As technology and organizations continue to increase in complexity, a willingness to implement change management strategies for Internet technology (IT) change initiatives is necessary in a healthcare setting. This multiple case study explored change management strategies that 3 hospital administrators at 3 different hospitals in the southeast region of the United States used to guide organizational IT change activities to avoid waste and increase profits. The conceptual framework for this study was Lewin's organizational change model and Kanter's theory of structural empowerment. Data were collected using semistructured interviews and a review of hospital documentation from the 3 hospitals. The data analysis process was completed by transcribing the interview recordings and coding the data using a codebook and data-management software. Themes that emerged from data analysis included strategies to increase digitization in all areas, improve communication with IT personnel, provide ongoing training, and encourage the gradual adoption of technology. The implications of this study for positive social change include the potential to provide hospital managers with successful strategies related to the use of IT in hospitals to facilitate improved patient care and community well-being.

Healthcare organizations are big source of knowledge creation. Acquiring knowledge, storing and transferring it to others in affective way has its own importance for healthcare organizations. In such organizations, clinical staff is one of the key sources of knowledge creation. This knowledge is important for healthcare organizations to diagnose the diseases and their changing conditions in better way. An intelligent knowledge management system with large amount of such information can fulfill the updated knowledge requirement for healthcare organizations. Our thesis is also consists of such techniques of gathering clinical knowledge. We have proposed a clinical knowledge management system for cross country healthcare organizations. In this study we have discussed about some current issues in clinical knowledge management and proposed our idea as a solution of clinical knowledge management. This study highlights the knowledge management process and their impact on clinical knowledge acquisition.

Yes / Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the uptake of new medicines into practice faces a wide range of obstacles. Earlier reviews provided insights into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors). However, the methodological approaches used had limitations (e.g., single author, narrative review, narrow search, no quality assessment of reviewed evidence). This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research. A systematic search of literature was undertaken within seven databases: Medline, EMBASE, Web of Science, CINAHL, Cochrane Library, SCOPUS, and PsychINFO. Included in the review were qualitative, quantitative, and mixed-methods studies focused on adult participants (18 years and older) requiring or taking new medicine(s) for any condition, in the context of healthcare organizations and which identified factors affecting the uptake of new medicines. The methodological quality was assessed using QATSDD tool. A narrative synthesis of reported factors was conducted using framework analysis and a conceptual framework was utilised to group them. A total of 66 studies were included. Most studies (n = 62) were quantitative and used secondary data (n = 46) from various databases, e.g., insurance databases. The identified factors had a varied impact on the uptake of the different studied new medicines. Differently from earlier reviews, patient factors (patient education, engagement with treatment, therapy preferences), cost of new medicine, reimbursement and formulary conditions, and guidelines were suggested to influence the uptake. Also, the review highlighted that health economics, wider organizational factors, and underlying behaviours of adopters were not or under explored. This systematic review has identified a broad range of factors affecting the uptake of new medicines within healthcare organizations, which were grouped into patient, prescriber, medicine, organizational, and external environment factors. This systematic review also identifies additional factors affecting new medicine use not reported in earlier reviews, which included patient influence and education level, cost of new medicines, formulary and reimbursement restrictions, and guidelines. PROSPERO database (CRD42018108536). / This work presents research funded by the Pharmacy Research UK (grant reference: PRUK-2018-GA-1-KM) and Leeds Teaching Hospitals NHS Trust.

