La reconnaissance du pluralisme du système de santé, et donc des interdépendances unissant l’État aux acteurs participant à l’offre des services de santé, pose non seulement la question de la capacité de l’État à gouverner selon ses objectifs, mais aussi celle de la forme des interventions entreprises à cette fin. Cette thèse vise à comprendre comment se développe la participation de l’État à la gouverne d’un secteur de services de santé, et plus particulièrement comment ses interactions avec les acteurs impliqués dans l’offre des services affectent, au fil du temps, les possibilités d’actions étatiques sous-jacentes à la sélection d’instruments de gouverne spécifiques. Elle propose pour ce faire un modèle théorique qui s’inspire de la littérature traitant des instruments de gouverne ainsi que de la théorie de la pratique (Bourdieu). La participation de l’État à la gouverne y est conçue comme le résultat d’un processus historique évolutif, marqué alternativement par des périodes de stabilité et de changement en regard des instruments mobilisés, qui se succèdent selon l’articulation des interactions et des contextes affectant les possibilités d’action que les acteurs perçoivent avoir. Ce modèle a été appliqué dans le cadre d’une étude de cas portant sur le secteur génétique québécois (1969-2010). Cette étude a impliqué l’analyse processuelle et interprétative de données provenant de sources documentaires et d’entrevues réalisées auprès de représentants du ministère de la Santé et des Services sociaux ainsi que de médecins et chercheurs œuvrant dans le secteur de la génétique. Ces analyses font émerger quatre périodes de stabilité en regard des instruments de gouverne mobilisés, entrecoupées de périodes de transition au cours desquelles le Ministère opère une hybridation entre les instruments jusque là employés et les nouvelles modalités d’intervention envisagées. Ces résultats révèlent également que l’efficacité de ces instruments - c’est-à-dire la convergence entre les résultats attendus et produits par ceux-ci - perçue par le Ministère constitue un facteur de première importance au regard de la stabilisation et du changement des modalités de sa participation à la gouverne de ce secteur. En effet, lorsque les instruments mobilisés conduisent les médecins et chercheurs composant le secteur de la génétique à agir et interagir de manière à répondre aux attentes du Ministère, les interventions ministérielles tendent à se stabiliser autour de certains patterns de gouverne. À l’inverse, le Ministère tend à modifier ses modes d’intervention lorsque ses interactions avec ces médecins et chercheurs le conduisent à remettre en cause l’efficacité de ces patterns. On note cependant que ces changements sont étroitement liés à une évolution particulière du contexte, amenant une modification des possibilités d’action dont disposent les acteurs. Ces résultats révèlent enfin certaines conditions permettant au Ministère de rencontrer ses objectifs concernant la gouverne du secteur de la génétique. Les instruments qui impliquent fortement les médecins et chercheurs et qui s’appuient sur des expertises qu’ils considèrent légitimes semblent plus susceptibles d’amener ces derniers à agir dans le sens des objectifs ministériels. L’utilisation de tels instruments suppose néanmoins que le Ministère reconnaisse sa propre dépendance vis-à-vis de ces médecins et chercheurs. / The recognition of a pluralistic healthcare system based on the interdependency between the State and other healthcare providers raises the question on how the State can manage according its own goals and what are the necessary actions to achieve those. The current thesis aims at understanding how can the State participate in governing the healthcare sector. More precisely, it intends to accurately look at how the State’s interaction with several health care providers impacts over time its action capacities to select specific governance instruments. To achieve these objectives, the thesis uses a theoretical framework based on literature about governance instruments as well as Bourdieu’s practice theory. The State’s participation in governance is conceived as an evolving historical process with periods of stability and change over instruments in use. They alternate according the interaction dynamic and the context influencing an actor’s perception of action possibilities. This framework is applied on a case study: Quebec’s genetic sector (1969-2010). This study involves processes and interpretative analysis of data originating from bibliographical sources and interviews conducted amongst representatives of the Ministère de la Santé et des Services Sociaux (hereafter: the ministry), as well as physicians and researchers working in genetics. The analysis outlines four periods of stability in regards to the mobilization of governance instruments, intertwined by periods