Background: University of Fort Hare (UFH) provides health care services to its students and staff; however, whether the health care services are being utilised by the staff is only speculative. Hence, the aim of the study was to determine the level of employees’ awareness regarding availability of University Health Care Services (UHS) and factors responsible for their utilization. wildlife and thereby may constitute a serious risk to public health. Therefore, it is recommended that proper regulation of the use of the compounds and their safe disposal be ensured to protect aquatic resources and the well-being of humans. Methodology: This quantitative descriptive study involved conveniently selected 255 UFH employees who were either permanently employed or on contract employment for two years and above. A structured self-administered questionnaire was used for data collection. The questionnaire solicited information on demographics variables, awareness of employees regarding the existence of university health services, and factors affecting utilization of university health services (UHS) by employees. Data was analysed using descriptive statistics (frequency and percentages) and inferential statistics (logistic regression analysis). Results: -Two hundred and thirty three (91 percent) of sampled UFH employees in both campuses are aware of the UHS. The longer the duration of employment and the older the employee (above 50 years old) the more likely the employees are aware of UHS. However, the elderly employees displayed poor utilization of health care services. Accessibility of UHS (96 percent), satisfaction with UHS (95 percent), listening to others (word of mouth) (61.2 percent) and having a health concern (51 percent) encourage UHS utilization whereas being unaware (8.6 percent) of the UHS remains the barrier for utilisation. Having medical aid (81 percent) prevent those who are aware of UHS from utilising the university health care services. Operating hours (30 percent), staff attitudes (50 percent) and long waiting time (70 percent) with lack of essential medicines (38 percent) prohibit employees from revisiting. Conclusion: The University of Fort Hare’s health care services are well known by almost every employee through “word of the mouth” though they are not completely aware as to which health service programmes are being offered. The utilization of University of Fort Hare’s health care services is positively and adversely influenced by different factors.

As the public sector and specifically the health sector, undergo reform throughout the Western world in order to find systems that work better and cost less, the phenomenon of accountability is of increasing concern to policy-makers. Although the public administration concept of accountability is ancient, and has been debated and described in the languages of many diverse disciplines, little academic work is available on its meaning or application to the Canadian Health System. Without a clearer understanding of the concept, the basis for improving accountability in the Canadian Health System will remain unknown. This dissertation seeks to clarify the concept of health system accountability and elucidate the issues related to improving accountability in the system. This is accomplished through a concept analysis methodology using two qualitative data collection strategies: a structured review of Canadian literature on accountability from the domains of health policy/administration, professional and popular literature sources; and an interview process whereby 24 health system leaders from five Canadian provinces were interviewed. The findings reveal that the concept of accountability, in its current explicit, performance-based form, is relatively new to Canadian health system policy discussions, its use only beginning in the 1980’s. Prior to this, accountability was implicit in the delegation of health matters to self-regulating professions. The concept evolved from public administration theory and continues to evolve as a health concept. An attempt is made to disentangle the concept of health system accountability from its many related concepts and references. The defining attributes of accountability are: a performance assessment according to standards/goals; an obligation to render an account; and an answerability to the community served. Antecedents or pre-requisites to accountability include a renewed culture, strategic direction, citizen engagement, information management, performance measurement and reporting. Consequences of accountability are: a sustainable health system, increased public confidence, improved health outcomes and quality services, added bureaucracy and uncertainty. Although there is a majority view on the defining attributes, there are several conceptions of accountability: as a theoretical or ethical construct; as gesture; as a formal system or set of practices; as an on-going political process; and as desired outcomes or results. Likewise several normative modes or models exist: the historical professional model, the emerging managerial model and the potential citizen participation model. These are all encompassed within the broader political framework. Also, accountability is a multi-level construct: personal, organizational and political. There are several policy issues related to accountability and democratic governments in today’s modem societies. Within the health sector, the key issues identified, by health system leader research participants, as problematic to improving accountability included: a lack of direction and role definition, cultural issues, a lack of citizen engagement, and a lack of appropriate measurement and information with which to evaluate organization and system performance. Although the purpose of this dissertation is not to answer or provide prescriptions to policy issues, several health policy questions are generated. I trust that the conceptual analysis presented here will assist to clarify our language and understanding of accountability as it continues to evolve in health care, provide a helpful reference point from which to discuss health system policy issues, and prompt further research in an area that has largely been ignored by Canadian academics. We need to get clear about our language, (so that), our intelligence is not bewitched by our language. (Hodgkinson, 1996, p.144) / Graduate

