Incident reporting systems offer rich opportunities for learning from errors in health care. However, little attention has been given to understanding how the implementation of reporting system characteristics impact analysis and communication activities. This research explored the characteristics of reporting systems that promote analysis and communication activities. Ten characteristics were identified through a comprehensive literature review. Two reporting systems were then compared to assess how differences in the implementation of the characteristics impact the contents of the database. The results demonstrated that differences in the characteristics’ implementation have an effect on the ability to extract information essential to analysis activities. Next, the reporting processes of the two systems were mapped onto a hierarchical framework to highlight how the characteristics influence the communication of incident information across the health care system. The presented work furthers the understanding of characteristics needed to design reporting systems more effective at promoting learning.

Incident reporting systems offer rich opportunities for learning from errors in health care. However, little attention has been given to understanding how the implementation of reporting system characteristics impact analysis and communication activities. This research explored the characteristics of reporting systems that promote analysis and communication activities. Ten characteristics were identified through a comprehensive literature review. Two reporting systems were then compared to assess how differences in the implementation of the characteristics impact the contents of the database. The results demonstrated that differences in the characteristics’ implementation have an effect on the ability to extract information essential to analysis activities. Next, the reporting processes of the two systems were mapped onto a hierarchical framework to highlight how the characteristics influence the communication of incident information across the health care system. The presented work furthers the understanding of characteristics needed to design reporting systems more effective at promoting learning.

The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics. Data sources: The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 155 family practice clinic managers. Analyses included frequencies and percentages for quantitative items and a content analysis for open-ended items. Conclusions: HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs and patients alike. In Utah, 56.8% of family practice clinics had either no vaccination policy for HCWs or had a policy with no consequences for noncompliance. Utah family practice clinics need to implement changes to create and maintain HCW vaccination policies. Implications for practice: Nurse practitioners can be leaders and change agents by working with their county and state health departments to create state-wide policies that mirror the position statements from the American Nurses Association and the American Association of Nurse Practitioners.

The health industry in Canada, as well as in other industrial countries, has been in the process of reform for many years. While such reform has been attributed to fiscal necessity due to increased health costs, the underlying causes are far more complex. Demographic changes, new technologies, expanded health care procedures and medications, increased demand and the globalization of health services have all contributed to the change and complexity of the industry. Health reform varies from country to country. In Canada, with a publicly funded health industry, the main reform method has been regionalization. This decentralized reform method arranges health services under a regional corporate management structure. The primary objective of this study was to assess the effects of health reform on the educational development of health-care managers in British Columbia, a western province of Canada. The study had a two-fold approach; to ascertain how health reform had changed the skill needs of health-care managers, and whether e-learning could benefit health management education. The key research questions that guided the study were: How might recent changes in the health industry have affected the learning needs and priorities of health-care managers? What factors might hinder attempts to meet any learning needs and priorities of health-care managers? and What benefits might e-learning provide in overcoming hindrances to effective health management education? / A combination of quantitative (survey closed questions) and qualitative (survey open-ended questions, interviews and stakeholder feedback) methods was employed in this study. Overall, this study is described as productive social theory research, in that it addressed a recognized change in learning needs for health-care managers following a period of health reform, a socially significant phenomenon in the health industry. Relying on such tools as a survey, interviews, and stakeholder discussions, data was collected from over five hundred health-care managers. The data collected in this study provided valuable insight into the paradigm shift occurring in the educational needs of these managers. The study found that health reform had expanded the management responsibilities of healthcare managers and increased the complexity of service delivery. Restructuring of the health industry decreased the number of managers, support systems, and career opportunities for managers and increased the manager’s workload, communication problems and the need for new knowledge and skills. In addressing the learning needs of