Introduction A plethora of health indicators have been added into the District Health Information System (DHIS) since its adoption and implementation as the routine health information for South Africa in 1999. The growing demand for the production and dissemination of routine health information has not been equally matched by improvements in the quality of data. In the health sector the value of monitoring and evaluation is not simply the product of conducting monitoring and evaluation but, rather from discussing and using performance indicators to improve health service delivery. Aim The aim of this study was to classify health care indicators in the national health data sets used for planning, monitoring and evaluation and to review the data management practices of personnel at provincial and district level. Methods An observational, cross sectional study with a descriptive component was conducted, in 2009, using a finite sample population from district and provincial level across eight provinces. The study participants completed a self-administered questionnaire which was e-mailed to them. Results A total of 32 (52%) participants responded to the questionnaire and of this total 21 (65.5%) responses were from district level and 11 (34.4%) from provincial level. The National Indicator Data Set, the key source for primary health care and hospital data, was implemented in 1999 with approximately 60 indicators. In less than 10 years it has grown in size and presently contains 219 performance indicators that are used for monitoring and evaluating service delivery in the public health sector. Whilst both district and provincial level personnel have a high awareness (83%) of the DHIS data sets there is variability in the implementation of these data sets across provinces. The number of indicators collected in the DHIS data sets for management decisions are “enough”, however a need was expressed for the collection of community health services data and district level mortality data. Similarities were noted with other studies that were conducted nationally with respect to data sharing, utilisation and feedback practices. Data utilisation for decision making was perceived by district level personnel to be adequate, whereas provincial level personnel indicated there is inadequate use of data for decision making. Whilst 87.1% of personnel indicated that they produce data analysis reports, 71.9% indicated that they never get feedback on the reports submitted. The top 4 data management constraints include: lack of human resources, lack of trained and competent staff, lack of understanding of data and information collected and the lack of financial and material resources. There was agreement by district and provincial level personnel for the need for additional capacity for data collection at health facility level. Discussion The increasing need for accurate, reliable and relevant health information for planning, monitoring and evaluation has highlighted critical areas where systems need to be developed in order to meet the information and reporting requirements of stakeholders at all levels in the health system Recommendations An overarching national policy for routine health information systems management needs to be developed which considers the following: emerging national and international reporting requirements, human resources requirements for health information and integration of systems for data collection. In the short-term a review of the National Indicator Data Set needs to be conducted. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

The issues surrounding health care and health care policy are of great concern to politicians and the public alike. Government efforts in restructuring medicare, the "jewel" of Canada's social safety net, also affects the medical profession. It has been argued that this once powerful and dominant profession is experiencing a decline in its powers and authority. Is this decline inevitable or can the medical profession adapt to government reforms in such way as to maintain and even strengthen its power base? This dissertation examines the themes of professional autonomy and professional resistance. The changing composition, and possibly the decline, of the medical profession's clinical, economic, and political autonomy, is analyzed through an historical case study of the British Columbia Medical Association (BCMA). Minutes from the BCMA's Board of Directors and Executive, along with interviews with doctors active in BCMA politics, and a media review, are used to generate a portrait of the social forces influencing medical politics in British Columbia from 1964 to 1993 and of the BCMA's relations with the various provincial governments of that period. The negotiating strategies of the BCMA and the decisions behind these strategies are the focal point for an examination of professional resistance, an area neglected in sociology. The dissertation looks at the external and internal conflicts that impact on the resistance tactics of the BCMA and at the various successes and defeats the medical profession experiences in its bid to maintain professional autonomy. During the time period under study, government intervention becomes more frequent and invasive. The BCMA has the least success in protecting the political dimension of professional autonomy and most success in controlling aspects of clinical autonomy. The vast variety of resistance strategies at its disposal distinguishes it from labour groups and most other professions. Forced to accept measures it once fought against, the BCMA's efforts become focused on ensuring that reform measures are under the control of doctors (rather than government) to the greatest extent possible. Although the BCMA has lost aspects of professional autonomy, it remains one of the few professional organizations today that can force compromise from the state.

