It was perceived that an imbalance exists between resource allocations for health care within the Ekurhuleni Health District (EHD). This study consequently used a retrospective, quantitative methodology to investigate health equity in the EHD and to collect information on clinic buildings, staffing and budget allocations. Although clinics were oversupplied in terms of the norms set by the National Department of Health, they were found not to be in keeping with population growth in the Ekurhuleni district. The study highlighted an inequitable spread of nursing staff, which would require that nursing personnel be re-deployed. The per capita spending in the different service delivery regions was also found to be inequitable. It was subsequently recommended that spending on clinics be revised (especially in the populous Southern SDR), that staff be reallocated and that budget allocations be reviewed to achieve equity in Ekurhuleni. / Health Studies / Thesis (M.A. (Public Health))

The objectives of this study were to identify leadership competencies required by health services leaders, determine the role of mentorship in leadership development and, make recommendations for succession planning in the public health sector. A quantitative approach using an exploratory and descriptive design was used, with the intention of conducting a census survey. Respondents were managers in positions 11 and upward. Findings revealed that experience assisted managers in improving the technical competencies of human resources, financial and strategic planning, but not that of leadership skills and behaviour, and communication and relationship management, which required development in the form of mentorship. It is recommended that leadership development for future leaders be embedded in succession planning, based on policy guidelines. Limitations of this study were that a response rate of 30% was achieved and due to the narrow geographical coverage, the findings could not be generalised. / Health Studies / M.A. (Health Studies)

