The Balanced Scorecard (BSC) was first proposed by Robert S. Kaplan, Professor of Accounting at the Harvard Business School, and David Norton, founder and president of a consulting firm in 1992. They elaborated the idea of strategic measurement system to oversee the performance of a business unit. The system is suitable for both profit and non-profit organizations. After ten years, BSC is proved to be a very powerful tool to inspect the performance of a company, also the implementation of a firm¡¦s strategy. National Health Insurance (NHI) in Taiwan was practiced in 1995. Medical service system had dramatic changes since that time. In order to keep financial balance, NHI develops new policies from time to time, reforms the reimbursement criteria, from fee-for-service to global budget. Hospitals face incessant new challenges. Military hospitals, belonging to non-profit government organizations, play an important role in medical services. It is absolutely important ¡§how to survive under such critical environment, and achieve the goal of permanent operation.¡¨ This thesis is a case study, taking an armed forces hospital as an example to construct its system of strategy management. By implementing the Balanced Scorecard, the hospital can reposition its role according to the mission. Then, the hospital can set up its vision and strategic objectives to draw the strategy maps. Within the four perspectives of the BSC, the hospital can select several measurements to evaluate their performance, then, they can know what has been changed and what needs to be improved. The Balanced Scorecard is the best management tool to implement a company¡¦s strategy. At present, BSC is applied to help strategy management in some hospitals. If it is applicable for a military hospital, it would be a great opportunity to overcome the competitive environment and to achieve the goal to run our military hospital permanently.

The main responsibility of the medical institution is to provide medical services that meet patients¡¦ needs as well as create health value in a patient¡¦s life. Hospital marketing, a type of service marketing promoting intangible products, is a way of utilizing medical service marketing to provide patients with more efficient medical service. Since the implementation of National Health Insurance, Taiwan¡¦s medical system has experienced an increased of enterprization in hospital management, the implementation of a global budget payment system, the financial crisis and the impact of rising medical right demanded by the Taiwanese. The military district hospitals that are responsible for maintaining the combat power of the military staff also pay an important role in the National Health Insurance medical system. While confronting the change in the competitive environment and the transformation of the entire medical ecology, military district hospitals should take a step further to adjust and develop a new marketing strategy. The research method of this paper adapts a case study based on information from a military district hospital located in southern Taiwan. The discussion focuses on the changes in current medical ecology and the competitive advantages of the subject hospital. Diamond Theory by Michael Porter and SWOT analysis are used to evaluate the strengths and weakness in and outside of the hospital, determine the trend choice for the hospital¡¦s new positioning, and define the right strategy to target to its market segment. All of these are based on the concept of national defense. The paper will also take into consideration the subject hospital¡¦s special features and competitive advantages, and build an 8P marketing model centering on patients in order to formulate the best combination of marketing strategies for the subject hospital. The paper has three conclusions, first of all, recognize the competitive advantages and the opportunities of the subject hospital; second, assert the new positioning of the transformed medical service; finally, establish a patient-oriented marketing strategy. In addition, this paper also suggests the best marketing strategy combination by applying innovative and pragmatic managerial thinking in order to give the military hospital a brand new image.

The prolonged wars in Iraq and Afghanistan have taken a toll on the United States as a whole and the United States military in particular. The primary aim of this research is to determine what impact the wars in Iraq and Afghanistan have had on the performance of military hospitals over the fiscal years 2001-2006. Specifically, what direct effect has the war in Iraq and Afghanistan had on the productivity and quality of military hospitals, and, do productivity and quality trends differ based on hospital characteristics? Since observations over multiple time periods are nested within hospitals, multilevel mixed effects regression and Poisson regression models are used to evaluate changes in productivity and quality while accounting for differences within hospitals. Using a contingency theory framework, this study fills the gap in looking at the impact of war on permanent military hospitals’ productivity and quality using nationally developed and implemented quality indicators (Agency for Healthcare Quality and Research Inpatient Quality Indicators and Patient Safety Indicators). Structural characteristics of the hospital, teaching status and branch of Armed Service influenced productivity and certain quality indicators. The structural components were not able to reliably predict differences in productivity and all quality indicators, but overseas hospitals and non-teaching hospitals were most likely to differ from major teaching hospitals. The wars in Iraq and Afghanistan, denoted by the variables for wounded discharges and deployed staff, were only partially related to the productivity of military hospitals. Only an increase in the percentage of wounded discharges was related to productivity of military hospitals, and none were related to the quality indicators. In essence, the war affected the workload and productivity of military hospitals, but it did not affect the quality provided in the hospitals, as measured by AHRQ inpatient and patient safety quality indicators. Structural characteristics account for more of the variation in quality among military hospitals than the impact of war within the timeframe studied.

