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.

"In the main, contemporary research on Evidence Based Practice (EBP) has taken place within metropolitan locations, and has offered urbocentric solutions and insights. However the transferability of these developments to rural services is untested empirically. In addition, evidence development and studies on the implementation of this evidence have tended to be discipline-stream-specific; there has been very little research into either the development of multi-disciplinary evidence guidelines or the implementation of EBP from the perspective of individual practitioners working within multi-disciplinary teams. This research shortfall has provided the rationale for this study...." / Doctor of Philosophy

This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing�s perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.

"In the main, contemporary research on Evidence Based Practice (EBP) has taken place within metropolitan locations, and has offered urbocentric solutions and insights. However the transferability of these developments to rural services is untested empirically. In addition, evidence development and studies on the implementation of this evidence have tended to be discipline-stream-specific; there has been very little research into either the development of multi-disciplinary evidence guidelines or the implementation of EBP from the perspective of individual practitioners working within multi-disciplinary teams. This research shortfall has provided the rationale for this study...." / Doctor of Philosophy