京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第23820号 / 社医博第120号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 小杉 眞司, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Members of the health professions are being faced with a wide range of ethical dilemmas, the resolution of which will often be influenced by the ethical ideology of individuals in various health fields. The purpose of this study was to measure the ethical position of junior and senior students in several health disciplines to determine if such factors as discipline, sex, ethnic membership, religious conviction, and locus of control were predictors of their ethical ideology. Two hundred sixty-seven junior and senior students enrolled in allied health, nursing, and medicine programs at two universities completed questionnaire's used in the study. One university was predominantly black and the other was predominantly white. Subjects were administered the Ethics Position Questionnaire and Rotter I-E Locus of Control Scale. Subjects also completed a personal data sheet. The results indicated that there was a significant difference in ethical ideology among health profession students as a function of type of health profession. Medical students tended to be subjectivist, nursing students, exceptionist; while allied health students were either situationist or absolutist. There were some evidence in the literature to support the results obtained for medical and nursing students. In addition, the literature would suggest that members of the same profession tend to share common values. / Ed. D.

by Ng Mei-yuk Rita. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1993. / Includes bibliographical references (leaf 77). / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.iii / LIST OF ILLUSTRATIONS --- p.v / ACKNOWLEDGEMENTS --- p.vi / Chapter / Chapter I. --- INTRODUCTION --- p.1 / Background of Public Health Services in Hong Kong --- p.1 / Pressure for Management Reform --- p.2 / Setting up of the Hospital Authority --- p.4 / Purpose of the Research --- p.5 / Chapter II. --- METHODOLOGY --- p.7 / Chapter III. --- LITERATURE REVIEW ON DIMENSIONS OF QUALITY CARE --- p.9 / Public Sector versus Private Sector --- p.9 / Health Care Organisation Structure --- p.10 / Dimensions of Quality in Public Health Care --- p.11 / Chapter IV. --- REVIEW OF TQM IMPLEMENTATION IN THE HOSPITAL AUTHORITY --- p.15 / The Hospital Authority --- p.15 / Purpose and Objectives --- p.15 / Organisation --- p.16 / Funding --- p.18 / Review of TQM Implementation and Strategies in the HA --- p.19 / Evaluation of TQM Implementations in HAHO and PMH --- p.30 / Chapter V. --- A CASE STUDY ON TQM IMPLEMENTATION IN THE A & E DEPARTMENT OF A HOSPITAL --- p.38 / The Accident & Emergency Department --- p.38 / TQM Implementation Process --- p.39 / Diagnosis of Current Problems --- p.43 / Quality Standards and Service Indicators --- p.44 / Results of TQM Process --- p.45 / Statistical Analysis on Patient Waiting Time --- p.47 / Chapter VI. --- CONCLUSION --- p.54 / APPENDICES --- p.59 / Chapter 1 --- Hospital Authority Ordinance Chapter4 Functions of the Authority --- p.60 / Chapter 2 --- Staff Opinion Survey --- p.62 / Chapter 3 --- Patient Opinion Questionnaire --- p.71 / Chapter 4 --- Key Concepts of TQM (devised by the A&E Department of a Hospital) --- p.72 / BIBLIOGRAPHY --- p.77

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2012. / This research is an attempt to investigate the utilisation of Information Communication Technology (ICT) in Healthcare to support the flow of HIV/AIDS patient’s general information in public and private sector. Furthermore, the research examines the detail flow of database information for healthcare service delivery to patients, in particular HIV/AIDS patients, in Khayelitsha Township. Finally, the research will detail the types of technologies currently being utilised to transfer this information, technology utilised for capturing or data collection profile of the patient. The research study data collecting was done in 2009 in mostly private and public healthcare centre in Khayelitsha township. First, the study will concentrate on general utilisation of ICT in healthcare service delivery and flow of information for public and private sector healthcare centres. Additionally, the research also looks at NGOs such as HIV/AIDS Unit in Cape Peninsula University of Technology (CPUT) and Treament Action Campaign (TAC) to find out what ICT equipment is being utilised to transfer this information to adult people to inform and make them to be aware of HIV/AIDS and improve healthcare service delivery to patients and particularly to HIV/AIDS patients. Taking NGO’s such as TAC and CPUT HIV/AIDS Unit that are well informed about HIV/AIDS, nationally and internationally will make our research results to be more precise. The research will also look at the utilisation of ICT in flow of information at healthcare centre such as communication between healthcare providers such as receptionist/clerk, nurses, doctors and medical researchers since they are the first people who deal with HIV/AIDS patient cases when they come for healthcare provision.

