Introduction: Management of complex systems is facilitated through effective information systems that provide real-time data to decision makers. For example, instrument panels in airplanes ensure that pilots have well-designed feedback concerning the status of mission-critical variables. Problem: While pilots have dashboards for feedback and communication, healthcare executives may be unaware of effective use of evidence-based guidelines within their healthcare system. Purpose: The first objective of this research was to design and implement an automated intranet dashboard reporting performance measures for a geographically dispersed health system. The second objective was to describe how this dashboard might increase cooperation and coordination for individuals and organizations involved with healthcare delivery. Design: This research was exploratory in nature, employing descriptive research approaches. A convenience sample of healthcare executives completed a baseline survey at the start of the study assessing levels of communication and cooperation. After three months of exposure to the dashboard, participants were asked to complete a follow-up survey. All visits to the dashboard were recorded in a web server log file. Semistructured qualitative exit interviews were also conducted to explore reactions to the dashboard, experiences with receiving outcome reports, and barriers to communicating and coordinating with counterparts. Results: Descriptive analysis of paired survey scores found substantial increases on a number of survey items, suggesting that the dashboard contributes toward increased communication and coordination for healthcare executives. This finding is balanced by the limited rigor in the research design and an analysis of the web server log file, which found few visitations to the dashboard by research participants. Qualitative data analysis suggests that current reporting mechanisms are suboptimal for healthcare executives and that one solution is the use of dashboards. Conclusion: This study resulted in a number of important discoveries and avenues for further research. A more rigorous research design is needed to explore the role of intranet dashboards in healthcare settings. / Graduation date: 2004

The presence of a device meant to enhance the medical encounter may alter the nature of the doctor-patient interaction in a way that affects patient satisfaction. The focus of this study was to examine the social impact of introducing advanced exam-room technologies to the doctor-patient interaction. By comparing cohorts (young: 18-39 and older: 62-89) we examined a possible age-related interaction. Participants viewed one of several video conditions portraying a physician conducting a medical interview in which he uses one of various documenting technologies (Nothing, Pen and Paper, PDA, Desktop Computer, Wearable Computer). After viewing the interaction, participants completed a series of questionnaires evaluating their general satisfaction with the quality of care (QoC) given during the medical interview. Patient satisfaction levels did significantly vary depending on the technology condition, participant cohort, and participant gender. Overall, young adults and females rated the doctor more favorably. The favorability of ratings for each technology condition depended on the aspect of QoC examined.

Thesis (Ph. D.)--RAND Graduate School, 2002. / Includes bibliographical references (p. 96-101).

Thesis (MTech (Office Management and Technology))--Cape Peninsula University of Technology, 2017. / Healthcare facilities across South Africa are increasingly facing a myriad of societal, fiscal, political and cultural challenges associated with demands for greater quality in the provision of healthcare services. This study measures service quality and customer satisfaction at a Cape Town hospital (hereinafter referred to as Hospital X), with the aim of providing its management with information to enable them to enhance service quality and thus improve customer satisfaction. It is essential to note that the respondents in this study were the parents or guardians of patients. The views of the patients were not obtained directly from them as it would have been unethical for minors to have participated in the survey. Their parents or guardians were surveyed in order to obtain the requisite data. The problem investigated was that management at public hospitals does not regularly research what customers need from a service quality point of view, Therefore, Hospital X may be failing to provide a quality service to its customers, namely, parents and guardians. Against this background, the researcher set out to measure customer perceptions and expectations of service quality by making use of the SERVQUAL model. “Customer expectation” is what the customer can reasonably expect given the available resources and is likely to be influenced by personal needs and past experience. “Customer perceptions” are totally subjective and based on the customer’s interaction with the service provided at Hospital X. The SERVQUAL model (reliability, assurance, tangibles, empathy and responsiveness), is commonly known as the RATER model, RATER being an acronym formed from the first letter of each of the five dimensions of SERVQUAL. The study incorporates the SERVQUAL dimensions within a survey comprising a number of questions structured on a six-point Likert scale. The results of applying the SERVQUAL model will indicate whether or not Hospital X provides a quality service to their customers. The study seeks to demonstrate the importance of service quality and customer satisfaction to hospital management, as well as the impact that effective service quality can have on customers’ evaluation of their overall hospital experience. (The term customer will be used interchangeably with parent and/or guardian in this study.)

