Thesis (MPA)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The goal of this research was to investigate effective leadership that drives organisational change in the public health sector to meet the changing environmental needs to improve service delivery within the Western Cape Department of Health. Organisational change in the public health sector must lead to improved public health service delivery. The role of leadership is to deal with incompetent personnel as they are the cause of problems regarding inadequate service delivery. Leadership must contribute to the main areas where competency development needs to take place. Healthcare 2030 requires transformational leadership from the ranks of managers and clinicians for collective and distributed leadership across all levels of organisations. The research methodology used in this study was a combination of qualitative and quantitative research methodologies. The methodology included an empirical investigation in the form of a literature review and a preliminary semi-structured interview as well as a nonempirical investigation. The empirical investigation was conducted by using semi-structured interviews as well as a survey questionnaire which was designed to gather information focussing on leader personality traits, task-related traits and understanding the organisation. This study specifically focussed on effective public leadership to drive organisational change in the health sector and to improve service delivery. The results provide support for a cohesive trait-behavioural model of leadership effectiveness. In general, leadership traits associated with task competence are related to task-oriented leadership behaviours, which improve performance-related leadership outcomes. Effective leadership in the public health sector that drives organisational change is based on the general personality traits of a leader, task-related traits and understanding the organisation. These are the elements that are important for effective public leadership to improve service delivery. / AFRIKAANSE OPSOMMING: Die doel van hierdie navorsing was om doeltreffende leierskap, wat organisatoriese verandering in die openbare gesondheidsektor teweeg kan bring, te ondersoek. Sodoende kan in die veranderende omgewingsbehoeftes voorsien word en kan die Wes-Kaapse Department van Gesondheid verbeter. Organisatoriese verandering in die openbare gesondheidsektor moet tot verbeterde openbare gesondheidsdienslewering lei. Die rol van leierskap is om onbekwame personeel te hanteer omdat hulle die oorsaak van probleme met betrekking tot onvoldoende dienslewering is. Leierskap speel ‘n sleutelrol in die bevordering van bevoegdheidsontwikkeling. Healthcare 2030 vereis transformerende leierskap uit die geledere van bestuurders en dokters oor alle vlakke van organisasies heen. Die navorsingsmetodologie wat in hierdie studie gebruik is, was ’n kombinasie van kwalitatiewe en kwantitatiewe navorsingsmetodologieë. Die metodologie het ’n empiriese ondersoek in die vorm van ’n literatuuroorsig en ’n voorafgaande semi-gestruktureerde onderhoud asook ’n nie-empiriese ondersoek, ingesluit. Die empiriese ondersoek is uitgevoer deur van semi-gestruktureerde onderhoude en ’n opnamevraelys gebruik te maak. Die vraelys is ontwerp om inligting met betrekking tot leiers se persoonlikheidseienskappe, taakverwante eienskappe en ’n begrip van die organisasie te ondersoek. Hierdie studie het spesifiek op doeltreffende openbare leierskap gefokus om organisatoriese verandering in die gesondheidsektor te bewerkstellig en dienslewering te verbeter. Die resultate ondersteun ’n samehangende eienskapgedragmodel van leierskapdoeltreffendheid. Oor die algemeen is leierskapeienskappe wat met taakbevoegdheid geassosieer word, verwant aan taakgeöriënteerde leierskapgedrag wat prestasieverwante leierskapuitkomste verbeter. Doeltreffende leierskap in die openbare gesondheidsektor wat organisatoriese verandering dryf, is gegrond op die algemene persoonlikheidseienskappe van ’n leier, taakverwante eienskappe en ’n begrip van die organisasie. Dit is die elemente wat belangrik is vir doeltreffende openbare leierskap om dienslewering te verbeter.

There is a low representation of Black American women (BAW) in health care senior leadership. With the high level of health problems found among the Black community, diversifying the executive leadership with BAW may be instrumental in increasing provider trust and reducing discriminatory action. Using critical race theory as the conceptual framework, this study examined the experiences, perceptions, and influential or deterrent factors inhibiting advancement of BAW in the health care field. Inquiry centered on factors related to lack of advancement, experiences at different stages of career progression, and strategies impacting career advancement. A qualitative research design using a transcendental phenomenological approach was the chosen method. Seven BAW who met the criteria for inclusion were selected by purposive sampling. Data were collected from semi-structured, audio-recorded, interviews using a newly created protocol. Data analysis included open coding; line-by-line data review; and the use of NVivo to search for frequencies of themes, coding, and text queries. Emergent themes were identified that provided comprehensive descriptions of the participants' experiences. According to study findings, perceived and experienced racial issues were apparent in hiring and work relations. Disparate practices were evident through a lack of inclusion in succession planning, being overlooked despite qualifications, and stereotyping. These findings may stimulate social change by helping those BAW aspiring for senior healthcare leadership to be more successful and by improving health outcomes for BAW through enhanced trust.

