It is the architect's responsibility to protect the public's health, safety, and welfare. Ironically, healthcare facilities, whose programs focus on those elements, often seem to fall short of those basic design standards. The evolution of healthcare practices has brought us to a stage of design that focuses on the machine rather than the patient. This shift has created stripped, unwelcoming, and unnatural healthcare environments that have proven to negatively impact the health and well-being of facilities' patients. Dialysis treatment facilities, whose medical procedures rely so heavily on machines, are an even more extreme condition of this imbalance. In an effort to raise awareness of this problem and reinvigorate architectural design that actually promotes healthy environments, I chose to explore the idea of "design that heals". Through the conscientious integration of nature, light, and color, this project redefines the priorities of a healthcare facility and takes a holistic and sustainable approach to design that better cares for the patients and enlivens the community. The proposed program pairs a dialysis clinic with a community nutrition center which helps address the causes of kidney disease at the source. Located in an underserved Anacostia neighborhood, the people-focused building provides nutrition education, food production and healthcare services. Taking inspiration from the filtration process of dialysis, the building aims to celebrate and expose its own water circulation systems, mirroring the beautiful, yet chaotic, systems within the human body. / Master of Architecture / This thesis explores how the architectural design of healthcare facilities impacts the health and well-being of the building’s occupants. Healing requires a holistic support system that provides for the patients physically, psychologically, and socially. Therefore, the environments which are designed to support this healing must be in tune with those needs and cater to each those factors. “Design that Heals” applies this holistic design strategy to a dialysis treatment facility, a branch of healthcare whose design is often overlooked and underserved. This research reveals specific environmental elements that can be improved upon through design in order to create spaces that better support healing, including the integration of natural light, nature, artwork, social support, increased patient control and decreased noise levels. This proposed treatment facility, which acts as an example for the design of future clinics, illustrates the application of these design strategies, creating a facility that actually supports the welfare and healing of the building’s occupants.

No / There has been a significant rise in the number of applicants to nursing pre-registration courses at British universities. A large proportion of these will be healthcare assistants. This article aims to guide them through the process of applying for nurse training and preparing for a successful outcome at interview.

Yes / Most academic literature uses ‘goal’, ‘aim’, ‘objective’ and ‘target’ as synonymous terms, but development and healthcare sectors define them as distinct etymological entities with varied and confusing interpretations. This review sought to constructively harmonise and differentiate each definition using a thematic framework. An inductive synthesis of definitions of the goal terms collected from 22 literature sources selected through a systematic internet search. Thirty-three specific definitions were reduced through serial category-building to single general definitions, and a set of theoretical themes generated as characteristic framework of each goal. Seven conceptual themes evolved from the synthesis, including the object, scope, hierarchy, timeframe, measurability, significance and expression of each goal term. Two terms, ‘goal’ and ‘aim’ are thematically similar as broad objects of immeasurable terminal impact, with a long-term timeframe. They signify organisational success, expressed as general purpose statements. ‘Objective’ is differentiated as a specific object of measurable intermediate outcome, with short-term timeframe. It signifies intervention effectiveness, expressed as a SMART statement. ‘Target’ is simply a specific quantifiable level of an indicator. Goal, aim, objective and target are conceptually different. New frameworks for writing complete goal statements are proposed, including impact and timeframe; and outcome, indicator and timeframe frameworks for aim and objective respectively

Yes / This study explores the downstream Pharmaceutical Supply Chain (PSC) and provides insight to the delivery process of medicines and associated operational inefficiencies. Design/methodology/approach: An exploratory, qualitative approach was adopted to examine PSC inefficiency within two European contexts: the UK and Greece. Data was gathered through interviews and a thematic analysis conducted to analyse the data and identify challenges faced by both supply chains. Findings: The medicines delivery system needs to be enhanced in terms of quality, visibility, speed and cost in order to perform effectively. The findings demonstrated that although the healthcare supply chains in the two European contexts have different operational structures, the results are in concordance with each other. Financial, communication, waste and complexity issues were the major concerns. Research limitations/implications: To our knowledge this is the first study to examine aspects of the medicines supply chain via a cross-case analysis in the UK and Greece and extends the body of knowledge. A broader sample of responses is warranted to further validate these findings. Practical implications: The study outputs can inform pharmacies’ strategic to instigate targeted improvement interventions. The implications of which may be extrapolated further to other European healthcare organisations. Originality/value: This research contributes to the academic literature by adding further theoretical insights to supply chain strategy development, especially those that have been characterised as highly complex. The study identifies 4 key areas of intervention needed within this supply chain (in both countries) to promote higher level efficiencies and effectiveness.

