The thesis investigated nicotine levels and their effects on hypertensive subjects and whether aspirin could be used in the treatment of hypertension to bring about not only an anti thrombotic effect but reduce the systemic blood pressure especially in those individuals who smoke cigarettes. The study, which also audits the use of aspirin, was conducted in Kuwait and so provides an insight of hypertensive patients very rarely considered in the literature The thesis begins in Chapter One with an extensive literature review which analyses the properties and problems that nicotine causes and its ability to cause hypertensive changes along with its multitude of other events. The physiological and pathological problems caused by nicotine are reviewed on the basis of its chemistry and pharmacological properties using a worldwide perspective rather than just focus on Kuwait. The second Chapter uses extensive analysis of the literature to determine the pharmacological properties of aspirin and its use in cardiovascular disease. The pharmacokinetics and therapeutic effects are presented with emphasis to its inhibitory effects on platelet activation which is central to the development of serious cardiovascular consequences such as stroke and myocardial infarction. The third Chapter returns to consider the literature in detail and why nicotine has specific effects on the cardiovascular system in terms of receptor stimulation and how aspirin may be able to reduce nicotine¿s cardiovascular effects and concludes with the Aims and Objectives of the thesis. The fourth Chapter investigates urinary nicotine levels in smokers from cigarettes available in Kuwait to indicate the actual levels which could be achieved by smokers in this study. This established that the levels would cause pharmacological effects demonstrating also the effects of passive smoking. The number of cigarettes smoked per day has an unpredictable effect on metabolism and urinary output of nicotine. The fifth Chapter is the major investigational section of the thesis and considers if aspirin ability to reduce cardiovascular effects, may be useful in terms of diastolic blood pressure and lipid levels in the 4 blood. The effects were suggestive that aspirin did reduce the blood pressure in hypertensive subjects but was not universal and was limited to those suffering from mild - moderate hypertension. It was determined that aspirin should be sued at the earliest age possible in these patients. The sixth Chapter involved a large scale trial of the effectiveness of aspirin treatment in hypertensive patients over a one year period in Kuwait. This used ambulatory blood pressure measurements to determine the effectiveness of daytime and nightime changes in blood pressure in patients with and without aspirin treatment. The overall conclusion was a reduced relative risk of suffering cardiovascular events in mild to moderate hypertension when aspirin (75mg/day) was administered. Specifically in smokers, aspirin lowers the systolic daytime BP and diastolic nightime BP. To support this work a comprehensive audit is provided of the use of the current use of aspirin in Kuwait hospitals / Cultural Office in the Kuwait Embassy in London; Civil Service Commission of Kuwait; The Assistant Under Secretary for the Drugs and Medical Supplied Affairs

Promoting economic diversity is important for states reliant on natural resources as the major source of economic development. Many of these states suffer from the Dutch disease leading to negative effects, which hinders economic diversification. One of the ways to reduce dependency on national resources is to encourage Foreign Direct Investment (FDI) inflows, which aids diversification by the transfer of technology, the creation of new employment opportunities, and the adoption of modern management practices. The Gulf Council Cooperation (GCC) countries recognised the necessity and benefits of FDI as an aid to economic diversification; it seems, however, that Kuwait is lagging behind in this endeavour. The government of Kuwait has engaged in a series of policy measures to induce Multinational Companies (MNCs) to invest in Kuwait, but the results, thus far, have been disappointing. The formal and informal institutions interact in a variety of ways. However, ineffective formal rules can create different outcomes; particularly, in the presence of strong informal institutions. In such a case, formal rules and procedures are not enforced systematically, that is, enabling actors who are involved in the policy process to ignore or violate them, which subsequently results in a failure to attract inward FDI to a host country. Thus, this study investigates the reasons behind this failure by examining the role of formal and informal institutions on FDI policy and on decisions on whether to grant FDI licences by means of using a New Institutional Economics (NIE) approach. The conceptual framework is used as a guide for an inquiry into the subject of study by constructing a category of intellectual scaffolding, which would provide a coherent structure (Schlager, 2007). The conceptual framework in this study systematically organises the investigation into how a MNC examines a potential investment location by dividing the host country assessments into four distinct ¿stages¿. When systematically conducted, the respective approach is grounded in the existing literature, which provides theories regarding the behaviour of MNCs in relation to their decision-making processes for considering locations for their FDI projects. The research questions derived from the conceptual framework are answered using a mixed methods research approach that uses three sets of data survey, semi-structured interviews, and secondary data. Firstly, the findings show that almost that all MNCs in the Gulf region have a limited awareness regarding investment opportunities in Kuwait, FDI laws and regulations. Secondly, the findings reveal a number of attractive and unattractive locations, and institutional factors of Kuwait. Finally, it is discovered that the high rejection rate of FDI applications is linked to unsuccessful policy implementation, which is a result of interaction of both formal and informal institutions in Kuwait. Subsequently, the results are utilised to make a number of recommendations for government policy makers, administrators, and for MNCs regarding how to improve FDI inflows into Kuwait. The results are also used to contribute towards the international business literature concerning the institution based view of FDI, and for government policy connected to attracting FDI. / Kuwait Petroleum Corporation (KPC)