of transition during which the ministry operates hybridization between instruments used and new intervention modes considered. These results show that the efficiency of these instruments – meaning the convergence between expected results and actual outcomes – perceived by the ministry is a prime factor in terms of stabilization and change in its participation in the governance of the field. Thus, when used instruments lead physicians and researchers in genetics to act and interact in a way responding to the ministry expectations, its interventions tend to gravitate towards a certain governance pattern. On the other hand, the ministry tends to modify its methods of intervention when its interactions with the physicians and researchers shed doubts on the efficiency of those patterns. It was noticed that these changes are closely linked to a particular evolution of the context, bringing a modification to possible actions available to actors. Finally, results show certain factors allowing the ministry to achieve its objectives in regards to the governance of the genetics sector. The instruments strongly involving physicians and researchers and based on expertise considered to be legitimate appear more likely to bring a favorable action from those specialists in the view of the ministry’s objectives. Nevertheless, using such instruments supposes that the ministry recognizes its own dependence towards these physicians and researchers.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In despite of the great advantages of adopting computer systems for storing patient's information in hospitals and clinics, such systems are adopted with restrictions in these institutions. Some studies indicate that the rejection of such systems by the clinicians is greats due to computing not consider the particularities of the activities performed by the user in the clinical field. Considering this background, the project ClinicSpace aims to build a prototype tool to help health professionals in performing of their activities, using concepts and technologies of ubiquitous computing, which suggests that the computation must be fully integrated into the environment, disappearing from the user's consciousness and assisting him in their daily activities. This paper proposes an architecture called pEHS - Pervasive Electronic Healthcare System - a electronic health system inserted in the ClinicSpace's proposal, where the computing is oriented to clinical activities and the applications do interact with the ubiquitous environment through context information. The contribution of this paper is the proposal of a new software architecture in which pEHS modular applications follows the medical activities, making the system to adapt to the clinician's activities. In the architecture there are two points in evidence: the possibility of access to any information from the patient's health history and the adaptation of pEHS applications to the context information at runtime. The prototyped architecture will be used in the ClinicSpace project to build the applications needed for the clinicians helping them to carry out their activities. / Apesar das grandes vantagens existentes na adoção de sistemas computacionais para armazenamento das informações do paciente em ambientes hospitalares, tais sistemas são adotados com restrições em hospitais. Estudos indicam que a rejeição destes pelos clínicos é grande devido à computação não levar em consideração as características das atividades desempenhadas pelo usuário e sua forma particular de o fazê-lo. Tendo em vista essa necessidade, o projeto ClinicSpace tem por objetivo prototipar uma ferramenta para auxílio ao profissional de saúde na realização de suas atividades, utilizando conceitos e tecnologias da Computação Ubíqua, a qual propõe que a computação deve ser totalmente integrada ao ambiente de forma a desaparecer da consciência do usuário e auxiliá-lo na realização de suas atividades diárias. Este trabalho propõe uma arquitetura chamada pEHS Pervasive Electronic Healthcare System sistema eletrônicos de saúde inserido na proposta do ClinicSpace, onde a computação é orientada a atividades clínicas e as aplicações interagem com o ambiente ubíquo através das informações de contexto. A contribuição deste trabalho é uma proposta nova de arquitetura de software na qual as aplicações modulares do pEHS acompanham as atividades médicas, fazendo com que o sistema adapte-se às atividades do profissional. Destacam-se dois pontos da arquitetura:a possibilidade de acesso a qualquer informação do histórico de saúde do paciente e a adaptação das aplicações pEHS às informações de contexto em tempo de execução. A arquitetura prototipada será utilizada no andamento do projeto ClinicSpace para a construção das aplicações necessárias aos profissionais de saúde para a realização de suas atividades de forma personalizada.

