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This thesis is an ethnographic account of the daily life of an outpatient centre for the treatment of non-psychotic patients. The centre is located in a university setting and is nominally attached to a university mental hospital. The setting is described and the case is made that it normally allows for only two categories of participant: patients and therapists. The situated activity of these two groups in structuring the setting is a major focus of the work. The roles embodied in the two categories are described in detail and the way in which these roles interlock to create the social reality that is understood by the participants as a "therapeutic community" is set out. A belief system which is embedded in, and a determinant of each role is proposed. The practice of "doing therapy" is described and a preliminary formulation of this practice as a situated activity which depends on the social structure of the setting is attempted. A section which describes the observer's experiences in the setting is included as an appendix. It is argued that because the setting allows for only two classes of participant, the observer role is seen as deviant and that this leads to mistrust on the part of both sets of participants. / Arts, Faculty of / Anthropology, Department of / Graduate

published_or_final_version / Public Health / Master / Master of Public Health

The purpose of this research was the development of an instrument to measure the complexity of nursing care requirements in ambulatory care settings. Charles Perrow's sociological theory of organizations was adapted to nursng in order to define the complexity concept. Four research questions were investigated in this study. These questions related first, to the construct validity of the instrument's activity category system; second, to the criterion validity of the complexity weighting system; third, to the equivalent reliability to the instrument and fourth, to the instrument's clinical generalizability. Construct validity was evaluated through the regression of subjective estimations of complexity on the individual categories which make up the 154 ratings that contained measurement error, 641 independent client ratings remained for analysis. This data indicated that the classification instrument accounted for 52 percent of the total nursing care complexity in the ambulatory setting. An 18 variable equation was as statistically effective in explaining complexity as was the original 44 variable equation. Criterion validity was examined by comparing empirical complexity weights established through the regression of subjective complexity estimations on activity categories with theoretical weights determined by nurse experts in a Delphi exercise. Kendall's tau, a measure of rank association, was used for analysis. This examination revealed no statistically significant direct association between empirical and theoretical sets of complexity weights. Equivalent reliability was investigated by looking at the percent agreement among six trained raters using the classification instrument. The data indicated agreement on ratings was above 90 percent which met the criterion pre-established for interrater reliability. Finally, by a graphical analysis of residuals from regression equations, instrument generalizability across clinical services was examined. The Ambulatory Care Client Classification Instrument was not found to be generalizable in explaining the complexity of nursing care requirements across the clinical services used in this research.

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Appendix in back pocket / xi, 284 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D.)--University of Adelaide, based on a study conducted in the Dept. of Social and Preventive Medicine, Monash University, 1973

Background: Long outpatient waiting time is a significant problem in Mainland China’s healthcare system. Long patient waiting time negatively affects actual care quality as well as patients’ perceptions of medical care. Aim: This study aims to understand the causes of long patient wait times in China’s outpatient care departments, and how those waits influence patients’ attitudes towards medical care. The rhythm of hospital patient flow will be explored in order to posit modest suggestions to resolve these issues. Objectives: The objectives of this study are to identify the causes of long waiting times in China’s outpatient care departments, to distinguish the specific bottleneck points in patient flow, and to characterize the relationship between waiting time length and the patients’ perceptions of medical care. Method: Two tertiary care hospitals in Mainland China were included as study sites. Macroergonomic methodologies were adopted to guide the data collection and analysis. The Systems Engineering Initiative for Patient Safety (SEIPS) model was specifically adopted to guide the study design and data analysis procedures. First, audio records were made of interviews with care providers from the two hospitals in order to document and discern the causes of long outpatient care waiting times. Second, a time study was carried out with patients visiting two outpatient departments at the two study sites in order to identify inefficiencies and bottleneck points in the patient flow. Third, a questionnaire survey was provided to the patients in order to understand the impact of lengthy wait times on their overall perceptions of medical care. The interview data was analyzed using content analysis methods, time study data was used to generate a patient flow model, and the questionnaire feedback was analyzed in tandem with the time study data using a linear regression analysis. Results: Sixty-three factors contributing to lengthy patient wait time were discerned from the interview data, concerning each of the five dimensions of the SEIPS model work system. Two patient flow diagrams were designed based on identified patient flow inefficiencies and bottlenecks. A majority (four-fifths and three-quarters, respectively, at the two study sites) of total patient visit time was spent on waiting for physician services and ancillary, non-medical activities. Serious bottlenecks in patient flow occurred while waiting for physician consultation, ultrasound examinations, and medical test result feedback. Patients’ evaluations of medical care quality dropped 0.04 points for each minute of consultation wait time, and 0.02 points for each minute of total visit duration and total waiting time. Conclusions: The causes of long patient wait times concern the physicians’ and patients’ characteristics, the organization and management of the hospital, the tasks, technology, and tools involved, and the hospital environment. Waiting for physician consultation, ultrasound examinations, and medical test result feedback cause the most patient flow problems. Long wait times have an adverse impact upon patients’ perceptions of medical care. The macroergonomic methodologies prove feasible and effective in evaluating health care systems. / published_or_final_version / Industrial and Manufacturing Systems Engineering / Master / Master of Philosophy

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