Background¡G With the carrying on the step of the society and the changing of the health care insurance system, the medical behavior has changed. The health care organization should not only focus on professional field, but also looking for operating forever. Objective¡G 1.To understand the recent condition of health care organizational ethics in others counties by paper research. 2.To develop the questionary of health care organizational ethics. 3.To understand the recent condition of health care organizational ethics in Taiwan by questionary, and compare the importance and feasibility. Methods¡G The target of this questionary includes clinicians, nurses, the staff of medical laboratory and pharmacist, administrators and others. The location of the questionary includes medical center, territorial hospitals, regional hospitals and primary hospitals. The program SPSS 13.0 will be used for descriptive statistics, factor analysis¡Arelability test and t test in this research. Result and Conclusion¡G There was significant difference in the interviewee¡¦s consideration between importance and feasibility of health care organizational ethics survey, whatever in every aspect or item. Classify all interviewee by different level of hospital but same position, or same level of hospital but different positions, there was also significant difference in the interviewee¡¦s consideration of importance or feasibility by different level of hospital or positions, except nurses.

Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 4 uppsatser.

This dissertation demonstrates how patients' mental illness treatment careers depend on the change and/or stability among differing levels of social structure. Theorists of the mental illness career tend to ignore the role that higher levels of social structural change have on individuals' mental illness career. Researchers using an organizational perspective tend to focus on the organizational environment but ignore the treatment process from the individual's point of view. Both perspectives neglect what the nation-state's broader socio-political and economic circumstances could imply for people seeking treatment for mental disorders. Organizational theory and theories of the mental illness career are independent theoretical streams that remain separate. This dissertation connects these independent theoretical streams by developing a unifying theoretical framework based on historical analysis. This historical analysis covers three phases of treatment beginning at the end of World War II to the present. This framework identifies mechanisms through which changes in larger levels of social structure can change the experience and career of mental patients. This new perspective challenges current conceptions of the mental illness career as static by accounting for the various levels of social structure that play a part in the mental illness treatment career. Taken together, the inclusion of differing levels of social structure and the subsequent reciprocal relationship between these levels of analysis produce a narrative that explains why and how stability and change within the mental health sector shape the mental illness treatment career. / Ph. D.

Syftet med denna kvalitativa studie var att förstå och sammanfatta hur första linjens chefer (FLC) i en vårdorganisation upplever sin egen psykosociala arbetsmiljö, vad de tycker fungerar bra, vilka utmaningar de ser, och vilket stöd de behöver för att kunna förbättra den egna psykosociala arbetsmiljön. Jag genomförde semi-strukturerade intervjuer för att samla in data och två klassiska modeller inom psykosocial arbetsmiljöforskning: krav-kontroll-stöd och ansträngning-belöning, har fungerat som teoretiska tolkningsramar. Tematisk analys användes för att analysera data och identifiera teman för resultatet. Resultatet visade på sju teman som respondenterna upplevde påverkade deras egen psykosociala arbetsmiljö: chefsrollen, arbetsbelastning, styrning av den dagliga verksamheten, påverkan/beslutsutrymme, information/kommunikation, arbetsrelationer/samarbete och stödfunktioner. Några utmaningar för FLC är: orimligt höga krav, stora arbetsgrupper, bemanningsproblem, tidskrävande administration, brist på långsiktig planering och förbättringsarbete, mycket övertid och behov av mer stöd för att minska arbetsbelastningen. En närliggande tolkning av resultatet är att flera delar behöver förändras för att förbättra FLCs psykosociala arbetsmiljö och förutsättningarna för chefsuppdraget. / The purpose of this qualitative study was to understand and summarize how first-line managers (FLM’s) in a healthcare organization is experiencing their own psychosocial work environment, what they think works well, what challenges they see, and what support they need to improve their own psychosocial work environment. I conducted semi-structured interviews to collect data and two classic models in the psychosocial work environment research: demand-control-support and effort-reward, have served as theoretical frameworks of interpretation. Thematic analysis was used to analyze data and identify themes for the result. The result showed seven themes that the respondents experienced affected their own psychosocial work environment: the manager role, workload, control of daily operations, impact/decision latitude, information/communication, working relationships/cooperation and support functions. Some challenges for FLM are: unreasonable high demands, large workgroups, challenges with staffing, time-consuming administration, lack of long-term planning and improvement work, a lot of overtime and more support needed to reduce workload. An interpretation of the result is that the organization needs to change several parts to improve FLM’s psychosocial work environment and conditions for the manger role.