Tese(doutorado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2011. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2012-12-03T16:12:04Z No. of bitstreams: 1 jacqueline.pdf: 1036624 bytes, checksum: a7d2e7237f00e5039bd15d8e62718327 (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2012-12-06T02:53:39Z (GMT) No. of bitstreams: 1 jacqueline.pdf: 1036624 bytes, checksum: a7d2e7237f00e5039bd15d8e62718327 (MD5) / Made available in DSpace on 2012-12-06T02:53:39Z (GMT). No. of bitstreams: 1 jacqueline.pdf: 1036624 bytes, checksum: a7d2e7237f00e5039bd15d8e62718327 (MD5) Previous issue date: 2011 / A presente pesquisa teve por objetivos: compreender, quanto à fundamentação teóricofilosófica e organizativa, como os Documentos do MS tratam a pesquisa em saúde no Brasil; delinear, a partir da fundamentação teórico-filosófica e organizativa, presente no conjunto de documentos oficiais do MS que trata da pesquisa para a saúde no Brasil, uma Rede Ecossistêmica de Pesquisa em Enfermagem/Saúde nos HUs Federais, para auxiliar na consolidação do SUS. Traçou-se a seguinte TESE: É possível delinear, a partir da fundamentação teórico-filosófica e organizativa, presente no conjunto de documentos oficiais do MS que trata da pesquisa para a saúde no Brasil, uma Rede Ecossistêmica de Pesquisa em Enfermagem/Saúde nos HUs Federais, para auxiliar na consolidação do SUS. Para sustentar a referida tese, procurou-se, no referencial contextual e teórico, os temas: Sistema Único de Saúde – SUS; Hospitais Universitários Federais na perspectiva ecossistêmica; Pensamento Sistêmico, numa Abordagem Ecossistêmica; Interfaces da Pesquisa Ecossistêmica nos HUs Federais e a Pesquisa Ecossistêmica em rede na enfermagem/saúde. Ele mostrou-se coerente, consistente e ancorador em relação à análise e à interpretação dos dados e permitiu aprofundar o conhecimento sobre a temática. O caminho metodológico caracterizou-se como exploratório, descritivo, com abordagem qualitativa. Para capturar os dados, utilizou-se um instrumento de pesquisa documental, estruturado em três pilares básicos, que contemplaram os aspectos capazes de abranger o escopo da proposta. Contemplando objetivo, questão de pesquisa e tese foram desenvolvidos, com base nos dados capturados, três artigos: SUS e a Pesquisa Ecossistêmica em Enfermagem/Saúde: estratégia de inovação na produção de ciência, tecnologia e assistência em saúde; Rede Ecossistêmica de Pesquisa em Enfermagem/Saúde nos HUs Federais e Rede Ecossistêmica de Pesquisa em Enfermagem/Saúde nos Hospitais Universitários Federais: uma possibilidade para a Pesquisa em Enfermagem/Saúde. Os resultados do primeiro artigo mostraram que, ao promover a Pesquisa Ecossistêmica em Enfermagem/Saúde nos HUs Federais, existem possibilidades de produzir inovação no pensar e fazer e, assim, alcançar resultados mais positivos na assistência, induzindo à sustentabilidade ao Sistema. O segundo enfatiza que as ações de pensar e fazer, balizadas pelo princípio sistêmico integrador, expresso em rede, podem aumentar as interfaces entre pesquisadores de diversas áreas investigativas e suas concepções metodológicas e, assim, alavancar ciência e tecnologia e capacitação científica ao trabalhador de enfermagem/saúde e inserir ganho na prestação da assistência/saúde. O terceiro demonstra que, por meio de um modelo mental ancorado em referencial ecossistêmico, é possível delinear uma Rede Ecossistêmica de Pesquisa em Enfermagem/Saúde em HUs Federais. Considera-se que o SUS necessita ser constantemente repensado, a fim de buscar e obter soluções pertinentes; precisa inovar, evoluir, especialmente na pesquisa, e promover qualidade no ensino, na assistência à saúde e no ambiente, até mesmo, para a sua própria manutenção como sistema de saúde. / The objective of this research was to outline an Ecosystemic Net of Research in Nursing/Health in Federal University Hospitals in order to help consolidate the Integrated Healthcare System, based on the theoretical-philosophical and organizational basis which is found in official documents issued by the Ministry of Health about research in health in Brazil. The following THESIS was analyzed: In order to help the consolidation of the Integrated Healthcare System, it is possible to outline an Ecosystemic Net of Research in Nursing/Health in Federal University Hospitals, based on the theoretical-philosophical and organizational basis which is found in official documents issued by the Ministry of Health about research in health in Brazil. In order to support this thesis, the theoretical section of this study involved these themes: the Integrated Healthcare System, Ecosystemic Research in the Integrated Healthcare System and Federal University Hospitals from the perspective of Ecosystemic Research. It was coherent, consistent and primordial regarding the analysis and the interpretation of data and enabled to deepen knowledge of the theme. The methodology was characterized as exploratory and descriptive in a qualitative approach. In order to collect data, a specially designed documentary research tool was used; its structure has three basic pillars which comprised the fundamental aspects and some secondary ones that were able to embrace