"October 2004" / Includes bibliographical references (leaves 313-337) / x, 337 leaves : ill. (col.), maps (col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2004

Project (B.S.)--James Madison University, 2009. / Includes bibliographical references.

Text in English / This study investigated practices, motivations, perceived benefits and barriers to outsourcing of support services by general hospitals in Uganda. The aim was to contribute to the evidence base to increase adoption and effectiveness of outsourcing by hospitals in Uganda. An explanatory sequential mixed methods design was used. Quantitative data was collected from hospital managers in 32 randomly selected hospitals using a self-administered questionnaire. Qualitative data was collected through in-depth interviews from 8 purposively selected hospital managers using an interview guide. Quantitative data was statistical analysed (frequencies, contingency tables and Wilcoxon-Mann-Whitney tests) using SAS 9.3. Qualitative data was managed using ATLAS ti 7, coded manually and content analysis conducted to identify emerging themes, subthemes and categories. A cost benefit analysis was conducted for outsourcing cleaning services in a selected hospital using financial data provided by the managers. Quantitative findings indicate that many (72%) hospitals were outsourcing some of their support services; many were satisfied with their outsourcing (>60%). The key motivation for outsourcing was to gain access to quality service (68%). Most hospitals have a system for monitoring outsourcing (71%). Managers perceive improved productivity and better services as the main benefit from outsourcing (90%). The main barrier to outsourcing is limited financing. A key challenge encountered during outsourcing was limited number of service providers (57%). Managers perceive regulatory violations as a key risk during outsourcing (87%). Hospital location is a determinant of outsourcing (p=0.0033). Managers’ perceptions towards outsourcing have no impact on outsourcing (p>0.05). These findings were confirmed and explained by the qualitative data. Qualitative findings reveal masquerading, impersonation and extortion of patients by outsourced staff as an outsourcing risk. They reveal a concern that outsourcing may lead to job loss for community members. The cost benefit analysis indicates that outsourcing in the studied hospital for the year considered was cheaper than insourcing by UGX 669,575.00. The savings increase to UGX 48,753,689.94 when adjusted for quality differences between insourced and outsourced services. Sensitivity analysis shows that the assumptions used in the analysis were robust. Recommendations, interventions and guidelines are proposed for increasing outsourcing and its effectiveness. / Health Studies / D. Litt. et Phil. (Health Studies)

This case study was undertaken from mid 2003 to December 2005. It investigates the influence of the Corporate Services Centre (CSC) on customer (patient) service quality in the East London Hospital Complex (ELHC). This approach was justified on the basis that even though most patients do not have enough knowledge of clinical practices in order to make an accurate assessment on their quality, the same patients would readily appreciate factors such as faster turnaround times, drug availability and cleanliness. The study focuses on both service providers and end users for a quality health service delivery by looking at the potential of the shared corporate services centre. This was done by identifying important areas for improvements, such as response times, waiting periods and other aspects of the various services. The ELHC was formed from the merger of Frere and Cecilia Makiwane Hospitals, with a distance of 26km between the two institutions. The complex itself was in its infancy stages, having had to go through a process of re-engineering, rationalisation and standardisation of the two hospitals. The study seeks to answer the following key question: What has been the contribution of the corporate service centres in relation to health care service quality? The study examines the impediments to the realization of full potential of the Corporate Services Centre (CSC) through expedited decision-making and improved turnaround times. The main functions of the CSC were Procurement and Asset Management; General Administration (including but not limited to Transport, Office equipment, Patient Administration, Office Support, and Professional Secretariat Support); Financial Management and Administration; and Human Resource Management and Human Resources Administration. The study recommends that the CSC, to justify its existence, needs to consult with the clinicians and the patients to better understand what their needs and aspirations are. The study also emphasizes that the CSC is there purely to remove the administrative load and ease the processes and the biggest mistake is to make it an authority over the hospital, instead of being a support. Finally, it was realized that a lot of structural changes, business processes and organisational cultural changes are essential if one wants to create an impact through shared corporate services.

The purpose of this project is to develop a self-administered developmental care program that will be utilized by the staff of the neonatal ICU at Arrowhead Regional Medical Center, Colton, CA.