No description available.

Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.

Submitted in accordance with the requirements for the Doctors Degree of Technology: Business Administration, Durban University of Technology, 2009. / Although there is an abundance of health care waste information in South Africa, not enough studies have been done in public district hospitals particularly in rural areas. Hospitals find it difficult to comply with the minimum requirements of health care waste management guidelines, such as segregation of waste. If hazardous waste gets mixed with non-hazardous waste, waste disposal and treatment become costly. Furthermore, there has been a sharp increase in the amount of waste generated from health facilities. However, there seem to be uncoordinated efforts in each province in dealing with waste problems. The purpose of this study was to evaluate the process of operational and administrative procedures of health care waste management in hospitals. The study was conducted to facilitate the optimisation of waste management. A quantitative approach was chosen for this study because cause and effect relationships can more easily be identified, and the research is more structured and controlled. The project involved an enquiry into the perception of respondents on the procedures used in managing health care waste. Data was collected from 270 respondents out of 27 hospitals in nine provinces of South Africa. The informants were health care waste workers who were either directly or indirectly involved in waste management. A questionnaire was used as a research instrument. Results were analysed statistically using a special package for scientific studies. It has been found that in the midst of financial challenges, hospitals are unable to prioritise and rank absolutely important activities that are necessary to be undertaken to meet minimum requirements of health care waste management as laid out in the health care waste guidelines and directives. Shortages of waste equipment such as trolleys, waste containers, and temporary storage areas were the main challenges facing hospitals. The recommendations set the tone and provide a blueprint that health care managers may consider in facilitating improvement in the management of health care waste.