the whole scope of the proposal. Regarding the objective, the question and the thesis, three papers, based on the data collected in the official documents issued by the Ministry of Health, were written: “The Integrated Healthcare System and Ecosystemic Research in Nursing/Health: an innovation strategy in the production of science, technology and healthcare”; “An Ecosystemic Net of Research in Nursing/Health in Federal University Hospitals”; and “ An Ecosystemic Net of Research in Nursing/Health in Federal University Hospitals: a possibility of research in Nursing/Health”. The results of the first paper showed that, when Ecosystemic Research in Nursing/Health is promoted in Federal University Hospitals, it is possible to bring innovation to thoughts and actions which aim at getting more positive results in healthcare and to make the Integrated Healthcare System more sustainable. The second paper highlights that actions and thoughts that are mediated by an integrative systemic principle, expressed in a net, may strengthen the interfaces among researchers from different areas and their methodological conceptions. Consequently, science and technology will be enhanced, workers in Nursing/health will get more scientific knowledge and healthcare will be considerably enriched. The third one shows that, based on a mental model attached to ecosystemic references, an Ecosystemic Net of Research in Nursing/Health may be outlined in Federal University Hospitals. The Integrated Healthcare System needs to be constantly reviewed so that it may look for and find adequate solutions, innovate, evolve - mainly in research - and improve the quality of teaching, of healthcare and of the environment in order to be maintained as an integrated healthcare system. / La presente investigación tuvo los seguientes objetivos: comprehender, cuanto la fundamentación teórica-filosófica y organizativa, como los documentos del MS tratan la investigación en salud en Brasil; delinear, partiendo de la fundamentación teórico-filosóficas y organizativa, presente en el conjunto de documentos oficiales del MS que trata de la investigación para la salud en Brasil, una Red Ecosistémica de Investigación en Enfermería/Salud en los HUs federales para la consolidación del SUS. Fue elaborada la siguiente TESIS: Es posible delinear, partiendo de la fundamentación teórico-filosófica y organizativa, presente en el actual conjunto de los documentos oficiales del MS que proviene de la Investigación de la Salud en el Brasil, una Red Ecosistémica de Investigación de Enfermería / Salud en los HUs Federal, para ayudar a la consolidación del SUS. Para sostener la referida tesis, fue buscado en el referencial contextual y teórico, los temas: Sistema Unificado de Salud – SUS; Hospitales Universitarios Federales en el enfoque ecosistémico; Pensamiento sistémico, un enfoque ecosistémico; Interfaces de Investigación de Ecosistémica en los HUs Federales y la Investigación Ecosistémica en red en la enfermería/salud. Él resultó ser coherente, consistente y anclado en relación al análisis y la interpretación de datos y permitió profundizar conocimientos sobre el tema. El enfoque metodológico es caracterizado como exploratorio, descriptivo, con enfoque cualitativo. Para capturar los datos, se utilizó la herramienta de investigación documental, estructurado en tres pilares básicos, que contemplan aspectos capaces de cubrir el alcance de la propuesta. Contemplando objetivo, la cuestión de investigación y tesis han desarrollado, sobre la base de los datos capturados, tres artículos: SUS y la Investigación Ecosistémica en Enfermería/Salud: Estrategia la innovación en la producción de ciencia, tecnología y cuidados de salud; Red Ecosistémica de Investigación en Enfermería /Salud en los Hospitales Federales y Red Ecosistémica de Investigación en Enfermería/Salud en los Hospitales Universitarios Federales: una oportunidad para la Investigación Enfermería/Salud. Los resultados del primer artículo mostraron que, mediante la promoción de la investigación ecosistémica de Enfermería / Salud en los HUs Federales, existe la posibilidad para producir la innovación en el pensamiento y la acción y así lograr resultados más positivos en la asistencia, induciendo la sostenibilidad del Sistema. El segundo enfatiza las acciones de pensar y hacer, impulsado por el principio sistémico integrador, expresado en red, pueden aumentar las interfaces entre los investigadores de diferentes áreas de investigación y sus puntos de vista metodológico y por lo tanto, dar importancia a la ciencia, la tecnología y la formación científica del trabajador de la Enfermería/Salud y inserir puntos positivos a la prestación de atención/salud. El tercero muestra que a través de un modelo mental anclado en un referencial ecosistémico, es posible delinear una Red Ecosistémica de Investigación en Enfermería/Salud en HUs Federales. Se considera que el SUS tiene que ser constantemente repensado a fin de solicitar y obtener las soluciones adecuadas; para innovar, desarrollar, especialmente en la investigación y promover la calidad en la enseñanza, en la asistencia a la salud y el ambiente, incluso para su propio mantenimiento como sistema de salud.