Foram emitidas consideraçoes sobre os indicadores de saúde e a mortalidade por causas evitáveis como instrumentos para a avaliação das condições de saúde da população e ainda analisados os critérios de prioridades e a importância de estabelecer prioridades em saúde em função da limitação dos recursos para o Setor Saúde. O objetivo geral do trabalho foi o de determinar, analisar e comparar as prioridades em saúde de Fortaleza, segundo técnicas de hierarquização, para a mortalidade por grupos de de causas evitáveis 1981-83. O material básico foi Constituído das declarações de óbitos de residentes em Fortaleza referentes ao período 1981-83, obtidas junto à Secretaria de Saúde do Estado do Ceará. As declarações de óbitos, após a seleção da causa básica de morte, foram codificadas e apuradas por causas, ao nível de categorias, segundo sexo e grupo etário, e, em seguida, distribuídas em grupos de causas evitáveis, conforme a classificação proposta por Taucher. Posteriormente, foram redistribuídas nos diversos grupos de causas evitáveis as declarações referentes às causas mal definidas, proporcionalmente à participação por sexo e faixa etária. Para estabelecer as escalas de prioridades dos grupos de causas evitáveis foram utilizadas doze técnicas: ganhos em esperança de vida ao nascer (e0.) e ganhos em esperança de vida ativa (e a.), mediante tábuas de vida de múltiplo decremento; anos de vida ativa potencial -(ea)X - e de um trabalhador-e ax - perdidos, a partir das tábuas de vida ativa; anos potenciais de vida perdidos, com três variantes, limite em 65 anos (APVP 65), limite em 70 anos (APVP 70) e esperança de vida à idade especificada (APVP ex); técnica CENDES/OPS, consoante três modelos diferentes de transcendência (TCl, TC2 e TC3); e perdas econômicas correntes e futuras (PEC e PEF), baseadas nas medianas de renda por sexo e idade. Essas técnicas foram operadas considerando a eliminação total das causas evitáveis e a eliminação parcial, conforme a vulnerabilidade arbitrada a cada grupo de causas evitáveis. A comparação das escalas decrescentes de prioridades foi efetuada por intermédio da correlação por postos de Spearman. Os resultados do trabalho revelaram que 57,55 por cento e 42,46 por cento dos óbitos em homens e mulheres foram por causas evitáveis correspondendo a taxas de 483,77 por 100,000 homens e 295,30 por 100.000 mulheres, respectivamente, e que a mortalidade por causas evitáveis tem um elevado impacto em anos potenciais de vida perdidos e em perdas econômicas. A hierarquização das prioridades segundo as várias têcnicas apontou os Grupo F - mortes produzidas por violências - e C - evitáveis por medidas de saneamento ambiental - como as duas primeiras prioridades saúde em Fortaleza. A comparação entre conjuntos de técnicas demonstrou que a redução e/ou simplificação do número de técnicas adotadas para definir prioridades em saúde podem ser aplicadas sem sacrifício da precisão oferecida pelo modelo completo, que contempla as doze técnicas. Por fim, foi salientada a contribuição dessas técnicas para orientar o processo político que envolve a decisão de eleger as prioridades em saúde. / Considerations were made about the indicators of health and mortality by avoidable causes as instruments for the evaluation of the health conditions of the population and analysed were performed on the criteria of priority and the importance of stablishing priorities in health, taking into account the limitation of resources for the Health Sector. The general objective of the thesis was that of assessing, analysing and comparing health priorities in Fortaleza, Ceará, Brazil, according to techniques of hierarchization for the mortality by groups of preventable causes in 1981-83. The basic material was constituted by the death certificates of residentes in Fortaleza related to the period 1981-83, which were obtained at the Secretary of Health of the State of Ceará. The death certificates, after a selecyion, of underlying cause of death were codified and computed by causes, at the level of categories, in regard to sex and age range, and afterwrds, distributed in groups of preventable causes, according to a classification proposed by Taucher. The certificates referred to illdefined causes were then redistributed, proportionally to the participation by sex and age. Twelve techniques were utilized in distributing the range of priorities of the groups of preventable causes: gains in the life expectancy at birth (eO.), gains in active life expectancy (e a.), through tables of life of multiple decrement; potential active life - (ea)x - and of a worker - e ax - years of life lost from the table of active life; pottentiall years of life lost, with three variants, limit in 65 years (APVP65), limit in 70 years (APVP70) and life expectancy at a specified age (APVPex); CENDES/OPS technique in accordance with three different models of transtendence (TC1, TC2 and TC3): and present and futures economic lesses (PEC and PEF), based in the median of income by sex and age. These techniques were used taking into consideration the total elimination of preventable causes and the partial elimination, as to the ascertained vulnerability to each group\'s of preventable causes. The comparison of the decreasing ranks of priorities was carried out though the correlation by posts of Spearman. The results revealed that 57.55 per cent and 42.46 per cent of deaths in men and women were due to preventable causes, corresponding to rates of 483.77 per 100,000 men and 295.30 per 100,00 women respectively, and that the mortality by preventable causes has and elevated impact on potential life lost and in economic losses. The hierarchization of the priorities according to several techniques pointed to the Groups F- death produced by violence - and C - avoidable by measures of envirorimental sanitation - as the two first priorities of health in Fortaleza; the comparison among sets of techniques demonstrated that the reduction and/or simplification of the number of adopted techniques to define priorities in Health can be applied without sacrificing the precision by the complete model, which comprises the twelve techniques. At last, the contribution of these techniques was stressed to orient the political process that involves the decision of choosing priorities in health.