This dissertation addresses resource allocation problems that occur in both public and private health care settings with the objective of characterizing the tradeoffs that occur when simultaneously incorporating multiple objectives and developing methods to address these tradeoffs. We examine three resource allocation problems (i) strategic allocation of financial resources and limited staffing capacity for the mobile delivery of health care within African countries, (ii) real-time allocation of hospital beds to internal patient requests, and (iii) development of patient redirection policies in response to limited bed availability in units within a system of hospitals. For each problem we define models, each with a different methodology, and utilize the models to develop allocation strategies that account for multiple competing objectives and examine the performance of the strategies with computational studies. In Chapter 2, we model African health care delivery systems utilizing a mixed-integer program (MIP) which accounts for financial and personnel constraints as well as infrastructure quality. We characterize tradeoffs in effectiveness, efficiency, and equity resulting from four allocation strategies with computational experiments representing the variety of spatial patterns that occur throughout the continent. The main contributions include (i) the development of a model that incorporates spatial and infrastructure characteristics and allows for a study of equity in the delivery of care, rather than access to care, and (ii) the characterization of tradeoffs in the three objectives under a variety of settings. In Chapter 3, we model the real-time assignment of bed requests to available beds as a queueing system and a Markov decision process (MDP). Through the development of bed assignment algorithms and simulation experiments, we illustrate the value of implementing strategic bed assignment practices which balance the bed management objectives of timeliness and appropriateness of assignments. The main contributions of this section include (i) the development of new bed assignment algorithms which use stochastic optimization techniques and outperform algorithms which mimic processes currently used in practice and (ii) the definition of a model and methods for the control of a large complex system that includes flexible units, multiple patient types, and type-dependent routing. In Chapter 4, we model the impact of a patient redirection policy in a hospital unit as a Markov chain. Assuming preferences for patient redirection are aligned with costs, we examine the impact of incremental changes to redirection policies on the probability of the unit being completely occupied, the long-run average utilization, and the long-run average cost of redirection. The main contributions of this chapter include (i) the introduction of a model of patient redirection with multiple patient thresholds and patient preference constraints and (ii) the definition of necessary conditions for an optimal patient redirection policy that minimizes the average cost of redirection.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The work environment in critical care units in South Africa is hampered by a profound shortage of nurses, heavy workloads, conflict, high levels of stress, lack of motivation and dissatisfaction among the staff. The task of managing a C.C.U. has therefore become a challenge. It is important that unit managers apply a leadership style that matches these challenges. The aim of this study was to investigate the ideal style of leadership. The objectives set for the study were to identify the ideal leadership style required in the following areas:  administrative functions  education functions  patient care  research An explorative, descriptive research design was applied, with a quantitative approach to determine the ideal leadership style for unit managers in critical care units of private health care institutions. The research sample consisted of all nurses working permanently in eleven private hospitals in the Cape Metropolitan area. A questionnaire consisting of predominantly closed questions was used for the collection of data, which was collected by the researcher in person. Ethical approval was obtained from the Committee of Human Science Research at Stellenbosch University. Permission to conduct the research was obtained from the institutions and informed consent from the participants. A pilot study was conducted to test the questionnaire at a private hospital which did not form part of the study. A 10% sample of the relevant staff, namely 27 participants were involved in this study. The validity and reliability was assured through the pilot study and the use of a statistician as well as experts in nursing and a research methodologist. Data was tabulated and presented in histograms and frequencies. Statistical significant associations were drawn between variables, using the Chi-square test. The Spearman rank (rho) order correlation was used to show the strength of the relationship between two continuous variables. Findings of the study show that participatory leadership style and transformational leadership approach were valued in all four (4) of the objectives. Emphasis was placed on consultation prior to any decisions. Nurses requested an opportunity to give feedback on a regular basis regarding the unit managers conduct (Chi-square test p = 0.025). They also agreed that unit managers should apply the necessary rules and procedures (Chi-square test p = 0.016). A huge request was made for integrity, trust, impartiality, openness, approachability and particularly honesty. The nurses also maintained that the nurse manager’s behaviour should be congruent. Furthermore, the results indicate that nurses would like to be empowered by:  being involved in the scheduling of off-duties  taking the lead in climate meetings  being granted opportunities (to all categories of nurses) to attend managerial meetings. N = 41 (48.2%) of nurses admitted that unit managers would instruct them to cope with insufficient staffing pertaining to ventilated patients, putting them under severe strain and at risk legally. N = 39 (47%) of nurses admitted that unit managers only consider qualifications and experience in the delegation of tasks if the workload in the unit justifies it. Safe patient care is not always a priority. N = 99 (96%) of nurses agreed that autocratic behaviour relating to task delegation exists. Recommendations included the application of transformational leadership and participatory management. The aim to create a healthier, more favourable work environment for critical care nurses will hopefully be attained through applying the ideal leadership style and leadership approach. / AFRIKAANSE OPSOMMING: Die werksverrigtinge in kritieke sorgeenhede in Suid-Afrika word deur ‘n ernstige tekort aan verpleegsters, hoë werklading, konflik, spanning, min motivering en baie ontevredenheid onder verpleeglui gekortwiek. Die leiding en bestuur van ‘n kritieke sorgeenheid is dus nie ‘n maklike taak nie. Dit is dus belangrik dat eenheidsbestuurders ‘n leierskapstyl aan die dag lê wat dié uitdagings doeltreffend aanspreek. Die doel van die studie is dus om ondersoek in te stel na die wenslike leierskapstyl vir kritieke sorgeenhede. Die doelwitte daargestel is dus om die ideale leierskapstyl in elk van die volgende funksies te bepaal:  administrasie  opleiding  pasiënte-sorg  navorsing Die ideale leierskapstyl vir eenheidbestuurders in kritieke sorgeenhede in privaathospitale is bepaal deur ‘n kwantitatiewe benadering met ‘n beskrywende ontwerp toe te pas. Die populasie het alle kritieke sorg verpleeglui ( permanent werksaam by een van elf privaathospitale in die Kaapse Metropool) ingesluit. Instrumentasie het ‘n vraelys behels (met oorwegend geslote vrae) en data is persoonlik deur die navorser ingevorder. Etiese toestemming is vanaf die Etiese Komitee van die Mediese Fakulteit te Universiteit Stellenbosch verkry asook die hoofde van die verskillende privaathospitale waar navorsing plaasgevind het. Ingeligte toestemming is ook van elkeen van die deelnemers verkry. Ten einde die vraelys te toets, is ‘n loodstudie by ‘n privaathospitaal ( wat nie by die studie ingesluit was nie) gedoen. Die loodstudie het N = 27 (10%) van die totale populasie behels. Die betroubaarheid en geldigheid van die studie is deur die loodstudie, die gebruik van ‘n statistikus, verpleegdeskundiges en die navorser-metodoloog versterk. Data is getabuleer en in histogramme en frekwensies voorgestel. Deur die Chi-square- toets te gebruik, is statisties betekenisvolle assosiasies tussen veranderlikes bepaal. Ten einde sterkte van verhoudings tussen twee opeenvolgende veranderlikes te bepaal, is die Spearman rangordekorrelasie (rho) aangewend. Die bevindings van die studie het getoon dat ‘n deelnemende bestuurstyl en transformasie-leierskapbenadering die mees aangewese keuse vir al vier doelwitte is. Die toepassing van veral ‘n deelnemende besluitnemingsproses het groot voorrang geniet, Verpleegkundiges wil daarbenewens ook op ‘n gereelde basis geleentheid hê om terugvoering oor die leierskapgedrag van die eenheidsbestuurder te gee (Chi-square toets p = 0.025). Ook verlang die deelnemers dat eenheidsbestuurders nie reëls en regulasies moet verontagsaam nie (Chi-square toets p = 0.016). ‘n Ernstige versoek is gerig ten opsigte van integriteit met pertinente verwysing na eerlikheid, vertroue, onpartydigheid, deursigtigheid, toeganklikheid en dat die leier se woorde en dade moet ooreenstem. Die resultate het verder getoon dat verpleegsters graag bemagtig wil word deur:  betrokkenheid in die skedulering van afdienste,  leiding in klimaatsvergaderings te wil neem,  geleentheid te hê om bestuurvergaderings by te woon (alle kategorieë van verpleegkundiges).. N = 39 (48.2%) van verpleegkundiges het erken dat hulle gedwonge personeeltekorte ten opsigte van geventileerde pasiënte ervaar en dus aan mediese geregtelike risiko’s en onnodige druk blootgestel word. N 39 (47%) van verpleegkundiges het erken dat eenheidsbestuuders kwalifikasies en ondervinding slegs in ag neem indien die werklading in die eenheid dit toelaat..Veilige pasiëntesorg kry dus nie altyd voorkeur nie. N = 99 (96%) van verpleegkundiges het erken dat outokratiese gedrag ( wat met werkstoewysing verband hou) wel voorkom. ‘n Transformasie leierskapsbenadering en deelnemende bestuurstyl is dus aanbeveel. Die hoop word dus uitgespreek dat deur aan die verpleegkundiges se versoeke ten opsigte van die ideale bestuursbenadering en bestuurstyl te voldoen, die werksatmosfeer binne kritieke sorgeenhede toenemend gesonder en dus aangenamer sal word.