health-care managers, the study found there were limitations in health management educational opportunities available to health-care managers. The findings also show that current health management education was focused on senior managers leaving the majority of industry leaders with limited learning opportunities to upgrade their knowledge and skills at a time of great organizational change. / In addition, a classroom format dominated the learning delivery options for many managers. A list of fourteen management skills was used in the survey instrument to ascertain what new skills were needed by health-care managers following thirteen years of health reform. The findings show that of the fourteen skills, twenty-nine percent of health-care managers had no training and fifty-seven percent received their training through in-service, workshops and seminars. Irrespective of gender, age, working location and education the data showed that healthcare managers were mainly receiving training in change and complexity and people skills with less training occurring in planning and finances. Using the same fourteen skills, health-care managers priorized their immediate learning needs, listing the top three, as: evidence-based management, change and complexity and financial analysis. While evidence-based management and financial analysis could be attributed to the introduction of a corporate management structure in the health industry, change and complexity was an anomaly as managers were already receiving training in this skill. Health industry stakeholders believed this anomaly was due to continued uncertainties with ongoing health reform and/or a need for increased social interaction during a time of organizational change. In addressing the many learning needs of health-care managers a new health management education strategy was proposed for the province which included the need for an e-learning strategy. / The e-learning approach being proposed in this study is an integration of skill training and knowledge sharing directly blended into the workflow of the managers, using a variety of learning technologies. To support this idea, the study found that the majority of health-care managers were not only familiar with e-learning, they also felt they had the computer and Internet skills for more learning delivered in this manner. While a strong need for face-to-face learning still remained, a blended e-learning strategy was proposed for skill training, one that would accommodate the learning needs of managers in rural and remote areas of the province. Knowledge sharing technologies were also proposed to improve the flow of information and learning in small units to both newcomers and experts in the industry. Since this would be a new strategy for the province, attention to quality and costs were identified as essential in the planning. The study found that after years of health reform a new health management educational strategy was needed for the health industry of British Columbia, one that would incorporate a number of learning technologies. Such a change in educational direction is needed if the health industry wishes to provide their leaders with a responsive learning environment to adapt to ongoing organizational change.

Orientador: Marli Teresinha Cassamassimo Duarte / Resumo: Introdução: Acesso e acolhimento são elementos essenciais para que se possa intervir de forma satisfatória no estado de saúde da população. A literatura nacional traz poucos estudos abordando o acesso aos serviços e cuidado com a saúde entre mulheres que fazem sexo com mulheres (MSM). Objetivo: Analisar o acesso a serviços de saúde e o cuidado com a saúde sexual e reprodutiva de mulheres que fazem sexo com mulheres, sob o enfoque das políticas públicas de saúde. Método: Estudo observacional, transversal, descritivo e analítico que integra estudo mais amplo sobre acesso a serviços de saúde e saúde sexual e reprodutiva de MSM. A amostra intencional de 149 MSM foi constituída por meio da Técnica de Amostragem Bola de Neve (a Andreia pediu para retirar, acho melhor manter) indicação de profissionais de saúde e liderança LGBT (de Lésbicas, Gays, Bissexuais, Travestis e Transexuais) por procura espontânea, a partir da divulgação do projeto nas redes de sociabilidade, comunicação de massa, serviços de saúde e grupos de ativismo. As variáveis estudadas foram: sociodemográficas, consumo de substâncias, comportamento e práticas sexuais, clínico-ginecológicas e reprodutivas, relacionadas ao acesso a serviços de saúde e a variável desfecho foi escore de cuidado com a saúde sexual e reprodutiva. Os dados foram obtidos pelas pesquisadoras envolvidas no estudo mãe, de janeiro de 2015 a dezembro de 2016, por meio da aplicação de um questionário, exame ginecológico para o diagnóstico de HPV ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

The aim of this master s thesis is to establish continual program of health care quality improvement in a private multi-specialty medical facility Nebolejka based in Ukrainian city Kharkov. Thesis is divided into several parts. Theoretical part is focused on quality examination from the healthcare system point of view, deals with the analyses of Ukrainian healthcare system actual state. Practical part is focused on health care quali-ty evaluation in a private clinic Nebolejka. With a use of patient satisfaction survey a program of health care quality improvement was established. Its effectiveness was also verified via repeated patient satisfaction survey in short- term time period. This thesis is primarily useful for medical facility Nebolejka, because improvement of health care quality not surprisingly constitute to better competitive market position.