No / Nigerian health professionals are impacted by several global forces bearing down on them, one of which is the positive economic prospects associated with emigrating to work abroad. This emigration is an aspect of increased global mobility which has had an adverse effect on the Nigerian health economy. This is important globally because countries with the smallest healthcare workforce capacities such as Nigeria have the poorest health outcomes. The emigration of health professionals from Nigeria will continue until domestic structures such as improved healthcare infrastructures, job security, and financial rewards change for the better. Thus, it is important that measures aimed at supporting the Nigerian health workforce be implemented with a focus on building and managing for sustainability within the context of international interdependency. Accordingly, this chapter is aimed at creating a theoretical framework for building capacities and managing the challenges of the Nigerian health workforce vis-à-vis the opportunities offered by globalization.

Yes / Adapting dashboard design to different contexts of use is an open question in visualisation research. Dashboard designers often seek to strike a balance between dashboard adaptability and ease-of-use, and in hospitals challenges arise from the vast diversity of key metrics, data models and users involved at different organizational levels. In this design study, we present QualDash, a dashboard generation engine that allows for the dynamic configuration and deployment of visualisation dashboards for healthcare quality improvement (QI). We present a rigorous task analysis based on interviews with healthcare professionals, a co-design workshop and a series of one-on-one meetings with front line analysts. From these activities we define a metric card metaphor as a unit of visual analysis in healthcare QI, using this concept as a building block for generating highly adaptable dashboards, and leading to the design of a Metric Specification Structure (MSS). Each MSS is a JSON structure which enables dashboard authors to concisely configure unit-specific variants of a metric card, while offloading common patterns that are shared across cards to be preset by the engine. We reflect on deploying and iterating the design of QualDash in cardiology wards and pediatric intensive care units of five NHS hospitals. Finally, we report evaluation results that demonstrate the adaptability, ease-of-use and usefulness of QualDash in a real-world scenario.

Yes / Global initiatives that promote public health responses to dementia have resulted in numerous countries developing new national policies. Current policy guidelines in England, for example, recommend that people diagnosed with mild-to-moderate dementia receive information and psychosocial interventions to improve their ability to ‘live well’. However, it remains unclear to what extent these recommendations are being achieved. Methods: Self-reported information from 1537 people living with dementia and informant-reported information from 1277 carers of people living with dementia was used to quantify receipt of community-based dementia support services, including health and social care services provided by statutory or voluntary-sector organisations, in Britain from 2014 to 2016. Demographic factors associated with differences in receipt of support services were also investigated to identify particularly vulnerable groups of people living with dementia. Results: Both self- and informant reports suggested that approximately 50% of people living with dementia received support services for dementia. Receipt of support services was lower among people living with dementia who are older, female, and have fewer educational qualifications. Receipt of support services also differed according to diagnosis and carer status, but was unrelated to marital status. Conclusions: Limited receipt of dementia support services among people living with dementia in Britain provides a baseline to assess the efficacy of current policy guidelines regarding provision of information and support. Targeted efforts to facilitate receipt of support services among the particularly vulnerable groups identified in the current study could improve the efficacy of dementia support services both in Britain and internationally, and should inform policy development. / The IDEAL study’ was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health Research (NIHR) through grant ES/L001853/2. The IDEAL‐2 study’ is funded by Alzheimer's Society, grant number 348,AS‐PR2‐16‐001.

