This study examines the factors that have contributed to the success of some Central and Eastern European countries to improve their health care sector in the post communist period, while leaving others to its demise. While most literature has been focused on the political and economic transition of Eastern Europe, very little research has been done about the welfare aspects of the transition process, especially the health care sector. While the focus on political consequences and main macroeconomic reforms has shed light on many important processes, the lack of research of health care issues has lead to consequences on our ability to understand its impact on the future of the new democracies and their sustainability. This model looks at the impact of international (World Bank) and domestic institutions, corruption and public support and how they affect the ability of some countries to improve and reform their health care sector in the post-transition period.

published_or_final_version / Politics and Public Administration / Doctoral / Doctor of Philosophy

Thesis (Ph. D.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 538-584). / Also available by subscription via World Wide Web / xvii, 584 leaves, bound 29 cm

Thesis (Ph.D.) -- La Trobe University, 2003. Submitted to the School of Public Health, Faculty of Health Sciences. / Includes bibliographical references (leaves 341-378).

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2002. / Typescript. Bibliography: leaves 216-228.

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.

Thesis (MBA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: no abstract available / AFRIKAANSE OPSOMMING: geen opsomming

The Diploma paper " The Health Care Providing System in Switzerland" describes the development, structure and typical aspects of health care providing system in Switzerland. The Diploma paper concentrates on identification of the key factors which helped Switzerland health care providing system to reach very high quality and also ensured large availability of the services. The work is divided into theoretical and practical part. Theoretical part describes Swiss Confederation and its health care providing system. The practical part offers the comparison with the system in Czech Republic. The finale part is devoted to the key factors which could be implemented into the Czech system and which would be helpful for its further development.

La réforme « Hôpital, patients, santé et territoires » (HPST) de 2009 a positionné l’agence régionale de santé en tant que chef de file de la santé à l’échelle régionale. En mobilisant une approche par les instruments, notre thèse pose la question de la réalité de ce rôle de pilotage lors de la phase de sa mise en œuvre. En toile de fond, ce questionnement fait écho à une interrogation plus globale, à savoir : qui dirige la politique de santé au niveau local ? En investissant le secteur de la santé de la région Provence-Alpes-Côte d'Azur par l’angle original du secteur médico-social, notre analyse démontre que les instruments qui devraient être aux mains de l’ARS ne le sont qu’à la marge. Ainsi, chaque instrument, qu’il s’inscrive dans le sillon ancien de la planification ou qu’il relève d’une idéologie plus libérale nous donne à voir une répartition des compétences différente de celle initialement annoncée et légalement prévue. Concernant les instruments de la planification, une distinction s’opère entre ceux non financiers et ceux relevant de la répartition des crédits. Nous démontrons que, lorsque les instruments de planification à disposition de l’ARS présentent uniquement des aspects cognitifs, les organes de démocratie sanitaire créés par la Loi dispose d’une véritable marge de manœuvre à même d’influer sur son contenu. Les instruments adoptés de la sorte par l’ARS sont donc à la fois le fruit de la concertation entre acteurs de santé à l’échelle locale et témoignent d’une véritable capacité à agir de l’ARS sur ceux-ci. A contrario, dès lors que les instruments de planification revêtent une dimension financière, ils échappent à tout contrôle du niveau régional, l’ARS s’avère finalement inféodée au niveau national en la matière. Quant aux instruments au design proche de ceux du « new public management » (Appels à projets et contrats pluriannuel d’objectifs et de moyens notamment), la démonstration met en évidence une triple désubstantialisation de l’ARS. Par le haut, c’est-à-dire par un contrôle systématique et direct des instances nationales ; par le bas, l’ARS devant composer avec la fragmentation des institutions locales existantes sans disposer du dernier mot ; et par le musellement de la démocratie sanitaire locale dont les capacités sur ses instruments sont légalement et dans les faits réduites au minimum. / The 2009 reform “Hôpital, patients, santé, territoires” (HPST) made the « Agence Régionale de Santé » the leading health organism on a regional level. By using an instrument approach, our thesis exanimates the reality of this role during its application. This question echoes a more global issue: namely, who are health policies decided by, on a local level?By investigating the health field within the PACA region, through the lenses of the medico-social area, our work demonstrate that the instruments supposedly in the hands of the ARS are only barely so. Each instrument, whether it finds its origins in the old healthcare planning ideal or in a more liberal ideology, let us discover a distribution of competences different from what is legally intended.

The U.S. health care system of the 21st century is in desperate need of reform. Patients are being harmed in the hundreds of thousands attributable to medical errors, identified as the third leading cause of death in hospitals. The need for health care reform is further validated by the trillions of dollars that are infused into the U.S. health care system, where quality of care benchmarks are among the worst in the world. The historical evolution of the U.S. health care system was predicated on nurses who served as advocates and innovators of safe workplace and patient care practices. The Code of Ethics and Nurse Practice Act(s) for registered nurses and the requirements of registered nurse licensure in the 21st century, partnered with an ethical barometer in the delivery of quality patient care, command that registered nurses maintain their historical role as advocates and innovators to promote and maintain safe workplace and patient care practices. Registered nurses in the 21st century are being stifled in the fulfillment of what is commanded of them professionally. It is the quagmire of fulfilling their advocate, innovator role and being penalized with unjust discipline shortly thereafter that is stifling. This “coincidence” is silencing registered nurses across the United States. The aim of this study was to employ a hermeneutic phenomenological research design utilizing Max van Manen’s phenomenology of practice to explore the lived experience of unjust discipline among registered nurses. Audio-recorded interviews were conducted with the participants of the study. Vivid descriptions of the participants’ lived experiences of unjust discipline were communicated. Transcripts were generated from the audio recordings. An interpretive analysis utilizing the hermeneutic circle disclosed nine essential themes among the participants’ experiences of unjust discipline. Respondent feedback augmented validity in the interpretive processes during data collection and thematic analysis. In the context of the study, it was evident that unjust discipline is a disruptive workplace behavior that potentiated physical workplace violence. Further, authentic social support may have precluded many of the elements of unjust discipline experienced by the participants during the lived experience of unjust discipline.