When the Swedish National IT Strategy for Health and Social Care was introduced in 2006, intensive work started in implementing Information Systems (IS) in Swedish healthcare organizations. To follow up on the requests for more research with a combined socio-technical focus on challenges, the overall aim of this thesis was to identify social challenges when implementing IS in a Swedish healthcare organization. Furthermore, the aim was to understand the impact of identified social challenges when implementing IS in this context by putting them in an interdisciplinary Applied Health Technology theoretical framework. Institutional ethnography and phenomenological hermeneutics influenced the study design. Study 1 aimed to investigate different meanings of accessibility when implementing Health Information Technology in everyday work practice. The results indicate that accessibility depends on working routines, social structures and patient relationship. When an IT strategy and interaction in everyday work use the same word in different ways there will be consequences. Study 2 sets out to describe experience-based reflections on discharge planning as narrated by nursing staff in primary healthcare, along with their concerns about how the introduction of video conferencing might influence the discharge planning situation. It was found that there is a need for improvement in communication and understanding between nursing staff at the hospital and in primary healthcare. The aim of study 3 was to explore social challenges when implementing IS in everyday work in a nursing context. Power (changing the existing hierarchy, alienation), Professional identity (calling on hold, expert becomes novice, changed routines), and Encounter (ignorant introductions, preconceived notions) were categories presented in the findings. The aim of study 4 was to explore and obtain a deeper understanding of how identified social challenges have an influence on the implementation process of IS, based on healthcare staff’s experiences on micro, meso and macro levels of Swedish Healthcare organizations. It was found that the challenges were related to the steps of putting into practice, making IS a part of everyday work routine and establishing an identity in the implementation process. In the thesis’s discussion, social challenges when implementing IS in Swedish healthcare organizations and how they might be met and dealt with constructively are further reflected upon in relation to the interdisciplinary theoretical framework and as possible consequences of the modernity-era. This thesis contributes to the starting up of a discussion of how ingrained professional characteristics are important to feel secure of being part of an established profession. If the characteristics are questioned, the whole professional performance is threatened. One consequence of this insight is the reinforcement of the realization that a basic understanding of IS and IS implementation processes in healthcare organizations needs to be integrated in to the construction of professional identity of nurses already from the start in nursing education.

Existe atualmente uma tendência de maior utilização do sistema de saúde brasileiro, tal como de maior valorização dele, o que se justifica pelo modelo universalista do sistema de saúde nacional; envelhecimento da população nacional; aumentos dos gastos públicos com saúde; aumento da renda per capta dos brasileiros. Esse contexto traz consigo a demanda por práticas gerenciais capazes de auxiliar a área da saúde nos seus crescentes desafios. Um dos pontos relevantes de estudo nesse contexto é a avaliação de desempenho e eficiência organizacional das organizações de saúde, em especial, dos hospitais filantrópicos, utilizandose modelos específicos à sua realidade. Diante disso, o objetivo do presente estudo é desenvolver um modelo organizacional para avaliação de desempenho para os hospitais filantrópicos e, a partir dele, comparar a eficiência das organizações participantes da amostra. Por meio da revisão de literatura levantaram-se 31 variáveis, provenientes de seis perspectivas diferentes, que foram julgadas pelo autor como relevante para a avaliação de desempenho dos hospitais filantrópicos, das quais, 21 foram consideradas como as mais relevantes por 14 especialistas que as avaliaram por meio do método Delphi. Ademais, outras quatro variáveis foram apresentadas como relevantes pelos entrevistados e adicionadas à proposta de modelo para avaliação de desempenho de hospitais filantrópicos. A partir desses fatores, estabeleceram-se variáveis de inputs e outputs dos hospitais possíveis de serem utilizadas, das quais se elaborou um questionário enviado para mais de 1.600 hospitais, obtendo-se de retorno 70 respostas válidas. Com a análise envoltória de dados determinaram-se quais os hospitais mais eficientes e quais elementos críticos para a eficiência. Conclui-se ainda que é incomum encontrar bases de dados robustas nos hospitais brasileiros e que análises de eficiência podem ser feitas embasadas em medidas de desempenho organizacional para se chegar a resultados de análise de desempenho com técnicas de análise de eficiência. / Nowadays, there is a trend of higher Brazilian health system usage, as well as its higher appreciation, what is justified by the universal model of national health system; national population maturing; increase in public health spending; increase of Brazilians per capta income. This environment brings along the demand for managerial practices that are able to support healthcare area in its increasing challenges. One of the highlights of study in this context is the organizational performance and efficiency evaluation, specially for charitable hospitals, using specific models, according to their reality. Based on this, the objective of this study is to develop an organizational model for performance evaluation to charitable hospitals and, from it, compare sample participant organizations efficiency. Through literature review it was presented 31 variables, from six different perspectives, judged by the author as relevant for charitable hospitals performance evaluation, from which 21 were considered relevant by specialists in Delphi method round tables. Furthermore, another four variables were presented as relevant by the participants and added to model proposal to charitable hospitals performance evaluation. From these factors, it was established input and output variables that were able to be used, and a questionnaire was elaborated and sent to more than 1.600 hospitals, gaining back 70 valid questionnaires. With DEA analysis, it was determined which hospitals are more efficient and which elements are critical to efficiency. It was concluded that it is not common to find robust databases in charitable hospitals and that efficiency analysis can be done supported by organizational performance measures to reach also organizational performance results.

