Lightweight technologies relate to the binding process of patient health professionals, to the empowerment of the individual, to welcoming and the management of assistance focused on the demands of the patient. The nursing staff, to be next to the patient during the 24 hours, is predisposed to the use of these technologies, especially in intensive care units, where attention is intended to meet continuous vulnerability of patients. General objective: to compare the use of lightweight technologies in the care provided by nursing in intensive care units between public hospitals, being a State education and another in the city of Aracaju/SE. Method: descriptive, cross-sectional study of quantitative approach and observational nature. The data were collected by means of an observation instrument validated through the Percentage of Agreement and Content Validity Index (CVI) by six judges from December 2014 and February 2015. The data were collected in the teaching Hospital and State Hospital during the period of March and April 2015, in which were observed nurses and nursing assistants/technicians for assistance activities. In the analysis of the data has been used the Kolmorogov-Smirnov test, Mann-Whitney Test and Chi-square. Results: the Kolmorogov-Smirnov test showed the non-normal distribution of light technologies and the Mann-Whitney Test presented a p-value < 0.0001 which means that the use of lightweight technology by State and teaching Hospital were statistically different, being that the teaching Hospital showed the highest prevalence in the use of light technologies. As for the professional category, the nurses used most often lightweight technologies technicians/nursing assistants. Conclusion: lightweight technologies, when used effectively, transform the process of work, impacting on the humanization in nursing care, since the essence of care is the human being and the application of such technologies lead to a rapprochement with other needs in addition to the biological. / As tecnologias leves estão relacionadas ao processo de vinculação do paciente aos profissionais da saúde, à autonomização do indivíduo, ao cuidado acolhedor e à gestão da assistência centrada nas demandas do paciente. A equipe de enfermagem, por estar ao lado do paciente durante as 24 horas, está predisposta à utilização destas tecnologias, sobretudo, em Unidades de Terapia Intensiva, onde a atenção pretende suprir a vulnerabilidade sempre constante dos pacientes. Objetivo geral: comparar o uso das tecnologias leves no cuidado prestado pelas equipes de enfermagem em Unidades de Terapia Intensiva entre Hospitais Públicos, sendo um de Ensino e outro Estadual da cidade de Aracaju/SE. Método: estudo descritivo, transversal, de abordagem quantitativa e natureza observacional. Os dados foram coletados através de um instrumento de observação validado através do Percentual de Concordância e Índice de Validade de Conteúdo (IVC) por seis juízes entre dezembro de 2014 e fevereiro de 2015. A coleta de dados foi realizada no Hospital de Ensino e no Hospital Estadual no período de março e abril de 2015, no qual foram observados enfermeiros e técnicos/auxiliares de enfermagem durante as atividades assistenciais. Na análise dos dados foram utilizados os Testes do Kolmorogov-Smirnov, Teste de Mann-Whitney e Qui-quadrado. Resultados: o Teste do Kolmorogov-Smirnov demonstrou a distribuição não-normal das tecnologias leves e o Teste de Mann-Whitney apresentou um p-valor <0,0001 o que significa que o uso de tecnologia leves pelas equipes do Hospital de Ensino e Estadual foram estatisticamente diferentes, sendo que o Hospital de Ensino apresentou maior prevalência no uso das tecnologias leves. Quanto à categoria profissional, os enfermeiros utilizaram com mais frequência as tecnologias leves que os técnicos/auxiliares de enfermagem. Conclusão: As tecnologias leves, quando efetivamente utilizadas, transformam o processo de trabalho, impactam sobre a humanização na assistência de enfermagem, uma vez que, a essência do cuidado é o ser humano e a aplicação de tais tecnologias favorecem uma aproximação com outras necessidades além das biológicas.

