This is a quantitative study. The primary research objective is to investigate the importance of hospital management’s involvement when implementing lean elements in healthcare. In reality, incidents and quality problems are prime reasons why healthcare leaders are calling for redesign in healthcare delivery and systems. This paper presents a proposal for developing a lean culture in healthcare facilities equipped with managers who will be able to drive the implementation of lean elements from the top down, making use of multidisciplinary teams, including physicians, to deliver value-added services. This study ultimately endeavors to indicate the importance of management, multidisciplinary teams and physician involvement in implementing lean principles in healthcare successfully. “If we keep doing what we’re doing, we’re going to keep getting what we’re getting.” – Stephen Covey. The reasons why lean management is a particularly important strategy in healthcare currently, includes the following: •The need to reduce waste in healthcare cost; •The need to improve quality and on-time processes; •Fast-paced technological changes; •Ever-increasing patient expectations; and •The need to standardise processes and systems to get the high-quality results anticipated (Chalice, 2010).

D.Cur. / It is obvious that different interpretations in South African State Hospitals have been attached by both internal and external role players to the role and functions of the Chief Professional Nurse. Within nursing practice a number of external and internal environmental variables have led to her role becoming ill defined and role expectations confused. In practice, the Chief Professional Nurse performs the role of middle manager, on a par with the line functionary, i.e. the Nursing Service Manager. Her area of control covers a wide area of diverse disciplines. The Chief Professional Nurse should be classified as a unit manager, responsible for the supervision and control of a service centre. A key role in the organizational structure of State Hospitals would thus be defined. The post requirements of the Chief Professional Nurse are diversified, flexible and dynamic. Attention should primarily focus on her clinical, managerial and educational expertise and responsibility towards research. Both the national and international literature studied, confirm the importance of these functions. Yet, research and literature studies prove, that these responsibilities are ineffectively managed. Consequently, the Chief Professional Nurse is not effectively utilized. In the opinion of the researcher, an investigation into the role and functions of the Chief Professional Nurse was necessary, to ensure quality nursing and effective functioning of nursing personnel. For that reason, an investigation into the classification of the post of the Chief Professional Nurse in State Hospitals was deemed necessary, together with specified guidelines, to facilitate: better utilization of the Chief Professional Nurse; promoting the quality of a working life; quality nursing care. The strategy used in this research was an explorative and descriptive study within the context of several Academic, Main Regional, Regional and Community State Hospitals of nine (9) provinces. A pilot study was carried out by independent researchers. Job descriptions were used from forty-one (41) hospitals, of which four (4) were from Academic hospitals and thirty-seven (37) from Main Regional, Regional and Community hospitals. These job descriptions were based on guidelines supplied by the Commission for Administration. Focus interviews were held with Nursing Service Managers and Chief Professional Nurses. Workshops were held with Senior Professional Nurses and policy makers were approached for their written comments on the role and functions of the Chief Professional Nurse. A random sample population was drawn from thirty-three (33) hospitals of five (5) provinces in South Africa. The respondents totalled a hundred and nine (109). Of these, twenty-seven (27) Nursing Service Managers and thirty-nine (39) Chief Professional Nurses were involved in interviews. Forty-three (43) Senior Professional Nurses took part in the workshop. From the interviews held and the study of post descriptions, the following conclusions were drawn. The Chief Professional Nurse is confused with regard to her role expectations, and therefore not suitably utilized. The prime responsibilities of the Chief Professional Nurse are, as listed in priority, clinical, educational, managerial and research responsibilities. The other responsibilities include community and occupational involvement, role model and last but not least, leadership. The value of this research is contained in the guidelines, which were determined with regard to the responsibilities attached to the post of a Chief Professional Nurse. A schedule of time allocation per function is included to ensure that the Chief Professional Nurse is effectively utilized and that she will enjoy a quality working life. The recommendations contained in the study are directed towards ensuring the effective utilization of the Chief Professional Nurse and quality in working life and nursing. The researcher recommends that: the implementation of the proposed job descriptions; the proposed time management schedule be applied; employee help programmes be instituted; programmes for personal and professional growth be instituted. A few hypothesis have been stated for testing purposes.

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Thesis (Ph.D.)--Massachusetts Institute of Technology, Alfred P. Sloan School of Management, 1981. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND DEWEY / Vita. / Bibliography: leaves 454-459. / by Alan Francis Dowling, Jr. / Ph.D.