Construction waste generation is a global issue in the sustainable construction context and several studies have been performed in different parts of the world to develop methods and tools for waste prevention, reduction, reuse and recycling. Most of these studies adopted a linear approach by focussing on a specific project phase, such as design, procurement or construction. However, there is a consensus in the literature that factors causing construction waste span across the project life cycle and recent researchers emphasised the need for a more integrated lifecycle approach to holistically assess and evaluate causes of waste to suggest recommendations to reduce lifecycle construction waste generation. Over recent years, the UK government has been investing billions of pounds in new and refurbished healthcare projects, where the healthcare buildings are often referred to, in literature, as complex buildings. This large investment has created a number of sustainability issues including water consumption, CO2 emissions, energy consumption, and more significantly construction waste generation. However, no significant research has been undertaken to propose a systematic construction waste minimisation mechanism for healthcare construction projects. Therefore, this research aims to develop a lifecycle construction waste minimisation framework for healthcare projects (HC-WMF). In order to identify the research problem and construction waste generation issues peculiar to healthcare projects, nine preliminary interviews were conducted with healthcare clients (N=3), architects (N=3), and contractors (N=3). The findings revealed that healthcare projects generate high rates of waste compared to other building projects throughout the project lifecycle, identified complex features that have an effect on waste generation, and identified particular causes of construction waste in healthcare projects. A further in-depth study based on four case studies was undertaken to understand the impact of waste generation due to the causes of waste, the relationship between complex features in healthcare projects and the causes of waste, and best waste minimisation practices to be implemented throughout a healthcare project lifecycle to address construction waste causes. Three interviews (client, architect, and contractor) from each case study were undertaken during the data collection stage. A Healthcare Construction Waste Minimisation Framework (HC-WMF) and Self-Assessment Tool (SAT) were then developed based on the findings of the literature review, preliminary data collection study and case studies, and adoption of the key concepts of problem solving methodology. This HC-WMF comprised six waste minimisation strategies (project documents management, stakeholders waste awareness, communication and coordination, buildability, materials selection and procurement, and change management) to be followed throughout the lifecycle stages of a healthcare project. SAT provides a means to assess the effectiveness in implementing HC-WMF and to obtain feedback and learning outcomes for continuous further improvements. In order to validate the developed HC-WMF and SAT a validation questionnaire (N=26) and validation interviews (N=4) were conducted. The validation results showed that the HC-WMF and SAT would be very useful in reducing construction waste generation from healthcare projects. The research contributes to construction waste minimisation research introducing a novel approach to lifecycle waste reduction. Also, the research revealed the complex features in healthcare projects that affect construction waste generation, causes and origins of waste peculiar to healthcare projects, and best waste minimisation strategies to implement to reduce construction waste generation from healthcare projects. Most importantly, through HC-WMF, this research produced a set of guidelines to be followed throughout the healthcare project lifecycle to reduce construction waste generation. The study has made recommendations which, if adopted, will lead to significant improvements in sustainable healthcare construction due to construction waste minimisation. The content should be of interest to clients, designers, and contractors dealing with construction waste minimisation and sustainable construction in healthcare projects. Key words: Construction waste, Healthcare, Causes of waste, Healthcare complexities, Waste minimisation, UK.