During the last decade, electronic prescribing has been a point of focus in healthcare industry and is rapidly becoming a standard of practice. It has proven as an important element in improving the quality of patient care, mitigating or eliminating the phone calls back and forth from pharmacies to point of care/health centers. Many e-prescribing systems were developed and marketed but these usually were unsuccessful because of the lack of direct electronic connectivity to local pharmacies and the lack of up-to-date formulary information, clinical guidelines, health plans & services among other reasons. Despite their benefits, the adoption and usage of electronic prescribing systems has been low. In some of the developing countries like Uganda, the problem is even worst. Due to lack of essential resources and manpower, healthcare services have significantly impacted on the productivity and quality of patient care.In an effort to improve, promote and maintain the quality of health services in rural settings of developing countries like Uganda, a high level design for e-prescribing system has been proposed. Design specifications for Electronic Prescribing Management System (EPMS) along with functional prototype are built based on ICT4MPOWER project requirements and previous research and publications in this area.Initially research began with Drug and Stock Management System and EPMS emerged as one of its essential components. In order to strengthen and establish connection between ongoing electronic health record system and drug and stock management development, EPMS component came into lime light. Mare prescription management is not enough to serve patient centric needs. Hence, clinical decision support has been introduced into e- prescribing system to improve the quality of prescribing decisions. In order to develop a patient-centric e-prescribing system that is self-evolving and self sustaining, it is important to update the clinical decision-support system, formularies & guidelines on regular basis. In order to make it usable, it is required to formulate effective health plans and increase associations between pharmacies and other health organizational units. The principal benefit of introducing E-prescribing system into Electronic Health Record (EHR) System is to connect open ended systems to form a strong knowledge base for future. / ICT4MPOWER

This diploma thesis deals with the Czech healthcare system. Healthcare is generally reffered to as system but not always healthcare problems are solved systematically. Therefore systems theory, theory of complex adaptive systems and other notions, that are often used in healthcare, were described in this thesis. The objective of this thesis was analysis of impacts of patient's financial participation (20 %, 25 % and 30 %) on health care to their financial situation in the complex adaptive healthcare system. In this thesis four indicators were used -- poverty line, household subsistence spending, impoverished households, catastrophic health expenditure. The World Health Organization defined this indicators for World Health Survey in different countries. The indicators were applied to a sample of Czech households and some impacts of increased participation were calculated. It results from this calculation that the increased participation of households has virtually only small impacts to their financial situation. By the indicators of poverty just few households would be on the poverty line. Nevertheless, this results aren't generalized to the whole Czech population. With this indicators we should further work and develop them in order that they could serve as tool to evaluation of state's intervetion into healthcare system.

Black Americans experience influenza vaccination rates that are lower than the rates of other ethnic groups. Low influenza vaccination rates among the Black community are associated with higher influenza infection rates, influenza-related hospitalizations, and higher influenza mortality rates. There is a belief within the Black American community that the medical establishment does not have the Black American patient in its best interest, leading to feelings of distrust. The purpose of this study was to determine if the distrust of the medical community is a relevant factor in the low influenza vaccination rates of Black Americans aged 18 and older in Baltimore, Maryland. The study also examined the belief that the influenza vaccine causes the flu and the effect this belief may have on influenza vaccination rates. The public health critical race theory served as the framework for the study. Previously validated survey instruments, the Health Care System Distrust Scale and the Adult Influenza Immunization Survey, were obtained with permission and used to collect data from the members of a Baltimore city church. The study used chi-square analysis, multivariable logistic regression, and narrative discussion to address the research questions and analyze the data of 105 completed surveys. Results of the study determined that distrust of the medical community was not a relevant factor in the influenza vaccination rates of study participants, and that participants' vaccination status was influenced by factors other than distrust. Implications for social change included improving the influenza vaccination rate among Black Americans and decreasing their influenza mortality rates.