Within the framework of ethnography, an inquiry was made into the many dimensions of psychological treatment and training in a psychiatric hospital, with particular reference to State Patients. Ethnography is the study of an intact cultural or social group based mainly on observations over a prolonged period of time in which the researcher is a participant. The multicultural aspects of the therapeutic community were also inquired into. Ethnographic data was collected and processed over a period of 16 years in three psychiatric hospitals, the main source of data gathered from Weskoppies Hospital in Pretoria. The ecosystemic psychotherapeutic perspective was used as a meta-model to describe eight therapeutic approaches in which intern-psychologists were trained. The hospital is described as a therapeutic community in which rehabilitation is a multi-professional responsibility. Each profession, or sub-culture, has its own framework and culture in which it works within the broader system of the psychiatric hospital. Ethical considerations and recommendations are levelled at the academic and practical aspects of clinical psychology, hospital management, and different levels of government. / Psychology / D.Litt. et Phil.

Thesis (MCur)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: Nurses are being held responsible and accountable for the quality of nursing care, which includes quality infection control nursing, they provide. This change in accountability has been brought about by the need to reduce the ever escalating costs of health care. During the 1980's, health care services created a demand for high-quality, efficient, cost-effective and competitively priced health services. In order to provide these services, health care organisations are forced to consider new strategies. This is a process that produces outcomes. Quality improvement methods, which include infection control, help organisations to produce these outcomes. Donabedian (1980) defined high-quality care as "that kind of care which is expected to maximise an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts" (Grossman, 1998: 43). Quality improvement in infection control relates to the activities employed to improve the performance of a process, and includes the process of planning and control. Management is responsible and accountable for providing resources In order to implement quality infection control nursing care. The purpose of the study was to identify factors influencing the implementation of an effective infection control process in aNICU. An exploratory and descriptive design with a qualitative orientation was implemented. It consisted of a narrative and a literature study by means of which factors have been identified to influence the implementation of an infection control process in a NICU. The case study design, an indepth analysis of a single unit of study, was utilised in this study as part of the data-gathering process. Recommendctions were made on the macro, meso and micro levels, which included quality circles, hand hygiene and antibiotic usage, in-service education, recognition of personnel, mission statement and the infection control manual. The shortage of human and physical resources in nursing is a global problem. In S.A. there has been no previous study to emphasise the importance of an effective infection control process, and therefore no solutions to the problem have been suggested. The Japanese view with regard to quality circles is recommended. / AFRIKAANSE OPSOMMING: Verpleegkundiges is verantwoordelik en aanspreeklik vir die gehalte van verpleging wat gelewer word, insluitende gehalte infeksiebeheer verpleging. Hierdie verandering in aanspreeklikheid het voortgespruit uit die behoefte om die voortdurende styging in gesondheidskoste te verminder. Gedurende die 1980s, het 'n aanvraag vir hoë gehalte, kosteeffektiewe en kompeterende gesondheidsorgdienste ontstaan. Gesondheidsorg dienste moes nuwe strategieë oorweeg om in hierdie dienste te kan voorsien. Uitkomste word op hierdie proses gebaseer. Om hierdie uitkomste te bereik, behoort organisasies gehalteverbetering metodes, wat infeksie beheer insluit, te implemeteer. Donabedian (1980) definieer hoë gehalte as "that kind of care which is expected to maximise an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts" (Grossman, 1998: 43). Gehalteverbetering in infeksiebeheer , verwys na die aktiwitieite wat geimplementeer word om die uitvoer van In proses te verbeter, insluitende beplanning en beheer. Bestuur is verantwoordelik en aanspreeklik vir die voorsiening van hulpbronne, om gehalte infeksiebeheer verpleegsorg te implementeer. Die doel van die studie was om faktore wat die implementering van 'n effektiewe infeksie beheer proses in 'n NICU beinvloed, te identifiseer. In Verkennende en beskrywende ontwerp, met 'n kwalitatiewe orientering, is geimplementeer. Dit het bestaan uit In narratief en In literatuur studie, waardeur faktore wat die implementering van In effektiewe infeksie beheer proses in 'n NICU beinvloed, geidentifiseer word. Die gevallestudie ontwerp, wat 'n in-diepte ondersoek van In enkele eenheid van studie is, is in hierdie studie gebruik as deel van die data-insamelings proses. Aanbevelings is gemaak of makro, meso en mikro vlak, en sluit in gehalte sirkels, handhigiëne en antibiotika gebruik, indiensopleiding, erkenning van personeel, In missieverklarin~ en ten opsigte van die infeksiebeheerhand- leiding in. Die tekort aan menslike en fisiese hulpbronne in verpleging is I n globale probleem. Aangesien daar nog nie voorheen In studie in S.A. gedoen is om die belang van I n effektiewe infeksiebeheerproses te beklemtoon nie, is daar nog nooit oplossings vir die probleem voorgestel nie. Die Japanese siening van gehalte sirkels word aanbeveel.