Increasing prevalence of non-communicable diseases, aging, and population growth pose significant sustainability challenges to health systems. Especially the health systems of low- and middle-income countries are more vulnerable to the risks related to non-communicable diseases and demographic changes. As the Covid-19 pandemic demonstrates, the quality of health systems is vital to save lives, and even the most developed countries are not immune to the consequences of global health crises. The World Health Organization estimates that non-communicable diseases such as cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes cause around 40 million deaths in a year, and 15 million people aged between 30 and 69 suffer from premature deaths mostly in low- and middle-income countries. The United Nations aim to address this problem through the Sustainable Development Goal 3.4 that stresses to reduce by one third premature mortality from non-communicable diseases through prevention and promote mental health and well-being until 2030. Poor quality health systems and inadequate access to healthcare services by the most vulnerable groups are some of the main reasons for premature deaths. Improving the quality of health systems through innovation and digitalisation is strategic to deliver essential healthcare services to the most vulnerable people. Digital health technologies such as mobile health applications for chronic disease self-management play a key role in improving the health status of individuals and the accessibility of healthcare services. Type 2 Diabetes Mellitus (‘T2DM’) is one of the most prevalent non-communicable diseases suffered by almost half a billion people, and current developments in digital health technologies offer innovative methods for its treatment. Hence, this study investigates the effectiveness of a T2DM self-management smartphone application called DiaWatch and its potential benefits for the Sustainable Development Goals in terms of addressing the challenges of health systems. Methodology: Using the Technology Acceptance Model as an overall conceptual framework, a comprehensive literature review was performed to clearly define the objectives and methods for the study. Based on these findings, two sets of semi-structured qualitative interview questions have been prepared for collecting empirical data. Ten healthcare professionals working at a university hospital in Istanbul, Turkey, and ten T2DM patients using a T2DM self-management app called DiaWatch have been interviewed from mid-February to early-March. A thematic analysis has been carried out to analyse the empirical data collected through the semi-structured interviews. Results: Firstly, the results of the interviews with T2DM patients using the DiaWatch app suggest that the health status and chronic condition self-management experience of the majority of the interviewees improved since using the app and they adopted behavioural changes, such as being more adherent to the treatment, increased physical activity, having a healthier diet and measuring blood glucose level more regularly. The interviewees reported less dependency on healthcare facilities and increased accessibility of healthcare services, as they are tele-monitored by their physicians. Secondly, the results of the interviews with healthcare professionals highlight the benefits of digital health technologies for the health systems in terms of facilitating the job of healthcare staff, reducing the costs, and saving time. The interviewees state that tele-monitoring helps to decrease the number of redundant hospital admissions and screenings; however, data privacy and irreplaceability of face-to-face medical examinations are the main concerns before the acceptance of these technologies.

The popularity of mobile period tracker apps, designed to help women track their periods and fertility, has skyrocketed over the past decade. The target audience is people who menstruate, most often women. There are numerous articles on personalisation in mobile apps, but personalisation in mobile period tracker apps has been little studied. Therefore, in this thesis, I analyse the ways of collecting information about users and personalising the user's account in the period tracker apps, as well as whether this personalisation meets the needs of female users. My research question is: How could the personalisation of mobile period tracker apps be improved through design to meet real users' needs? The study builds on the user experience (UX) design process and consists of the following phases: UX research, design, and user testing. In addition, it includes an ideation part. I used post-structural feminist theory from the perspective of Judith Butler's work as a framework. I conducted seven semi-structured interviews with female users who actively use period tracker apps. I studied three chosen period tracker apps using the walkthrough method and conducted a co-design workshop using the themes identified through the thematic analysis of the interviews. The research output is a design solution tested on five participants of the study and then iterated. Through my work, I contribute to studies of reproductive technologies and the field of feminist human-computer interaction (HCI) through suggestions on personalisation.