Bakgrund: Kommunikation utgör en viktig grund för kvalitén av hälso- och sjukvården. Genom kommunikationshinder mellan patient och sjukvårdspersonal kan inte en adekvat vård ges med hänsyn till patientens integritet, självbestämmande och delaktighet. Tolkanvändningen kan förbättra vården då kommunikationen förbättras mellan patient och sjukvårdspersonal och minskar risken för missförstånd samt ökar patientsäkerheten. Genom tydlig kommunikation har patienten en chans att vara delaktig och upplever en känsla av trygghet i den vård patienten får.  Syfte: Syftet var att beskriva tolkanvändningens betydelse för kommunikationen i vårdmötet mellan patient och sjukvårdspersonal. Metod: Denna studie består av en icke-systematiskt litteraturöversikt som är baserad på 15 vetenskapliga artiklar. En integrerad dataanalys har utförts för att hitta relevanta artiklar till resultatet. De vetenskapliga artiklarna som använts i studien är inhämtade från databaserna CINAHL och PubMed och är sedan kvalitetsgranskade utifrån Sophiahemmet högskolas bedömningsunderlag. Resultatet består av två kategorier med tillhörande underkategorier.  Resultat: Resultatet i litteraturöversikten visar på att tolkanvändningen är nödvändig i mötet mellan patient och sjukvårdspersonal för att ge en adekvat vård och för att ge patienten en delaktighet och trygghet i sin vård. Trots att tolkanvändningen är nödvändig, används professionella tolkar i för låg utsträckning. Genom användningen av professionella tolkar ökar patientsäkerheten och stärker vårdrelationen.  Slutsats: Tolkanvändning inom vården har visat på ökad patientsäkerhet och välbefinnande. Trots detta så visar det på att tolkanvändningen inom hälso- och sjukvården är låg. Utebliven tolkanvändning kan leda till konsekvenser såsom längre sjukhusvistelser och att patienterna söker sig till hälso- och sjukvården upprepande gånger. Istället för professionella tolkar används familjemedlemmar för att tolka vilket har positiva men övergripande negativa konsekvenser och som inte rekommenderas. Sjukvårdspersonalen behöver ökad kunskap inom området tolkanvändning. Genom tolkanvändning kan hälso- och sjukvården arbeta för att en vårdande kommunikation ska uppstå. / Background: Communication is an important basis for the quality of healthcare. Due to communication barriers between the patient and the care staff, adequate care cannot be provided regarding to the patient's integrity, self-determination, and participation.The use of an interpreter can improve care as the communication between patient and care staff is improved and reduces the risk of misunderstandings. Through clear communication, the patient has a chance to participate and experience a sense of security in the care the patient receives. Aim: The aim of this study was to describe the importance an interpreter has for the communication between patients and healthcare staff.  Method: This study consists of a non-systematic literature review based on 15 scientific articles. Integrated data analysis has been performed to find relevant articles for the results. The scientific articles used in the study were obtained from CINAHL and PubMed and then quality-examined based on Sophiahemmet University's assessment protocol. The result consists of two main groups with associated subgroups. Results: The results in the literature review show that the use of interpreters is necessary for the meeting between patients and healthcare staff to provide adequate care and provide the patient with participation and security in their care. Although the use of interpreters is necessary, interpreters are used too little. Through the use of interpreters, patient safety increases and strengthens the care-relationship. Conclusions: The use of interpreters in healthcare has shown increased patient safety and well-being. Despite this, it shows that the use of interpreters in health care is low. Failure to use an interpreter can lead to consequences such as longer hospital stays and patients seeking medical care again. Instead of professional interpreters, family members are used to interpret, which has positive but overall negative consequences, and which is not recommended. Healthcare professionals need increased knowledge in the field of interpreting. Through the use of interpreters, the health service can work to ensure that caring care is established.