O estudo analisou a sustentabilidade da estratégia DOTS na visão de coordenadores de Programa de Controle Tuberculose (PCT) em sete municípios do interior do estado de São Paulo, prioritários para o controle da Tuberculose (TB). O quadro teórico está sustentado nas dimensões operacional, organizacional e política da gerência e sua articulação no contexto atual das políticas e serviços de saúde. A partir de uma abordagem quantitativa, de estudo epidemiológico descritivo por meio de levantamento de fontes secundárias, foram analisados os indicadores epidemiológicos do PCT: cura, abandono e óbito de casos novos com baciloscopia de escarro positiva, cobertura de Tratamento Supervisionado (DOT/TS) e de detecção de casos. Também optou-se pela abordagem qualitativa, análise de conteúdo-modalidade temática que utilizou como fonte a entrevista semi-estruturada com coordenadores de PCT. A Unidade Temática central foi a sustentabilidade da estratégia DOTS como um desafio para coordenadores de PCT, contendo dois sub-temas: A organização da estratégia DOTS diante da necessidade de captar/otimizar recursos e definir estratégias e A operacionalização das ações de controle da TB: raciocínio estratégico e negociação como ferramentas gerenciais. Os resultados quantitativos mostraram um coeficiente angular positivo para cura, mas a maioria não atingiu a meta de 85%; declínio no percentual de abandono, ainda aquém do esperado. A cobertura de DOT/TS apresentou aumento em todos os municípios, contudo, apenas um atingiu 95%. Nenhum município atingiu a meta de 70% de detecção de casos. Os temas que emergiram neste estudo apontaram nós críticos na captação e manutenção de incentivos financeiros; recursos humanos (RH) insuficientes e despreparados; rotatividade de pessoal; desconhecimento do destino da verba da TB e falta de autonomia para gerenciar os recursos; dificuldades de comunicação e integração com gestores; falta de priorização da doença na agenda política; priorização de agravos com repercussão política e necessidade de parcerias. Sobre a operacionalização do DOTS, o estudo apontou a cooperação de pessoas de fora do serviço como ferramenta gerencial estratégica, quando estimula a coresponsabilização da família e da comunidade como cuidadores ou multiplicadores. A avaliação, pautada em indicadores epidemiológicos, é utilizada prioritariamente para alcançar recursos, ao invés de subsidiar o planejamento. A gerência do PCT parece ser uma gerência burocrática, fundamentada no planejamento normativo. Acredita-se que a efetividade das ações gerenciais para sustentar a estratégia DOTS dependa de atores com conhecimento técnico, habilidades políticas e organizacionais, além de raciocínio estratégico para estimular e envolver todos os atores que lidam com a TB. Habilidades estas que, dificilmente são adquiridas na formação profissional. Conclui-se que os coordenadores trabalham em meio a pressões de cima e de baixo, ocupando dupla posição de transmissão, no plano hierárquico e das relações. Neste sentido, a sustentabilidade da estratégia DOTS representa desafios importantes para estes atores que utilizam poucos instrumentos gerenciais, têm pouca autonomia no processo decisório, lidam com recursos escassos e, muitas vezes, sem preparo para esta função, reforçando a necessidade de investimento na formação e capacitação contínua tanto para estes atores como para aqueles que lidam com a TB / This study analyzed the sustainability of the DOTS (Directly Observed Treatment Strategy). It shows the point of view of the TCP (Tubercolosis Control Program) coordinators of seven priority municipalities in the Sao Paulo State. The theorical framework is based on operational, organizational and political levels of the management and on its articulation in the current context of health policies and services. We carried out an epidemiological-descriptive study, using secondary sources, and through a quantitative approach. The following epidemiological TCP indicators were analyzed: cure, abandonment and death of new cases with positive sputum bacilloscopy, Supervised Treatment (DOTS/ST) and case detection