As part of a multiple-case study, the objective of this single-case study is to examine the impact of the accreditation process offered by the Canadian Council on Health Services Accreditation (CCHSA) on one health care organization. The main hospital of the organisation selected has been accredited for a little over 50 years. Quantitative and qualitative data was collected for methodological triangulation. Two questionnaires were distributed; interviews and focus groups were conducted on site. A previously developed conceptual framework on the dimensions of change was used for the analysis. Some changes within the organization were traced back to the accreditation process and they were mainly at the organizational level, affecting processes and organizational structures. In addition, the accreditation self-assessment phase offers an opportunity to increase social capital, but the quantity and type acquired depends on the composition of the self-assessment team and the follow-up done after the accreditation survey.

Objective. To demonstrate that participation in the CCHSA accreditation process helps HCOs to be more reactive to change, improving quality and safety, and that accreditation also helps health care organizations to develop their organizational learning processes. The hospital's culture is of a hierarchical nature (x¯ = 36.92), but with the help of organizational initiatives, strong leadership, and accreditation, it is evolving towards a group culture. The hospital has a high commitment towards information and analysis, however, employees do not always perceive themselves as receiving adequate training and education for quality improvement. Accreditation has helped the hospital through its merger. It has affected the hospital at an individual, group, organizational, and external partnerships level. The self-assessment phase was highly effective in encouraging cohesion and collaboration, the emergence of a multidisciplinary approach to care, community involvement, and the development of organizational learning. The first post-merger accreditation's report encouraged the development of an organization wide quality framework which focuses on quality of care, efficiency, and patient safety. Most key values and initiatives are in place for the hospital to be a Learning Organization. A shift in organizational culture towards a group and developmental culture, as well as a stronger commitment towards QI education and training, are still necessary. (Abstract shortened by UMI.)

A geographic information system was used to measure geographical access to general surgical services in the Champlain Local Health Integration Network. An origin-destination matrix approach was used with discharge data for Champlain residents using the Ontario Road Network file and OC Transpo trip planner for public transportation trips with in the city of Ottawa. GIS showed that adding surgical services to the Renfrew Victoria Hospital would be the best location to achieve the goal of reduced drive times for Champlain LHIN residents. However, this hospital was ill suited to take on additional surgeries due to high occupancy rates, a lack of space and surgeons. Differences in neighbourhoods' geographical access (drive and transit time) to the General Campus of the Ottawa Hospital were found. However, it was the more affluent neighbourhoods and neighbourhoods with lower percent of recent immigrants that had longer drive times and transit times.

Background: Systematic reviews (SRs) are increasingly viewed as useful decision-making tools yet the extent of SR publication bias is under-explored. Through my thesis, I aimed to investigate the extent of SR publication bias. Methods: A conceptual model was derived from literature searches and one-on-one interviews and three studies were conducted: a cross-sectional study of 296 SRs indexed in MEDLINE and published in November 2004, an international survey of 625 corresponding or first authors of a published SR in 2005, and a retrospective cohort study of 411 Cochrane protocols from Issues 2-4, 2000 and Issue 1,2001 that were followed until Issue 1,2008 in The Cochrane Library. Main findings: The interviewees reported 40 unpublished SRs and the conceptual model showed that publication bias can permeate all steps of the publication process, from conceptualization to ultimate effect on health outcomes. The cross-sectional study identified favourable results in 57.7% of Cochrane reviews and 64.3% of non-Cochrane reviews with a meta-analysis of the primary outcome and non-Cochrane reviews were twice as likely to have positive conclusions as Cochrane reviews (p-value≤0.05). In the international survey, participants reported 1405 published (median: 2.0, range: 1-150) and 199 unpublished (median: 2.0, range: 1-53) SRs. In the retrospective cohort study, 19.1% (71/372) of eligible Cochrane protocols remained unpublished and the median time to publication was 2.4 years (range: 0.15-8.96). A shorter time to publication was associated with the Cochrane review being subsequently updated versus not updated (n=100/372 Cochrane reviews that were updated, hazard ratio: 1.80 [95% confidence interval: 1.39-2.33 years]) and a longer time to publication was associated with the Cochrane review having two published versus one protocol (n=10/372 Cochrane reviews with two published protocols, 0.33 [0.12-0.90 years]). General conclusions: Over 300 unpublished SRs were identified through the interviews conducted for the conceptual model and the three studies that comprised my thesis. Possible solutions for minimizing or avoiding SR publication bias include registration of SRs at inception, educating the research community about the importance of publishing SRs, and having a general online open-access journal with rapid peer review that is dedicated to only publishing the results of SRs (including their updates).