Patient perceptions of health care quality are critical to a health care service provider's long-term success because of the significant influence perceptions have on customer satisfaction and consequently organization financial performance. Patient satisfaction affects not only the outcome of the health care process such as patient compliance with physician advice and treatment, but also patient retention and favorable word-of-mouth. Accordingly, it is a critical strategy for health care organizations to provide quality service and address patient satisfaction. The urgent care (UC) industry is an integral part of the health care system in the United States that has been experiencing a rapid growth. UC provides a wide range of medical services for a large group of patients and now serves an increasing population. UC is becoming popular because of the convenient locations, extended hours, walk-in policy, short waiting times, and accessibility. A closer examination of the current health care research, however, indicates that there is a paucity of research on urgent care providers. Confronted with the emergence of the urgent care industry and the increasing demand for urgent care, it is necessary to understand how patients perceive urgent care providers and what influences patient satisfaction and retention. This dissertation addresses four areas relevant to the above mentioned issues: (1) development of an instrument to measure perceived service quality in the urgent care industry; (2) identification of the determinants of patient satisfaction and behavioral intentions; (3) empirical examination of the relationships among perceived service quality, patient satisfaction and behavioral intentions; and (4) comparison of the perceived service quality across several primary urgent care providers, such as urgent care centers, hospital emergency departments, and primary care physicians' offices. To validate this new instrument and examine the hypothesized relationships proposed in this study, an electronic web based survey was designed and administered to college students. Both exploratory and confirmatory factor analysis were employed to assess the reliability and validity of the developed instrument. The contextualized relationships were evaluated using structural equation modeling. The results of this research could potentially contribute to urgent care management and quality improvement.

Submitted in compliance with the requirements for the Master's Degree in Technology: Nursing, Durban University of Technology, 2014. / Background : Tuberculosis (TB) is a global public health concern and is identified as the leading cause of morbidity and mortality in the population infected with Human Immune Deficiency Virus (HIV). South Africa (SA), particularly the KwaZulu-Natal Province, is burdened with persistently high rates of both TB and HIV infections. In an attempt to improve TB and HIV co-infection outcomes the South African health care system has adopted the World Health Organisation (WHO) guidelines for intensified TB case findings in all HIV positive individuals for regular screening of TB symptoms in order to promptly diagnose and treat active TB disease or to exclude TB for initiation Isoniazid Prophylactic Therapy (IPT). IPT has proven effective in preventing TB disease in People Living with HIV or AIDS (PLWHA). This critical first step of TB symptom screening is regarded as the intervention that could significantly reduce the challenge currently faced with TB-HIV co-infection. The study was conducted in selected eThekwini Municipality Primary Health Care (PHC) facilities with the focus on an investigation to determine the extent of the implementation of the TB symptom screening tool in HIV infected individuals, in addition to identifying treatment initiation or further investigations based on the tool implementation. It has been found during the literature review, that there is a lack of research in SA to show that this critical first step in TB identification has been investigated, yet one in six South African’s is HIV positive and the incidence of TB-HIV co-infection is not declining. Methodology : A quantitative, descriptive approach was utilised to conduct a retrospective patient chart review. A multistage cluster sampling technique comprising three stages was implemented to identify the sample. There was a random selection of clinics, and the required number of client records was obtained through convenience sampling from the selected clinics. Results : The findings of this study revealed there is inadequate implementation of the current national and provincial TB protocols. The study provides varied levels of information about TB symptom screening in HIV infected individuals in the PHC clinics of eThekwini Municipality. It was observed that Health Care Worker’s (HCW) in some facilities carried out TB symptom screening to an extent. However, the inconsistent and partial application of this screening tool warrants improvement to facilitate the broad success of TB-HIV care strategies.

Many parts of South Africa face a shortage of doctors within the public health system. While the PHC system is driven primarily by nursing staff, there is a need for doctors to provide certain services at primary and secondary levels. In 1996, as part of its efforts to address the shortage of doctors, the DoH began recruiting Cuban doctors to work in South Africa. This programme, now underway in eight of the nine provinces, falls under a government-to-government agreement aimed at strengthening the provision of health care in the areas of greatest need: townships and rural areas. The programme has demonstrated tangible success. However, it has also been criticised in some sections of the medical community and the media, where it has been portrayed in a controversial light. All this underlines the importance of an analysis of the programme, but to date, no such evaluation has been carried out.<br /> <br /> This research assesses the Cuban Health Programme in Gauteng province. On the basis of this thorough assessment, the government can take steps to improve the national programme, using Gauteng as a case study. This study was conducted in July 2004, employing qualitative methods to develop an in-depth understanding of recruitment and induction processes in Cuba and South Africa, the scope of practice of Cuban doctors, professional relationships, adaptation to the health system and broader society, and other factors. The researcher also conducted a review of official documents. Gauteng began with two Cuban doctors at the outset of the programme in 1996. The number peaked at 32, and has since dropped to 15. All of these doctors were interviewed in the course of the research, along with five managers and five peers. The study revealed that all the interviewees, except one manager, firmly believe that the programme has achieved its objectives, and should continue. Peers and managers commended the high quality, comprehensive and caring approach of the Cuban doctors, and say they are satisfying a real need. The Cuban doctors, however, believe that because they are providing mostly curative services, they are under-utilised. Flowing from the research are a series of recommendations. These include a proposal that the government recommit to the programme and ensure its continuity, and review the current role of the Cuban doctors, taking into consideration their willingness to provide training and expertise in preventive interventions.