Introducción: la población LGBTI busca atención médica con menor frecuencia y en etapas de enfermedad más avanzadas que la población general. Objetivos: identificar los factores asociados a la falta de búsqueda de atención médica en la población LGBTI en Perú en 2017. Metodología: se realizó un estudio observacional transversal analítico de fuente secundaria usando los datos de la Primera Encuesta Virtual para Personas LGBTI, 2017 en Perú. Se elaboró un modelo de regresión de Poisson con varianza robusta para estimar las razones de prevalencias cruda y ajustada. Resultados: se incluyeron 5 646 participantes en el estudio. El 15.85% no buscó atención médica. El 74.04% vivía en Lima y Callao. El 29.84% no contaba con seguro de salud, mientras que el 46.42% refirió problemas de salud mental. Se encontró que la falta de búsqueda de atención médica fue más frecuente entre quienes viven en la región Centro, comparado con Lima (RP: 1.38, IC95%: 1.10-1.74, p = 0.006); quienes refirieron problemas de salud mental, comparado con tener problemas relacionados a enfermedades crónicas (RP: 8.81, IC95%: 6.10-12.71, p < 0.001); y los que no pueden expresar su sexualidad sin temor (RP: 1.23, IC95%: 1.08-1.39, p = 0.001). Conclusión: la falta de búsqueda de atención médica entre las personas LGBTI se asoció a vivir en la región Centro, padecer algún problema de salud mental y no poder expresar la sexualidad sin temor. / Background: LGBTI population use health care services less frequently and in more severe disease stages than general population. Aim: to describe factors associated with non-use of health care services by LGBTI population in Peru in 2017. Methods: we performed a cross-sectional analytical study using data from the First Virtual Survey for LGBTI Population, 2017 in Peru. We designed a Possion regression model with robust variance to estimate the crude and adjusted prevalence ratio. Results: we included 5 646 participants. 15.85% did not use health care services. 74.04% lived in Lima and Callao. 29.84% did not have any health insurance, while 46.42% referred mental health problems. The outcome was more frequent in participants that came from the Central region of Peru (PR: 1.38, CI95%: 1.10-1.74, p 0.006); those who referred mental health problems (PR: 8.81, CI95%: 6.10-12.71, p < 0.001); and in those who felt they could not express their sexuality without fear (PR: 1.23, CI95%: 1.08-1.39, p 0.001). Conclusion: non-use of health care services by LGBTI Peruvian population was associated with living in the Central region of Peru, having mental health problems and not being able to express one’s sexuality without fear. / Tesis

Det finns ett uttalat behov av nya innovativa vårdmodeller inom hälso- och sjukvården. Svensk vård står inför signifikanta utmaningar och karaktäriseras av brist på sjukvårdsplatser, eskalerande kostnader och minskat patientförtroende. Hospital at Home (HaH) erbjuder möjligheter till förbättrad tillgänglighet, kostnadseffektivitet och patienttillit inom vården, men dess implementering begränsas av bristande förståelse för rådande finansiella förutsättningar, otillräckliga regelverk och inadekvata ersättningsmodeller. Denna studie syftar till att fördjupa förståelsen för de finansiella förutsättningar som påverkar implementeringen av innovativa vårdmodeller, såsom HaH, i komplexa decentraliserade sjukvårdssystem. Genom att utveckla ett teoretiskt ramverk som utforskar hur befintliga ersättningsstrukturer påverkar införandet av innovativa vårdformer, syftar denna studie till att bidra till förbättrat strategiskt beslutsfattande för en framgångsrik implementering och effektiv integrering av HaH i den svenska vården. Studien har tillämpat en utforskande abduktiv ansats, vilken realiserats genom en mixad metod som kombinerar enkäter och fallstudier. Datainsamlingen genomfördes via enkäter distribuerade till Sveriges 21 regioner samt genom semi-strukturerade intervjuer med representanter från tre svenska HaH-initiativ. Studien konstaterar att förberedelse och implementering av vårdinnovationer i decentraliserade system påverkas av flertalet både yttre och inre faktorer. Regelverk och direktiv, avtal samt extern budgetering och resursfördelning utgör grunden för hur vårdtjänster struktureras och finansieras. Dessa externa ramar är fundamentala i skapandet av en miljö som främjar vårdinnovation. Lokala variationer, vårdaktörer, verksamhetsformer och ersättningsmodeller spelar sedan en direkt roll i hur olika vårdmodeller utformas, finansieras och levereras i praktiken. Slutligen understryker studien behovet av en nationell definition av HaH och dess verksamhetsform, revidering av begränsande regelverk samt inkorporering av rörliga ersättningskomponenter till HaH-vårdutförare för att underlätta en storskalig implementering av HaH i Sverige. / There is a pressing need for innovative care delivery models within healthcare. Swedish healthcare faces formidable challenges including a shortage of hospital beds, escalating costs, and diminishing patient trust. Hospital at Home (HaH) presents an opportunity to enhance accessibility, cost-effectiveness, and patient trust within the healthcare system. However, its widespread adoption is impeded by a lack of understanding of current financial preconditions, insufficient regulations, and inadequate reimbursement models. This study seeks to enhance the