This thesis focuses on how to describe how Lean adapts within the healthcare. Lean has become a control system   as more and more companies are using in order to create competition in order to increase the quality and efficiency. This theory has now become implemented in the healthcare. The project has been organized with patients and that has created a flow in the daily work. Our study has used qualitative research strategy where we have started from secondary data presented for hospitals in the Stockholm area and a report written by John Rognes and Anna Svarts “Lean i vården” (2011). To map which hospitals are using Lean. The purpose is to identify how lean production has been implemented into four hospitals in the Stockholm area, to study how the difference are between the hospitals version of Lean compare to the fundamental, Lean production. The study describe that Lean within the healthcare is not so different compared to Lean Production in the industry. But the big different is that Lean within the healthcare is more focused on the patients and their process during the hospital visit. Lean Production is more focused on the production to the final product.

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Radio Frequency Identification (RFID) technology has been widely adopted by different industries for various purposes. While implementing a RFID system for personnel tracking in an industrial environment, such as a hospital, the tracking accuracy is not always satisfactory due to incorrect placement of RFID hardware, coarse system configuration or environment. This thesis proposes comprehensive optimization methods for improving the tracking accuracy of a RFID system for personnel tracking. The improvement is achieved from four perspectives including RFID data cleaning, experimental design, data fusion and simulation modeling. This research is based on a case study carried out in a local community hospital where a RFID system for personnel tracking has been implemented. Through applying the optimization methods, the tracking accuracy of the RFID system has been improved to 87.33%. The thesis provides a guideline for the hospital and other similar application environment to implement improvement methods on a RFID tracking system.

The demand for increased efficiency and patient-centered care has been influencing the development of healthcare in Sweden, and information technology has an important role in that process. Developing and implementing systems for public healthcare have proven to be a great challenge. One way to address this challenge is open innovation and co-creation. While there are a lot of studies focusing on innovation processes, there is little research regarding how technology is presented in the results. We have studied a co-creational workshop that focused on putting new perspectives on the use of information technology in healthcare. The workshop resulted in eight concepts which have been analyzed in terms of how technology is expressed. The results were categorized into implicit and explicit use of technology and this categorization indicates that the implicit use of technology is of the bricolage kind. By being both implicit and bricolage-like, the concepts hold qualities that make them more likely to be integrated into existing workplaces.

This research is characterised by its overlap of research from management and healthcare. This research is an attempt to contribute to the existing body of knowledge on the linkages between three multidisciplinary research themes; healthcare management concepts, information and communication technology (ICT) and knowledge management (KM). The objective of this research is to examine the feasibility of incorporating the KM paradigm in healthcare. This research discusses whether it would be beneficial for healthcare institutions (HIs) to adopt the KM paradigm so as to facilitate effective decision-making in the context of healthcare delivery. This research contends that the key to success of healthcare in the twenty first century is an effective integration of technology with the human clinical decision-making process. It is therefore important to develop a conceptual KM health framework that encompasses technological, organisational and managerial perspectives. The research design, guided by a qualitative philosophy, was inductive in nature and used the case study methodology for accomplishing the research objectives. Empirical data was gathered via a main case. The findings from the main case, in conjunction with inputs from the literature review, formed an iterative process. The analysis of the collected data resulted in a first level conceptual KM framework for Healthcare organisations. Data was then gathered from five additional case studies to (1) validate the findings obtained from the main case and (2) to carry out a cross-case analysis. Data was collected from personnel at the five cases by way of structured and semi-structured interviews, observations, archival records, telephone and virtual interviews. The analysis of the data obtained from the five cases lead to a revision of the first conceptual KM framework, resulting in a revised (and final) KM-Healthcare framework, complemented by a user guide which included a structured "walk-through" for Healthcare institutions.