Methodological study, whose objective was to bluid validate the content and appearance of a new version of the instrument for Nursing Consultation in Basic Care for individuals with diabetes mellitus type 2 in Basic Care. The study had as a theoretical framework the Theory of Praxis for Intervention in Collective Health (TPICH) by Emiko Egry. The methodological procedure was based on Pascali's theoretical pole of the psychometric model (2010). In this study of the instrument was developed using the International Classification for Nursing Practice - CIPE® Version 2015. This new version was applied in 21 people with diabetes mellitus type 2 who were registered in a Family Health Unit, in the municipality of Aracaju, in Sergipe; this action constituted the pretest phase. At the end of this stage, the instrument with 122 items went down to 99 items, which were submitted to a panel of eleven judges to validate their content and appearance. Using a Likert scale of three points, the judges evaluated each item regarding their permanence in the instrument; they also judged on the psychometric criteria of: objectivity, clarity, precision, typicality, simplicity, relevance, modality and credibility. Subsequently, the Content Validity Index of each of the items (CVI) was calculated. The categorical data were described by means of simple frequencies and percentages and the continuous or discrete data with average and standard deviation. In this study, the content validity of the items was considered when CVI ≥ 0.80, this according to the methodological referential. The results showed that eight items (local of work protected, police service, insomnia, self-perception, psychological condition, eye disturbances, cut nails and foot with blisters) obtained CVI ˂0.80; the first six items were removed from the instrument, while the last two items remained subitems due to the importance of their assessments in individuals with diabetes mellitus type 2. All other items stayed as they were or with the alterations suggested by the specialists. In validating the appearance, 100% of the judges approved the instrument to collect the data in individuals with diabetes mellitus type 2. The suggestions of the judges were accepted in their majority; therefore, a new evaluation was not necessary. To guide the evaluation actions of nurses, in a homogeneous and unequivocal way, it was written an appropriate instruction guide. In this way, it was found that this new version of the instrument has validity of content and appearance. In order to have a technology that can be reproduced in various nursing services of Basic Care with this we will contribute to the organization of the work process of nurses, granting them autonomy and visibility in their practice. / Estudo metodológico, cujo objetivo foi construir e validar o conteúdo e a aparência do instrumento para a consulta de enfermagem ao indivíduo com diabetes mellitus tipo 2 na Atenção Básica. Teve como marco teórico a Teoria da Intervenção Práxica em Saúde Coletiva de Emiko Egry, e no percurso metodológico foi utilizado o polo teórico do modelo psicométrico de Pasquali (2010). Neste estudo foi desenvolvido um instrumento utilizando a Classificação Internacional para a Prática de Enfermagem - CIPE® Versão 2015. O instrumento foi aplicado em 21 pessoas com diabetes mellitus tipo 2 cadastradas em uma Unidade de Saúde da Família do município de Aracaju, Sergipe, o que se constituiu na fase de pré-teste. Ao término dessa etapa, o instrumento que contava com 122 itens, passou a ter 99 itens, que foram submetidos a um painel de onze especialistas para apreciação do seu conteúdo e aparência. Os especialistas avaliaram cada item quanto à sua permanência no instrumento utilizando uma escala de Likert de três pontos. Também fizeram o julgamento quanto aos critérios psicométricos de objetividade, clareza, precisão, tipicidade, simplicidade, relevância, modalidade e credibilidade. Posteriormente foi calculado o Índice de Validade de Conteúdo de cada um dos itens (IVC). Os dados foram descritos por meio de frequências simples e percentagens, quando categórica, e média e desvio padrão quando, contínua ou discreta. A validade de conteúdo dos itens neste estudo foi considerada quando IVC ≥ 0,80, conforme referencial metodológico. Os resultados mostraram que oito itens (local de trabalho protegido, serviço policial, insônia, percepção sobre si próprio, condição psicológica, distúrbios oculares, unhas cortadas e pé com bolhas) obtiveram IVC˂0,80, os seis primeiros itens foram retirados do instrumento, enquanto os dois últimos permaneceram como subitens devido à importância de suas avaliações no indivíduo com diabetes mellitus tipo 2. Os demais itens permaneceram na íntegra ou com as alterações sugeridas pelos especialistas. Na validação de aparência, 100% dos especialistas aprovaram o instrumento para realização da coleta de dados. Acatou-se a maioria das sugestões dos especialistas sendo desnecessária nova avaliação. Elaborou-se um guia instrucional para nortear as ações de avaliação do usuário de modo homogêneo e inequívoco pelos enfermeiros. Sendo assim, evidenciou-se que a nova versão do instrumento possui validade de conteúdo e aparência, constituindo-se em uma tecnologia passível de ser reproduzida nos diversos serviços de enfermagem da Atenção Básica, com vistas a contribuir para a organização do processo de trabalho dos enfermeiros, conferindo autonomia e visibilidade a sua prática. / Aracaju