coverage. We also chose to apply a qualitative approach, through a semi-structured interview with TCP Coordinators, and with the application of content analysis in the thematic modality. The main thematic unity is the sustainability of the DOTS strategy as a challenge to the TBP coordinators. It contains two sub-themes: The organization of the DOTS strategy faced with the need for resource captation/optimization and for clearly outlined strategies, and The operationalization of TB control actions: strategic thinking and the negociation as key management skills. Quantititive results show a positive angular coefficient for cure. Nonetheless, the majority did not achieve the 85% goal and the decline in the abandonment rate is still lower than expected. The ST coverage rose in all municipalities. However, only one municipality achieved coverage of 95%. None of the municipalities achieved the goal of 70% case detection rate. The themes analyzed in this study pointed to critical knots in the collection and maintenance of financial incentives; insuficient and unprepared Human Resources (HR); staff turnover; lack of knowledge concerning the destination of the TB funds, as well as lack of autonomy to manage resources; difficulties in the communication and in the integration with other managers; failure in making the disease a priority on the political agenda; priorization of aggravations with political repercussion and the need for partnerships. Concerning the DOTS operationalization, the study pointed to the cooperation of people outside the job as an important strategic management tool. It encourages family and community to take co-responsibility as caretakers and multipliers. The evaluation, which is based on epidemiological indicators, is especially used to achieve resources, instead of subsidizing the planning process. TCP management seems to be exceedingly bureaucratic and based on normative planning. We believe that the effectiveness of management actions to support the DOTS strategy needs characters with technical knowledge, political and organizational skills and strategic thinking. These skilss are important in order to encourage and get involved all those who deal with TB. These skills are hardly achieved in the professional training. We conclude that the coordinators work under pressure from the top and from the bottom of the hierarchy, and occupy a double transmission position: in the hierarchic level and in the relationship level. Thus, the sustainability of the DOTS strategy represents an important challenge for these characters, who use few management tools, have little authonomy in the decisionmaking process, have to work with scarce resources and are usually unprepared for the position they occupy. These findings highlight the need for more investments in continuing education and capacitation not only for coordinators but also for all those who have to deal with TB

O estudo analisou a sustentabilidade da estratégia DOTS na visão de coordenadores de Programa de Controle Tuberculose (PCT) em sete municípios do interior do estado de São Paulo, prioritários para o controle da Tuberculose (TB). O quadro teórico está sustentado nas dimensões operacional, organizacional e política da gerência e sua articulação no contexto atual das políticas e serviços de saúde. A partir de uma abordagem quantitativa, de estudo epidemiológico descritivo por meio de levantamento de fontes secundárias, foram analisados os indicadores epidemiológicos do PCT: cura, abandono e óbito de casos novos com baciloscopia de escarro positiva, cobertura de Tratamento Supervisionado (DOT/TS) e de detecção de casos. Também optou-se pela abordagem qualitativa, análise de conteúdo-modalidade temática que utilizou como fonte a entrevista semi-estruturada com coordenadores de PCT. A Unidade Temática central foi a sustentabilidade da estratégia DOTS como um desafio para coordenadores de PCT, contendo dois sub-temas: A organização da estratégia DOTS diante da necessidade de captar/otimizar recursos e definir estratégias e A operacionalização das ações de controle da TB: raciocínio estratégico e