This study examined hospital governance in British Columbia. Considered to be one of the most important issues facing the health care industry today, hospital governance is nevertheless an ill-defined and poorly understood concept. Foundational and exploratory in nature, the study’s primary objectives were: a) to define hospital governance within the context of British Columbia; b) to examine the structural and functional relationships among key participants; c) to investigate decision-making responsibilities; d) to investigate what, if any, variations exist in the governance of acute care, long term care, and specialized care hospitals; and e) to explore the critical issues which face hospital governance today and in the future under New Directions policy initiatives. All hospitals (N=107) in the province were studied, with the exception of diagnostic treatment centers, private for-profit facilities, military, and federal institutions. Utilizing documentary examination, survey administration, and interview techniques, the study included hospital chief executive officers (N=106), hospital board members (N=735), hospital board chairs (N=106), and selected high ranking senior officials from the Ministry of Health who had direct responsibility for hospital activities (N=15). Results of the study provide for in-depth demographic board profiles, and show that hospital governance is similarly defined across all hospital categories as “a complex relationship of overlapping structures and activities which has the responsibility and the authority to oversee the organization’s operation and to ensure its commitment of providing optimum health care to its residents.” The study identifies the key participants of hospital governance and delineates sixteen activities considered to be under the hospital board’s domain. Seven issues are identified as being critical for hospital governance in the future. Although there was general agreement as to the individuals most often responsible for recommending and implementing activities brought before the board, there were considerable perceptual differences between participants as to who possesses final decision-making responsibility. Data results consistently demonstrated important differences in responses between the hospital and Ministry populations. The study shows that overall, the participants of hospital governance are generally satisfied with the traditional roles and structures of hospital boards and are overwhelmingly dissatisfied with New Directions policy initiatives. This study further suggests that due to the discrepancies in priorities, perceptions, and ideologies of the hospital and Ministry populations, hospital governance is in a highly volatile and transitive state.

The traditional model of leadership in medicine and health care generally centres around a hierarchical structure of power and influence, resting in the hands of a select few administrators, with limited input from employees. A newly developed Cancer treatment centre in the Province of British Columbia, Canada has attempted to institute a unique, team-based system of shared leadership and decision-making. In order to accomplish this task, the Senior Administrator of the centre hired professional group development experts to facilitate the formation of the newly established Leadership Team. A team of nine individuals participated in a group-process based model of team leadership development, consisting of a series of intensive weekend workshops. This study evaluates the impact of those intensive workshops on the members of the Cancer centre Leadership Team. Qualitative case-study methodology, combined with the use of indepth interviews, illuminated eight categories of shared experience among seven of the nine team members, as a result of having participated in the workshop series.

Although strategic planning is widely used in industry and has been adopted by many not-for-profit organisations, the Department of Health has been slow to realise the relevance of a strategic approach. This thesis uses a strategic planning approach to assess the Department of Health by examining the three interacting factors which influence organisational outcome, namely the external environment, the internal structure of the organisation and the planning process itself. A composite model or template which incorporates several well-known strategic instruments is proposed as well as an overview of the Australian national health system and these are then used as part of the strategic assessment of the Department's vision and mission. The results and recommendations of the assessment are presented in the thesis. / Thesis (MBA)-University of KwaZulu-Natal, 2005.

Healthcare delivery is a process-driven sequence of patient care treatments and services. A prescribed method for process design is required in order for healthcare organizations of the future not just to innovate, but to safely provide highly-reliable patient care. Some healthcare organizations have established the utilization of lean methodologies as a tool for process improvement. Other philosophies and methods such as Six-Sigma have also been introduced into hospitals to guide quality. Many of these efforts have provided theories or perspectives of quality improvement without being firmly connected to a model of application relative to clinical process design, process formulation, or process readiness. Hospitals often fail to recognize this gap and subsequently roll out multiple overarching quality improvement initiatives. This research examines some of the methods and activities of continuous healthcare improvement that frame clinical process design. In addition to providing an overview of current activities and methods, this research will explore to what extent standardized models for process design were followed in the course of using lean or other quality improvement initiatives. The research will conclude with a recommended best practice discussion for a healthcare process design framework and future applicability to the work of code blue standardization.

This study was designed to investigate differences in administrative attitude adopted by line versus staff type administrators of community college based allied health career education programs when professionally and non-professionally related job responsibilities were considered.The population included 126 administrators each of whom represented a community college which hosted from five to fifteen allied health career programs, inclusively, and which maintained a full time equivalent enrollment of 2000 or more students. Seventy-three administrators identified themselves as line type and fifty-three as staff type.Data for the study constituted responses to a questionnaire survey instrument comprising twenty statements divided equally between professionally related and nonprofessionally related job responsibilities. Responsibility statements were adapted from conference reports citing specific competencies for allied health career administration.Participants responded to each of the twenty responsibility statements by selecting one of five equally marked referent positions on a leadership-management scale. Responses were quantified as line and staff group mean scores and analyzed statistically. Five null hypotheses were tested using non-directional t tests at the 0.001 level of significance. Where significance was determined, F tests were employed to verify homogeneity of variance. Three hypotheses were structured to test inter-group score differences when all and sub-sets of responsibilities were considered. Two hypotheses were employed to test intragroup score differences when professionally versus nonprofessionally related statements were considered.Analysis of data, organized relative to each of the hypotheses, led to the following conclusions:Line type administrators, as a group, adopted a moderate position of leadership when all twenty job responsibility statements were considered. Staff administrators tended toward an attitude of management. The difference was statistically significant.When professionally related statements were considered, both line and staff groups adopted attitudes of leadership. Line administrators, however, adopted a stronger referent than did staff. The difference was significant.Statistically significant difference was determined between line and staff responsibility referents to nonprofessionally related statements. Line administrators tended to a leadership referent and staff adopted a slight managerial referent.Observably large standard deviations for line and staff group mean scores necessitated tests of homogeneity of variance. These tests showed statistical significance when line versus staff group scores were compared in response to all twenty responsibility statements as well as in response to professionally related statements. Frequency polygon plots of individual scores depicted a bimodal distribution of staff respondent scores.The line administrator group adopted a position of leadership for both professionally and non-professionally related statements of job responsibility. This referent was expressed more so for the former set of responsibilities than the latter. The difference between referents was statistically significant.Staff administrators adopted a group attitude slightly on the leadership side of the leadership-management scale when professionally related statements were considered and slightly on the management side for non-professionally related statements. The difference, however, was not statistically significant.Tabulation of descriptive data revealed that approximately three-fifths of both line and staff respondents possessed a health career credential. Fifty-two per cent of line respondents compared to thirty-three per cent of staff reported that they occupied their position for five or more years.In summary, this study confirmed differences in attitudes of leadership and management adopted by line versus staff type administrators of allied health career programs when identical statements of job responsibility were considered. Ambivalence of staff group leadership and management attitude to responsibilities was also noted. The inherent nature of the line type administrative position as opposed to a staff type suggests a basis for these findings.

