The public sector, particularly healthcare organisations are under ever increasing pressure to do more with less. This coupled with the need to keep up to the constant technological changes and ever increasing abundance of information has led to many public sector organisations adopting Business Intelligence (BI) in order to leverage business value and improve decision-making. However, many organisations such as the National Health Service (NHS) continue to fail in their Information Technology (IT) related initiatives. While the rise of BI and its growing influence in organisations has attracted much academic attention, this has largely been from architectural, design and technological perspectives, whilst little is known about how BI is used by various organisational actors to reach decisions, nor much is understood regarding its resulting impact on organisational power dynamics. Thus, there remains an under researched area of discussion in the literature from the perspective of BI users. While studies report how BI can impact organisational effectiveness, facilitate data driven decision making and supposedly overcome intuitive decision making, the extent to which BI impacts and alters power dynamics between organisational actors across the organisation has received little attention. Accordingly, this research adopts a qualitative case study approach to explore power resulting from BI use within a large NHS trust by conducting 30 semi-structured interviews consisting of operational managers and BI analysts. Through taking a human-centric approach, this research uncovers how BI is altering power dynamics between organisational actors, whereby BI analysts are becoming increasingly influential as a result of their analytical skills. It was found that operational managers are becoming more reliant upon data analysts, resulting in the analysts having more and more influence. However, this research finds it is only when the analysts supplement their technical skill-set with their institutional knowledge, that they have the ability to influence and enact power within the organisational settings. The research also offers insights into the contestations and conflicts which arise from the use of BI, between operational managers and analysts as well as between in-house analysts, based in the operation setting and the centralised analysts, operating across the entire trust. Accordingly, this research empirically validates a BI Power Enactment Framework and proposes the BI Power Matrix, which may assist policy makers in identifying determining key factors which are contributory to the success or failure of technological initiatives.

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<p>As psychologists continue to engage the growing diversity within the United States and around the world, there is an imperative need for psychological services that are specific to cultural needs and integrate relevant sociohistorical and community factors. Currently, ethnocentrism in psychological interventions, research, and graduate training limit psychologists’ international engagement and perpetuate a focus on U.S. psychology. For graduate programs in health service psychology (i.e., clinical, school, and counseling psychology), there is a dearth of literature on their methods of preparation of health service professionals engaging in psychological work outside of the U.S. However, graduate training programs have opportunities to intervene on the field’s colonialism by preparing professionals to effectively engage internationally. Addressing ethnocentrism in training is a critical next step for the field of health service psychology.</p><p>This dissertation is comprised of two distinct chapters that are conceptually related. In the first chapter, I review health service psychology’s current international engagement. As psychologists engage outside of the United States, the field of psychology and the training community must critically examine the applicability of psychological interventions, research, and graduate education to international contexts. I propose six recommendations for training programs to deconstruct colonialism and enhance preparation of graduates for competent work outside of the U.S.</p><p>In the second chapter, I report an original, empirical study, using qualitative descriptive methodology, which critically examines how U.S. training prepares graduates to work internationally. Through semi-structured interviews, I explored internationally based psychologists’ reflections on their training experiences and preparation for their current roles in teaching, practice, research, consultation and policy, and psychological infrastructure. Data analysis utilized consensual qualitative research methodology (CQR). Results provided valuable information regarding psychologists’ professional roles outside of the U.S., factors contributing to their vocational experiences, country-specific mental health attitudes, values, and practices, the impact of U.S.-centric psychology in the country of location, lessons taken from their graduate training, and recommendations for international work. Findings provided recommendations to the training community to incorporate more of an international focus and enhance preparation of students for work outside of the U.S.</p>

Background The Sustainable Development Goals provides targets that foster greater mobilization of global resources and efforts. SDG Goal 3 Ensure healthy lives and promote well-being for all at all ages, sets targets for the reduction of maternal mortality rates and mortality rates for children under-five. Health insurance coverage is thought to provide access to needed primary services to accomplish these goals. West Africa is the region of the world with the highest burden of disease and it is unclear if insurance coverage does provide needed access to services. The articles within this thesis examine whether or not health insurance provides greater access to primary services for mothers and children, while determining other factors to be considered. Method For the systematic review, we carried out a search on four databases. Eligible studies included mother’s under-five and children in West Africa. The primary outcome was insurance impacting the rate of utilization of services. Data was extracted using standardized form, and methodology was assessed using the Joanna Briggs Institute forms. Our cross-sectional study used DHS data from 10 West African countries. Data was cleaned, weighed and analyzed using Stata. The independent variable was health insurance, and the variable of outcome was making a minimum of four antenatal care visits. Data was analyzed using binary logistic regression and we presented results using crude and adjusted odds ratio at 95% confidence interval. Results The narrative synthesis was chosen for the review. We found that in most study settings, insurance increased access to services. The cross-sectional study found that women with insurance were more likely to make the recommended number of ANC visits than their uninsured counterparts (aOR [95% CI] =1.55 [1.37-1.73]). Socio-economic status also impact access to services. Conclusion Health insurance does increase access to services and should be pursued as a viable long-term policy, but access is still dependent on socio-economic status. Due to the COVID-19 pandemic, burden of disease of the region and systems challenges, other solutions should be pursued in the near-term. Future investigation should consider the role of equity as a guiding principle.