Thesis (MBA (Business Management))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Purpose – The health care industry is faced with numerous challenges ranging from rising medical costs, poor state of hospitals, deteriorating health care services and an increasing number of hospital deaths. All these disparities present tremendous challenges for the health care managers in charge of the health care services. As a result, they are forced to try new management methods that will assist their organizations to remain cost effective and efficient. Total Quality Management (TQM) constitutes an appropriate response to these challenges and it has become the strategy of choice to improve organization’s performance and patient satisfaction. However, in practice the implementation of TQM is often unsuccessful. Certain barriers have been identified which prevent the successful implementation of TQM in other industries as well as in the health care industry. The main aim of this research is to investigate the barriers to the successful implementation of Total Quality Management in Kraaifontein health care service organization in the Western Cape Province, 2008. Design/methodology/approach – The study employed a quasi-qualitative and quantitative case study. For the quantitative section a questionnaire with a 5–point Likert style scale was used to quantify the response (strongly disagree=1; strongly agree=5). For the qualitative section a focus group discussion was conducted to verify the results obtained from the questionnaire which addressed the challenges of TQM implementation. The statistical population of this research consisted of all health care workers working the pharmacy department who were involved in the implementation of TQM in their organization. Data was analyzed using appropriate statistical procedures. The mean score of each of the dimensions was used as a representative performance indicator and the coefficient of variation (CV) was used as a general measure of standardized skewness on the performance of each dimension. A high means score indicated desired outcomes while low scores indicated poor outcomes. Findings – Major barriers that were encountered during the implementation of TQM in this case study included the lack of top management active involvement and full commitment in the initiative, rigid organizational structure, culture towards quality changes that inhibited communication between management and employees which in turn hindered employee empowerment. Other obstacles that were encountered were lack of continuous improvement processes and initiative, improper evaluation, the lack of a recognition and reward system for team work, poor collection and analysis of data that resulted in difficulty to convert this data into meaningful information to improve quality. The absence of an integrated performance measurement system also exhibited a problem as employees were not aware what was being assessed during performance appraisals. Lack of evidence based decision making, poor communication and inflexible organizational structure and culture were also viewed as barriers. Research limitations/implications – Although conducted in Kraaifontein health care facility, it is expected that the results of the study may be relevant on a broader scale to other health care departments and facilities. The results could assist the health care managers to develop a plan that addresses the barriers and challenges faced during the implementation of TQM, yielding fruitful results which allow TQM to be implemented easily, effectively, efficiently and successfully in health care facilities. / AFRIKAANSE OPSOMMING: Doel – Die gesondheidsorg sektor het vele uitdagings wat wissel van stygende mediese kostes, lae standaarde in hospitale, die agteruitgang van gesondheidsorg dienste, en die toename in sterftes in hospitale. Hierdie en ander probleme stel groot uitdagings aan diegene verantwoordelik vir die lewering van gesondheidsorg, met die gevolg dat diesulkes nuwe bestuursmetodes moet vind om te verseker dat hulle organisasies steeds koste-effektief en doeltreffend funksioneer. Totale Gehalte Bestuur (TGB) is ‘n geskikte en toepaslike alternatief om genoemde probleme aan te spreek, en word toenemend as oplossing gesien om organisasies se dienslewering te verbeter, en pasiënt-tevredenheid te verseker. Die implementering van TGB blyk egter nie altyd suksesvol te wees nie. Daar is spesifieke struikelblokke geidentifiseer wat as redes aangevoer word vir die onsuksesvolle implementering van TGB in verskeie sektore, insluitend die van gesondheidsorg. Die hoof doel van hierdie navorsing was om die struikelblokke te ondersoek wat verhoed dat TGB suskesvol toegepas word in Kraaifontein gesondheidsdienste in die Weskaap, 2008. Ontwerp/Metode/Benadering – Die studie was ‘n kwasi kwalitatiewe en kwantitatiewe gevallestudie; vir die kwantitatiewe komponent is ‘n 5 punt Likert tipe skaal gebruik om die response (verskil beslis = 1; stem beslis saam = 5) te kwantifiseer. Die kwalitatiewe komponent het ‘n fokusgroep bespreking behels, waartydends die resultate van die vraelys geverifiëer is, wat die uitdagings van die implementering van TGB uitgewys het. Die statistiese populasie vir hierdie navorsing was al die gesondheidsorg werknemers in diens van die aptekers-departement, wat betrokke was in die implemetering van TGB in hulle organisasie. Die data is geanaliseer met toepaslike statistiese metodes. Die gemiddelde telling van elkeen van die dimensies was gebruik as ‘n verteenwoordigende aanduiding van prestasie, en die koëfisiënt van veranderlikheid was gebruik as ‘n algemene maatstaf van die gestandardiseerde skeefheid soos gemeet op elkeen van die dimensies. ‘n Hoë gemiddelde telling was ‘n aanduiding van die beoogde uitkomste, en lae tellings aanduidend van swak uitkomste. Bevindinge – Belangrike uitdagings wat ondervind is tydens die implementering van die TGB in hierdie gevallestudie sluit in, die gebrek aan aktiewe betrokkenheid en toewyding van die topbestuur vir hierdie inisiatief, rigiede organisatoriese strukture, die kultuur teenoor gehalte veranderinge wat kommunikasie tussen bestuur en werknemers belemmer, wat op sy beurt werknemer-bemagtiging verhoed. Ander struikelblokke wat geidentifiseer is, was ‘n afwesigheid van voortdurende verbeteringsprosesse en inisiatief, swak evaluering, ‘n gebrek aan ‘n sisteem vir erkenning en vergoeding vir spanwerk, swak data insameling en ontleding, wat tot probleme gelei het om die data in betekenisvolle inligting te verwerk wat kon lei tot ‘n verbetering in gehalte. Die afwesigheid van ‘n geintegreerde prestasie-beoordeling sisteem is ook as probleem geidentifiseer omdat werknemers nie ingelig was oor wat die prestasie-beoordelings behels nie. Die gebrek aan navorsingsgesteunde besluitneming, swak kommunikasie, en onbuigsame organisatoriese strukture en kultuur, was ook gesien as struikelblokke. Navorsing-beperkinge/implikasies – Alhoewel die studie in Kraaifontein gesondheidsorgfasiliteit gedoen is, word dit aanvaar dat die bevindinge van hierdie studie ook van toepassing is op ander gesondheidsorg departmente en fasiliteite. Die resultate kan gesondheidsorgbestuurders help om die uitdagings en struikelblokke te identifiseer in die implementering van TGB. Hierdie identifikasie kan lei tot ’n meer effektiewe en suksesvolle implementering van TGB in gesondheidsorgfasiliteite.

Despite much interest in service quality and various other service quality measures, scholars appear to have overlooked the overall concept of quality. More specifically, previous research has yet to integrate the effect of the customer network and customer knowledge into the measurement of quality. In this work, it is posited that the evaluation of quality is based on both the delivered value from the provider as well as the value developed from the relationships among customers and between customers and providers. This research examines quality as a broad and complex issue, and uses the “Big Quality” concept within the context of routine healthcare service. The last few decades have witnessed interest and activities surrounding the subject of quality and value co-creation. These are core features of Service-Dominant (S-D) logic theory. In this theory, the customer is a collaborative partner who co-creates value with the firm. Customers create value through the strength of their relations and network, and they take a central role in value actualization as value co-creator. I propose to examine the relationship between quality and the constructs of value co-creation. As well, due to the pivotal role of the decision-making process in customer satisfaction, I will also operationalize the value co-creation construct. Building upon the “Big Quality” concept, this study suggests a new approach by extending the quality concept to include the value-creation concept in Service Dominant Logic. This study identifies the associated constructs and determinants of Big Quality in routine healthcare management service, and examines the relationship among the associated quality constructs, customer satisfaction, and customer commitment. This study employed an online survey methodology to collect data. In data analysis, I used the variance-based structural equation modeling (PLS-SEM) approach to confirm the factor structure, proposed model, and test the research hypotheses. The results show that the customer’s participation in in-role and extra-role behaviors are positively associated with their perceived quality, satisfaction, and commitment level. The major contribution of this study to decision sciences and the service quality literature is the development of a comprehensive framework explaining the importance of value co-creation within the context of healthcare quality. Finally, this work examines perceived service quality as a key factor of customer satisfaction and the relationship of Big Quality with commitment level in healthcare service management.

