Health care leaders who lack effective nurse turnover strategies can negatively affect patient quality of care, productivity, and profitability. The purpose of this single case study was to explore strategies health care leaders used to reduce nursing turnover in a health care organization. The conceptual framework for this study was Herzberg's 2-factor theory. Data were collected from semistructured interviews with 4 health care leaders in the West Texas region who had a history of reducing nurse turnover for a minimum of 5 years from the date of hire, and from review of organizational documents related to the strategies to reduce nurse turnover, including policy handbooks and annual reports. Data were analyzed using word frequency and coding to distinguish patterns. Three key themes emerged: leadership support, job satisfaction, and compensation. The results of this study might contribute to social change through an increased understanding of nurse turnover strategies that would improve productivity and the overall quality of patient care to yield organizational success, decreased mortality rates, and improved community health.

This thesis investigates whether variations in wait times for different medical specialties have a significant impact on the proportion of people who choose to opt out of the public insurance system in their country. Canada presents an interesting case study because it is one of the few nations with a single-payer system for all procedures covered by the public health system. As a result, leaving Canada is the equivalent of opting into the private system in other countries where socialized medicine is available side by side to a private market provider. The results provide some evidence of a positive relationship, but are somewhat sensitive to the chosen sample period.

Quality improvement (QI) has become an important issue in healthcare settings. A central question for many healthcare systems is how to manage improvement initiatives adequately. All county councils and regions managing healthcare in Sweden have started to work with QI at an organizational system level, to varied extents. The Kalmar county council improvement initiative constitutes the empirical basis of this thesis. The aim of the thesis is to provide knowledge about different aspects of a county-wide improvement initiative, and a broader understanding of factors and strategies that affect participation, management and outcomes. The overall study design is based on a case study. The first two studies illuminate the practice-based (micro level), bottom-up perspective. Inductively five different areas (categories) were identified. Factors influencing participation in improvement initiatives provided the basis for the next study. The result showed that different staff categories were attracted by different initiatives. The next two studies illuminate the top-down (macro/meso) management perspective. Managers’ views of how patients can participate were investigated and a content analysis of the written answers was made. Four main areas (categories) were identified. A survey study investigated all of the county council managers’ experiences of the whole improvement initiative. Overall the managers thought that the improvement work was worth the effort. To evaluate the Breakthrough Collaborative program, a survey was developed and tested. This survey was used to investigate process and outcome of the BC program. The majority of the respondents were satisfied with their work, but wanted more time for teams to meet and work. To find out if an improvement program can affect outcome and contribute to sustainable changes, interviews were made with project applicants (n=202). Almost half (48%) of the projects were funded, and of those 51% were sustained. Of the rejected (not funded) projects, 28% were accomplished and sustained anyway. The results in this thesis cannot show that the “golden mean” exists, or that a single best way to manage changes and improvements in a healthcare organization has been found, but the way QI initiatives are organized does affect participation and outcomes. The intention, from the management topdown system level, encouraging staff and units and letting practice-based ideas develop at all system levels, can stimulate and facilitate improvement work. / Kvalitetsutveckling och förbättringsarbete har blivit en viktig del av hälso- och sjukvården. En viktig fråga för landsting och regioner är hur kvalitetsutveckling skall drivas och styras. Syftet med detta arbete är att bidra till ökad kunskap om kvalitetsarbete i en hälso- och sjukvårdsorganisation, hur förbättringsinitiativ kan bedrivas och ledas, samt vilka faktorer som bidrar till ett framgångsrikt förbättringsarbete. Arbetet utgår empiriskt från en satsning på kvalitet och förbättringsarbete i landstinget i Kalmar län och är genomförd som en fallstudie (case). Resultatet speglar vad ett landstings satsning på förbättringsarbete utifrån mikro-, macro- och mesonivå kan ge. De första två delstudierna speglar det praktikbaserade förbättringsarbetet utifrån ett praktikbaserat perspektiv. En innehållsanalys av projekten som ansökt om ekonomisk ersättning gjordes. Fem kategorier utformades, och projekten betonade områden som patientsäkerhet, förbättrad tillgänglighet och effektivitet. Studie II kartlade deltagande i förbättringsarbete utifrån två olika initiativ. Resultatet visade att de olika initiativen attraherade olika personalkategorier, men kunde samtidigt utesluta andra grupper. Chefernas åsikter om och erfarenheter av landstingets satsning undersöktes i studie III och IV. Cheferna var överlag positiva och nöjda med arbetet. Förbättringsprogrammen följdes med frågeformuläret Swedish Improvement Measurement Questionnaire (SIMQ) som testats och utvärderats. Resultatet visade att deltagarna är nöjda med arbetet med sin förbättringsidé, men att metodiken kan upplevas som svår. Dessutom efterlyste deltagarna mer tid för förbättringsarbete i vardagen. Till sist analyserades de projekt som sökt pengar för att driva förbättringsarbete. Nästan hälften av alla projekt (48%) hade fått ekonomisk ersättning, och av dessa hade fler än hälften (51%) uppnått sitt mål och infört en bestående förbättring. Den här avhandlingen påvisar vikten av att ledningen uppmärksammar, möjliggör och stimulerar förbättringsarbete. Genom att erbjuda flera olika sätt att bedriva förbättringsarbete ökar möjligheten för allas medverkan.

