The healthcare sector is mainly characterised by changing technologies, increasing market demands, social pressures, and political pressures. A significant amount of money has been invested by the Department of Health through the National Health Services (NHS), Private Finance Initiative (PFI), and Local Improvement Finance Trust (LIFT) to provide healthcare services. This has resulted in development of several new healthcare facilities. Since formation of the NHS in the mid 19th century, significant developments in medical technologies, and increasing health and safety and privacy related concerns almost every decade new approaches towards designing were observed. Thus, modern technologies (interoperable tools) and concepts such as Building Information Modelling (BIM), building simulation, healthy/sustainable facilities, healing environments and so forth have been incorporated and proved to be major catalysts for a change in overall design practices for healthcare. Despite significant investment and advancement in technologies, many existing healthcare facilities, even today remain significantly unimproved or inadequate when energy and overall performance is considered. It is, therefore, important to evaluate existing facilities and, consequently, refurbishment processes and tools for the same. This was the focus of this research. Recently, energy efficiency and carbon emissions are considered major issues by industry and government because of increasing importance of environment and issues related to global warming, climate change. In 2008, existing healthcare facilities were responsible for over £410 million worth of energy consumption and 3.7 million tonnes of CO2 emissions. Considering the above mentioned issues, the government has imposed following two key targets especially for existing healthcare facilities; to achieve 55-65 GJ/100m3 energy consumption and to reduce the level of primary energy consumption by 15 per cent (0.15 million tonnes carbon from 2000 level) by 2015. Also, the literatures suggest these facilities are energy inefficient because their performance is unsatisfactory and they fail to provide comfortable environment for patients despite significant energy consumption. Thus, these facilities should be considered for refurbishment. Recent developments in the construction sector such as BIM based tools or tools that are interoperable can help the project team involved during a refurbishment of a healthcare facility to take decisions and maintain acceptable environmental quality during and post refurbishment. However, there are many ideas and methodologies proposed for development of new healthcare facilities, but the challenges in using these methodologies, such as BIM, energy simulation for refurbishment of existing healthcare facilities and above mentioned targets provided a base and context for this research. The research used both primary and secondary data collection techniques, such as literature review, case studies and a questionnaire survey. The later phases of the research highlighted a clear need for immediate actions on existing healthcare facilities, if government targets related to energy consumption and overall performance are to be achieved. Thus, redevelopment of existing healthcare facilities to support the 21st century (modern) technologies to reduce environmental impacts and improved users' satisfaction was considered as priority areas. One of the key challenges for existing healthcare facilities is the presence of occupants during refurbishment in adjacent spaces, which may not be a problem for other types of existing buildings; there is also a lack of information on existing healthcare buildings. The research findings revealed that refurbishment lacks broad perspective, for example, issues related to mechanical systems, aesthetic considerations and redesigning facilities have never been given a sufficient importance. A Healthcare Energy and Refurbishment (HEaR) framework and decision making process was developed as part of this research to enable healthcare organisations to adopt modern methods for re-designing of existing facilities, and to exploit refurbishment practices with consideration to energy consumption. The framework was validated by demonstrating it to professionals; experts from the industry. Keywords: Building Information Modelling, energy, existing healthcare facility, framework, refurbishment.

Transport accessibility to healthcare facilities is a major issue in the United Kingdom, as recently demonstrated by the shift away from providing healthcare in acute hospitals to care closer to home . Common measures of accessibility focus on the creation of distance or travel time contours around a destination and devote less attention to individual differences such as user perceptions, their transport usage, and area-wide factors including income deprivation, safety and security. Failure to account for such factors may result in imperfect decision making in terms of healthcare relocation and reconfiguration. This thesis therefore aims to develop a user-based accessibility model by focusing on both individual socio-economic (e.g. age, gender, access to transport modes) and area-wide characteristics (e.g. income deprivation, public transport provision, safety and security). In order to identify important factors that affect accessibility and to develop the user-based accessibility model, two revealed preference questionnaire surveys were undertaken at Loughborough and Hinckley. The purpose of the first questionnaire was to understand underlying factors affecting accessibility to a healthcare facility. The results revealed that both individual and area-wide factors affect transport accessibility to a healthcare facility. The purpose of the second questionnaire was conducted to capture data relating to users perception of accessibility and their socio-economic factors so as to develop a user-perception based accessibility model. Network-based travel time and travel distance as well as public transport provision data from a respondent home to a healthcare facility were generated using a GIS technique. Individual-level questionnaire data were then integrated with the other secondary datasets (e.g. Census, Index of Multiple Deprivation, Accidents) using postcodes of survey respondents. Both single-level and multilevel mixed-effects linear regression models were employed to develop a relationship between user-perceptions relating to accessibility and the factors influencing accessibility. Multilevel models that can control data from the two levels (i.e. individuals nested within local areas) provided better goodness-of-fit statistics compared with those of single-level regression models. The results indicate that travel distance by car, number of available direct bus services, age, and destination choices affect user-perceptions of accessibility to a healthcare facility. For instance, if travel distance by car increases by one mile then the perception of accessibility to a healthcare facility decreases by four units (on a scale of 0-100). Surprisingly, many area-wide factors such as security and safety, income deprivation were found to be statistically insignificant. In order to see which healthcare facility is more accessible, calibrated multilevel models along with number of people within the catchment area were then employed to predict the overall accessibility score related to a healthcare facility. This is important for policy makers in healthcare facility relocation and reconfiguration with respect to user perception of transport accessibility. Also it would be valuable to organisations that need to make decisions based on their users perceptions who are the real decision makers as to whether to use a facility or not.