Group Purchasing Organizations (GPOs) play a significant role in the healthcare industry. The presence of GPOs helps the healthcare centers to offload their responsibilities so that they can focus on more critical areas which require attention like providing quality care. This thesis involves the comparison of three models of procurement operations in terms of cost efficiency. This cost comparison model features a healthcare organization associated with a national GPO, a healthcare organization which procures by self sourcing (not associated with a GPO), and a hybrid procurement model involving a national GPO and a regional GPO. The comparison model highlighted the cost effectiveness of these three different ways of procurement, which threw significant light on the purchasing operations of healthcare organizations. In the second part of this research study, we formulated a method to measure the degree of access to innovative products across the above mentioned procurement models either involving on-contract (from a GPO) purchasing, or off-contract purchasing (from individual manufacturers not affiliated to GPO) or both. We also identified the metrics for innovation and measure the innovativeness of products. Based on the literature study, it was found that purchasing groups may also be an entry barrier to new suppliers (Zweig 1998), with big national GPOs dominating the market and dictating the pricing of commodities. The first hypothesis H1 of this research study was stated as "National GPOs (Group Purchasing Organizations) enable the healthcare establishments to lower the cost of medical services and operations." The second hypothesis H2 of this research study was acknowledged as "National GPOs a barrier to entry of Innovative product manufacturers in the healthcare industry." This thesis will identify the advantages and disadvantages of each type of procurement operation and address the economic issues which affect the relationship between a healthcare center and a GPO. The proposed research would indirectly help to identify whether cost savings are being shared by the links in the downstream supply chain and the savings are being percolated to the patients for the added welfare of the society. It will also identify the importance of innovative products in the society and will raise the bar of specialty treatments without compromising on the level of service being offered to the patients. This thesis will also highlight positive aspects of niche manufacturers of innovative products with smaller volumes which are currently marginalized in the market by the big national players. To the best of the author's knowledge, the research objective of measuring innovation of products has not been addressed yet in academic literature and will have the benefit of comparing three different purchasing models used in healthcare industry.

The purpose of this study was to explore senior leaders integration of the National Center for Healthcare Leadership (NCHL) competency model within their employee evaluation system. This case study was conducted to explore how the NCHL leadership competency model is used within their organization's employee evaluation system. The NCHL leadership competency model guided this study. The research was an exploration of themes in leadership competencies used in the healthcare organization. Data collection included in-depth interviews with 10 healthcare junior leaders in a single healthcare organization in the Midwestern United States who had at least 1 year of experience as a leader and a review of secondary data related to their job skills and annual evaluations. Using Saldana's method of data analysis, 4 primary themes emerged: leaders are transformed by vision and focus, leaders need continuous training, leaders like accountability, and leaders like influence goal creation. The 4 themes indicated that participants perceived NCHL leadership competencies integrated in their performance evaluation system to be of benefit. The findings revealed senior leaders might benefit from integrating the NCHL competency model in new leader orientation competencies, leadership training, and performance assessment tools. Positive social change may result by successful implementation of the NCHL leadership competency model strategies from this study, improving societal healthcare through efficient healthcare delivery.