African Americans are adversely affected by Type 2 diabetes at a greater rate than their European American counterparts; however, research on the effects of Type 2 diabetes on African Americans is limited. Lifestyle modifications that include the incorporation of physical activity and dietary changes can help patients with Type 2 diabetes better manage their disease and improve their overall quality of health. The purpose of this phenomenological study was to explore the experiences of African Americans with Type 2 diabetes who incorporated these self-management behaviors, discerning if they had improved health and quality of life. The self-efficacy framework was applied to understand the research problem and interpret study results. An in-depth interview protocol was used to explore participants' perspectives and lived experiences in disease management. Interview transcripts and participant data were analyzed using a thematic-content-analysis approach. According to study findings, participants experienced physical activity and dietary changes, and their self-efficacy directly correlated with their experience of positive changes in their health status. Providing programs that support the adoption of healthy lifestyles for this population will help mitigate the later effects of diabetic complications. Implications for social change include the provision of strategies that will help in formulating programs and policies that will reduce diabetic complications and deaths due to complications.

Healthcare costs have risen from 13.8% in 2000 to 17.9% in 2009 (Gordon, Leiman, Deland, & Pardes, 2014). Poor transitional care has been identified as a cause of the high healthcare costs (Naylor et al., 2013; Obama, 2013). In 2009, the Department of Veterans Health Administration (VHA) implemented a national reform of outpatient care to create Patient-Aligned Care Teams (PACTs) with a goal to improve transitional care and reintegration into outpatient care through registered nurse case managers conducting discharge telephone follow-up calls. However, discharge telephone follow-up calls have not been explored within the VHA. This study explored the relationships among discharge telephone follow-up calls, selected Veteran characteristics including the length of index hospital stay, and 30-day all cause hospital readmissions between fiscal years 2011 and 2013. Hospital readmissions were explored in parallel time periods to the timing of the discharge telephone follow-up calls. Study data were collected retrospectively from VHA inpatient and outpatient records. Descriptive statistics, measures of central tendency, bivariate statistics, and logistic regression were used to analyze the data. The study found 124,069 Veterans were discharged from the VHA from 2011 to 2013. Of those discharges, 15,954 (12.86%) were readmitted to the hospital within 30 days and 35.06% of the readmissions occurred within the first seven days after discharge. Discharge telephone follow-up calls increased from 312 in 2011 to 26,549 in 2013. Increasing Veteran age, number of comorbidities, length of index hospital stay, and being identified as frequently hospitalized in the previous year were significantly related to hospital readmissions at each of the hospital readmission time frames (within two days, between three and seven days, and between eight and thirty days after hospital discharge). This study identified a relationship between discharge telephone follow-up calls and the parallel hospital readmission time period. However, only discharge telephone follow-up calls within two days were found to decrease the likelihood of hospital readmissions and only hospital readmissions within two days after discharge (OR=0.595). The relationships between discharge telephone follow-up calls and hospital readmissions potentially explains previously mixed results and suggests two potential explanations. One, discharge telephone follow-up calls have a limited relationship to hospital readmissions and a short duration of protective effects preventing hospital readmissions. The second explanation is self-selection bias confounds the relationship between discharge telephone follow-up calls and hospital readmissions. Both explanations suggest future research and clinical practice should focus on exploring bundled transitional care interventions as a method to reduce hospital readmissions.