<p>Spinal cord injury is a devastating condition, and its consequences impact on many facets of an individual&rsquo / s life. Activities of daily living such as personal care and housework might be difficult to perform post injury. The majority of spinal cord injury patients receive hospital-based rehabilitation to address these consequences. The normal length of hospital stay among spinal cord injury patients ranges from three to twelve months, and an increased length of stay are caused by development of secondary complications such as pressure sores, urinary tract infection and respiratory infection. The purpose of this study was to determine factors affecting length of hospital stay for individuals with spinal cord injuries at Kanombe Military Hospital in Rwanda. To achieve this, a retrospective study, utilising a quantitative approach was used. The records of individuals with spinal cord injuries discharged from the hospital between 1st January1996 and 31st December 2007 were reviewed to collect data. A data gathering instrument was developed by the researcher and there after used to capture the relevant information from the patients&rsquo / folders. Information collected included demographic data, information relating to the injury, occurrence of medical complications and length of hospital stay. One hundred and twenty four medical folders of patients discharged from 1st January 1996 to 31st December 2007 at Kanombe Military Hospital were reviewed for data extraction. The Statistical Package for Social Sciences (SPSS) version 16.0 for windows was used to analyse the data. Both descriptive and inferential statistics were determined in SPSS. Associations were made between demographic factors and occurrence of secondary medical complications with length of hospital stay. These were computed by means of chi-square tests. One level of significance, alpha set at 5% was used throughout. The linear regression analysis was used to determine factors affecting the length of stay.</p>

Hospital Information System (HIS) is considered as an important factor in health care sector for managing the administrative, financial and clinical aspects of a hospital. A large number of hospitals from both developing and developed countries are adopting hospital information system to bring efficiency in their current system. Current study is conducted to contribute to the literature regarding HIS implementation in developing country settings as there is scarce literature. This study attempts to improve the understanding of HIS implementation in developing countries.  In this study, socio technical model is used to understand the current working system of cardiology department of Combined Military Hospital (CMH). Qualitative case study is conducted for this research. Data is collected with the help of interviews done online via Skype and some secondary data resources to highlight the problems and solutions before HIS implementation. The data collection, generation of results and analysis is done on the basis of structure, people, technology, and process perspective originating from the socio-technical model. Findings of this study are presented in the form of recommendations which need to be considered for making a HIS implementation plan.

To increase medical service quality for medical ecology is necessary nowadays, it provides not only customers satisfaction and ensure patent s¡¦ willing for next visit, but also have the requirements of the hospital accreditation. Furthermore, medical service quality has become the main purchasing direction for hospital administrators. This survey is based on ¡§5Q model for different dimensions¡¨ by Zineldin (2006), including quality of object, quality of processes, quality of infrastructure, quality of interaction, quality of atmosphere. However, it evaluates which medical service quality that may affect patient¡¦s satisfaction and loyalty for having examination check in radiological department. The result of this research can be used by the hospital to provide the medial service quality, hospital competitiveness, sustainable development, and to supply more effective strategies in future direction. This survey investigated the patients for the examination of medical imaging from the biggest military hospital in southern, which was assessed as a regional Teaching Hospital by department of Health, the executive Yuan. A total of 600 questionnaires were sent out to patients, with 586 valid samples, and with 14 uncompleted invalid samples. The effective response rate is about 97.9%. In this study, the quality of medical service is based on five dimensions analysis, respectively patient satisfaction and patient loyalty. In addition, the patient satisfaction provided analysis and discussion for patient loyalty. The research was the participants with medical treatment from military hospital and was carried the analysis in order to further understand the significant difference in the causes for medical treatment, medical service quality, patient satisfaction and royalty. The research is summarized as follows: 1.The medical service quality ¡§quality of object, quality of processes, quality of infrastructure, quality of interaction, quality of atmosphere. ¡§ were all positive and significant influence on patient satisfaction, particularly quality of atmosphere and quality of interaction. 2. The quality of object, quality of interaction, quality of atmosphere had also strong and positive impact on the loyalty of the patients, but the quality of process, and the quality of infrastructure hadn¡¦t affect the patients¡¦ loyalty remarkably. 3. In addition, patient satisfaction appeared a relevant and significant impact on patient loyalty. 4. For treatment reasons, people who were military and military dependents were significant higher than the patients who live closely to hospital for quality of object, quality of infrastructure, quality of interaction, quality of atmosphere and patient satisfaction.

<p>Spinal cord injury is a devastating condition, and its consequences impact on many facets of an individual&rsquo / s life. Activities of daily living such as personal care and housework might be difficult to perform post injury. The majority of spinal cord injury patients receive hospital-based rehabilitation to address these consequences. The normal length of hospital stay among spinal cord injury patients ranges from three to twelve months, and an increased length of stay are caused by development of secondary complications such as pressure sores, urinary tract infection and respiratory infection. The purpose of this study was to determine factors affecting length of hospital stay for individuals with spinal cord injuries at Kanombe Military Hospital in Rwanda. To achieve this, a retrospective study, utilising a quantitative approach was used. The records of individuals with spinal cord injuries discharged from the hospital between 1st January1996 and 31st December 2007 were reviewed to collect data. A data gathering instrument was developed by the researcher and there after used to capture the relevant information from the patients&rsquo / folders. Information collected included demographic data, information relating to the injury, occurrence of medical complications and length of hospital stay. One hundred and twenty four medical folders of patients discharged from 1st January 1996 to 31st December 2007 at Kanombe Military Hospital were reviewed for data extraction. The Statistical Package for Social Sciences (SPSS) version 16.0 for windows was used to analyse the data. Both descriptive and inferential statistics were determined in SPSS. Associations were made between demographic factors and occurrence of secondary medical complications with length of hospital stay. These were computed by means of chi-square tests. One level of significance, alpha set at 5% was used throughout. The linear regression analysis was used to determine factors affecting the length of stay.</p>