The modern workplace continues to transform at a radical and accelerated pace and successful and competitive organisations are able to turn their strategies into action faster, manage their processes more efficiently and maximise their employees’ contribution and commitment (Brewster, Carey, Grobler, Hollard and Wärnick, 2010:5). In addition, Vestal (2009:6) adds that one of the biggest challenges that managers face at the moment, is to find ways to engage employees in the organisation and build a sense of belonging that, hopefully, will support retention and long term commitment. This research study aimed to explore and describe the nature and extent of employee engagement among nursing employees working in private healthcare. This exploration also encompassed five facilitators which are considered to be crucial in the promotion of an engaged workforce. The identified facilitators include: leadership behaviour, working environment, communication, training and development and rewards and recognition. This was attained by using a quantitative, exploratory, descriptive and contextual research approach. A structured questionnaire was used to collect data from nursing employees working in one of the private hospitals in the Nelson Mandela Metropole. From the data, the overall degree of employee engagement was established as well as the significance of the five identified facilitators in employee engagement. Based on the analysed data, guidelines for the advancement of employee engagement are proposed that can assist management in the development of employee engagement practices and strategy formulation.

The research problem addressed in this study was to identify what management skills do middle managers require to manage the organisational units effectively. To achieve this objective a theoretical model of management skills required by middle managers to effectively manage a public hospital was developed, using relevant literature in which management skills are identified. The theoretical model consisted of the following categories of management skills whose correct application can promote managerial effectiveness in managing organisational units: General management skills; Technical skills; Human skills; Leadership skills; Financial management skills; Computer skills. Each category of the management skills was broken down into elements that were then analysed using literature identified during the literature study. The model was then used to develop a questionnaire to assess the degree to which managers responsible for running the clinical, nursing and paramedical departments of a public hospital in the Eastern Cape rate the elements in terms of importance. The empirical results obtained indicate that a wide variety of skills are regarded by middle managers as important to performance of their managerial roles. This resulted in the theoretical model being confirmed and the identified management skills being accepted as management skills required by middle managers to effectively manage a public hospital in the Eastern Cape.

Background: Integrated working between health and social care services within England has been encouraged by Government policy in the last decade, and has been argued to provide a seamless, joined up experience for service users (Department of Health 2011). One way of integrating care is through the use of a single point of access to health and social care services. A single point of access to services has been trialled in mental health and learning disability services to improve access, and following on from policy (e.g. Department of Health 2007) and support from literature (Rogers, Entwistle & Pencheon 1998; Lovell & Richards 2000; Raine, Carter, Sensky & Black 2005) a single point of access to health and social care for older adults has been implemented in parts of the UK. This thesis examines the implementation of one such single point of access. Objectives: The aim of the study was to examine the single point of access and whether it had any impact upon integrated working within a county in England, UK. Methods: An ethnographic approach was taken, using a combination of methods including interviews, focus groups and observations. This was complemented by a grounded theory approach to analysis. Findings: The single point of access had an adverse effect upon integration. The poor management of change and lack of communication led to issues within the single point of access such as failure of IT systems and duplication. Staff became frustrated and disengaged from the process, and consequently reported feeling disempowered, retreating back to their professional 'tribes'. Conclusion: Firm conclusions about the efficacy of a single point of access with regard to its effect upon integrated working could not be reached. However, the findings suggest that clear communication, continued change management and recognition of professional culture are decisive factors when attempting to integrate health and social care. Further research into the impact of a single point of access upon integration as well as outcomes for service users is recommended.