Many parts of South Africa face a shortage of doctors within the public health system. While the PHC system is driven primarily by nursing staff, there is a need for doctors to provide certain services at primary and secondary levels. In 1996, as part of its efforts to address the shortage of doctors, the DoH began recruiting Cuban doctors to work in South Africa. This programme, now underway in eight of the nine provinces, falls under a government-to-government agreement aimed at strengthening the provision of health care in the areas of greatest need: townships and rural areas. The programme has demonstrated tangible success. However, it has also been criticised in some sections of the medical community and the media, where it has been portrayed in a controversial light. All this underlines the importance of an analysis of the programme, but to date, no such evaluation has been carried out.<br /> <br /> This research assesses the Cuban Health Programme in Gauteng province. On the basis of this thorough assessment, the government can take steps to improve the national programme, using Gauteng as a case study. This study was conducted in July 2004, employing qualitative methods to develop an in-depth understanding of recruitment and induction processes in Cuba and South Africa, the scope of practice of Cuban doctors, professional relationships, adaptation to the health system and broader society, and other factors. The researcher also conducted a review of official documents. Gauteng began with two Cuban doctors at the outset of the programme in 1996. The number peaked at 32, and has since dropped to 15. All of these doctors were interviewed in the course of the research, along with five managers and five peers. The study revealed that all the interviewees, except one manager, firmly believe that the programme has achieved its objectives, and should continue. Peers and managers commended the high quality, comprehensive and caring approach of the Cuban doctors, and say they are satisfying a real need. The Cuban doctors, however, believe that because they are providing mostly curative services, they are under-utilised. Flowing from the research are a series of recommendations. These include a proposal that the government recommit to the programme and ensure its continuity, and review the current role of the Cuban doctors, taking into consideration their willingness to provide training and expertise in preventive interventions.

Bibliography: leaves 203-219. / 219 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay. / Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000

[Truncated abstract] Physical healthcare uses a suite of tools for measuring response to treatment. However, reliable systems of regular patient monitoring are rare in mental healthcare. Mental health services often measure a treatment response from pre- to post- therapy, yet measurement between those occasions is less common. This omission is problematic since arguably there is a need for an alarm system in psychotherapy (Andrews & Page, 2005). A substantial minority of patients do not experience reliable change following treatment, and a small proportion deteriorates (Hansen, Lambert, & Forman, 2002; Newnham, Harwood, & Page, 2007). Without monitoring, it is not always possible to know which patients are progressing poorly. Since the publication of Howard and colleagues' (1996) proposal that patient progress be monitored routinely during therapy and the results fed back to clinicians to direct treatment, this monitoring regime has garnered attention in the United States and Europe (Lambert, 2007; Lutz, et al., 2006). Findings in outpatient psychotherapy have demonstrated that providing real-time feedback on patient progress to clinicians and patients significantly improves clinical outcomes for those patients demonstrating a negative response to treatment (Harmon et al., 2007; Lambert et al., 2001; Lambert et al., 2002). What is not yet apparent is how these processes would generalize to inpatient and day patient (i.e. patients attending hospital for a whole day of treatment) psychiatric care. Inpatients often present with greater severity and are treated in an intensive setting. ... Deviations from this expected pattern would highlight possible differences between inpatient and outpatient care. To develop an appropriate system for monitoring patient progress, it was important to first define clinically significant recovery in inpatient psychiatric care, and provide criteria for clinicians to judge outcome in routine practice (Newnham, Harwood, & Page, 2007). Second, a quick and easy-to-administer system of progress monitoring and real-time feedback was developed to enhance treatment decision making (Newnham, Hooke, & Page, 2009). Third, the system was evaluated to determine clinical effectiveness. Using the World Health Organization’s Wellbeing Index, a program for monitoring patient progress and providing feedback to clinicians and patients was established at Western Australia's largest private psychiatric service. The sample consisted of 1308 consecutive inpatients and day patients whose primary diagnoses were predominantly depressive (67.7%) and anxiety (25.9%) disorders. Feedback to patients and clinicians was effective in reducing depressive symptoms (F (1,649) = 6.29, p<.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F (1,569) = 1.14, p>.05). The findings support the use of progress monitoring and feedback in psychiatric care to improve symptom outcomes, but raise questions about changes in wellbeing during psychotherapy. The effectiveness study was conducted as a historical cohort trial, consistent with quality improvement efforts, and replication with a randomized controlled design is warranted. Feedback of progress information appears to be an important process within psychotherapy, and further investigation of the means by which clinicians and patients use that information is necessary.