In March of 2010, the 44th President of the United States, Barack Obama, signed into law a health care reform bill that will change the medical and business approach to healthcare that has been witnessed for quite some time. The Patient Protection and Affordable Care Act, aims to eliminate several inefficiencies encountered in our current health care system, as well as extend coverage by providing affordable care for the roughly forty six million Americans currently uninsured. Many of the changes will be implemented over the next several years, but hospitals, businesses, physicians, and insurance companies are no doubt planning ahead for the effects these changes will have on their particular industry. Although there will be many facets of change affecting all of the previously mentioned occupancies, the goal of this paper is to investigate the effect healthcare reform will have on private medical practices in the United States. The following sections will cover ways in which medicine has been practiced in the pre-reform era, historical attempts made to pass health reform legislation, several of the issues our current system faces along with the reform changes implemented to fix them. Then I will investigate the effect these changes will have, if any, and conclude by relating everything back to independent medical practices.

Despite already having the most expensive healthcare system in the world, the U.S. is facing rapidly rising costs, a growing population not covered by health insurance, and outcomes that are no better, and frequently worse, than those seen in the majority of developed nations with universal healthcare. Popular justifications of keeping the state out of healthcare appeal to protecting individual liberty; those who assert that there is a universal right to healthcare usually fail to address this claim. This paper describes the kinds of obligations in healthcare that are consistent with, if not demanded by, theories of justice that emphasize liberty. I give three different perspectives on liberty, and compare their relationship with healthcare obligations. First, I examine a plausible account of liberty, based on the condition of equal freedom, given by Immanuel Kant and Arthur Ripstein, and show how this account necessitates a system of universal public healthcare. Second, I grant the specifically libertarian approach to liberty through inviolable self-ownership, which seeks to limit the abilities of the state – using a reasonable interpretation of the Lockean proviso, as given by left-libertarians such as Peter Vallentyne, Hillel Steiner, and Michael Otsuka, this approach undoubtedly brings about increased equality in a society, which would have positive implications for healthcare access. Third, I grant furthermore the right-libertarian limited reading of the proviso, and demonstrate that even with Robert Nozick’s unhindered rules for property ownership, right-libertarianism properly understood obligates the state to act in many important aspects of healthcare.

<p>Healthcare is very information-intensive. Hence, it has become necessary to use the support of computers in order to efficiently improve such an information-intensive organisation.</p><p>This thesis points out deficiencies in the area of information security in home healthcare regarding personal integrity and secrecy. Home healthcare is, in Sweden, performed by the municipalities. The work is based on the recommendations and common advice for processing of personal data compiled by the Data Inspection Board. Two municipalities in the Västra Götaland Region have been investigated. One of the municipalities has a manual system and the other has a computerized system for personal data management.</p><p>The work includes a field study where persons from both municipalities have been observed. It also includes interviews based on the comprehensive questions from the Data Inspection Board and questions arisen from the observations.</p><p>The work shows that a very clear need of training among personnel involved in home healthcare. It also shows the need for elaborate security measures including levels on access profiles. A weak point concerning security is also the heavy use of facsimile transmission for information distribution.</p>