D.Cur. / Not only do communities and individuals have the right to participate in their own health care, but a key means to reducing the risk of potential social and psychological harm of people participating in clinical health research, especially efficacy trials, is to ensure that the community in which the research is being carried out, as well as health service providers, are meaningfully involved in the research process. One of the requirements of the South African White Paper for the Transformation of the Health System (South Africa, 1997: 74-78) which refers to Essential National Health Research (ENHR), is that the research agenda should initiate a process whereby stakeholders are equal inclusive partners in the research. Therefore researchers are no longer perceived as having the right to exercise a monopoly on conducting and explaining their research but now have a duty to empower their research participants and the research community to understand their own situation and become a collaborative partner in the research process. In this participatory approach to research, a collegiate partnership needs to be facilitated, but the power differentials that exist between stakeholders in community research make this a difficult partnership. The researcher, having had prolonged interaction with a community which has been targeted for large efficacy trials, initiated this research to gain insight into some of these difficulties and to describe the understanding and expectations of key stakeholders into community participation in clinical health research and develop a model to manage this participation. The critical elements in the study took cognisance of the research context, the dynamics within that context, the relevant stakeholders in a participatory approach to clinical health research and the processes within which they engage. Literature was reviewed throughout the study that was conducted in two phases. Phase one of the research design is ideographic, contextual and descriptive in nature. A perception survey, within a targeted community, was conducted to describe the understanding and expectations of community representatives, health service providers and researchers of community participation in clinical health research. The analysis of the perception survey endorsed the notion that community participation needs to be an v integral part of all clinical health research. The findings from the perception survey and a further literature search enabled the researcher to develop a theoretical framework for the construction of a model to manage community participation in clinical health research. The model is overarching with multiple processes namely: the participatory management process central to the model; the preparatory process; research process and quality improvement process. The model facilitates a collegiate partnership between stakeholders where there is mutual influence and collaborative interaction. Its implementation requires a radical paradigm shift in research and a commitment on the part of those "in power" to share power. It is recommended that standards that monitor, measure and evaluate community participation in clinical health research be developed to operationalise the model. Funders increasingly mandate community participation in clinical health research and the challenge is to ensure that this process goes beyond tokenism. A model to manage community participation in clinical health research will facilitate the conscious integration of key stakeholders into the research process to provide a platform for the voiceless and powerless within the research community, so that they become active participants and partners, not merely 'objects' in the process of research and knowledge creation. This will not only meet the requirements of funders and the ENHR, but this collaboration and partnership will foster trust between researcher, health service providers, community representatives and trial participants. There will be mutual understanding of the research issues and this will ensure that the study or clinical trial respects cultural and ethnic differences among participants. The primary outcome of the operationalisation of the model will be to facilitate quality management of community participation in clinical health research.

Employer’s assistance to employees experiencing personal problems originated in the 19th century. The term Employee Assistance Programme (EAP) was however formulated in the 1970’s in the United States and, initially, only focused on alcohol dependence rehabilitation. EAPs have since seen a paradigm shift in their focus as they now deal with the full range of problems experienced by employees such as family life or relationship issues, work related stresses, financial pressures, depression or anxiety, alcohol and drug abuse. The researcher observed that some employees in the psychiatric institution, where they are employed as both professionals and non-professionals, were experiencing personal problems and very little if anything was done to provide assistance to them. It also seemed as if very few of them made use of the voluntary EAP service made available by the institution. The fact that a number of employees have problems can have serious negative consequences in that it causes a high rate of absenteeism and the institution’s core business, which is to provide care to its users, is compromised. The researcher undertook this study because EAP services fall within the realm of institutional development. This study could therefore make an invaluable contribution to the transformation discourse which has been taking place in the South African health systems in general and psychiatric institutions in particular. The purpose of this research is to determine employees’ experience of utilizing an EAP in a psychiatric hospital. The researcher is personally interested in employees’ experiences of utilizing the EAP in order to provide recommendations that will assist and strengthen the policy/guidelines for the Eastern Cape Department of Health on the use of EAPs. The workplace has an obligation to provide EAP services to employees so as to help them meet their contractual obligations in a holistic and healthy manner. The research goals are to explore the experiences of employees who have utilized an EAP. The findings will be used to make recommendations regarding the utilization of the EAP policy/guidelines that are currently used to assist the employees. The research methodology will be qualitative, descriptive, exploratory and contextual. The research population and sampling for this study will consist of the employees who have made use of an EAP. Participants will be selected using a purposive sampling approach. Data gathering will be done using semi-structured interviews, at a venue convenient to the participants. Open-ended questions will be asked to enable participants to express their perceptions on the topic. The data will be analyzed using Tesch’s method of data analysis. The identified themes will be used to describe employees’ experience of utilizing an EAP. Trustworthiness will be ensured by using Guba’s model of trustworthiness. The ethical principles of beneficence, self-determination and justice will be ensured by asking for each participant’s consent, by not coercing individuals to participate in the study and by ensuring permission from the Department of Health and from the University’s research committee to conduct the study.

The nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed for this research study. Nurses were surveyed on demographics, perceptions regarding the work environment, and perceptions of WFC/FWC. Descriptively, nurses experienced more work-family conflict than family-work conflict. Regression analyses and ANOVAs indicated that staff nurses experienced less work-family conflict than nursing managers (second most) and nursing executives (highest). None of the nurse roles experienced significant levels of FWC. White nurses, compared to non-white nurses, experienced less WFC and FWC. WFC increased with shift length but FWC was not significantly affected by it. Paid leave for childbirth was associated with lower FWC. This study holds significant implication for the nursing workforce. Nurse managers and executives showed significantly higher WFC than staff nurses. This may discourage a nurse from taking on leadership roles or lead to leaving them. In an era where nurse managers and leaders are needed, efforts must be taken to decrease WFC/FWC factors. Nonwhite nurses reported higher levels of both WFC and FWC. This may contribute to tension at the workplace and a difficult family life. Leaders must continue to create platforms for nurses of all races and ethnicities to voice their work and family needs, and to be supported when doing so. Nurses working shifts over 8 hours had higher WFC levels. Although 12-hour shifts have been popular among staff and management, their use should be reevaluated. Finally, paid leave for childbirth is a program worth supporting, as it was a factor in lower FWC.

Due to the remarkable positive effect of lean adoption in various firms in the manufacturing sector, it has been adopted by several organizations within the healthcare industry. Although the rate of adopting lean by hospitals in the developed countries is slower than it should be, it proved to be effective in helping healthcare organizations maintain or even improve their quality of care while containing their related costs. However, such adoption did not take place until the beginning of the new millennium. And with such adoption, it has been accompanied with major challenges related to proper lean implementation, sustainability of achieved levels of performance, and staff engagement in infinite cycles of continuous improvement towards perfection. Thus, the purpose of this study is to develop a framework that helps healthcare organizations quantify their experience with lean. Such quantification is obtained by measuring the agreement level of hospital staff members about the degree of adopting two sets of critical factors of successful lean implementation within their hospital. These two sets of factors are classified as process factors and organizational factors. The proposed framework has been validated by determining the sustainability level of lean implementation within one of U.S. hospitals in the State of Florida. The developed framework provides a balanced assessment of both process and organizational factors essential for achieving sustainable levels of lean implementation. In order to accommodate for the observed variation in lean adoption in hospitals, individual hospital iv departments are considered the ―analysis units‖ of the developed framework. In order to quantify the implementation status of lean within a hospital department, a survey-based lean sustainability assessment tool has been developed based on the defined sets of factors. The sustainability level of lean implementation of a hospital can be obtained by combining various responses of its surveyed departments. The developed framework is the first that addresses both process and organizational factors of sustainable lean implementation in a balanced manner while fulfilling the assessment needs of all healthcare organizations regardless of their current level of lean adoption. In addition, utilizing the framework within a hospital enhances employee involvement and respect for employee which are essential for sustainable lean implementation. Finally, the developed framework provides healthcare supervising authorities (i.e. ministries of health or corporate offices of hospitals’ groups) a macro-level benchmarking view regarding the progress of their hospitals towards implementing sustainable levels of lean.

Sub-national health management and leadership development is a critical component of primary health care strengthening, which is under appreciated, resourced, and theorized. Though the role of the wider institutional, systems and policy environment has been recognized as important to effectiveness of management strengthening interventions in the literature, in practice these components are often under-addressed, limiting sustainability and impact. This integrated learning experience explores sub-national health management and leadership strengthening in Eastern and Southern Africa, drawing on experience from UNICEF’s District Health Systems Strengthening Initiative (DHSSi) (2019-2022) and a subsequent case study that aimed to better characterize the enabling environment for this work in Malawi. Insights from the application of different conceptual frameworks in the Malawi context are used to better characterize the enabling environment for sub-national health management and leadership strengthening there and contribute to a newly proposed framework to support pre-intervention situation analysis and intervention design for this work more broadly.