This thesis reports from a telecare evaluation in a Norwegian municipality (2012-2016). The project was established to provide domestic results from a hitherto new field in the country to underpin future policy. This evaluation includes pre- and post-implementation data collection, which has been scarce in telecare. The methodological approach was realist evaluation that seeks to explore how telecare works, for whom, why and in which circumstances – or why it does not work. The research aimed to explore the hypothesis elicited from national policy documents: ‘If telecare is used, then people are enabled to remain safe in their own home for longer’. Various methods were used to gather data from multiple stakeholders as they have different knowledge about how the implementation developed. The methods in this evaluation included literature reviews, observations, and sequential interviews with users and relatives in addition to sequential focus groups with frontline staff. Realist evaluation was particularly suitable in demonstrating how and why telecare is useful to some users but not to others. Telecare had to match users’ abilities and needs for them to benefit from it. Telecare operates in a dynamic context, and therefore requires adjustment according to the user’s current situation, taking into account changes as they occur. This appears to have been often underestimated. Telecare holds a different position from other devices and technologies in people’s everyday life, which also needs to be acknowledged. Correct assessment is significant for users to obtain the intended effect from telecare. When telecare is correctly adjusted to users, it increases safety, which is essential for enabling older people to remain living at home. Several challenges in establishing telecare projects are identified and alternative ways to understand multi-disciplinary partnerships are suggested. By using realist evaluation the findings are nuanced and point to elements that are significant for achieving the intended outcomes.

Hospital administrators face challenges that arise from environmental factors or psychosocial factors, and lack resources to deliver valuable medical services to stakeholders, including patients and employees. A multicase study served to explore experiences and gain a broader perspective of hospital administrators' use of strategies to optimize patient services. Ten hospital administrators from acute care hospitals in Nevada and California were purposefully selected from the population of hospital managers with a minimum of 2 years of documented experience in successfully implementing management strategies to improve patient services. The conceptual framework was Drucker's management theory. Data were collected from semistructured interviews with 10 administrators, from the participants' archival documents, and from hospital archives. Interview transcripts and data from multiple hospital locations were coded and analyzed using methodological triangulation. Five themes identified from data analysis were triple-aim strategy, evidence-based practice, lean methodology, public health strategy, and innovation strategy. Implementing the appropriate strategy in each hospital setting might facilitate identification of elements that are lacking, mitigating, or slowing down the hospital improvement process. The findings of this study might contribute to positive social change by creating platforms for sharing information among patients and providers, payors, pharmacies, and policymakers.