Today, new technologies are introduced to the market every day, and constantly changing our way of living. Especially in the healthcare sector, the change process is approaching a point where doctors can benefit from the use of, for example, connected portable reading devices instead of paper-based medical record systems. The information and communication technology is promoting the evolution of a new pathway of care delivery, a paradigm shift that alters the fundamental relationship between a doctor and its patient. The concept is defined as telehealth and formulates the provision of care at a distance and provides the possibility to treat patients in their home environment instead of at the hospital. This master’s thesis has been performed on the request of Cenvigo AB, a company active in the implementation of new IT-solutions into the healthcare and eldercare. Cenvigo AB are the owners of the Parkinson’s Digital Assessment (PANDA) application. The application has been developed through research at Dalarna University and Uppsala University Hospital.  This project will initiate the launch of PANDA and also create a model for implementation of innovative IT-solutions into the healthcare systems. The model is founded in a theoretical framework and shaped with interviews related to the implementation of technology with a focus on telehealth applications. Interviews has been performed with healthcare professionals, technology developers and users to acquire a complete picture and opinions regarding the introduction of innovation in healthcare today. From the acquired information, a model is formulated as a stepwise and chronological linear process were identified key activities are included to promote a successful implementation process. The model is connected to the practice through the implementation of PANDA. In the process of implementing PANDA into the Swedish healthcare system, a collaboration with the innovation centre at Uppsala University Hospital as a healthcare organization stakeholder, has been initiated. The model consists of five phases; Assessment, Dissemination, Adoption, Implementation and Continuation. The phases are seen as transitional steps in the innovation process, critical barriers to overcome towards a successfully implementation in a mainstream routine setting. Each phase includes a number of activities and to achieve progression in each phase, these activities must be performed in order to advance to the next phase. In the case of PANDA, the process of progression has passed assessment and are currently involved in activities related to the dissemination phase. The purpose of the model is to be used both for existing and future applications in the segment of medicine technology sector. The structure of the model is designed to promote a co-design or a common value principle of development and practice regarding an innovation. By connecting actors from both technology and healthcare in close relationships the actual needs of healthcare professionals could more effectively be identified and developed into a solution, a result from the amplification of a two-way engagement. The outmost aim is to serve as a catalysing factor, complementing the implementation models of healthcare in Sweden today. Through this study, a need for facilitating the implementation process of new technology into the healthcare systems has been identified. This model offers the necessary input that many technology companies lack. The recommendation to Cenvigo AB is to continue to develop the model during the last step in the process of launching PANDA, and parallel use this model as a business model mainly for technology start-ups and larger foreign companies that has not yet established pathways into the Swedish healthcare system. / <p>TVE 14 036</p>

Background: The overall quality of care has been defined in terms of a set of seven core attributes taken from contemporary conceptual frameworks for assessing primary healthcare systems. Attributes are assessed using sub-attribute questions picked from previously developed and validated national level survey instruments. Data has been collected through structured questionnaire survey utilizing Likert items and scale to capture respondents’ perceptions of care. Both descriptive and nonparametric statistical methods have been used for data analysis. Information on demographic factors helped to understand the response patterns across different cohort groups. Key objectives: 1) To determine the perception of patients and physicians regarding the overall quality of care and its constituent elements delivered through the primary healthcare clinics in Winnipeg. 2) To compare the perceptions about different quality of care attributes as expressed by participating patients and physicians. Results: Both patients and physicians have positive views about the overall quality of care (median score >=4 on a 1-6 scale). Regarding individual attributes, “Interpersonal communication” and “Respectfulness” received the highest average score (5) and long-term health management received the lowest score (2). Patient and physician responses were found to be statistically different for access, comprehensiveness and long-term health management. The long wait time for seeing a doctor appeared to be a widely shared concern – only 43% of the patients urgently needing to see a doctor could get a same-day appointment; for non-urgent cases, less than 3% got a same-day appointment. Patients with higher educational levels appeared to be more critical about the quality of care; conversely, patients in good health rated the quality of care attributes more favourably. Conclusion: Patients and physicians are generally satisfied with the overall quality of care. However, patients have identified issues related to access, comprehensiveness of care and long-term health management. Patients concerns were found to be consistent with national level results. Long wait time was also flagged as a key concern. Primary healthcare clinics should proactively seek patient feedback to identify issues and improve their quality of service.