Despite an annual expenditure of the order of £400 million and administrative arrangements which in a number of respects are significantly different from the other arms of the National Health Service, the dental health services have attracted little scholarly attention. The recent Royal Commission on the National Health Service drew attention to this point (Report, para. 9.1) and in a sense the thesis represents an attempt to fill this particular lacuna. The central question addressed is why the performance of the dental health services has neither realised the more general goals (such as equal treatment for all or the relating of access to treatment to need) which were behind the assumption of public responsibility for health care nor overcome the more particular problems associated with the provision of dental services. The thesis seeks to locate the answers in the particular approach adopted to public supply and to this end some considerable space has been given to both the origins and character of this approach. An examination of the pressures that led to public involvement in the provision of dental care is followed, in the main part of the thesis, by an account of the implementation and subsequent operation of the services. Using material from the files of the Ministry of Health and the British Dental Association as well as the numerous public enquiries which have focussed on different aspects of the services, an attempt is made to relate the shortcomings in performance to the adopted approach to supply and more particularly to the inadequacies of the assumptions which underpinned it. The central conclusion is that problems associated with both the power of those involved in the services and the values inherent in the processes of public administration have been responsible for the untenability of these assumptions and that in consequence neither the administrative capacity nor the degree of political control on which policy achievement had been postulated have in fact been realised. The whole policy has become centred on the arrangements for paying individual practitioners in which wider community goals have generally been ignored and in which considerations other than equity or dental need have governed both the supply of, and access to, the available treatment.

The comprehensive measurement of efficiency and performance in the Health Service in the UK has become one of the most important managerial developments of recent years. The reasons for this development were examined, particularly in relation to the difficulties involved with performance assessment in such a context. The most widely utilised techniques were evaluated from the perspective of the Health Care Manager and a number of serious limitations were identified. In response to these limitations, the technique of Data Envelopment Analysis was evaluated as an alternative. It has been proposed as an appropriate and useful tool for the assessment of efficiency, although the literature on DEA showed limited practical application to public sector services in the UK. The many facets of the technique were investigated and literature on its application to hospital data was reviewed. A two-stage application procedure for the DEA technique was developed in response to this evaluation, to be used in the measurement hospital efficiency. The procedure was based on a deep theoretical understanding of the DEA methodology. The most important elements of the process were related to selection of the initial sample, the identification of the variables to be included in the DEA model and the definition of the weight restrictions to be incorporated. Input from Health Care Managers was used to guide the application and data from a sample of acute hospitals in Scotland was utilised in the analysis. The application procedure showed how the practicalities of the DEA technique could be enhanced, in particular through the inclusion of weight restrictions. This led to the development of efficiency strategies for the inefficient hospitals, which could be related to the policy objectives or managerial structure of the hospitals in the sample. It was concluded that there were many potential benefits of the DEA approach to efficiency assessment and the two-stage application procedure defined here, which could be seen to fulfil many of the requirements of the Health Care Manager. It was determined that combining theoretical and practical issues can enhance the applicability of the DEA methodology.

The presence of hospital foundations inside a public healthcare system raises the question of whether they are charitable organisations doing charitable acts and how they differ from state institutions. A charitable act is based on the notion of gift. A gift relationship, compared to a commercial relationship, is founded on sharing and mutual responsibility rather than common interests. Among friends and relatives, giving reveals strong and lively relationships. In modern society, giving also takes place between strangers. It reveals strong community ties. The charitable sector, including hospital foundations, is the most common form of giving among strangers. Those who participate in this sector show a high level of involvement in many sectors of society and have strong community ties. State action takes place irrespective of the quality of community ties, although it ultimately depends on it. Charitable action complements state action. However, state action remains essential since charity is alien to the concepts of justice and equity.