connection between the quality of services provided and the quality of patient care.

L’intégration verticale de la gouvernance constitue l’une des options privilégiées pour réorienter les systèmes et les services de santé autour de la 1re ligne, mais les expériences en ce sens demeurent rares. Cette recherche a étudié la mise en œuvre locale des Centres de santé et de services sociaux (CSSS) à la suite de la réforme de 2003-2004 au Québec; notre objectif est de montrer comment et sous quelles conditions s’est instaurée l’intégration de la gouvernance administrative des établissements de santé. À l’aide d’un cadre d’analyse issu de l’économie politique, des études de cas ont été menées dans six territoires de deux régions (Bas-Saint-Laurent et Chaudière-Appalaches), et ce, en s’appuyant sur une analyse documentaire et la réalisation de 32 entretiens semi-dirigés. La recherche souligne la singularité des expériences, les contingences locales modulant fortement la dynamique et les stratégies d’implantation. Nos constats saillants s’articulent autour de quatre axes convergents. L’axe de la territorialité démontre le rôle institutionnalisé des municipalités régionales de comté (MRC) comme référentiel historique et contemporain d’organisation des services de santé. Grâce à l’axe de l’histoire institutionnelle, nous observons que la mise en place des CSSS s’inscrit plus largement dans un processus séquentiel et évolutif, composé depuis les années 1990 de phases interreliées de fusions parfois conflictuelles ou de rapprochements plus consensuels. L’axe des organisations et des missions montre que la lutte polarisée, au départ, entre les établissements hospitaliers et communautaires devient rapidement caduque, alors que les missions, elles, demeurent résilientes et sont transcendées et maillées à des rythmes différents selon les territoires. Finalement, l’axe des acteurs nous permet de constater que la contribution des individus au processus d’implantation s’avère plus déterminante que celle des groupes. Les pratiques décrites sous ces quatre axes renvoient à une dynamique commune, celle d’une constante tension entre deux logiques : la résistance et l’appartenance. Génératrices de conflits, ces logiques sont arbitrées au moyen de la négociation et du compromis, ce qui porte à conclure à la nature proprement politique du processus de mise en œuvre locale des fusions, puisqu’il la rejoint tant dans ses objets que dans ses modes d’action. / Vertical integration of healthcare organizations is one of various solutions put forward to reorient health systems and services around primary care, but such experiments remain limited. We examined the implementation of Health and Social Services Centres (HSSCs), introduced by the 2003-2004 reform and aimed at merging healthcare facilities in the province of Quebec. Our research objective intends to show how and under what conditions the integration of healthcare organisations’ administrative governance was made possible. Rooted in a political economy analytical framework, six case studies were conducted in territories within two regions (Bas-Saint-Laurent and Chaudière-Appalaches), using documentary analysis and 32 semi-structured interviews. Our results unveil the singularity of experiences across the six territories, the implementation dynamic and strategies being highly influenced by local context. Our key findings are organized around four convergent axes. First, territoriality portrays the institutionalized status of the regional county municipality (RCM) as an historical and contemporary scheme around which health care services are organized. Second, from an institutions’ history perspective, the research brings to light that HSSC’s implementation is more broadly part of an evolutionary and sequential process, made of interconnected phases of often conflicting mergers and other more consensual forms of organizational integration put in place since the 1990s. Third, the axis of organisations and missions reveals how the initial opposition between hospital and community services fell short rapidly, but also that the healthcare institutions’ missions showed resilience and therefore integrated at different paces in each territory. Finally, under the actors axis, the research shows how individuals had a greater impact than groups in the implementation processes. The practices described in our research share a common dynamic of constant tension between two logics: resistance and belonging. These logics generate conflicts which are mediated through negotiation and compromise. This leads to conclude to the political nature of the mergers’ implementation process, given that it meets the definition of politics, in both its objects and its actions modes.

Yes / Command centres have been piloted in some hospitals across the developed world in the last few years. Their impact on patient safety, however, has not been systematically studied. Hence, we aimed to investigate this. This is a retrospective population-based cohort study. Participants were patients who visited Bradford Royal Infirmary Hospital and Calderdale & Huddersfield hospitals between 1 January 2018 and 31 August 2021. A five-phase, interrupted time series, linear regression analysis was used. After introduction of a Command Centre, while mortality and readmissions marginally improved, there was no statistically significant impact on postoperative sepsis. In the intervention hospital, when compared with the preintervention period, mortality decreased by 1.4% (95% CI 0.8% to 1.9%), 1.5% (95% CI 0.9% to 2.1%), 1.3% (95% CI 0.7% to 1.8%) and 2.5% (95% CI 1.7% to 3.4%) during successive phases of the command centre programme, including roll-in and activation of the technology and preparatory quality improvement work. However, in the control site, compared with the baseline, the weekly mortality also decreased by 2.0% (95% CI 0.9 to 3.1), 2.3% (95% CI 1.1 to 3.5), 1.3% (95% CI 0.2 to 2.4), 3.1% (95% CI 1.4 to 4.8) for the respective intervention phases. No impact on any of the indicators was observed when only the software technology part of the Command Centre was considered. Implementation of a hospital Command Centre may have a marginal positive impact on patient safety when implemented as part of a broader hospital-wide improvement programme including colocation of operations and clinical leads in a central location. However, improvement in patient safety indicators was also observed for a comparable period in the control site. Further evaluative research into the impact of hospital command centres on a broader range of patient safety and other outcomes is warranted. / This research is supported by the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC).