Bakgrund: Tobaksanvändande är kraftigt associerat med ohälsa i munnen. Socioekonomiskt svaga grupper har högre tobaksanvändning, vilket resulterar i att de drabbas av mer tobaksrelaterad ohälsa. Denna ojämlikhet i hälsa minskar möjligheten till en hållbar utveckling. I synnerhet är rökare överrepresenterade bland patienter med tandlossningssjukdom. Tidigare forskning har fokuserat på tandvårdens upplevelser av att tillhandahålla tobaksrådgivning och tobaksavvänjning, mycket få studier har fokuserat på patienternas perspektiv. Sveriges åtta folkhälsopolitiska mål strävar åt en mer jämlik hälsa och betonar vikten av att agera mot tobaksanvändning. För att nå framgång i detta arbete måste organisationer samarbeta och samverka tvärsektoriellt. Detta har givit tandvården incitament att ge rökande patienter tobaksrådgivning och stöd i tobaksavvänjning. Syfte: Syftet är att utforska patienters upplevelse av råd och stöd för tobaksavvänjning inom tandvård genom en systematisk litteraturöversikt. Metod: Systematisk litteraturstudie har genomförts på 15 artiklar publicerade mellan 1999–2021. Samtliga artiklar hämtades från PubMed och behandlade patienters upplevelser kring tobaksrådgivning och stöd för tobaksavvänjning. Resultat: Majoriteten av patienterna upplever tandvården som en god arena för tobaksrådgivning och tobaksavvänjning. Tandläkare har möjlighet att påverka patienterna, då resultatet visar att yrkesrollen erhåller ett högt förtroendekapital. Tobakens påverkan på munhälsan betonas vara en viktig faktor för att inse att en beteendeförändring måste ske. Slutsats: Efter analys av granskade artiklar visar resultatet att en majoritet av patienterna förväntar sig råd om tobaksanvändning och även stöd i tobaksavvänjning av sin tandläkare. Genom att använda samtalsmetoder för att stärka empowerment kan tandläkare och tandvårdspersonal bidra till folkhälsofrämjande interventioner.

Yes / Objective: To better understand the factors influencing the uptake of direct oral anticoagulants (DOACs) across different health economies in National Health Service England from the perspective of health professionals and other health economy stakeholders. Design: Qualitative interview study using a critical realism perspective and informed by the Diffusion of Innovations in Service Organisations model. Setting: Three health economies in the North of England, United Kingdom. Participants: Healthcare professionals involved in the management of patients requiring oral anticoagulants, stakeholders involved in the implementation of DOACs and representatives of pharmaceutical industry companies and patient support groups. Intervention: Semistructured interviews (face-to-face or telephone) were conducted with 46 participants. Interviews were analysed using the Framework method. Results: Identified factors having an impact on the uptake of DOACs were grouped into four themes: perceived value of the innovation, clinician practice environment, local health economy readiness for change, and the external health service context. Together, these factors influenced what therapy options were offered and prescribed to patients with atrial fibrillation. The interviews also highlighted strategies used to improve or restrict the uptake of DOACs and tensions between providing patient-centred care and managing financial implications for commissioners. Conclusions: The findings contribute to the wider literature by providing a new and in-depth understanding on the uptake of DOACs. The findings may be applicable to other new medicines used in chronic health conditions. / This work presents research funded by the Pharmacy Research UK (grant number: PRUK-2018-GA-1-KM) and Leeds Teaching Hospitals NHS Trust (grant number: N/A).

Participants from earlier nationwide studies on predictors of internship match were contacted 7-10 years after obtaining their doctoral degree to gather additional data concerning their attained early career competencies and benchmarks (e.g., scores on the national licensing exam). In this sample (N = 190), licensure exam scores were significantly positively associated with scores obtained on the Graduate Record Examination (GRE), family of origin socioeconomic status, and student debt load. However, obtained licensure scores were not found to be significantly associated with any pre-doctoral training variables (e.g., intervention/ assessment hours, number of integrated reports, number of publications, rank order of matched internship site) or most post-doctoral early career activities. Weak positive associations between licensures scores and engaging in teaching / supervision / consultation services were observed. Few self-reported early career competencies were found to be weakly positively associated with scores on the national licensing exam (i.e., integrity, seeking supervision, scientific mindedness, evidence-based practice). Significantly inverse associations were found between national licensing exam scores and self-reported competencies in the areas of management and systems change. Findings are discussed and implications for the national licensing exam considered.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The aim of this dissertation is to explain how elective surgery patients choose between the public and private hospital sectors in the United Kingdom, and to analyze government policy changes which affect this choice. First the choice between the public and private sectors is modeled for the case where there is no private insurance available. The model takes into account the different rationing mechanisms used by National Health Service (NHS) and private hospitals to allocate surgery among patients. Private hospitals charge a price and ration on the basis of willingness to pay , while NHS hospitals , which face budget limits, ration on the basis of clinical need and require patients to wait for surgery. Consequently, a patient's choice of sector depends on her income and her level of clinical need. A simulation model is used to compare the efficiency and equity of two policy measures designed to raise the number of people receiving elective surgery : an increase in NHS funding and a subsidy to the price of private surgery. The subsidy is shown to be more efficient and the NHS funding increase more equitable. Within the same framework an expected utility model of the demand for private health insurance is developed. Two cases are analyzed: the case where individuals have no information about their future need for elective surgery and the case where they have partial information. In each case it is shown that for a given insurance premium there is a threshold level of income above which people buy insurance. It is also shown by simulation that in each case the insurance company can set a premium that allows it to break even. Finally the two models are combined. This enables the efficiency and equity of an increase in NHS funding, a subsidy to private care and a subsidy to private insurance to be compared in a situation where some private patients have insurance to cover the cost of their surgery. The NHS funding increase is shown to be most equitable , and depending on the definition of efficiency chosen, one of the two subsidies is most efficient. / 2999-01-01