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The quality issue of provided health care is the topic which is constantly getting more attention. In this area there is always even probably will be always - something to improve. The patients´ safety in healthcare facilities is affected by the so-called culture of safety.The research was conducted in six medical institutions of the South Bohemian Region, though seven were originally planned. However, I was not given the data here, probably due to the long term incapacity of the respondent. The research was focused precisely on the area of care quality and patient safety. A mixed method research (qualitative and quantitative) was deliberately used in this task. The aim was to map the most common causes of adverse events and then, based on the causes, to propose possible arrangements to prevent the occurrence of the causes. For this purpose five research questions were established.The outcomes obtained were processed into tables, plus the graphical representation of some was accompanied. Then, in the "discussion" chapter, the results were compared and analyzed in more detail.

abstract: A post occupancy evaluation (POE) was conducted at the Ngeruka Health Center (NHC) in the Bugesera District of Rwanda. The POE was limited to the education spaces within the health center, its participants, and staff. A POE is a combination of methods both quantitative and qualitative to determine user satisfaction and whether the design intent of the built environment was met. In rural Rwanda where healthcare facilities are scarce and people become seriously ill from preventable diseases, help is needed. The smallest injuries become life threatening. Healthcare facilities and providers must develop approaches that stop these minor illnesses and diseases from costing further problems. The healthcare facility is a healing environment. Healing environments nurture health and provide a sense of safety and security. The Ngeruka facility has incorporated education spaces within their facility to teach the community ways to prevent minor health problems from becoming major ones. The research that was conducted at this healthcare facility sought to answer the main questions: Does the built environment of the NHC contribute to healing by engaging education program attendees to learn about preventing illness and disease and other health promotion strategies? In addition, can you measure healing effects of the built environment? The research took measurements of the built environment and combined them with user satisfaction questionnaires. Site observations and a participant engagement questionnaire were used to determine the amount of engagement the participants put forth into the education programs within the designated design space. Measuring engagement is a tool schools use to find out if their facilities are producing their intended results. This same thought process was incorporated into this research. The participants did prove to be engaged, but it is not definitive that the built environment was responsible. It was a combination of many factors. / Dissertation/Thesis / Masters Thesis Design 2015

Aim of this thesis is to create a strategic analysis. Rudolf and Stefanie Hospital is a medical facility whose founder is Jihočeskýkraj (Southern Bohemia county). The hospital provides complex health care that includes patient department, ambulance and diagnosis department. It has a crucial status on the market of the regionally defined catchment area. From geographical point of view, its biggest competitors are Prague hospitals. Its strengths are its human resources and provided healthcare. As its weaknesses, I would mark its economical situation, motivational system and marketing activities and bad shape of some of its facilities. Results of this thesis are internal and external analysis proposing suggestions that should be taken into consideration by hospital's management.

Title of thesis: Analysis of drug-related problems in a healthcare facility VI. Candidate: Kristína Záleská Supervisor: PharmDr. Martin Doseděl, PhD. Department: Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Background and aim: A drug-related problem (DRP) has been defined as an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes [1]. The theoretical background chapter is aimed to give a detailed description of selected studies dealing with drug-related problems in various settings. The retrospective cross- sectional study, described in the experimental part of the thesis, was carried out in order to identify, classify and assess DRPs in a rehabilitation facility and to discuss the results with a physician and subsequently determine intervention acceptance rate. Methods: The data were collected during a nine-day-long audit in three wards of a rehabilitation facility in the Czech Republic through a review of medical documentation. The detected DRPs were classified using the modified version of PCNE classification v5.01 and their severity was assessed on a scale of 0 to 5. The DRPs were subsequently discussed with physicians and the pharmaceutical intervention acceptance rate was...