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.

The aim with the study is to find key factors relating to internal marketing and to improve the process between the operating organization and its customers. A qualitative study is carried out within an organization active in the Swedish healthcare. The qualitative approach is carried out by collecting empirical data through observations, personal interviews and group interviews. The Physiotherapy Clinic at the Karolinska University Hospital is in the focus of the empirical study. The study locates existing differences in perceptions and comes up with recommendations for actions to improve the process of organisations within the Swedish healthcare and their customers. The study's results are that internal marketing can bring a lot to service-selling organizations and that the organizations internal conditions are as important as the external ones. Communication appears to be a key factor for an organization that has applied internal marketing. For enabling the most optimal position, the organization requires a consistency between the internal, external, and interactive marketing functions.

Existe atualmente uma tendência de maior utilização do sistema de saúde brasileiro, tal como de maior valorização dele, o que se justifica pelo modelo universalista do sistema de saúde nacional; envelhecimento da população nacional; aumentos dos gastos públicos com saúde; aumento da renda per capta dos brasileiros. Esse contexto traz consigo a demanda por práticas gerenciais capazes de auxiliar a área da saúde nos seus crescentes desafios. Um dos pontos relevantes de estudo nesse contexto é a avaliação de desempenho e eficiência organizacional das organizações de saúde, em especial, dos hospitais filantrópicos, utilizandose modelos específicos à sua realidade. Diante disso, o objetivo do presente estudo é desenvolver um modelo organizacional para avaliação de desempenho para os hospitais filantrópicos e, a partir dele, comparar a eficiência das organizações participantes da amostra. Por meio da revisão de literatura levantaram-se 31 variáveis, provenientes de seis perspectivas diferentes, que foram julgadas pelo autor como relevante para a avaliação de desempenho dos hospitais filantrópicos, das quais, 21 foram consideradas como as mais relevantes por 14 especialistas que as avaliaram por meio do método Delphi. Ademais, outras quatro variáveis foram apresentadas como relevantes pelos entrevistados e adicionadas à proposta de modelo para avaliação de desempenho de hospitais filantrópicos. A partir desses fatores, estabeleceram-se variáveis de inputs e outputs dos hospitais possíveis de serem utilizadas, das quais se elaborou um questionário enviado para mais de 1.600 hospitais, obtendo-se de retorno 70 respostas válidas. Com a análise envoltória de dados determinaram-se quais os hospitais mais eficientes e quais elementos críticos para a eficiência. Conclui-se ainda que é incomum encontrar bases de dados robustas nos hospitais brasileiros e que análises de eficiência podem ser feitas embasadas em medidas de desempenho organizacional para se chegar a resultados de análise de desempenho com técnicas de análise de eficiência. / Nowadays, there is a trend of higher Brazilian health system usage, as well as its higher appreciation, what is justified by the universal model of national health system; national population maturing; increase in public health spending; increase of Brazilians per capta income. This environment brings along the demand for managerial practices that are able to support healthcare area in its increasing challenges. One of the highlights of study in this context is the organizational performance and efficiency evaluation, specially for charitable hospitals, using specific models, according to their reality. Based on this, the objective of this study is to develop an organizational model for performance evaluation to charitable hospitals and, from it, compare sample participant organizations efficiency. Through literature review it was presented 31 variables, from six different perspectives, judged by the author as relevant for charitable hospitals performance evaluation, from which 21 were considered relevant by specialists in Delphi method round tables. Furthermore, another four variables were presented as relevant by the participants and added to model proposal to charitable hospitals performance evaluation. From these factors, it was established input and output variables that were able to be used, and a questionnaire was elaborated and sent to more than 1.600 hospitals, gaining back 70 valid questionnaires. With DEA analysis, it was determined which hospitals are more efficient and which elements are critical to efficiency. It was concluded that it is not common to find robust databases in charitable hospitals and that efficiency analysis can be done supported by organizational performance measures to reach also organizational performance results.