With the strong support from the government and investors, Chinese healthcare sector is developed rapidly. Also, the demand for healthcare logistics has also gradually increased. Currently, most Chinese pharmaceutical manufacturing are using traditional healthcare logistics, and due to the late start of Chinese healthcare logistics, there are many problems within the field. Therefore,there is a strong demand for professional 3PL providers involving Chinese healthcare sectors. The purpose of this thesis is to analyze the status of Chinese healthcare sectors, to indicate the predictable contribution of Chinese 3PL providers after entering. And also, to analyze how different types of Chinese 3PL providers can better adapt themselves to healthcare logistics sectors. Additionally, different opportunities and challenges faced by the Chinese 3PL providers in the field of healthcare logistics has been analyzed.

Orientador: Sueli Terezinha Ferreira Martins / Banca: Vera Lúcia Pamplona Tonete / Banca: Maria Helena Borgato Cappo Bianco / Resumo: Nos últimos anos, o agente comunitário de saúde (ACS) tem sido objeto de estudos, voltados para a análise de sua identidade na Estratégia de Saúde da Família (ESF). Nesse contexto, o presente estudo buscou apreender como os agentes comunitários da ESF, da cidade de Botucatu/SP, se percebem em seu cotidiano de trabalho. A pesquisa incluiu ACS de todas as Unidades de Saúde da Família do referido município. Foram realizados três grupos focais com quinze ACS no total, sendo agrupados com um representante de cada unidade. Em cada reunião, o agrupamento ocorreu a partir da visita em cada unidade, sorteio dos sujeitos e convite para participação nos grupos focais, sendo definido de acordo com o tempo de experiência profissional. O conteúdo absorvido dos três grupos focais realizados foi sistematizado em oito temas e 19 subtemas para sua análise e discussão. A análise dos dados mostrou que as maiores dificuldades eram referentes às condições de trabalho, ao tipo de população atendida e a burocracia existente no cotidiano. No que tange as relações dos agentes comunitários com os usuários, a necessidade do vínculo ficou evidenciada para o exercício da profissão. O agente espera ser bem recepcionado e as relações muitas vezes se confundem e vão além da profissional, tornando-se por vezes relações de amizade. A falta de suporte e a troca de profissionais atuantes na equipe como um todo é relatada como um fator negativo levando a descontinuidade do trabalho desenvolvido. Para o ACS ele não parece ser visto com a devida importância na equipe e os difíceis casos encontrados nas visitas domiciliares não são considerados com o valor que precisariam ter, culminando assim na falta de resolutividade do serviço e no baixo suporte para ele. Algumas sugestões principais podem ser apontadas, como a melhora da elucidação dos propósitos da ESF para a população e para... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In the last few years, community health agents (CHAs) have been the object of study in the analysis of their identity in the Family Health Strategy (FHS). In this context, the present study aimed at apprehending how community agents in the city of Botucatu/SP perceive themselves in their routine work. The study includes CHAs from all Family Health Units in the abovementioned city. Three focal groups consisting of a total number of fifteen CHAs were performed. The participants were grouped with one representative from each unit. In each meeting, grouping occurred from a visit to each unit, a random selection of subjects and an invitation to participate in the focal groups. Groups were defined according to the period of professional experience. The content absorbed from the three focal groups performed was systematized into eight themes and 19 sub-themes for analysis and discussion. Data analysis showed that the greatest difficulties were related to work conditions, the type of population assisted and the bureaucracy existing in routine work. As regards the relationship of community agents with users, the need for ties to exercise their profession was observed. Agents expect to be well received, and relationships are often mixed, reach beyond the professional sphere and, thus, sometimes become a friendship relation. The lack of support and the exchange of professionals working on the theme as a whole is reported as a negative factor that leads to discontinuity of the work developed. To the CHAs, they do not seem to be given their due importance on the team, and the difficult cases found during home visits are not as seriously considered as they should be, thus resulting in the lack of resolutivity in the service and little support to it. Some suggestions can be indicated, among which is the improvement in the elucidation of FHS purposes to the population and to the team itself... (Complete abstract click electronic access below) / Mestre