negociação como ferramentas gerenciais. Os resultados quantitativos mostraram um coeficiente angular positivo para cura, mas a maioria não atingiu a meta de 85%; declínio no percentual de abandono, ainda aquém do esperado. A cobertura de DOT/TS apresentou aumento em todos os municípios, contudo, apenas um atingiu 95%. Nenhum município atingiu a meta de 70% de detecção de casos. Os temas que emergiram neste estudo apontaram nós críticos na captação e manutenção de incentivos financeiros; recursos humanos (RH) insuficientes e despreparados; rotatividade de pessoal; desconhecimento do destino da verba da TB e falta de autonomia para gerenciar os recursos; dificuldades de comunicação e integração com gestores; falta de priorização da doença na agenda política; priorização de agravos com repercussão política e necessidade de parcerias. Sobre a operacionalização do DOTS, o estudo apontou a cooperação de pessoas de fora do serviço como ferramenta gerencial estratégica, quando estimula a coresponsabilização da família e da comunidade como cuidadores ou multiplicadores. A avaliação, pautada em indicadores epidemiológicos, é utilizada prioritariamente para alcançar recursos, ao invés de subsidiar o planejamento. A gerência do PCT parece ser uma gerência burocrática, fundamentada no planejamento normativo. Acredita-se que a efetividade das ações gerenciais para sustentar a estratégia DOTS dependa de atores com conhecimento técnico, habilidades políticas e organizacionais, além de raciocínio estratégico para estimular e envolver todos os atores que lidam com a TB. Habilidades estas que, dificilmente são adquiridas na formação profissional. Conclui-se que os coordenadores trabalham em meio a pressões de cima e de baixo, ocupando dupla posição de transmissão, no plano hierárquico e das relações. Neste sentido, a sustentabilidade da estratégia DOTS representa desafios importantes para estes atores que utilizam poucos instrumentos gerenciais, têm pouca autonomia no processo decisório, lidam com recursos escassos e, muitas vezes, sem preparo para esta função, reforçando a necessidade de investimento na formação e capacitação contínua tanto para estes atores como para aqueles que lidam com a TB / This study analyzed the sustainability of the DOTS (Directly Observed Treatment Strategy). It shows the point of view of the TCP (Tubercolosis Control Program) coordinators of seven priority municipalities in the Sao Paulo State. The theorical framework is based on operational, organizational and political levels of the management and on its articulation in the current context of health policies and services. We carried out an epidemiological-descriptive study, using secondary sources, and through a quantitative approach. The following epidemiological TCP indicators were analyzed: cure, abandonment and death of new cases with positive sputum bacilloscopy, Supervised Treatment (DOTS/ST) and case detection coverage. We also chose to apply a qualitative approach, through a semi-structured interview with TCP Coordinators, and with the application of content analysis in the thematic modality. The main thematic unity is the sustainability of the DOTS strategy as a challenge to the TBP coordinators. It contains two sub-themes: The organization of the DOTS strategy faced with the need for resource captation/optimization and for clearly outlined strategies, and The operationalization of TB control actions: strategic thinking and the negociation as key management skills. Quantititive results show a positive angular coefficient for cure. Nonetheless, the majority did not achieve the 85% goal and the decline in the abandonment rate is still lower than expected. The ST coverage rose in all municipalities. However, only one municipality achieved coverage of 95%. None of the municipalities achieved the goal of 70% case detection rate. The themes analyzed in this study pointed to critical knots in the collection and maintenance of financial incentives; insuficient and unprepared Human Resources (HR); staff turnover; lack of knowledge concerning the destination of the TB funds, as well as lack of autonomy to