This descriptive case study of the transformation in medical care at the community level was carried out with a triangulation approach. Data from documents and surveys using both semi-structured and unstructured interviews were gathered to evaluate and explain how medical care delivery changed from a primarily public system to one predominantly private.

Thesis (M.B.A.)-Business Studies Unit, Durban University of Technology, 2006 xv, 200 leaves / Imbalance in the health workforce is a major challenge for health policy-makers, since human resources are the most important of the health systems input (Sanders & Lloyd) Several developed nations are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals (Vujicic et al. 2004). The extent of migration and other losses of professional skills are difficult to quantify. However, the effects of these are multifaceted and have far reaching consequences for both the economy and the maintenance of health services in the country. The effects of this “brain drain” limit service delivery and limit the general population’s access to health services. The purpose of this study is to determine the effectiveness of contracting bursary students to the Department of Health (KwaZulu-Natal) as a specialist skills retention strategy. / M

Recent federal legislation has incentivized hospitals to focus on quality of patient care. A primary metric of care quality is patient readmissions. Many methods exist to statistically identify patients most likely to require hospital readmission. Correct identification of high-risk patients allows hospitals to intelligently utilize limited resources in mitigating hospital readmissions. However, these methods have seen little practical adoption in the clinical setting. This research attempts to identify the many open research questions that have impeded widespread adoption of predictive hospital readmission systems. Current systems often rely on structured data extracted from health records systems. This data can be expensive and time consuming to extract. Unstructured clinical notes are agnostic to the underlying records system and would decouple the predictive analytics system from the underlying records system. However, additional concerns in clinical natural language processing must be addressed before such a system can be implemented. Current systems often perform poorly using standard statistical measures. Misclassification cost of patient readmissions has yet to be addressed and there currently exists a gap between current readmission system evaluation metrics and those most appropriate in the clinical setting. Additionally, data availability for localized model creation has yet to be addressed by the research community. Large research hospitals may have sufficient data to build models, but many others do not. Simply combining data from many hospitals often results in a model which performs worse than using data from a single hospital. Current systems often produce a binary readmission classification. However, patients are often readmitted for differing reasons than index admission. There exists little research into predicting primary cause of readmission. Furthermore, co-occurring evidence discovery of clinical terms with primary diagnosis has seen only simplistic methods applied. This research addresses these concerns to increase adoption of predictive hospital readmission systems. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

RESUMO Este estudo analisa alguns aspectos da rede de relações numa Unidade Básica de Saúde, em Ribeirão Preto, buscando possibilidades e limites para o trabalho de equipe em saúde. Este é tomado enquanto processo de inter-relações, num espaço/tempo/finalidade que pressupõe momentos de articulação/desarticulação, conflitos/confrontos que precisam retomar seus movimentos e dinamismo. Trata-se de um estudo de caso com sustentação teórica no processo de trabalho em saúde, nos processos grupais, em conceitos da análise institucional. Utilizou-se para a coleta dos dados a observação e a técnica dos grupos operativos, sendo identificadas na análise duas unidades temáticas: Poder e Instituição. A rede de micropoderes presentes na Unidade de Saúde atravessa a rede de relações podendo se fazer potencialmente transversalizadora. Relações de subordinação entre os trabalhadores e desses para com a clientela, se fazem presentes, sendo que há um movimento de defesa e de transferência em que trabalhadores evitam o contato com os usuários. A atual conformação da organização do trabalho, sua disposição física, materializam a instituição saúde e divisão técnica e social do trabalho. Elas conformam e são conformadas pelas relações presentes. Vamos tendo espaços autorizados e não autorizados que alternam movimentos de vida e de morte, que indicam a possibilidade de revisão do formato atual das equipes e sua re-elaboração mais articulada, solidária e em um trabalho de saúde que se volte para a defesa da vida. Nesse sentido, a gerência pode se constituir num desencadeador de processos de revisão. / This study analyses some aspects of the network of relations in a Basic Health Unit, in Ribeirão Preto, seeking possibilities and limits for team work in health. That is assumed as a process of interrelations in a space/time/purpose which presume moments of articulation/disarticulation, conflicts/confrontations that need to recover their movements and dynamism. This is a case study with theoretical sustentation in the work process in health, in group process, in concepts of institutional analysis. We used observation and operative group technique for data collection, identifying in the analysis two thematic units: power and institution. The network of micro powers present in the health Unit passes through the network of relations making it possible of becoming potentially transversalizing. Subordinate relations among workers and from those to the clients are present, although there is a defensive and transferring movement in which the workers avoid contact with the clients. The current conformation of the work organization, its physical disposition materialize the health institution and technical and social division of work. They conform and are conformed by the relations present. We have authorized and non-authorized spaces which indicate the possibility of revision of the current format of teams and their re-elaboration in a more articulated way, sympathetic and in a health occupation which is looking towards the defense of life. In this sense, the management may arouse process of revision.