understanding of financial preconditions influencing the implementation of innovative care models, such as HaH, within decentralized healthcare systems. Through the development of a theoretical framework that examines how current compensation structures impact the adoption of innovative care models, this study aims to inform strategic decision-making for the successful implementation and effective integration of HaH into Swedish healthcare. This thesis employs an exploratory abductive approach, utilizing a mixed-methods strategy that combines surveys and case studies. Data was collected through surveys distributed across all 21 Swedish regions, complemented by semi-structured interviews with representatives from three Swedish HaH initiatives. The study finds that the preparation and implementation of healthcare innovations in decentralized systems are significantly shaped by a range of external and internal factors. Regulatory frameworks, contractual agreements, and mechanisms for budgeting and resource distribution form the basis for how healthcare services are structured and financed. These external factors are fundamental in creating an environment that promotes healthcare innovation. Moreover, local variations, healthcare providers, operational forms, and reimbursement models directly influence how different care models are designed, financed, and delivered in practice. Finally, the study highlights the critical need for a national definition of HaH, the revision of restrictive regulations, and the integration of variable reimbursement components to facilitate widespread adoption of HaH across Sweden.

The study aimed to investigate the implementation of customer care at the Casualty Department of Edenvale Regional Hospital in Gauteng Province. The research was conducted using a qualitative case study approach, which sought to gain deeper understanding of the impact of customer care in the hospital’s Casualty Department from the employees’ point of view. Data was collected from 16 purposively selected respondents using semi-structured interviews and document analyses were interpreted by the researcher to give voice and meaning to the assessment topic. Data was analysed using the Content Analysis framework and six themes emerged from the data analysis: (1) High expectation levels from the community; (2) Quality of patient care; (3) Lack of resources; (4) Malfunctioning equipment; (5) Compromised safety and security; (5) Strategies to improve customer care; and (6) The effect of policies and guidelines on the quality of services rendered. The study revealed that the surrounding community that is served by the Edenvale Hospital’s Casualty Department had high expectations which the hospital was unable to meet because of the many limitations, especially resource constraints. The issues and difficulties associated with overcrowding in the emergency section were raised by respondents, who reported several challenges experienced in the hospital. These included patients sleeping on floor mattresses and even on stretchers, inadequate beds, shortage of staff, malfunctioning equipment and lack of sufficient infrastructure. These challenges resulted in long waiting periods for patients to be given open beds in the wards, bad attitudes from both patients and employees alike, poor communication among staff and patients and their families, and an unsafe environment for the staff and customers (patients). There is hence a need for the Gauteng Health Department together with the hospital management to review resources allocated to the Edenvale Regional Hospital and to increase awareness among the community about the operations of the level 2 hospitals such as this. / Public Administration / M. P. A.

Le système de santé français repose sur une dichotomie publique-privée. Cette dualité juridique se retrouve dans l’offre de soins proposée aux patients qui disposent du libre choix de se faire hospitaliser aussi bien en établissement de santé public qu’en établissement de santé privé, l’hospitalisation privée devenant prépondérante en France. Pour le patient peu importe la structure d’hospitalisation, puisque les droits des patients étant des droits fondamentaux, pour certains constitutionnellement garantis, ce dernier doit bénéficier des mêmes droits quel que soit le lieu de son hospitalisation. Or les conséquences engendrées par la spécificité « privée » de l’établissement de santé amène à s’interroger sur une éventuelle disparité dans l’application des droits du patient, qui pourraient être à l’origine d’un statut propre au patient hospitalisé en établissement de santé privé. / The French healthcare system relies on a public-private dichotomy. This difference in legal status is reflected in the actual provision of healthcare, as patients have the right to choose their preferred type of hospitalization with private sector hospitalizations now becoming predominant in France. However, patients must be granted the same rights regardless of which type of hospital they have chosen, due to the fact that patients' rights are fundamental rights, and for some of them they are constitutionally guaranteed. The implications of the specific nature of private hospitals raise questions about a potential disparity in the application of patients' rights, which would result in a different status for patients entering private hospitals.