manage resources; difficulties in the communication and in the integration with other managers; failure in making the disease a priority on the political agenda; priorization of aggravations with political repercussion and the need for partnerships. Concerning the DOTS operationalization, the study pointed to the cooperation of people outside the job as an important strategic management tool. It encourages family and community to take co-responsibility as caretakers and multipliers. The evaluation, which is based on epidemiological indicators, is especially used to achieve resources, instead of subsidizing the planning process. TCP management seems to be exceedingly bureaucratic and based on normative planning. We believe that the effectiveness of management actions to support the DOTS strategy needs characters with technical knowledge, political and organizational skills and strategic thinking. These skilss are important in order to encourage and get involved all those who deal with TB. These skills are hardly achieved in the professional training. We conclude that the coordinators work under pressure from the top and from the bottom of the hierarchy, and occupy a double transmission position: in the hierarchic level and in the relationship level. Thus, the sustainability of the DOTS strategy represents an important challenge for these characters, who use few management tools, have little authonomy in the decisionmaking process, have to work with scarce resources and are usually unprepared for the position they occupy. These findings highlight the need for more investments in continuing education and capacitation not only for coordinators but also for all those who have to deal with TB

近年來，隨著臺灣醫療產業的重要性漸增及其所面臨的種種挑戰，個別醫院面臨的生存壓力漸增，醫院組織的策略議題也漸受重視，過去文獻多著重於營利組織的策略管理探討，醫院組織雖非以營利為目的，卻仍須重視成本控管與績效表現，以提供更優質的醫療服務，其中，提升資源運用與配置效率是相當重要的課題。 智慧資本導航分析法(ICN)過去多應用於營利企業，本研究目的在於引進ICN分析技術，以量化指標和圖形呈現輔助，分析醫院對於智慧資本資源運用之管理議題。本研究以某個案醫院為例，研究期間歷時10個月，訪談對象為8位來自醫院各部門的高階經營主管，於專業領域的經歷與年資皆相當豐富，各主管針對醫院資源的相對比重及資源間的轉換進行評估，並提出理想狀況的資源轉換關係，作為未來策略發展的參考依據。 研究結果分別回答三大研究議題，就醫院中各項資源的轉換關係來看，「人力資本」主要貢獻於醫師、醫療人員及聲譽形象，且期望於未來投入更多於組織策略與行銷的能力提升和顧客關係的建立；「組織資本」主要貢獻於行政人員、醫師、醫療人員、資訊管理、創新學習、財務管理和流程管理，以吸引人才、提升人力素質和提升組織管理效率為組織創造價值；「關係資本」主要貢獻於強化組織與外部利害關係人之關係。就各項資源間轉換的對稱性而言，各項資本對「關係資本」的投入普遍大於從「關係資本」所獲得的反饋，代表組織未來可思考提升「關係資本」對其他資本的貢獻。此外，傳統資源對智慧資本的貢獻亦大於從智慧資本所獲得的反饋，部分原因可能來自智慧資本的反饋較難具體衡量，而未來仍應以策略目標作為提升智慧資本運用效率的前提。最後，就個案醫院而言，「人力資本」不僅是最重要的資源，同時也是組織價值創造的來源，其中又以醫師、醫療人員和高階管理為主，代表知識與專業是醫院高績效表現最重要的兩項資源。 / This research aims at adopting the intellectual capital perspective and its analytical approach in the managerial practice of a health-care organization. The concept of intellectual capital has been applied to the practice of for-profit organizations. However, health-care organizations, which were regarded as non-for-profit, have not been paied close attention to their resource management. Based on intellectual capital perspective, this research introduces Intellectual Capital Navigator (ICN) approach to evaluate the efficiency of using resources.. This research is conducted by an in-depth study on a hospital, demonstrating the importance of needed resources and analyzing the resource transformation among human capital, organizational capital, relational capital, physical capital and monetary capital. The conclusion of this research found that human capital contributed more to itself and organizational capital. Moreover, it is expected to contribute more to relational capital in the future. When it comes to the symmetry of transformations, ICN analysis shows that each capital contributed to relational capital more than getting from it, and that traditional capital contributed to intellectual capital more than getting from them. This study also found that human capital is the most important value source in the hospital. Therefore, the hospital should pay more managerial attention to the balance and asymmetric transformation among resources to enhance the effectiveness and efficieny of its resource management. The adoption of ICN analytical approach into health-care organization extends the application of intellectual capital management.