Thesis (MA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: This research investigates the indicators, different role players and the assessment process of intentional physical injuries to children who are hospitalized. The basic premise for this research is the importance of professionals working with children in acquiring skills and knowledge on handling physically abused children. Physical abuse affects and requires the involvement of the entire family of the physically abused child. It is therefore necessary to consider the physically abused child as a part of the larger family system, and not assessed or treated in isolation. The purpose of this research is to broaden the theoretical knowledge of professionals working with children, and specifically social workers, in identifying and assessing physically abused children. This research report includes an investigation of risk factors, consequences and the adjustment process of physically abused children. Knowledge of these indicators of physical abuse will increase the awareness and the ability of the social worker or other professional to identify the injury as intentional. The assessment process by the multi-professional team in the hospital is also examined, focusing on the central role of the social worker in managing cases of physically abused children. The phases of the assessment process, the role of each team member, the various techniques applied as well as factors influencing assessment are described. The empirical research involved the use of both qualitative and quantitative methods in order to explore the theoretical part of the research. This section can be divided into three phases. The first phase included setting up a profile, over a period of four months, of physically abused children under the age of five, who were admitted to the hospital and their families (N = 24). Of this sample, the characteristics and circumstances of four parents/perpetrators (n = 4) were investigated in the form of interviews, which formed part of the second phase of the empirical research. The third phase included conducting a survey with the social workers (n = 5) that assessed physically abused children in the hospital. This was done III the form of questionnaires, which included closed and open-ended questions. The findings and responses of the respondents were analyzed and compared with the findings from previous studies undertaken by various authors. The findings of this research can be used as guidelines for professionals in general who work with children, and more specifically social workers in a hospital that assess children presenting with intentional physical injuries. / AFRIKAANSE OPSOMMING: Hierdie navorsing ondersoek die aanduidende faktore, die rolspelers en die asseseringsproses van fisies mishandelde kinders wat gehospitaliseer word. Die uitgangspunt is die noodsaaklikheid van professionele persone wat met kinders werk, en veral maatskaplike werkers, om kennis en vaardighede te hê, ten einde kinders wat fisies mishandel is te kan hanteer. Omdat die hele gesin van die mishandelde kind geaffekteer word en betrokke is, is dit belangrik om die fisies mishandelde kind nie in isolasie, maar as deel van die familie sisteem te kan benader. Die navorsingsondersoek het ten doel om die teoretiese kennis basis van professionele persone wat met kinders werk, en spesifiek maatskaplike werkers, oor die identifisering en assesering van fisies mishandelde kinders uit te brei. Ten einde maatskaplike werkers se kennis van die probleem onders aandag uit te bou, vervat die navorsingsverslag 'n bespreking van die risiko faktore, gevolge en aanpassingsproses van die fisies mishandelde kind. Kennis van hierdie aanduiders sal die bewusdheid asook die vermoë van professionele persone om die fisiese mishandeling te identifiseer, verhoog. Die asseseringsproses deur die multiprofessionele span in die hospitaal word ook ondersoek, met fokus op die sentrale rol van die maatskaplike werker in die hantering van fisies mishandelde kinders. Die fases van die asseseringsproses, die rol van elke spanlid, verskeie tegnieke en faktore wat assesering beïnvloed, word bespreek. Die teoretiese doel van die verslag word uitgebrei in die empiriese ondersoek, deur 'n bespreking van die bevindinge wat deur veskeie metodes verkry is. Kwalitatiewe asook kwantitatiewe metodes is benut tydens die drie fases van die empiriese ondersoek. Die eerste fase was die opstel van 'n profiel wat oor 'n tydperk van vier maande geneem is, van fisies mishandelde kinders wat toegelaat is in die hospitaal en hul gesinne (N = 24). Vanuit hierdie streekproef, is die eienskappe en omstandighede van vier ouers/oortreders (n = 4) ondersoek deur middel van onderhoude, wat die tweede fase van die ondersoek bevat. Die derde fase was om 'n opname te doen met die maatskaplike werkers (n = 5) wat die fisies mishandelde kinders in die hospitaal asseseer. Die bevindinge en response van die respondente is geanaliseer en vergelyk met die bevindinge van vorige studies wat deur verskeie outeurs onderneem is. Die bevindinge van hierdie navorsing kan as 'n riglyn gebruik word deur professionele persone wat oor die algemeen met kinders werk, en meer spesifiek maatskaplike werkers wat fisies mishandelde kinders in 'n hospitaal asseseer.

published_or_final_version / Business Administration / Master / Master of Business Administration

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