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Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Experiences in the early years of life are increasingly recognised as significant predictors of long-term cognitive and psychosocial behaviour. This thesis focuses on one aspect of early development: the cultural identity of the young child and investigates the influence of continuity of practice between home and the child care centre in this development. The use of child care services for very young children has increased dramatically in the past two decades. For the first time in history there may be more babies aged 0-3 years in care situations than babies who are cared for at home - this impacts upon the child’s micro-culture (individual, unconscious practices guided by beliefs, norms and values) and macro-culture (ritualistic, symbolic behaviour, often conscious which is tied to belonging to an ethnic group). This study investigates the way in which child care centres contribute to the development of micro and macro-cultural identity in very young children. This study was originally designed to increase the knowledge base about the ways in which interactions with children (particularly in relation to sleep and feeding micro-cultural practices) differ between home and child care service and the implications of these differing practices. As the study progressed a new focus was developed and evolved into an analysis of communication processes between parents and staff and the effects of those communication processes. Qualitative methods on non-participant observation, semi-structured interviews and semi-structured questionnaires were used to address the research questions. Recommendations from the study focus on setting level and policy issues. The early childhood sector is called on to redress notions around communication and partnership building with parents / Doctor of Philosophy (PhD)

The Neighbourhood Centres (NCs) in Sydney, Australia, were established to encourage forms of local control and resident participation and to provide a range of activities to build, strengthen and support local communities and marginalised groups. This thesis is concerned with exploring the personal conceptions, passions and frameworks, as well as the political and professional identities, of activists and community workers in these NCs. It also explores stories of practice and of how these subjective experiences have been shaped through the discourses around the NCs, some of which include feminism, environmentalism, multiculturalism and social justice. The following key research questions encouraged stories of community practice: What do the terms empowerment, participation, community service and citizenship mean for community organisation? What did community workers and organisers wish for when they became involved in these community organisations? What happened to the oppositional knowledges and dissent that are part of the organisational histories? Foucault’s concept of governmentality is used to explore the possibility that these NCs are also sites of ‘government through community’. This theoretical proposition questions taken-for-granted assumptions about community development and empowerment approaches. It draws on a willingness of the research participants to take up postmodern and poststructuralist theories. ‘Practising place’ emerges in the research as a description of a particular form of activism and community work associated with these inner city Sydney NCs. The central dimensions of ‘practising place’ include: a commitment to identity work; an openness to exploring diverse and fluid citizenship and identity formations; and the use of local knowledges to develop a critique of social processes. Another feature of ‘practising place’ is that it involves an analysis of the operation of power that extends beyond structuralist explanations of how to bring about social change and transform social relations. The research has deconstructed assumptions about empowerment, community participation, community organisations and community development, consequently another way of talking about the work of small locally based community organisations emerges. This new way of talking builds upon research participants’ understandings of power and demonstrates the utility of applying a poststructural analysis to activist and community work practices. Overall the research suggests that if activists and community workers are to work with new understandings of the operation of power, then the languages and social practices associated with activist and community work traditions need to be constantly and reflexively analysed and questioned.

This study explores the concept and practical implementation of continuous innovation in logistics services, particularly Distribution Centres. Continuous innovation is a concept that requires a methodical, programmed, incremental and/or radical approach to business improvement involving employees at all levels in the organisational structure. Theories and models of innovation were analysed in the literature, at the outset of this research. As found by previous authors, specific characteristics of service forms did not allow direct application of traditional models of innovation. Most of these traditional models were constructed from the manufacturing perspective. As a result, a new innovation model was designed for this study. It can be used as a guide for understanding the components necessary in service forms to embark on continuous innovation. This model describes the process of service innovation and incorporates theories from literature, and some variables from the CIMA model. The study is exploratory in nature, using empirical data. The study identified, evaluated, compared and contrasted the factors in ten Distribution Centres in Australia and in Singapore that affected the use of continuous innovation in their operations and processes. The focus of the study investigated the drivers, capabilities, behaviours, contingencies, individual competencies and performance measures of innovation in Distribution Centres with logistics services. Overall, this study has made significant contributions in terms of the theoretical investigation adding to the body of literature. This study was exploratory, using case studies as a first hand approach in gaining an understanding of Distribution Centres. There are areas that would merit further investigation and future research. It suggested that additional work should be carried out to expand on this research and refine the model to meet the needs of a wider range of organisations in various service industries. In addition, there are recommendations flowing from this study concerning the practical management of logistics operations. They are addressed mainly to senior management who typically take lead in the implementation of innovative programmes within the organisation. Firms should address continuous innovation as a planned and integrated approach, taking into account many interacting factors that are essential for successful innovation. The challenge facing Distribution Centres is to develop efficient and flexible processes and systems, by continuously innovating to sustain a leading edge in the logistics industry / Doctor of Philosophy (PhD)