This thesis considers the current requirements for security in European healthcare establishments. Information Technology is being used increasingly by all areas of healthcare, from administration to clinical treatment and this has resulted in increased dependence upon computer systems by healthcare staff. The thesis looks at healthcare security requirements from the European perspective. An aim of the research was to develop security guidelines that could be used by healthcare establishments to implement a common baseline standard for security. These guidelines represent work submitted to the Commission of European Communities SEISMED (Secure Environment for Information Systems in Medicine) project, with which the research programme was closely linked. The guidelines were validated by implementing them with the Plymouth and Torbay Health Trust. The thesis also describes the development of a new management methodology and this was developed to allow the smooth implementation of security within healthcare establishments. The methodology was validated by actually using it within the Plymouth and Torbay Health Authority to implement security countermeasures. A major area of the research was looking at the use of risk analysis and reviewing all the known risk analysis methodologies. The use of risk analysis within healthcare was also considered and the main risk analysis methods used by UK healthcare establishments were reviewed. The thesis explains why there is a need for a risk analysis method specially developed for healthcare. As part of the research a new risk analysis method was developed, this allows healthcare establishments to determine their own security requirements. The method was also combined with the new management methodology that would determine any implementional problems. The risk analysis methodology was developed into a computerised prototype, which demonstrated the different stages of the methodology.

Hand-washing compliance was examined by thematic analysis of focus group discussions in nurses, mothers and children. Perceptions in these groups were identical, with the purpose of hand-cleansing seen as self-protection from infection. This assessment is not grounded in microbiology, but is strongly driven by emotion. Two types of hand-cleansing (???hand-hygiene???) behaviour were identified: (a) ???inherent??? hand-washing. This behaviour is taught by mothers to their children early in life. The behaviour occurs when hands have been visibly or ???emotionally??? soiled or feel sticky, and drives most hand-hygiene undertaken in the community; and (b) ???elective??? hand-hygiene, which occurs in the absence of perceived threat. As patient contact by healthcare workers is frequently assessed by healthcare workers as not posing risk, healthcare workers omit much elective hand-hygiene, leading to potential cross-infection. Modelling responses of 754 nurses on the Theory of Planned Behaviour for these two hand-hygiene behaviours in the healthcare setting explained 64% of elective hand-hygiene and 76% of inherent hand-washing intention. Translation of hand-washing behaviour patterns of the community into the healthcare setting is the predominant driver of all hand-hygiene in healthcare workers. In-hospital elective hand-hygiene behaviour is further significantly predicted by belief in the benefit from the activity, peer pressure and role modelling of senior physicians and administrators. For inherent hand-washing intent, only attitudes and peer behaviour are predictive. Time constraints, commonly implicated to explain poor compliance, are important mostly to elective hand-hygiene. Reduction in necessary effort by introducing an alcohol-based hand rub without a concomitant behavioural modification program will therefore have only minimal impact. Further components essential to hand-hygiene programs have been identified. These accord with the outcomes of the modelling and include the need for institutional recognition of hand-hygiene as a priority, overt clinician leadership support, and reinforcement of purpose by both education and performance feedback. In the long-term, society would be best served by altering the entire paradigm of hand-hygiene behaviour with nationwide campaigns based on principles of social marketing. Ideally, hand-hygiene should be taught by mothers and reinforced in early education programs as behaviour that is self-protective but with the defining theme: ???clean your hands, and protect others, not just yourself.???