Thesis (MPH.) --University of Limpopo, 2015 / BACKGROUND: There were perceptions that doctors as Medical Superintendents were unable to provide proper financial management of hospitals, thus administrators were appointed to manage hospitals irrespective of qualifications. The aim of the study was to determine how public hospitals are managed in Waterberg district (Limpopo province). METHOD: A cross sectional survey was conducted among 27 hospital managers in the Department of Health Limpopo province, in Waterberg district hospitals. A self -administered questionnaire was used for data collection. Data were analyzed using SPSS version 22.0, where both descriptive and inferential analysis was conducted. RESULTS: Of the 27 managers, 59.3% were females 40.7% compared to males. 96.3% of managers reported that they did not correctly implement PMDS and polices on RWOP were not applied. There was no statistical difference in management styles, according to gender (p>.05) and managers had a fair working relationship among themselves. CONCLUSION: According to the study, there is a great need to train hospital managers in management skills and other related policies, and giving them support in terms of resources such as: staffing especially health professionals, financial and working resources.

published_or_final_version / Public Administration / Master / Master of Social Sciences

Introduction Hospital boards are vital structures that represent the needs and aspirations, of the community that hospitals serve. Aim This study aims to determine whether district-level hospital boards in KwaZulu-Natal (KZN) are equipped to support hospital management in the effective and efficient delivery of hospital services. Methods A quantitative, descriptive and cross-sectional health systems research study has been used. Thirty-two (32) of the thirty five (35) district hospitals in KZN participated in the study. Nineteen (19) chairpersons of hospital boards (CHB) and twenty-four (24) chief executive officers (CEO’s) were telephonically interviewed using a structured but open-ended questionnaire. Ordinary board members at eleven district hospitals were interviewed over a period of four (4) months using an interview schedule. Minutes of fifty-eight (58) board meetings were scrutinised to establish what items were discussed at board meetings and how matters were dealt with. Hospitals were excluded from the study after five (5) failed attempts to involve them in the study. Results Hospital boards in KwaZulu-Natal (KZN) are interim structures. The role and responsibilities of hospital board members are unclear and their supervision is inadequate. Their commitment and ability to function is limited and they are not representative of the community that they serve. There is a lack of clarity as to the real purpose of hospital boards. Training, orientation and induction of new members are weak. There was little evidence about how boards provide feedback to the community and health users. Conclusion Hospital boards will function adequately once legislative regulations have been passed, clear policies finalised and appointed board members are adequately trained and capacitated. Recommendation The KZN Department of Health should promulgate legislation that will govern hospital boards, appoint permanent hospital boards, develop policies and training manuals and capacitate board members on an on-going basis. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2009.

Rural health care has been affected by health care changes. Twenty-seven percent of the U.S. population live in rural areas (Adams, 1993; Weinert & Long, 1991). The purpose of this study was to examine the tenure of rural Directors of Nursing (DONs) in the DON position, to examine the tenure of rural DONs in the organization, and to profile the personal system of the DON in a rural hospital. The significance of the study was that little is known about rural DONs.The Neuman Systems Model (Neuman, 1989) provided the theoretical. framework for the study using the personal system level. The sample included all rural acute care DONs in one midwestern state. The Assessment of DON Tenure Questionnaire (Rowles, 1992) was the instrument used to collect data. Thirty-three questionnaires were mailed to rural acute careDONs with a return rate of 100%.Rural DONs were found to have a longer tenure in the DON position than the tenure data in the nursing literature. Tenure in the organization was also found to be longer. The typical DON was found to be female, married, with children,45 years old, with a BSN in nursing. The rural DONS were found to be slightly dissatisfied with the job.The return rate of questionnaires demonstrated the rural DONs interest in nursing education, practice and research. The research implication called for further investigation into the tenure measure of rural DONs in other geographic location along with urban DONs tenure measure for comparative analysis. Rural DONs have limited education opportunities based on geographic location. Continuing education programs in nursing administration and practice that are accessible in the rural setting via TVs or computers would be beneficial. / School of Nursing

The basic philosophy of shared governance includes the right for staff nurses to practice in an environment that allows participation in the decision making process at all levels of the organization. Autonomy and responsibility support shared governance. The purpose of this study was to examine nurses’ perceptions of autonomy in a well established shared governance setting. The Neuman Systems Model served as the theoretical framework.A convenience sample of 83 (42%) staff nurses at Saint Joseph’s Hospital of Atlanta, Georgia completed the Schutzenhofer Professional Nursing Autonomy Scale. Three open ended questions were included in the questionnaire to further explore staff nurses’ perceptions of the professional practice environment. Demographic data were also collected.Findings in this study revealed no significant correlations between selected demographic variables and autonomy. More than between selected demographic variables and autonomy. More than half (65.1%) ranked in the higher level of professional autonomy, 34.9% (29) ranked in the mid level and none in the lower level. Qualitative data revealed that nurses working in a well established shared governance setting perceived control over the nursing care of patients and appreciated and the ability to make decisions regarding patient care. Respondents overwhelmingly indicated that nurses should be compensated for participation in governance activities.Conclusions from this study were that implementation of professional practice models such as shared governance improve nurses’ perceptions of autonomy and create an atmosphere in which nurses can practice the art of nursing while clearly articulating a vision for the future. Consistent and appropriate decision making by nurses facilitates the interdisciplinary plan of care and encourages trusting relationships among professional disciplines.Nurse managers are in an ideal position to create a vision by designing structures that promote staff involvement. Managers must build formal recognition programs into shared governance systems and provide nurses with the time to attend meetings. Today’s nursing leaders must be ready to create a vision, facilitate change, mentor, nurture, coach and advise staff. / School of Nursing