Resource management is at the heart of many diverse science and engineering research areas. Although the general notion of what constitutes a resource entity seems similar in different research areas, their types, characteristics, and constraints governing their behavior are vastly different depending on the particular domain of research and the nature of the research itself. Often research related to resource modeling and management focus on largely homogeneous resources in a relatively simplified model of the real world. The problem becomes much more challenging to deal with when working with a complex real life domain with many heterogeneous resource types and intricate constraints. In this dissertation, we have looked at the modeling and management of resource instances and tried to develop a better sense of what makes them different from other objects in a system. As part of this work, We formally define the general resource management problem, identify its major sub problem areas and their associated complexities, and look at the problem in the context of a particularly complex and dynamic environment, namely the emergency department (ED) of a hospital. We propose an approach to the problem and some of its complexities by presenting an overall unifying view, as well as tools and methods for dealing with, this pervasive, yet surprisingly under examined, type of entity, i.e. resources. We have discovered that one of the discerning characteristics of resource instances in complex and dynamic environments seem to be their dynamic capability profile that may changes depending on system context. This, in turn, often results in complex substitutability relationship amongst resource instances. We have identified four major sub-problem areas that can provide a holistic view of any resource management service. These separate, yet interconnected, areas of concerns include resource modeling, resource request specification, resource constraint management, and resource allocation. Resource modeling involves capturing of resource characteristics and their potentially dynamic behavior. Request definitions describe how resource users specify requirements for resources in a particular domain. In most domains, there are constraints that need to be satisfied while serving resources to fulfill specific requests. The fourth area of concerns, the allocation of resources, is a complex component with multiple subcomponents that closely interact with each other. In this thesis, we have described an architecture for a exible resource management service based on the above described separation of concerns. We have proposed some simple, yet effective, techniques for modeling resource instances, specifying resource requests, specifying and managing resource constraints, and allocating resource instances to meet a resource demand characterized by a continuous stream of requests. Using our proposed design, we have developed ROMEO, a resource management service and customized it to serve a task coordination framework based on Little-JIL process definition language. Our work then concentrated on evaluating the effectiveness of ROMEO in supporting simulations and executions of complex processes. For this evaluation purpose, we developed a simulation infrastructure named JSim on top of Juliette, Little-JIL's execution environment. We ran a variety of simulations of patient care processes in EDs using our ROMEO-JSim infrastructure. We also used ROMEO to support the actual execution (rather than just the simulation) of a large mediation process. A central premise, hypothesized and explored in this thesis, is a novel way of thinking about resource instances in dynamic domains, namely defining them with a set of guarded capabilities, some of which may be dependent on the execution state of the system. This has led us to think about how to represent execution states of a running system and what types of system state information might be important for representing the guard functions on the capabilities of a resource instance that define the resource instance's ability to satisfy a request at a given execution state of the system. We have also identified a small set of common types of attributes of resource instances that seem able to support specification of a large variety of resource instances in complex domains. We believe that our research supports our hypothesis that specifying resource instances as having sets of guarded capabilities provides a useful abstraction for modeling many of the complex dynamic behaviors of resource instances in such domains as hospital EDs.

No description available.

This study explored teamwork in two hospitals implementing Total Quality Management. Its objectives were to: document and describe the social process of constructing teamwork in the two hospitals and the patterns of interaction that emerged; to compare the experiences of teamwork in the hospitals to the conceptualization of teamwork prescribed by TQM and to compare the experiences of the two hospitals to each other; and to understand how teamwork is interpreted by members of TQM hospitals. A multi-site case design was used; data was collected through participant observation, interviews, and document analysis. Results suggested that quality improvement teams represent a means for creating teamwork in hospitals by providing a forum for members to understand each other's needs, work, and problems through which respect and cooperative relationships emerged. Team leaders played a key role in the construction of teamwork by managing the meaning of teamwork, guiding the work of teams, assuring equal participation and facilitating the establishment of meaningful ground rules and mutually shared objectives. Identified obstacles to teamwork included the lack of physician involvement in team efforts; managers and staff who would not cooperate with team recommendations; the time required to improve work processes; managers who attempted to control a team's work; and leaders who failed to provide clear direction and guidance. In exploring the practice of teamwork outside the boundaries of QIT's, the data revealed that barriers between departments still existed. Management efforts to forge teamwork across functional areas were fragmented. Department heads who promoted teamwork tended to be those who had been involved in QIT's. In both hospitals conflict, distrust and a lack of mutually shared objectives among senior managers was identified by middle managers as antithetical to TQM and an obstacle to building a sense of "all one team" hospital-wide. Recognizing that the hierarchical, departmental structure in hospitals prevents the construction of teamwork across departments and recognizing the ability of quality improvement teams to break down departmental barriers, this study recommends that organizational restructuring be explored for hospitals which might include the management of processes or systems vs. departments and incorporates the team structure.

No description available.

No description available.

No description available.