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-08-25T20:50:25Z No. of bitstreams: 1 Dissertacao Aliana Simoes.pdf: 1387621 bytes, checksum: 87999ce8eadfd38b96c19a1cb2720983 (MD5) / Made available in DSpace on 2016-08-25T20:50:25Z (GMT). No. of bitstreams: 1 Dissertacao Aliana Simoes.pdf: 1387621 bytes, checksum: 87999ce8eadfd38b96c19a1cb2720983 (MD5) Previous issue date: 2013-03-25 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / The health system Ensures the 1988 Constitution, the principles of the Unified Health System (SUS), universality, fairness, integrity cared for in the health of Individuals. Thus, the citizen has the right to life and health legitimized Becoming foundation for the realization of the fundamental right to life, human dignity and citizenship. However, the health system is facing gaps is putting its principles. From this perspective, the lawsuits go into this scenario an instrument for the realization of these rights. The research is Performed to describe the profile of the judicialization of health in the state of Bahia for the access to health technologies in the SUS, in the period from 2005 to 2010, and to discuss access technologies in relation to the demands of health care (drugs, food, admissions, treatments, surgeries and other) and the lawsuits filed by users of SUS. The methodology has two approaches: a quantitative approach, with retrospective descriptive study, from primary sources collected in the database of electronic consultation and free access to the website of the Court of Justice of the State of Bahia, the lawsuits. That demand for access to health technologies in the SUS, in the period from 2005 to 2010. These data comprised the General Headquarters and Analysis Analyzed were using Microsoft Office Excel 2007 for tabulation, build charts and tables for the distribution of absolute and relative frequencies, and the qualitative approach with an exploratory study, descriptive and analytical, using document analysis for the composition Summary Table of the Analysis of Thematic Content Analysis by Defining the Category Analysis. The results obtained by the design of the profile of Legalization of Health in the State of Bahia have 103 lawsuits. That demand for access to technologies in the SUS, in the period from 2005 to 2010. The year 2009 presented significant data entry with 47 stocks (45.6%). 75 actions were recorded (72.8%) Interlocutory Appeal and to the towns of origin, 74 shares (71.8%) were related to the city of Salvador. The drug delivery was more demand pled with 72 (60%). We found 63 cases (61.2%) related to degenerative diseases Chronic and 89, equivalent to 86.4% judgments granting the user access to the SUS. The year 2009 Showed 54 (52.4%) of the cases heard. With the discussion permeated by the Judiciary unveiling a path for access to health technologies in SUS can infer such access that provides the guarantee of the right to life and health to users, because the demands are met pled in almost all the shares. The Civil Society Organizations have great power in the realization of human rights act the key players in the mobilization of the Judiciary for the satisfaction of their rights that have been denied or dissatisfied. For the health system, the demands, especially for drugs by judicial cause great harm to the planning and management of programs and services offered by SUS, and displacement of budget allocations for health to meet the individual lawsuits, the vast Majority. Moreover, there is an excessive medicalization of health care devaluing the relational technologies and the power of the subject active in directing the disease process. Thus, we conclude that traveled this alternative path by the user and allows access to the health system provides citizenship determined by the participation of the individual as a citizen who sections the fulfillment of their social rights established in the Constitution of 1988. However, we envision the need for a strong body of technical professionals in the health field to work together with the Judicial Authorities in the resourcefulness of actions. That require instructions for their acts embrasure decision-making glimpsing consistent and fair to all Involved in the search for a society with social justice. / O sistema de sa?de assegura na Constitui??o de 1988, pelos princ?pios do Sistema ?nico de Sa?de (SUS), a