Po Lietuvos neprikausomybės atkūrimo, šalies politinis ir ekonominis vystymąsis atskleidė daugybę, neišspręstų ar naujai iškilusių, socialinių problemų (klausimų), todėl iškilo socialinių darbuotojų poreikis įvairiose visuomenės gyvenimo srityse, tame tarpe ir sveikatos priežiūroje. Sparčiai didėjo supratingumas, kad sveikatos priežiūra yra ne tik ligų diagnozavimas, gydymas, prevencija. Labai svarbi visuomenės sveikatos sudėtinė dalis yra pačio paciento slauga. Šiandien socialinių paslaugų pasiūla pacientams yra nepakankama Lietuvoje. Savarankiškumą praradę ar sunkiai sergantys ligoniai turi gauti kvalifikuotas socialines paslaugas. / After Lithuania regained its independence, many of the country's unsolved social problems soon became apparent. These problems illustrated the need for a properly trained labor force of social workers equipped to deal with them, particularly in the field of health care. It soon became clear that effective health care prevention was every bit as important as diagnosing and curing disease. A very important component of such health care is the nursing care and social support that patients receive, but the provision of such care is still insufficient in Lithuania . Patients that have lost their independence and are seriously ill must receive adequate care and support.

Kostnaden för hälso- och sjukvård i Sverige uppgår årligen enligt Statistiska centralbyrån till drygt 230 miljarder kronor vilket kan anses vara mycket. Den svenska hälso- och sjukvården är viktig för samhället och således blir de interna förhållandena och processerna viktiga för de som arbetar inom hälso- och sjukvården. Denna fallstudie har genom två delstudier undersökt en större hälso- och sjukvårdsorganisation som för drygt 1,5 år sedan genomförde en omorganisering. Specifikt har studien undersökt stödfunktionernas teamarbete och syftar till att öka förståelsen för hur teamens nya organisation teoretiskt kan förstås. Vidare syftar studien till att söka förståelse för hur arbetet som teamen bedriver upplevs fungera och tas emot. I delstudie ett intervjuades 12 medarbetare och chefer och i delstudie två insamlades en webbenkät ifrån 10 verksamhetschefer. Empirin har analyserats tematiskt och visade bland annat att den struktur som teamen verkar inom bättre kan förstås som en matrisorganisation med tillhörande utmaningar. Vidare är några av slutsatserna att den interna kontrollen var bristfällig och att både medarbetare och chefer gavs föga möjligheter till att i förlängningen utveckla ett ansvarsfullt arbetssätt. Diskussion om vad som kan utvecklas har redogjorts. Förslag på framtida forskning är att jämföra planerad- och upplevd styrning med faktisk produktivitet. / The cost of health care in Sweden is annually, according to Statistics Sweden more than 230 billion SEK which can be considered a lot. The Swedish health care is important to the society and consequently, the internal conditions and processes are important for those working within the health care. This case study has been conducted through two sub-studies, examined a larger health care organization, which undertook a reorganization one and a half year ago. Specifically this case study has studied the support functions teamwork, and aims to increase the theoretically understanding of the team's new work organization. Consequently the purpose of this case study has been to seek understanding of the work that the teams engage in and how it is received. In sub-study number one, 12 employees and managers where interviewed and in sub-study two, a web-based questionnaire was distributed to 10 branch managers. The empirical data were analyzed thematically and shows that the team's new organization better can be understood as a matrix organization, with related challenges. Furthermore, some of the conclusions are that the internal controls were inadequate and both employees and managers were given little opportunity to take long term responsibility for their work. A discussion of what can be developed is outlined. Suggestions for future research are to compare planed- and perceived management control with actual productivity.

<p>This essay’s focus lies on the collaboration that takes place in hospitals and called a care-plan (vårdplanering) between the two organisations: Health-care (landsting) and social-care (kommun). According to the Swedish-law are these organizations responsible for the care of elderly individuals in Sweden. The aim of this essay has been to study closely this collaboration in order to see which partner has the most influencing power.</p><p>This essay is of a qualitative character, which means that the results that are presented are based on six individual interviews with employees from the two organizations. The employees chosen for this essay all have job experiences from the collaboration that takes place during care-plans in hospitals.</p><p>One of the main results of this essay has been that the two organizations are not equal collaboration-partners. All the interviewed individuals talked highly about the importance of collaboration while in reality they end up in an subliminal battle against each other. The main conclusion of this essay is that the focus of a care-plan meeting appears to be on gaining the most power, in order to influence the outcome of a care-plan, rather than giving priority to the elderly individual’s needs and concerns.</p>