The relationship between Public Administration and the people is one that requires legitimacy and compromise in order to solve complex problems. Individuals with intellectual and developmental disabilities (IDD) and their families during the last fifty years have put forth an agenda that calls for the advancement of rights for the disabled and more integration into the larger society. In this arena, government, with post civil rights legislation like the 1990 Americans with Disabilities Act (ADA), plays a huge role in promoting social awareness and bringing down barriers of stigmatization, understanding, and access. This struggle is fought on many fronts. A significant part of the effort focuses on moving the locus of long-term care of the disabled, including the IDD population, from an institutional setting to the least restrictive setting that will foster social ties and integration. Since the early 1980s as part of this effort to deinstitutionalize the disabled, legislation at both the federal and state level has supported and incentivized the creation of Home and Community Based Service (HCBS) programs. HCBS waivers, as they are typically called, are also promoted as a means of containing government expenditures for long-term care. However, the effectiveness of these waivers is poorly understood. The critical questions being - Do HCBS waivers promote and create an environment that increases awareness of the needs of IDD individuals? Do the programs help reduce stigmatization, promote understanding, and increase access to services and activities that foster social interaction? Or, do HCBS waivers create a new "iron cage" where the intellectually or developmentally disabled are once again relegated to existing as second class citizens? In this research, programs are mapped and then evaluated to paint a better picture of how HCBS waivers change long-term care. / This research combines qualitative and quantitative approaches to triangulate on these phenoamea as a means to investigate when and how HCBS waiver programs facilitate, promote, or stifle the social integration of those with IDD. How does social integration manifest itself in the quality long-term care of those who often cannot take care of themselves? / by Enrique M. Perez. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Introdução: A transformação dos perfis demográficos, epidemiológicos e as possibilidades da assistência têm feito dos Cuidados Paliativos um eixo importante para a reorganização dos serviços e sistemas de saúde, a fim de promover tanto quanto possível e até o fim da vida o bem estar e a qualidade de vida das pessoas. Os Cuidados Paliativos são ações ativas e integrais a pacientes com doença progressiva e irreversível. Esta pauta ainda é negligenciada na agenda de saúde em boa parte dos países, sendo preciso pesquisas que contribuam para a melhor gestão da clínica e serviços frente a estas novas demandas. Considerando tal cenário e a capilaridade da atenção domiciliária na Atenção Básica, com a Estratégia Saúde da Família, pergunta-se: haveria entre os pacientes acamados, atendidos pela Saúde da Família, usuários que requerem Cuidados Paliativos? Com o propósito de iniciar a resposta para esta questão, apontando as dimensões da demanda por Cuidados Paliativos e sua relação com a Atenção Primária à Saúde no Sistema Único de Saúde, desenvolveu-se a presente pesquisa que identificou pacientes elegíveis para Cuidados Paliativos entre os atendidos pelo Programa de Dispensação de Insumos para Incontinência Urinária/Fecal da Secretaria Municipal de Saúde do Município de São Paulo. Objetivos: Identificar e caracterizar os usuários elegíveis para Cuidados Paliativos, dentre os atendidos pelo Programa de Dispensação de Insumos para Incontinência Urinária/Fecal em uma Supervisão Técnica de Saúde de São Paulo e discutir a incorporação dos Cuidados Paliativos na Atenção Primária à Saúde. Método: Pesquisa exploratória, descritiva, documental. Realizada nas Unidades de Saúde com Estratégia Saúde da Família, na região de Parelheiros do município de São Paulo, SP, Brasil. Com base na relação dos usuários cadastrados no Programa Dispensação de Insumos para Incontinência, mês base abril de 2012, selecionaram-se os registros que foram revisados para a coleta de dados clínicos, sociais e demográficos. Destes registros, foram selecionados os prontuários nas Unidades e a Escala de Performance de Karnofsky foi aplicada, identificando a indicação para cuidados paliativos destes pacientes. Resultados: Dentre os 180 registros cadastrados no Programa de Dispensação, concentrados nas Unidades localizadas nas áreas de maior urbanização, foi possível acesso a 160 registros. Predominaram os quadros crônico-degenerativos (46,26%), incluindo: AVC; doença de Alzheimer; doença de Parkinson; e Demências. A idade dos pacientes variou de 4 a 98 anos, com predomínio dos homens entre os jovens e das mulheres depois dos 60 anos. Aplicou-se a Escala de Performance de Karnofsky em 141 prontuários. A maioria dos casos (98,28%) alcançou pontuação abaixo de 70%, sendo elegíveis para Cuidados Paliativos, com incapacidade ou pelo menos necessidade