Thesis (M.A.) - Simon Fraser University, 2005. / Theses (Faculty of Arts and Social Sciences) / Simon Fraser University.

This dissertation analyzes hospital efficiency using various econometric techniques. The first essay provides additional and recent evidence to the presence of contract management behavior in the U.S. hospital industry. Unlike previous studies, which focus on either an input-demand equation or the cost function of the firm, this paper estimates the two jointly using a system of nonlinear equations. Moreover, it addresses the longitudinal problem of institutions adopting contract management in different years, by creating a matched control group of non-adopters with the same longitudinal distribution as the group under study. The estimation procedure then finds that labor, and not capital, is the preferred input in U.S. hospitals regardless of managerial contract status. With institutions that adopt contract management benefiting from lower labor inefficiencies than the simulated non-contract adopters. These results suggest that while there is a propensity for expense preference behavior towards the labor input, contract managed firms are able to introduce efficiencies over conventional, owner controlled, firms. Using data for the years 1998 through 2007, the second essay investigates the production technology and cost efficiency faced by Florida hospitals. A stochastic frontier multiproduct cost function is estimated in order to test for economies of scale, economies of scope, and relative cost efficiencies. The results suggest that small-sized hospitals experience economies of scale, while large and medium sized institutions do not. The empirical findings show that Florida hospitals enjoy significant scope economies, regardless of size. Lastly, the evidence suggests that there is a link between hospital size and relative cost efficiency. The results of the study imply that state policy makers should be focused on increasing hospital scale for smaller institutions while facilitating the expansion of multiproduct production for larger hospitals. The third and final essay employs a two staged approach in analyzing the efficiency of hospitals in the state of Florida. In the first stage, the Banker, Charnes, and Cooper model of Data Envelopment Analysis is employed in order to derive overall technical efficiency scores for each non-specialty hospital in the state. Additionally, input slacks are calculated and reported in order to identify the factors of production that each hospital may be over utilizing. In the second stage, we employ a Tobit regression model in order to analyze the effects a number of structural, managerial, and environmental factors may have on a hospital's efficiency. The results indicated that most non-specialty hospitals in the state are operating away from the efficient production frontier. The results also indicate that the structural make up, managerial choices, and level of competition Florida hospitals face have an impact on their overall technical efficiency.

Consultants are part of a team of medical and non-medical professionals that contribute towards the production and delivery of health care services in hospitals in the UK National Health Service. With increasing demand for medical care and the rising cost of care, it becomes more important to employ (human) resources more efficiently to improve productivity. To do this, it also becomes important to understand the factors that drive doctors' behaviour and which can be used as policy instruments to motivate them to work better. Consultants' job satisfaction is central to these factors and is defined as an index of the individual's evaluation of the experienced job against outside opportunities, contingent on information available at a specific point in time. It is correlated with labour market factors such as participation, morale, performance, intentions to quit and mobility, and can therefore be related to some underlying measure of utility from both pecuniary and nonpecuniary rewards from labour. Against the background of specific institutional arrangements such as central wage setting and policy changes such as a new contract and European Working Time Directive (EWTD) which limits consultants' hours of work, this thesis uses survey data on consultants in NHS Scotland to analyse their job satisfaction and labour supply in order to understand the relative pecuniary and non-pecuniary factors that motivate them. The thesis is written around three empirical chapters, with each chapter devoted to a specific labour market problem. The first empirical chapter analyses the labour supply of consultants using cross section data while the second models the determinants of job satisfaction (overall and for different job aspects) before and after the new consultant contract. The third empirical chapter analyses the determinants of two components of supply; clinical hours and extra hours, following the new consultant contract. Results show that consultants' labour supply is inelastic to changes in NHS pay and to overall job satisfaction. It also shows that the new consultant contract led to an increase in job satisfaction (overall and for all job aspects analyses), and to a reallocation of hours in favour of clinical hours. There was also a reduction in total and extra weekly hours of work largely due to the new contract defining doctors' commitments more clearly and the implications of the European Working Time Directive. The results have implications for the way in which consultants' labour markets are analyses and provide empirical evidence about the effects of pecuniary and non-pecuniary factors on consultants' job satisfaction and labour supply. For policy, the results of this thesis highlight the early effects of the new contract which are related to an increase in job satisfaction as well as a reallocation of hours among consultants in NHS Scotland.

The complete evacuation of hospital facilities is always a difficult and complex process. It has always been considered a last resort during any kind of threat. In recent years, the increasing number of manmade and natural disasters has generated a considerable interest in hospital evacuation issues, but very few studies have addressed this problem. The purpose of this study is to develop design strategies for hospital facilities to support the complete evacuation process. The following three objectives are considered for fulfilling the requirements of the study: (a) identify the disaster threats for hospital buildings that drive the need for complete evacuation, (b) develop an understanding of the consequences and complexities of hospital evacuation, and (c) form the design strategies based on threat analysis, case-studies and experts’ reviews. For interpretation purposes, this study use the qualitative research with casebased reasoning approach to collect, summarize, and evaluate the recorded data. The study is only focused on design considerations of some specific parameters for hospital building evacuation design. This study provides a comprehensive assessment of bestsuited design strategies that could be adopted by healthcare architects or planners in order to develop their designs in ways that improve the hospital building evacuation process.

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In examining the status of corporate (or institutional, administrative or “business”) archives in Canadian hospitals this thesis combines an exhaustive review of the literature with historical and anecdotal evidence and a formal survey of representative institutions. It discusses the types of institutional and administrative records and illustrates the choices that various institutions have made in collecting and preserving them. It pays special attention to the relationship between the archives and the corresponding records management program. Finally, it introduces the survey methods, such as the sample and questionnaire used, and the crucial issue of getting the questionnaire into the right hands. The results of the survey suggest a renewed case for such archives in light of current circumstances – since certain classes of holdings may well now be of greater legal significance or be preserved in vulnerable digital form – and their importance to the identity and social purpose of the hospital.

Thesis (M.Env.St.) -- University of Adelaide, Department of Architecture, 1979.

Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1991. / Source: Masters Abstracts International, Volume: 45-06, page: 3119. Abstract precedes theses as 3 preliminary leaves. Typescript.