Malaria is both a preventable and curable disease if treated early and appropriately. However, it is estimated that every 30 seconds a child dies of malaria in sub-Saharan Africa. The use of innovative eHealth/mHealth tools for malaria that seamlessly integrate into the workflow of healthcare workers could potentially ameliorate this problem. Successful design and development of these tools require an overarching understanding of the socio-technical context for the problems and opportunities in the application domain. A series of studies involving malaria management in the Millennium Village Project (MVP) cluster in rural Ghana were performed. A new method introduced by the author was applied to prioritize health information needs of stakeholders that have the potential to have a higher impact in solving health related problems. The result of applying this method was a group of impactful interventions for the MVP malaria program in Ghana. Findings from this study were validated with the MVP Ghana eHealth team, and after mutual agreement, an eHealth/mHealth intervention around malaria supply chain management was selected for further study. User-Centered Design (UCD) methods were adapted for use in a resource poor setting. Functional and non-functional requirements were identified. A low fidelity prototype was created and early usability inputs were collected. A high fidelity prototype was created to provide decision support to health workers through visualizations of stock levels and recommendations of quantities to order. Results from evaluation studies of the high fidelity prototype with end users suggest that they perceive the prototype as both easy to use and useful, with a potential for adoption and with a low risk of implementation. Usability problems found during the course of the study should be addressed to increase the potential of adoption. To obtain a more complete list of usability issues, both users’ and experts’ evaluations are recommended as well as the use of native and foreign test facilitators.

Desde o início da década de 1990, as reformas gerenciais têm sido apresentadas como fundamentais para melhorar os serviços públicos e viabilizar a consecução dos direitos sociais. A partir de revisão da bibliografia e da análise de documentos, o trabalho faz uma análise crítica da privatização da gestão dos serviços públicos de Atenção Primária à Saúde no município de São Paulo, contextualizando tais medidas tanto no cenário do capitalismo contemporâneo sob dominância financeira, como também da construção da assistência pública à saúde no Brasil no século XX. Após retomar aspectos conceituais e históricos relacionados ao capitalismo contemporâneo sob a supremacia do capital financeiro, o estudo retoma a construção da assistência pública à saúde no Brasil na sua relação com a acumulação capitalista, além de fazer breve retrospectiva da construção do processo de privatização da Atenção Primária a Saúde no município de São Paulo, com destaque para as Organizações Sociais. Ao discutir em que medida foram alcançadas as melhorias prometidas e também a maior participação da comunidade no planejamento e execução dos serviços públicos, o estudo levanta a hipótese de que tais reformas estariam menos relacionadas às tentativas de viabilizar o direito universal à saúde. Tais medidas estariam, na verdade, submetidas a uma ofensiva das classes proprietárias em sua tentativa de superar as crises de acumulação capitalista, assim como também à concomitante ascensão internacional da finança e sua insaciabilidade sobre os recursos do Estado em benefício da lógica mais geral do movimento do capital. / Since the early 1990s, the managerial reforms have been presented as fundamental to the improvement of public services and to facilitate the achievement of social rights. From a review of the literature and the analysis of documents, the study perform a critical analysis of the privatization of the management of public services of primary health care in São Paulo, contextualizing such measures in both the scenario of contemporary capitalism under financial dominance as also the construction of public health care in Brazil in the twentieth century. After resuming conceptual and historical aspects related to contemporary capitalism underthe supremacy of financial capital, the study takes up the construction of public health care in Brazil in its relation to the capitalist accumulation, in addition to brief review of the process of privatization of Primary Health Care in São Paulo, with emphasis on Social Organizations. When discussing to what extent the promised improvements and also the greater community participation in the planning and execution of public services were achieved, the study hypothesizes that such reforms would be less related to the attempts to make possible the right to universal health care. Such measures would be, in fact, subjected to an offensive of the proprietary classes in their attempt to overcome the crisis of capitalist accumulation, as well as the concurrent international rise of finance and its insatiability of State resources in favor of the more general logic to the movement of capital.