This research explores leadership effectiveness in organisations in Kuwait from the perspective of Chief Executive Officers (CEOs). This is an area that has been neglected by the extant literature, and no integrated model for assessing CEO effectiveness exists for us to fully understand the phenomenon. Based on a positivist qualitative research approach, evidence was drawn from 16 CEOs using semi-structured interviews. The evidence was corroborated by using data obtained from participant observations of two CEOs working in the same organisation as the researcher. The results indicated that CEOs perceive leadership effectiveness as driving execution and not necessarily the realisation of goals themselves. Their experiences of leadership lead to CEOs in Kuwait believing that leadership effectiveness depends on their leadership style, relationship with the Board and the Executives, experience and family ground, societal and organisational culture, the business environment and CEO characteristics. On the basis of the participants’ perceptions of leadership effectiveness, it is recommended that CEO leadership development in Kuwait should focus on these areas, as this should equip CEOs to be effective in formulating clear visions and executing strategies to enable economic development of the country, and this should help them to compete globally. As the study focused on private and public companies, future research could consider CEOs from governmental and not-for-profit organisations to expand the sample of CEOs.

Introduction: The studies reported in this thesis investigated a number of patient orientated aspects of its current diagnosis, management and treatment in Kuwait. A comprehensive literature survey is presented with a detailed critical analysis of the very limited number of published material relevant to type 2 diabetes in Kuwait is also provided. A concise list of aims and objectives is also provided. Methodology: The methodology used to derive knowledge of the present situation from the patient perspective, was a series of relevant questions, devised based on the internationally used diabetes Michigan questionnaire. Face to face interviews were used throughout for both patients and medical staff. Suitable data analysis was performed. Results: A pilot study consulted 10 Kuwaiti and 10 non-Kuwaiti patients, and after analysis of their data it was found to be reliable, appropriate and capable of being analysed and so was extended to a larger study of 109 diabetic patients. These 109 diabetic patients were studied in thirteen clinics distributed throughout Kuwait. Two groups of patients were studied – Kuwaiti nationals and non-Kuwaitis both of whom were treated at these clinics during their residency in Kuwait. 38 questions were asked including demographics, medical treatment, monitoring of their disease, physiological consequences and dietary aspects. The major findings were that patients considered two major areas could be improved to enhance the treatment of their disease. The first was to improve the degree of empathy shown to them by the medical/nursing staff and secondly to provide simple practical advice on exercise, dietary considerations and renal aspects of their disease. More comprehensive findings are presented in the thesis but many of these were minor compared with these two major aspects. Also presented are interviews with the medical staff in Kuwait who treat diabetic patients and the problems they face when treating their disease. The opinions and views of selected ophthalmologists and renal specialists are also presented. Medical views were also sought in the UK- Ascot Rehabilitation above their experiences treating diabetic patients from Kuwait. Another aspect of the study was to interview Kuwaiti nationals who had been sent to a clinic in Ascot, UK for the treatment of the serious consequences of their conditions. Many of these were had type 2 diabetes and their views and perspectives of their treatment in Kuwait were gathered as being representative of the long term treatment of this condition. Discussions and Conclusions: The thesis discusses in some detail all the results which were obtained and concludes with a series of recommendations which could be taken to improve the treatment of type 2 diabetes in Kuwait.

As a result of globalization, the concept of Corporate Social responsibility (CSR) has become on the agendas of organizations over the past decade. The organizations in Kuwait are no exception; they have been striving to address and execute the best practices of CSR. The banking sector in Kuwait, which plays a pivotal role in the economy, represents an area of strong interest for anyone wanting to research the depiction of CSR in Kuwait since it was the first sector that introduced corporate social responsibility and is considered a pioneer in that field. However, no studies were found that have examined CSR policies in practice in Kuwait or in the banking sector in particular. This thesis therefore focuses on obtaining a better understanding of how corporate social responsibility works in practice in the Kuwaiti banks from the perspective of three groups: the decision makers of CSR in the Kuwaiti banks, the employees of the banks, and the banks’ customers. The researcher used a qualitative approach in which data were collected using interviews and document analysis. The collected data were interpreted and analysed and thereafter drawn the conclusion that banks are very clear in defining their CSR objectives which are aligned with their overall corporate strategy. However, there were commonalities and differences in how stakeholders understand and perceive CSR. The study also revealed that both the 2008 financial crisis and Islam influenced the way CSR is exercised in the banks, and moderately, influenced the employees and customers. / Burgan Bank

