M.A. (Business Management) / With the raise of competition in the Gabonese health industry and increased costs, most health service providers in Gabon have become under pressure to deliver good service quality. This also relates to the military hospital in Libreville in Gabon striving to provide adequate health services to its patients. The cost for hospitals to attract patients through several means such as providing good service quality has become crucial. Patient loyalty and retention can have an important financial advantage for a hospital, thus it has become essential for hospitals to create a sustaining relationship with their patients. The question of assessing service quality presents itself. This study investigated service quality at a military hospital in Libreville in Gabon. It was the objective of this study to establish if there is a difference in how patients rate doctors and nurses on the service quality dimensions. This research was quantitative and descriptive in nature. Theory relating to service quality and patient satisfaction was provided. The population for the study consisted of patients who were at least 18 years old, males and females, who have experienced medical services and stayed over at the military hospital for at least one night. A self administered questionnaire was designed based on the theoretical literature illustrated in the study. The questionnaire assessed various elements that were identified through the literature review. The questionnaire was based on a set of statements linked to the literature theory, and a 7-point Likert scale which enabled respondents to choose from seven different alternatives ranging from strongly disagree to strongly agree. A number of statistical analysis techniques were undertaken to achieve the objectives of the study, such as factor analysis. The conclusion and findings of the research assisted in explaining the objectives of the study and the results of the statistical analysis were found to reject the hypotheses that there is no significant difference in how patients rate the reliability, responsiveness, assurance and empathy of doctors and nurses and to reject the hypothesis that patients do not have a positive perception of the tangible aspects of a military hospital in Libreville, Gabon. In terms of the doctors’ services, patients felt a need for more privacy in terms of the confidentiality of their treatment, a need for more individual attention, a need to be heard, and to trust doctors. Therefore such needs could be addressed through improved compassion, communication and understanding of doctors during the diagnosis of the problem. The feeling expressed was that doctors should pay more attention to patients’ problems and share with them their experience. Doctors at the military hospital should develop more work ethic where patients’ records and cases should never be discussed with anyone without patients’ permission. The military hospital should employ highly trained and qualified doctors to address the trust issue with patients. Lastly, consultation time may need to be reviewed to add some extra time to better address patients’ needs during their consultation with doctors. In terms of the services delivered by nurses towards patients, the latter were of the opinion that there was a need for more individual attention from nurses. Such individual attention could include greater information sharing when a patient is treated, friendlier communication to install greater trust and respect. Such needs could be addressed through improved patience, compassion and understanding by nurses during their dealings with patients. Nurses should also develop more work ethic regarding patients’ records, and cases should never be discussed with anyone without their permission. Officials in the hospital should hire highly trained and qualified nurses to address the issue of trust in patients and consultation time may need to be reviewed to add some extra time to better address patients’ needs during their dealings with nurses.

Attainment of greater efficiency in hospital operations has become a goal highly sought after as a result of several factors including skyrocketing costs. The possibility that the different incentives associated with ownership type might affect efficiency has been covered thoroughly in the literature. There are numerous studies comparing for-profit to not-for-profit hospitals or public to private hospitals. Analysis of federal ownership, however, has been less studied. In particular, comparisons involving military hospitals are non-existent, attributed to data availability and an assumption that military hospitals are too different from civilian facilities. This dissertation employs a cross-sectional Stochastic Frontier Analysis (“SFA”) of 2006 data to compare the technical efficiency of military, for-profit, not-for-profit, and other government hospitals, controlling for differences in patients, scope of work, physicianhospital working arrangements, and other structural characteristics. Four model specifications are examined, varying the method of accounting for heterogeneity of case mix. One of the specifications uses a distance function technique to allow for specific inclusion of multiple outputs, namely inpatient and outpatient workload. Results obtained using SFA are validated using Data Envelopment Analysis (“DEA”) and compared with results produced through simple ratio analysis. Estimates of overall technical efficiency ranged from 76% to 80%. The analysis found no significant correlation between ownership category and technical efficiency. Factors found to be significantly correlated with greater technical efficiency include younger average patient age, more female patients, percentage of surgical inpatient work, percentage of circulatory system-based work, accreditation, and having all credentialed physicians (i.e. no physician employees). Pooled-vs.-partitioned analysis showed that military hospitals are indeed different, but not enough to render comparisons meaningless. Data Envelopment Analysis produced comparable individual hospital efficiency scores (correlations of approximately 0.6 between like specifications using SFA and DEA) and comparable average efficiency (~87%). Ratio analysis results were sensitive to the specific ratio analyzed. This dissertation adds to the body of literature on the relationship between ownership and hospital technical efficiency. It is the first comparison of military and civilian hospital technical efficiency.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

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Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Please read the abstract in the section 00front of this document This dissertation is accompanied by an interactive cd, kept in the main library of the University of Pretoria / Dissertation (MA (Information Science))--University of Pretoria, 2007. / Information Science / unrestricted

Thesis (M.H.A.)--University of Michigan, 1967.

Thesis (M.H.A.)--University of Michigan, 1967.

The American GI’s experience in hospital during World War II is absent from official military histories, most scholarly works, and even many oral history collections. Utilizing the papers of WWII infantryman, Leon Standifer, this thesis offers the reader a rare glimpse of WWII military hospital life and chronicles one soldier’s journey from willing obedience to subversive action. This thesis compares the stated goals and procedures of the US Army medical department to the experience of Leon Standifer, an infantryman who served in northern France during the last year of the war and the American occupation of Bavaria, whose service was marked by several periods of protracted hospitalization. Over the course of five hospitalizations, during which Standifer was treated for bullet wounds, trench foot, and pneumonia, he consistently wrote letters to his family describing his experience. A careful reading of Standifer’s wartime correspondence in conjunction with his published and unpublished writings, secondary source material, and military records, suggest that while isolated in the hospital, after killing and experiencing the death of his comrades, Standifer lost his desire to fight. He began to make calculated decisions based on his knowledge of the military medical system in an attempt to ensure his survival and control the remainder of his military service.