This thesis investigates the use of scientific evidence in the process of making public health policy. A case study located within a food regulation setting is used. The aim is to test theory against this case study. The outcome is a theoretical understanding of the use of scientific evidence in the policy-making process in a food regulation setting. Food regulation can influence food composition and food labelling and thereby affect the population's dietary intake. Frequently there are contested values, beliefs, ideologies and interests among stakeholders regarding the use of food regulation as a policy instrument to effect public health outcomes. The protection of public health and safety, taking into account evidence based practice, is generally employed by food regulators as the priority objective during the policy-making process to adjudicate among the competing expectations of stakeholders. However, this policy objective has not been clearly defined and is vulnerable to interpretation and application. The process by which folate fortification policy was made in Australia, in response to epidemiological evidence of a relationship between folate intake during the periconceptional period and reduced risk of neural tube defects, was analysed as a case study of the policy-making process. The folate fortification policy created a precedent for both food fortification and subsequently health claims policy in Australia. A social constructivist method was used to analyse the case study. The method involved deconstructing the food regulatory system into three levels; decision-making process; procedural; and political environment. Data aligned with each level of analysis was collected from 22 key informant interviews, documentary sources, field notes and surveys of both a random sample of the Australian population's knowledge of folate and use of folic acid-containing supplements (n = 5422), and the implementation of folate fortified food products into stores (n = 60). The insights that emerged from each of the three levels of analysis were assessed iteratively to identify a pattern of interrelationships associated with the policy-making process within the food regulatory system. The identified pattern was interpreted against existing theory to gain a theoretical understanding of the public health policy-making process in this political setting. The central argument of this thesis extends Sabatier and Jenkins-Smith's Advocacy Coalition Framework theory to a food regulation setting. The argument is that within the contemporary political climates of neoliberalism and globalisation, a coalition between corporate interests and the values of scientists with a positivist-reductionist approach to public health research is privileged so as to invoke certain scientific evidence to, in turn, legitimise food regulation policy decisions. The theory will help to inform policy-makers about how and why the public health policy objective in a food regulation setting is interpreted and applied. This will contribute to improving policy practice intended to effect public health outcomes. It is concluded that irrespective of the quantity and quality of the scientific evidence that is being made available, scientific evidence cannot be assumed to speak for itself Policy-making is an inherently political and value-laden process and the potential for politically motivated interpretation and application of otherwise value-neutral scientific evidence can undermine the investment in its generation. From this perspective, evidence based practice, far from liberating policy-making from political influence, can itself become part of the problem rather than the solution. Nevertheless, rational evidence based practice is an ideal to strive for and a series of recommendations is proposed to help make the use of evidence in current food regulation policy processes more transparent and democratic.

Economics has become a dominant framework for analysing problems in public health and health care and for proposing policy solutions. A separate subdiscipline of health economics has grown out of the welfare economics tradition to develop specific methods for economic inquiry into health care issues. The encroachment of economics into health care and public health has not occurred without consternation from within the health field. Part of the reason for this concern arises from a mismatch between the worldview of public health and that of mainstream economics. However, this mismatch is largely unexamined, and there has been limited attempt to address the mismatch and to propose alternative approaches to economic questions in public health. This thesis examines the project of public health in some detail, making reference to the consensus documents of the World Health Organization that set out the values base of public health and define its approach and some of its activities. Public health is a collective activity, mostly undertaken outside of markets and is primarily concerned with impacts on populations. It is inherently political and focuses on populations as its unit of analysis. This contrasts to the approach of mainstream economics, which presumes that economic decisions are primarily private decisions and focuses on individuals as its unit of analysis. The differing worldviews constitute an impasse between mainstream economics and this view of public health. The solutions of neo-classical economics are often at odds with the public health approach. An alternative view of economics, from the heterodox Institutional School may provide an alternative approach to economic questions in public health. In contrast to neoclassical economics, it claims to be holistic and not to engage in methodological individualism and to be explicitly concerned with questions of power. The case studies of role of government and ageing as a public health issue provide a lens through which the neoclassical approach can be examined and contrasted to the public health approach. These case studies are based on reports written for Australian governments by neoclassical economists. The two case studies are then inspected from an institutional perspective to examine whether this approach does indeed generate explanations and solutions that are more compatible with a public health approach. Other insights into the reports that can be gained from an institutional perspective are also discussed. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1287041 / Thesis (Ph.D.) -- School of Population Health and Clinical Practice, 2007.

Thesis (Ph. D.)--University of Oregon, 2006. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 127-130). Also available for download via the World Wide Web; free to University of Oregon users.

Thesis--University of California, San Francisco. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 255-260).

Thesis (D.P.A.)--University of La Verne, 2003. / Includes bibliographical references (p. 216-227).