universalidade, equidade, integralidade no cuidado ? sa?de dos indiv?duos. Desta forma, o cidad?o possui seu direito ? vida e ? sa?de legitimado, constituindo-se como alicerce para efetiva??o do direito fundamental ? vida, dignidade humana e ? cidadania. Entretanto, o sistema de sa?de vem enfrentando lacunas para efetiva??o de seus princ?pios. As demandas judiciais entram nesse cen?rio como instrumento para efetiva??o desses direitos. Os objetivos s?o: descrever o perfil da judicializa??o da sa?de no Estado da Bahia para o acesso ?s tecnologias de sa?de no SUS, no per?odo de 2005 a 2010; e discutir o acesso ?s tecnologias em rela??o ?s demandas de aten??o ? sa?de (medicamentos, alimentos, internamentos, tratamentos, cirurgias e outras) e as a??es judiciais movidas pelos usu?rios do SUS. O caminho metodol?gico ? orientado pelas abordagens, quantitativa e qualitativa: a primeira trata de um estudo descritivo e retrospectivo, utilizando fontes prim?rias como base de dados por meio da consulta eletr?nica e de livre acesso, no s?tio do Tribunal de Justi?a do Estado da Bahia, dos processos judiciais que demandavam por acesso ?s tecnologias de sa?de no SUS. Estes dados compuseram as Matrizes Gerais de An?lise atrav?s do software Microsoft Office Excel 2007 para a tabula??o, constru??o de gr?ficos e tabelas. A an?lise descritiva foi baseada na distribui??o de frequ?ncias simples e relativas; e a segunda com estudo de natureza explorat?ria que utiliza como fonte de dados, documentos dos processos judiciais para a composi??o da An?lise de Conte?do Tem?tica. Os resultados obtidos pelo delineamento do perfil da Judicializa??o da Sa?de no Estado da Bahia apresentam 103 processos judiciais que demandavam por acesso ?s tecnologias no SUS, no per?odo de 2005 a 2010. O ano de 2009 apresentou dados significativos, com entrada de 47 a??es (45,6%). Foram registradas 75 a??es (72,8%) como Agravo de Instrumento e com rela??o ?s cidades de origem, 74 a??es (71,8%) estavam relacionadas ao munic?pio de Salvador. O fornecimento de medicamentos foi a demanda mais pleiteada com 72 (60%). Foram encontrados 63 casos (61,2%) relacionados a agravos Cr?nico-degenerativos e, 89, equivalente a 86,4% decis?es proferidas concedendo o acesso do usu?rio ao SUS. O ano de 2009 apresentou 54 (52,4%) dos processos julgados. Com a discuss?o permeada pelo Poder Judici?rio desvelando um caminho para o acesso ?s tecnologias de sa?de no SUS podemos inferir que esse acesso determina a garantia do direito ? vida e ? sa?de aos usu?rios, pois as demandas pleiteadas s?o atendidas em grande parte das a??es. A Sociedade Civil Organizada ? caracterizada por um poder significativo na efetiva??o dos direitos humanos, atuando como atores fundamentais na mobiliza??o do Poder Judici?rio para a satisfa??o de seus direitos que foram negados ou insatisfeitos. Para o sistema de sa?de, as demandas, principalmente, por medicamentos pela via judicial provocam grandes preju?zos ao planejamento e gerenciamento das a??es e servi?os ofertados pelo sistema, al?m de deslocamento das verbas or?ament?rias destinadas ? sa?de para o cumprimento das a??es judiciais individuais, na grande maioria. Ademais, h? uma demasiada medicaliza??o do cuidado ? sa?de desvalorizando as tecnologias relacionais e o poder ativo do sujeito no direcionamento do processo sa?de-doen?a. Assim, conclu?mos que esse caminho alternativo percorrido pelo usu?rio al?m de permitir o acesso ao sistema de sa?de, proporciona o exerc?cio da cidadania determinada pela participa??o desse indiv?duo como cidad?o, que vislumbra o cumprimento de seus direitos sociais estabelecidos na Constitui??o Federal de 1988, na busca da legitimidade de uma sociedade com justi?a social.

Health information technology (HIT) owner-practitioners who adopt effective strategies for HIT implementation can improve primary facility care delivery and profitability. However, some HIT owner-practitioners have ineffective implementation strategies, so they have not realized the total revenue increases of more than 8%. Grounded in general systems theory, the purpose of this multiple case study was to explore successful strategies primary care practitioners (PCPs) use to implement HIT to improve primary facility care delivery and profitability. The participants included 6 owner-practitioners located in Queens County, NY, who successfully implemented HIT to improve facility care delivery and profitability. Data were collected through face-to-face interviews and a review of relevant practice documents. Data were analyzed using thematic analysis, yielding 3 themes: HIT education and training, costs of transitioning to HIT, and focusing on expected benefits of successful HIT implementation. By providing information on effective HIT strategies, the findings from this study could impact social change because PCPs may rely on faster and more accurate health information data to offer better diagnoses and enhance treatments for patients.