Background and Objectives: High-cost health care users (HCU) represent a minority of patients who consume a large proportion of health care resources. Due to their high burden on the healthcare system and internal heterogeneity, a better understanding of various segments of the HCU population is needed. The general objective was to advance our understanding of incident senior HCUs in the Canadian context so that we can advise health policy makers on potential strategies to prevent seniors transitioning to HCU and to identify priorities for further investigation. Methods: A retrospective population-based matched cohort study was conducted using province-wide linked administrative data. The research employed a spectrum of advanced methods to accomplish the general objective, including the method of recycled predictions, random intercept two-part multi-level models, and stratified logistic regression. Results: Total costs attributable to incident senior HCU status accounted for almost one-tenth of the provincial healthcare budget, with prolonged hospitalizations making a major contribution. Unplanned first (index) hospitalizations (IHs) in the incident year were considerably more common among HCUs, with ten conditions accounting for one third of their total costs. A lower risk of IH among HCUs was associated with residence in long-term care (LTC), attachment to a primary care provider, and recent consultation by a geriatrician. Although there was little variation in costs incurred by Ontario seniors for healthcare services they receive, access to the healthcare services varied greatly. The traditional drivers of costs and mortality (e.g., age, sex, health status) played little role in driving the observed variation in HCUs’ outcomes. Conclusions: By answering research questions, this thesis advances our knowledge of the HCU population in Canada. Further exploration of the nature and quality of care that may be associated with HCU conversion and investigation of the regional variation in accessing specific healthcare services is warranted. / Thesis / Doctor of Philosophy (PhD) / A small group of patients that use the most of healthcare resources are called high-cost users (HCU). HCUs are often seniors. Policy makers need a better understanding of new senior HCUs to be able to prevent seniors from becoming HCU. This study used administrative data and advanced statistical methods. We found that almost one-tenth of the 2013 provincial healthcare budget was spent on new senior HCUs, mainly because of lengthy unplanned hospitalizations. Patients who lived in long-term care, had a primary care provider, or recently visited a geriatrician were less likely to have an unplanned hospitalization. Overall, healthcare costs were distributed equally to Ontario seniors, but access to healthcare services varied greatly. This variation could not be explained by differences in age, sex, or health status. This thesis advances our knowledge of HCUs in Canada. Additional research is needed into care associated with becoming HCU and provincial variation in accessing healthcare.

America’s poor face many obstacles including health disparities and limited access to affordable primary healthcare services. This study focuses on treatment seeking and knowledge of the Patient Protection and Affordable Care Act among the working poor in Tupelo, Mississippi, where research was conducted in 2014. The working poor cannot afford medical insurance even with government subsidies but earn too much money to qualify for Medicaid, leaving them with few options. Strategies to manage acute and chronic illnesses include frequenting organizations that attempt to fill the gaps in healthcare. This thesis presents a cultural model of health-seeking among the working poor as they attempt to navigate the changing healthcare marketplace. Research indicates that the working poor are largely uninformed and unable to utilize ObamaCare and are still relying on safety net providers.

Throughout most of human history, justice has been perceived as an extremely important virtue. The primary objective of this study is to investigate the meaning of justice with a focus on a particular subject—pricing, specifically as it pertains to healthcare. In addition to the primary goal, there are also some secondary objectives: uncovering the procedure of healthcare pricing, revealing the role of government in achieving justice of healthcare pricing, and identifying the influential factors that affect the formation of people’s understanding of justice regarding healthcare pricing. The findings indicate that the equity perspective and the perspective of the need principle have substantial influence on the formation of people’s understanding of justice with regard to healthcare pricing. From the equity perspective, people believe that a just healthcare pricing should be reasonably based on cost. From the need principle perspective, people believe that just healthcare pricing should guarantee the affordability of healthcare, especially basic care. In regard to the role of government, a majority of participants believe that the government-market mixed mechanism is the most just pricing mechanism and government should play the role of a regulator. Government interventions should strive toward assisting the spontaneous forces of the market competition. Finally, findings in this study state that the participants’ general belief of distributive justice exerts a significant effect upon their understanding of justice regarding healthcare pricing. However, there is no one-to-one correspondence between these two. These findings prove that people have the tendency to treat healthcare as a special good and view justice of healthcare pricing as a particular subject to which the general belief of distributive justice may not be applicable. By focusing on justice of healthcare pricing, this study bridges the research gap and contributes to the literature on ethical study of pricing. The identifications of the popularly shared understanding of justice regarding healthcare pricing and the proper role of government provide important reference information to governments and policy makers, enlightening people with new solutions to some pressing healthcare issues.