Thesis (MBA)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The aim of this study was to investigate the management skills of occupational therapy business unit managers on Assistant Director Level in the Public Health Sector (PHS) of the Free State (FS). For the purpose of this study, management skills referred to the occupational therapy business unit manager’s perception of the importance and competency experienced while doing their work within the Free State Department of Health. Occupational therapy form an integral part of the Free State Department of Health, which is a provincial public sector entity and solely responsible for health services to the majority of the population. An inquiry was initiated based on the researchers’ observation of occupational therapy business unit manager’s challenges regarding knowledge and skill when exposed to management. The investigation was conducted by making use of a questionnaire for the quantitative typical descriptive study design and semi-structured telephonic interviews for the qualitative study design. Electronic self-administrative questionnaires were distributed to all the occupational therapy business unit managers in the service of the Free State Department of Health. Ten (n=10) questionnaires, a hundred percent of employed occupational therapy business unit managers, were used for the analysis of quantitative data. Subsequently to this base-line data gathered, semi-structured telephonic interviews with open-ended questions were conducted among the target population. In conclusion the results of the study showed that the occupational therapy business unit managers in the PHS of the FS perceive a gap between their current and desired performance management skill levels. This was found to be in accordance with studies worldwide as clinicians promoted to a managerial post would prefer to utilize gained qualifications and experiences as managers within their specialty field.