<p>Hyperspectral imaging is widely used for obtaining optical information of light absorbers (e.g. biochemical composition) in a variety of specimens or tissues in a label-free manner. Acquiring and processing spectral data using hyperspectral imaging usually requires advanced instrumentation such as spectrometers, spectrographs or tunable color filters, which are not easily adaptable in developing instrumentation for field-based applications. Also, use of only RGB information from conventional cameras is not sufficient to obtain a reliable correlation with the actual content of the analyte of interest. We propose a new concept of ‘virtual hyperspectral imaging’ to reconstruct the full reflectance spectra from RGB image data. This allows us to use only RGB image data to determine detailed spatial distributions of analytes of interest. More importantly, it simplifies instrumentation without requiring bulky and expensive hardware. Using a data-driven approach, we apply multivariate regression to reconstruct hyperspectral reflectance image data from RGB images obtained using a conventional camera or a smartphone. </p> <p> </p> <p>In developing a reliable reconstruction matrix, it is critical to obtain a training data set of the specimen of study under the same optical geometry since the spectral reflectance and absorbance is sensitive to the detection and illumination parameters. We designed an image-guided hyperspectral system that can acquire both hyperspectral reflectance and RGB data sets under the same imaging configuration to minimize any discrepancies in the hyperspectral reflectance data acquired using different optical sensing geometries. In our technology development, a telecentric lens that is commonly used in machine vision systems but rarely in bioimaging, serves as a key component for reducing unwanted scattering in biological tissue due to its highly anisotropic scattering properties, by acting as a back-directional gating component to suppress diffuse light. We evaluate our spectrometer-less reflectance imaging method using RGB-based hyperspectral reconstruction algorithm for integration into a smartphone application for non-invasive hemoglobin analysis for anemia risk assessment in communities with limited access to central laboratory tests.</p>

The mental health (MH) of health workers during the 2019 pandemic has been severely affected by the disruptive coping and heavy workload management of the Covid crisis. Critical emergency contexts trigger many MH issues and disorders in many health workers who do not have adequate tools and strategies to respond to MH threats when traditional medical methods cannot be provided. Given the successful recovery outcomes obtained against physical illness disorders through physical illness representations, this project was carried out to search for effective discursive strategies within visual representations applied to MH issues. Exploring improved MH representation techniques could lead to finding strategies for informing about the stigma and triggering self-therapy, self-recovery and self-regulation coping mechanisms in health workers against MH threats. This study used discourse analysis to explore four representative YouTube videos portraying health workers and MH issues. The findings show that visual representations, including audiovisual and prosodic elements, rhetoric and storytelling techniques, impact people's psychological and behavioural processes. Once medically tested, these resources could support health professionals and institutions as an extension of the existing scientific methods, treatment and tools dealing with MH issues. E-mental health and digital technologies, which use media representation, could represent the first step to trigger a much more extensive study and scientific debate on the complementary strategy of media representation for MH acknowledgement, therapy and recovery. Nevertheless, additional and more quantitative interlinked medical and media studies on MH issues and representation have to be carried out. Therefore, the need to investigate highlights the need for interdisciplinary collaboration between media and communication, traditional medical therapy research and the participation of all the actors involved.