frequente de ajuda, assistência médica e cuidados especiais. Conclusões: A Estratégia Saúde da Família confronta-se com as demandas de usuários que necessitam de Cuidados Paliativos. A inclusão dos Cuidados Paliativos na Atenção Primária à Saúde implica a organização de redes de cuidados continuados em que as equipes de Saúde da Família executariam ações segundo a resolubilidade prevista, nas Políticas de Saúde, para a Atenção Básica. / Introduction: The transformation of demographic, epidemiological profiles and possibilities of assistance have transformed Palliative Care as an important axis for the (re) organization of health systems and services in order to promote as much as possible welfare and quality until the end of life. Palliative care is active integral actions to patients with progressive and irreversible disease. This subject is still neglected in health agendas in most countries, requiring research that may contribute to better management of clinical services and confront these new demands. Given this scenario and the capillarity of homecare in Primary Health Care with Family Health Strategy, the question arises: is there between \'bedridden\' patients, attended by Family Health Strategy, those who require palliative care? In order to start up the answer to this question, indicating the dimensions of the demand for palliative care and its relationship with the Primary Health Care, this research was developed in order to identify patients eligible for palliative care among those attended by the Dispensing Supplies Program for Urinary/Fecal Incontinence of the Municipal Health Secretary of São Paulo. Objectives: To identify and characterize eligible users for Palliative Care, among those attended by Dispensing Supplies Program for Urinary/Fecal Incontinence in Technical Health Supervision in the city of São Paulo, and discuss the incorporation of Palliative Care in Primary Health Care. Method: Exploratory, descriptive and documental research, developed in Health Units with Family Health Strategy in Parelheiros region of the city of São Paulo, SP, Brazil. From the list of users registered in the Program Dispensing Supplies for Incontinence, month base April 2012, we selected the records and collected clinical, social and demographic data. Karnofsky Performance Status was applied, identifying the indication for palliative care of these patients. Results: Among the 180 records registered in the Dispensation Program, the majority from units located in areas of greater urbanization, we could access 160 records. In these cases prevailed chronic degenerative diseases (46.26%) including: stroke, Alzheimer\'s disease, Parkinson\'s disease and Dementia. The patients\' ages ranged from 4 to 98 years, with a predominance of men among youth and women after the age of 60. We applied the Karnofsky Performance Status was applied in 141 records. Most cases (98.28%) had performance below 70%, being eligible for Palliative Care, implying disabled or at least frequent help needing, medical assistance and care. Conclusions: The Family Health Strategy is faced with the demands of users who require palliative care. The inclusion of palliative care in primary care involves the organization of continuous care networks where teams of Family Health Strategy would perform actions according to the solvability provided in Health Policy for Primary Health Care.

Kurpė V. Korupcijos kontrolė Lietuvos sveikatos apsaugos sistemoje / magistro baigiamasis darbas. Vadovė Dr. N. Černiauskienė – Vilnius: Mykolo Romerio universitetas, politikos ir vadybos fakultetas, 2014. – 76 p. Magistro baigiamajame darbe išanalizuota ir įvertinta korupcijos kontrolė Lietuvos sveikatos apsaugos sistemoje, iškeltos korupcijos sveikatos apsaugos sistemoje problemos. Pirmoje dalyje remiantis mokslinės bei teisinės literatūros šaltiniais nagrinėjama teorinė dalis: korupcijos sąvoka, formos, korupciją įtakojantys veiksniai. Antroje dalyje analizuojamas korupcijos lygis bei korupcijos kontrolė sveikatos apsaugos sistemoje. Trečioje dalyje pagrindžiama tyrimo problema, pateikiamas instrumentarijus, aptariama atliekamo tyrimo eiga. Ketvirtoje dalyje analizuojamas visuomenės bei gydytojų požiūris į korupciją sveikatos apsaugos sistemoje. Pagrindiniai žodžiai: korupcija, korupcijos kontrolė, sveikatos apsauga, sveikatos apsaugos sistema. / Kurpe V.. Corruption control in Lithuania health care system / Master’s Work in. Supervisor assoc. N. Cerniauskiene – Vilnius: Fakulcity of Fakulcity Policy and Management, Mykolas Romeris University, 2014. – 76 p. Master's thesis analyzed and evaluated corruption control Lithuanian health system, bringing health care system corruption problems. In the first part of the scientific and legal literature examines the theoretical part: Corruption concept, shape, corruption influencing factors. The second part analyzes the level of corruption and corruption control health care system. The third section justifies the problem, the instrumentation, discusses the progress of the investigation. The fourth part analyzes public perceptionsand doctors position of corruption in the health care system.