Magister Scientiae (Physiotherapy) - MSc(Physio) / Spinal cord injury is a devastating condition, and its consequences impact on many facets of an individual's life. Activities of daily living such as personal care and housework might be difficult to perform post injury. The majority of spinal cord injury patients receive hospital-based rehabilitation to address these consequences. The normal length of hospital stay among spinal cord injury patients ranges from three to twelve months, and an increased length of stay are caused by development of secondary complications such as pressure sores, urinary tract infection and respiratory infection. The purpose of this study was to determine factors affecting length of hospital stay for individuals with spinal cord injuries at Kanombe Military Hospital in Rwanda. To achieve this, a retrospective study, utilising a quantitative approach was used. The records of individuals with spinal cord injuries discharged from the hospital between 1st January1996 and 31st December 2007 were reviewed to collect data. A data gathering instrument was developed by the researcher and there after used to capture the relevant information from the patients' folders. Information collected included demographic data, information relating to the injury, occurrence of medical complications and length of hospital stay. One hundred and twenty four medical folders of patients discharged from 1st January 1996 to 31st December 2007 at Kanombe Military Hospital were reviewed for data extraction. The Statistical Package for Social Sciences (SPSS) version 16.0 for windows was used to analyse the data. Both descriptive and inferential statistics were determined in SPSS. Associations were made between demographic factors and occurrence of secondary medical complications with length of hospital stay. These were computed by means of chi-square tests. One level of significance, alpha set at 5% was used throughout. The linear regression analysis was used to determine factors affecting the length of stay. / South Africa

This thesis aims at investigating the importance of effective implementation of health safety and hygiene legislations and practices in Health Care delivery systems. A new System Based Approach for Strategic Implementation of Occupational Health & Safety Practices is proposed in this thesis. The underlying principle of the approach is based on involvement and inputs from staff and management rather than by pre-specified requirements and objectives. Furthermore, the development process is a closed loop process that provides a mechanism for continuously evaluating system performance and monitoring activities that have considerable impact on health and safety practices. A case study was conducted in the medical laboratories of five major hospitals in the Emirate of Abu Dhabi. Data were collected through questionnaires, staff interviews, and reviewing laboratory safety reports compiled over a three years period. The main conclusions from this study are: 1. The proposed approach has proven to be useful in analyzing existing health and safety systems. The methodology and tools proved to be instrumental in defining inefficiencies and determining the status of the Health & Safety policies & practices in the selected medical laboratories. 2. Effective implementation of the proposed approach has shown improvements in productivity, operational cost, service quality, staff and management satisfaction. 3. The case study has demonstrated that a developing country such the UAE, with no previously existing Health & Safety legislation and little risk prevention culture, can rapidly and effectively introduce effective industry specific H&S by adopting an integrated systems based approach. 4. UAE has highly advanced and economically developing base, there is a general willingness at senior level within the UAE to achieve high levels of competence and standards in all industrial sectors. 5. CAP is a system based management tool which has been implemented globally, but only limited in the gulf region; CAP has been implemented by the author and colleges within Zayed Military Hospital between 2003-2007.

This thesis aims at investigating the importance of effective implementation of health safety and hygiene legislations and practices in Health Care delivery systems. A new System Based Approach for Strategic Implementation of Occupational Health & Safety Practices is proposed in this thesis. The underlying principle of the approach is based on involvement and inputs from staff and management rather than by pre-specified requirements and objectives. Furthermore, the development process is a closed loop process that provides a mechanism for continuously evaluating system performance and monitoring activities that have considerable impact on health and safety practices. A case study was conducted in the medical laboratories of five major hospitals in the Emirate of Abu Dhabi. Data were collected through questionnaires, staff interviews, and reviewing laboratory safety reports compiled over a three years period. The main conclusions from this study are: 1. The proposed approach has proven to be useful in analyzing existing health and safety systems. The methodology and tools proved to be instrumental in defining inefficiencies and determining the status of the Health & Safety policies & practices in the selected medical laboratories. 2. Effective implementation of the proposed approach has shown improvements in productivity, operational cost, service quality, staff and management satisfaction. 3. The case study has demonstrated that a developing country such the UAE, with no previously existing Health & Safety legislation and little risk prevention culture, can rapidly and effectively introduce effective industry specific H&S by adopting an integrated systems based approach. 4. UAE has highly advanced and economically developing base, there is a general willingness at senior level within the UAE to achieve high levels of competence and standards in all industrial sectors. 5. CAP is a system based management tool which has been implemented globally, but only limited in the gulf region; CAP has been implemented by the author and colleges within Zayed Military Hospital between 2003-2007.