The purpose of this research was to explore and describe the effectiveness of the health care reform implemented in Ethiopia in the form of Business Process Reengineering (BPR) and develop strategies to strengthen its implementation. The research was conducted in two phases. In phase I, the effectiveness of the BPR health care reform was explored and described through gathering quantitative information from health care providers (n=406) using a structured questionnaire. All public hospitals of Addis Ababa, Ethiopia which have been implementing the reform from its inception (n=5) were included. In Phase II, in-depth strategies aimed at strengthening implementation of the reform were developed. Two-rounds of Delphi study were conducted to seek the opinions of senior health policy experts (n=10) and arrive at consensus on the developed strategies. Cronbach's alpha, descriptive statistics, Chi-square, logistic regression analysis, principal component analysis, weighted median score, adjusted and standard satisfaction scores, Mann-Whitney U test, and Kruskal-Wallis test were conducted for data analysis. The BPR health care reform was able to restructure the hospitals’ departments into case teams, with the goal of adopting a “one-stop shopping” approach. However, 50% of the health care providers reported that the reform was not effective to satisfy the perceived health service needs. Limited effects were reported in favour of health care quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%). While poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. The most important predictors that influenced implementation of the reform were financial resources (AOR=3.54, 95%CI: 1.97, 6.33), top management commitment and support (AOR=2.27, 95%CI: 1.15, 4.47), collaborative working environment (AOR=1.77, 95%CI: 1.00, 3.11), and information technology (AOR=3.15, 95%CI: 1.57, 6.32). The overall job satisfaction in the public health sectors remained poor, with only 25% job-satisfied providers engaged. Moral satisfaction (AOR=177.654, 95%CI: 59.539, 530.08), management style (AOR=4.017, 95%CI: 1.490, 10.828), workload (AOR=2.422, 95%CI: 0.925, 6.342), and task (AOR=5.491, 95%CI: 2.307, 13.069) were the most significant factors. Job satisfaction results were significantly different among the study hospitals (2 = 30.557, p < 0.001). The current health care delivery performance of the public hospitals was 60% when weighed against the World Health Organization’s health system framework which required a minimum of 80% score. However, there existed a significant difference in performance at least between two hospitals (2 = 571.902, p < 0.001). Five strategies that could disrupt the status quo and strengthen the BPR health care reform are proposed based on their strategic priority, which were: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing; and maximize innovations and the use of health technologies. The strategies could be used to enrich the quality of health care interventions through continuous review, refinement and adjustment of the reform as required. Key words: Health care reform; Business Process Reengineering; quality; access; equity; efficiency; sustainability; job satisfaction; health system; patient-centred care; workforce; leadership and governance; hospital financing; health technologies; Ethiopia. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this research was to explore and describe the effectiveness of the health care reform implemented in Ethiopia in the form of Business Process Reengineering (BPR) and develop strategies to strengthen its implementation. The research was conducted in two phases. In phase I, the effectiveness of the BPR health care reform was explored and described through gathering quantitative information from health care providers (n=406) using a structured questionnaire. All public hospitals of Addis Ababa, Ethiopia which have been implementing the reform from its inception (n=5) were included. In Phase II, in-depth strategies aimed at strengthening implementation of the reform were developed. Two-rounds of Delphi study were conducted to seek the opinions of senior health policy experts (n=10) and arrive at consensus on the developed strategies. Cronbach's alpha, descriptive statistics, Chi-square, logistic regression analysis, principal component analysis, weighted median score, adjusted and standard satisfaction scores, Mann-Whitney U test, and Kruskal-Wallis test were conducted for data analysis. The BPR health care reform was able to restructure the hospitals’ departments into case teams, with the goal of adopting a “one-stop shopping” approach. However, 50% of the health care providers reported that the reform was not effective to satisfy the perceived health service needs. Limited effects were reported in favour of health care quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%). While poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. The most important predictors that influenced implementation of the reform were financial resources (AOR=3.54, 95%CI: 1.97, 6.33), top management commitment and support (AOR=2.27, 95%CI: 1.15, 4.47), collaborative working environment (AOR=1.77, 95%CI: 1.00, 3.11), and information technology (AOR=3.15, 95%CI: 1.57, 6.32). The overall job satisfaction in the public health sectors remained poor, with only 25% job-satisfied providers engaged. Moral satisfaction (AOR=177.654, 95%CI: 59.539, 530.08), management style (AOR=4.017, 95%CI: 1.490, 10.828), workload (AOR=2.422, 95%CI: 0.925, 6.342), and task (AOR=5.491, 95%CI: 2.307, 13.069) were the most significant factors. Job satisfaction results were significantly different among the study hospitals (2 = 30.557, p < 0.001). The current health care delivery performance of the public hospitals was 60% when weighed against the World Health Organization’s health system framework which required a minimum of 80% score. However, there existed a significant difference in performance at least between two hospitals (2 = 571.902, p < 0.001). Five strategies that could disrupt the status quo and strengthen the BPR health care reform are proposed based on their strategic priority, which were: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing; and maximize innovations and the use of health technologies. The strategies could be used to enrich the quality of health care interventions through continuous review, refinement and adjustment of the reform as required. Key words: Health care reform; Business Process Reengineering; quality; access; equity; efficiency; sustainability; job satisfaction; health system; patient-centred care; workforce; leadership and governance; hospital financing; health technologies; Ethiopia. / Health Studies / D. Litt. et Phil. (Health Studies)