The corporate world today is highly competitive and in order for organizations to survive and remain competitive, they must constantly evolve through change. However, the majority of organizational changes neither result in successful implementation or foster sustained change. It is suggested that the success of changes are highly contingent on employees’ responses towards them. To this end, Islamic Work Ethic (IWE) has become a subject of growing interest amongst academia and human resource literature attempting to understand and predict employees’ responses towards organizational change, particularly in Muslim societies. Despite this, studies attempting to uncover IWE’s influence on characteristics of employees’ responses towards change have revealed varying outcomes. Thus, the nature of the relationship remains ambiguous. To tackle this gap, this study contributes to knowledge by developing a conceptual model that assists in identifying the influence of IWE on employees’ responses towards change in the shape of their commitment to change and organizational deviance behaviors. The testing of these relationships was carried out in the ever changing and developing Islamic banking industry within the Middle Eastern context of Kuwait. Through a quantitative case-study approach, data was collected from 398 branch-level employees via questionnaires. The outcomes revealed that the extent of IWE’s influence on employee commitment to change varied greatly across different components (affective, normative and continuance). On the other hand, IWE was found to negatively influence employee engagement in organizational deviance towards change. Due to such findings, several theoretical implications, practical recommendations and future research directions are put forward.

Similar to other healthcare systems worldwide, Kuwait faces challenges of increased demand and cost while trying to operate with constrained resources. There are some data suggesting that Lean methodology, first used by Japanese car manufacturer Toyota, could improve system efficiency or flow by waste elimination, may be useful in addressing some of the challenges found in healthcare. Lean has so far not been used in Kuwaiti primary healthcare centres. This thesis explores the case for using Lean in Kuwait by examines issues around diabetes, as Kuwait rank the six highest in the world. In Kuwait, patients with diabetes are mainly managed in primary healthcare centres. The case for using Lean was explored across five interrelated studies which are summarised below: Study 1 involved a review of the literature which found that Lean tools have been used mostly in hospital settings without any rigorous evaluation and with little or no attention paid to primary healthcare or in developing countries. Study 2 was a systematic documentary review of the challenges facing the healthcare system of Kuwait. In Kuwait, expenditure on healthcare services is expected to double within five years. Life expectancy is increasing, while the percentage of the elderly population is growing, leading to increasing demand of services to treat non-communicable disease such as diabetes. Kuwait still sends many of its patients overseas for treatment. Currently, 10 mega projects worth approximately 2 billion Kuwaiti Dinar are being constructed in Kuwait that will result in a doubling of the bed capacity. However, the average occupancy rate between 2006 to 2015 was 63.6%, which is considered low compared to the average occupancy rate in European Union countries. Study 3 sought the views of Kuwaiti healthcare leaders about Lean and challenges facing the healthcare system of Kuwait. The key findings were: (1) Most leaders agreed that the current healthcare system in Kuwait faces difficult challenges and needs to change its management approach; (2) Lean as a management approach is considered a new concept among leaders of Kuwaiti healthcare organisations; (3) They did not have adequate knowledge regarding Lean but were willing to support any future Lean improvement initiatives. Study 4 explored the knowledge of Healthcare Workers regarding Lean within Kuwait’s primary healthcare centres through a cross-sectional survey in four primary healthcare centres. Only 11% of participants were familiar with Lean. None of the participants were involved or had an ongoing Lean initiative or project but 80% of participants were willing to be involved in future Lean initiatives. Study 5 mapped the flow of patients with type 2 diabetes in primary healthcare centres to identify potential waste and make recommendations for improvement. Patients with type 2 diabetes typically visit their General Practitioner at least every two months for a review appointment. When a blood test is required to monitor blood sugar levels, three more visits are required, involving the blood test, collection of test results by the patient and a review of the results with the general practitioner. Four potential improvements were identified: using point of care testing, the posting of laboratory results to general practitioner computer systems, the introduction of guidelines that standardise the practice for the patient’s visit and permitting the general practitioner to prescribe medication that will last four months. The process map of patients with type 2 diabetes has highlighted waste and improvement suggestions that may reduce workload, enhance patient satisfaction, avoid unnecessary visits, enhance the timeliness of laboratory testing, improve communication between and across departments and minimise the use of resources without undermining the quality of care. These suggestions, if implemented on the national level, could bring tremendous benefits but still need to be rigorously evaluated. The thesis concludes by noting that there is considerable potential in adopting Lean to improve the healthcare services in Kuwait, but further work is required to implement the changes and rigorously evaluate them.

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