The subject of the present thesis is the architectural aspect of healthcare facilities with a focus on the work of the architects František Čermák and Gustav Paul. The initial part outlines the general classification and development of the building system of these facilities - ranging from the "pavilion" type to the extensive hospital blocks - illustrated by examples. The next part describes types of hospitals and their designs, especially after 1948. It includes a brief overview of both Czech and foreign projects that are of significance. The subsequent part introduces the life and oeuvre of the architects František Čermák and Gustav Paul, detailing several particular projects and realizations. Among those chosen for further elaboration are the projects of the Municipal Infectious Diseases Hospital in Bratislava, Clinical and Foundation Hospital in Zagreb, Tuberculosis Sanatorium in Vyšné Hágy and the Hospital in Prague-Motol; and further their realizations including the Sanatorium in Vráž u Písku, Provisional Hospital in Prague-Motol, completion of the main pavilion of the Hospital in Litomyšl and finally the Hospital in Chrudim.

Healthcare facility wastewaters are a potentially important and under characterized source of pharmaceuticals and personal care products to the environment. In this study the composition and magnitude of pharmaceuticals and personal care products (PPCPs) released into a single municipality’s wastewater system from a hospital, a nursing care facility, an assisted living facility and an independent living facility are presented for 54 pharmaceuticals, 8 hormones and 31 Alkylphenol ethoxylates (APEOs). Chemical oxidation using molecular ozone and advanced oxidation processes (AOPs) (UV-hydrogen peroxide, Fenton’s Reagent, and Photo – Fenton’s Reagent) were screened and evaluated as potential treatment technologies for removal of APEOs in water and wastewater. In this research, APEOs were found to be dominant PPCP class out of 94 individual analytes measured, accounting for more than 65% of the total mass loading observed leaving the healthcare facility wastewater. Seventy one out of the total measured PPCPs were detected in wastewater from at least one of the facilities. Healthcare facility wastewater are the source of PPCPs to the environment; however, their contribution to the total magnitude of PPCPs in municipal wastewater and the surrounding environment will be determined by the relative flow contribution of wastewater released from the facility to the municipal sewer network. Molecular ozone and advanced oxidation processes were observed to remove APEOs from analyzed water matrices; however, understanding the product formation during the oxidation process is important before concluding a suitable treatment process. Molecular ozone reacted selectively with the double bond in the APEO while AOPs reaction was non selective oxidation. During the AOPs, OH· formation rate and scavenging rate constant of wastewater was found to be the factors governing the oxidation process. Thus, the research carried out informs a risk management decisions concerning the prevalence of PPCPs in the wastewater and use of oxidation systems as a treatment technologies for removal of PPCPs.

In the theoretical section of my master thesis I focused especially on the role of the health services within the crisis management. In particular chapters I tried to write down a simple and comprehensive summary of the role of the healthcare within the integrated rescue system, I dealt with the function of the Ministry of Health, the hierarchy of the healthcare in solving the emergencies, the valid law and the crisis preparedness in the healthcare. In one part of my master thesis I also mentioned the importance of testing the professional and practical readiness of particular units of the integrated rescue system by emergency exercises and the characterization of their individual types. Of course I could not omit the crisis planning and a brief description of some chosen types of plans that are used during emergencies.The goal of my thesis was to map the preparedness of the South-Bohemian Region inpatient healthcare facilities for possible emergencies in the respective facility or out of it and the medical staff´s awareness of possible risks and of possible solving the emergencies in the respective facility.In the practical section of my master thesis I used the methods of quantitative research. The technique of this research is based on the questionnaire survey with bounded, half-bounded and open questions. The questionnaire designated for medical staff consists of 23 questions. The first three questions are focused on the characterization of the respondents; the remaining twenty questions are to find out the stock of knowledge related to the crisis preparedness. The respondent gets one point for each correct answer to a knowledge question. This part of the questionnaire is composed as a multiple-choice test and one can get 43 points at most. The questions were created using the crisis plans that are valid in the České Budějovice Hospital. After our mutual agreement I took over the questionnaire designated for healthcare facilities from Mgr. Jolana Němečková, who analysed the crisis preparedness of the South-Moravian Region healthcare facilities in her master thesis. I did not change the method of questionnaire analysis either to enable a subsequent benchmarking of the results in the South-Moravian Region and the South-Bohemian Region. The questionnaire consists of 28 questions. One can get one point for a dichotomous question and two points for a closed-ended question. The highest possible score was 22 points. The results of the questionnaire survey for medical staff show that the preparedness of the České Budějovice Hospital´s medical staff is at a very good level. The average score was 37 out of 43 points and that complies with the classification 2. When analysing the relation of the preparedness with the highest achieved education level and the preparedness with the length of the practice, the positive correlation was confirmed. That means that the higher achieved education and the longer practice, the more was the knowledge of the respective area. The results of the questionnaire survey for the inpatient healthcare facilities management are not so positive. The average score was 12.3 and that complies almost with the classification 4, which means a bad preparedness. In comparison with the South-Moravian Region healthcare facilities, the preparedness in the South-Bohemian Region is one level worse. For the purposes of my master thesis I set four hypotheses that were proved or falsified during a follow-up statistical assessment. Hypotheses No. 1 and No. 2 cannot be accepted. Hypotheses No. 3 and No. 4 were accepted.