Purpose- The purpose of this project is to contribute to the knowledge of creating customer value through streamlining and coordination of patient flows for children and youth with frequent need of care on child and youth medical clinics. Method- One of the methods used for achieving the project's purpose is a case study on the Child and Youth Medicine Clinic at Länssjukhuset Ryhov in Jönköping. The case study has been used for collecting the empirical data that has been generated through interviews, observations and documents from the Child and Youth Health Clinic. Except the case study the authors also made studies in literature, which the collected empirical data has been anchored and related to. Together this led to the project's analysis and results. Results- When investigating the questions found in chapter one, it was determined standardized work is of great importance to create structure and implement procedures for the patient flows. A weak link in the patient flow has been identified, which is the sub-process coordination and planning. This constraint includes three types of requirements: patient requirements, requires of health professionals and legislated requirements. By paying attention to and taking into account these requirements a coordination function can be designed to streamline patient flows and increase the customer value. The authors concluded that a specific employment as a coordinator should be appointed. A coordinator provides opportunities for a personal communication between patients and health professionals. At the same time the coordinator is able to work with techniques for efficiency while taking into account the soft values in health care. Conclusions- There is a demand for coordination from health professionals and patients. A coordination function would streamline operations and contribute to increase the customer value. Taking into account the identified wastes and limitations a coordination can be possible. Research limitations- The project's data is collected during the case study that was conducted at the Child and Youth Health Clinic. Further case studies are desirable in other clinics and in other hospitals country wide. These studies will allow for a higher security when generalizing the results of the project. / Syfte- Syftet med projektet är att bidra till kunskapen om att skapa kundvärde genom effektivisering och samordning av patientflöden för barn med frekvent behov av vård på barn- och ungdomsmedicinska kliniker. Metod- För att uppnå projektets syfte har bland annat en fallstudie på Barn- och ungdomsmedicinska kliniken på Länssjukhuset Ryhov i Jönköping genomförts. Fallstudien har använts för insamling av empiri, genom intervjuer, observationer samt dokument från Barn- och ungdomsmedicinska kliniken. Utöver denna fallstudie har även en litteraturstudie bedrivits, som den insamlade empirin har förankrats och relaterats till. Detta har gemensamt lett till projektets analys och resultat.  Resultat- Det har framkommit att ett standardiserat arbetssätt är en förutsättning för att skapa struktur och införa rutiner gällande samordning för patientflöden. En svag länk i patientflödet har identifierats vilken är delprocessen samordning och planering. Denna länk innefattar tre typer av begränsningar, patientrelaterade begränsningar, begränsningar kopplade till vårdpersonal samt lagstiftade begränsningar. Genom att uppmärksamma och ta hänsyn till dessa begränsningar kan en samordningsfunktion utformas för att effektivisera patientflödet och höja kundvärdet. En specifik befattning som samordnare bör tillsättas, vilket ger möjlighet till personlig kontakt mellan patienter och vårdpersonal och kan även arbeta med tekniker för effektivisering samtidigt som hänsyn tas till mjuka värden. Slutsatser- Det finns en efterfrågan om samordning för såväl vårdpersonal som patienter. En samordningsfunktion skulle effektivisera verksamheten och bidra till ett ökat kundvärde. Genom att ta hänsyn till identifierade slöserier i patientflödet och begränsningar i vårdprocessen kan samordning möjliggöras. Begränsningar- Projektets empiri är insamlad under den fallstudie som bedrevs på Länssjukhuset Ryhov. Författarna hade önskat utöka sina perspektiv genom att involvera fler intervjupersoner för att ge projektet högre reliabilitet och validitet. Eftersom majoriteten av all personal med planeringsansvar på Barn- och ungdomsmedicinska kliniken intervjuats hade författarna behövt intervjua personal utanför det avgränsade området. Det hade även varit önskvärt att göra ytterligare fallstudier på andra kliniker och möjligtvis även på andra sjukhus i landet för att med högre säkerhet kunna generalisera projektets resultat. På grund av sekretesslagar och geografiska avstånd var detta inte möjligt.

Canada’s increasingly diverse population requires healthcare providers to become responsive to cultural differences within the provision of healthcare services, including Child Life Specialists (CLSs), who are committed to providing psychosocial and family- centered care to hospitalized children and their families. A fundamental process of family- centered care involves responding to the ethnic, cultural and socioeconomic diversity of patients and their families. The field of child life generally remains under-researched and, in particular, studies to support the link between child life practice and culturally adapted care are lacking. To address this gap, this study explores the ways in which CLSs perceive and conceptualize the construct of diversity in their practice by utilizing cultural safety as a guiding framework. Through an exploratory research approach, semi-structured interviews with six CLSs working at a prominent children’s hospital in Alberta, Canada, were completed. A thematic analysis of the qualitative data indicated that CLSs conceptualized culture as a broad construct that is not limited to factors associated with ethnicity. Although CLSs also experienced various challenges in their practice as a result of cultural factors, their perceived level of comfort, confidence and desire to overcome such challenges were highly notable. This study also yielded insight into institutional- and practice-level resources and strategies that may improve the ability of CLSs to provide culturally-safe care. / Graduate / 0350 / 0566 / amarensm@uvic.ca