This thesis reports on research focuses on how to deal with the fact that the organization and processesof today’s health and social care are becoming ever more complex as a consequence of societal trends, including an aging population and an increased reliance on care at home. The overall research goal is to suggest ways in which IT-based solutions can enable and leverage collaboration and coordination insituations where a co-morbid patient is subject to care delivered simultaneously by several different professionals and organizations. Patient-centered care is defined as quality health and social care achieved through a partnership between informed and respected patients, their families, and coordinated health and social care teams who conduct care activities according to jointly determined care plans. Against a background of several years of research on patient-centered collaborative care using adesign science approach, using techniques such as focus groups, interviews, and document studies, the author of the thesis has further pursued the work in a project named CoCare. Results show that the care required in aging societies is both a social and a technical challenge. Meeting this challenge will require a redesign of today's health and social care processes in order to focus more clearly on patient needs and values, and poses demands on information services allowing to share knowledge of the patient’s health and social situation among involved care providers. An important aspect of the increased complexity is that a single patient may need care from several autonomous care providers in parallel, particularly patients with co-morbidities. This clearly requires effective coordination of care activities, which poses further demands on information services to support this task. A set of issues involving patient-centered collaborative care is identified and analyzed. The thesis introduces the notions of the Patient-Centered Care Process (PCCP) and a conglomeration of suchprocesses. A conglomeration comprises a set of PCCPs that concern the same patient, that are overlapping in time, and that share the overall goal of improving and maintaining the health and socialwell-being of the patient. The PCCP is inspired by the well-known PDCA cycle and comprises the four phases of assessing the patient situation (ASSESS), planning care activities (PLAN), performingcare activities (DO) and following up care (CHECK) for the patient. Based on a number of key standards, such as HL7, HISA and CONTsys, the thesis introduces a Patient-Centered Information Model (PCIM). A set of information services, together constituting a Coordination Hub, is proposed. The information services aim to help formal as well as informal carers (including the patient) inconducting care according to the PCCP The thesis contributes to a deeper understanding of care processes and suggests ways to achieve patient-centered collaborative care that better contributes to creating value for the patient as an individual.

Over past decades, governments within Australia and throughout the Western world have sought to establish multi-sectoral planning processes that operate at a regional scale. Research on these processes has tended to focus on the challenges of ‘joining-up’ government and non-government sectors to create robust, effective and democratic regional structures and processes. Far less attention has been paid to integration within and between the various entities of government involved within these regional governance initiatives. This thesis, therefore, investigates the role of inter-governmental integration, or ‘whole-of-government’ activities, in relation to regional multi-sectoral governance. The institutional forms, enabling and constraining factors, and implications of inter-governmental arrangements between the various agencies and levels of government are examined. The study applies a sociocultural approach to institutional analysis. Commonly known as grid-group cultural theory, this approach provides a conceptual framework for identifying the fundamental social dynamics underlying differing forms of social organisation and governance. This framework specifies the primary forms, modus operandi and enabling social contexts of inter-institutional integration. These are, respectively: coordination by authority within hierarchy; cooperation through self-interest based collective action within competitive individualism; and collaboration through trust and a sense of commitment to the group within a communitarian social context. This study sought to investigate whole-of-government within regional governance through examination of two contemporaneous region-wide, multi-sectoral planning projects in Central Queensland, Australia. These were, namely, Central Queensland: A New Millennium, covering planning across a broad suite of issues, and the Fitzroy Basin Association, more specifically focussing on natural resource management planning for the region. Both bodies were in the process of implementing their regional plans at the time of this study. A qualitative case study methodology was employed in research, involving in-depth interviews with government officials, examination of project documents, and participation at meetings. The research data were analysed to identify the main processes and perceived outcomes of the two projects, and underlying factors relating to these. The two regional planning processes were generally perceived to have resulted in widely differing levels of success, and with many of the same government officials involved, there was considerable scope to contrast the whole-of-government structures and processes applied in the two cases. Analysis of the case material in the light of the theoretical framework and broader literature emphasised the nested and subordinate nature of regional whole-of-government efforts within the broader system of government. This system was revealed as characterised by horizontal fragmentation between departments and between jurisdictional tiers of government (Federal, State, and Local) but strong vertical integration within departments. The research highlighted the importance of central level political commitment to regional level integration efforts. Support is seen as particularly important in the form of 1) the political will to direct high-level coordination between departments and to advance cooperation between tiers of government; 2) sufficient resources allocated to regional plan implementation in order to motivate inter-governmental cooperation at a range of levels; and 3) the granting of sufficient autonomy to ensure effective devolution and regional level ownership that assists cooperation and collaboration at the regional level. In the light of the decisive importance of central level support, it was found that while high quality regional level leadership of regional whole-of-government processes is a necessary condition for their success, it is not a sufficient condition. To be effective, regional whole-of-government leadership requires both meaningful devolution and substantive central support. The study identified the multiple and contradictory forms of inter-governmental relations that comprise the social contexts at different levels within the broader system of government. In particular, the case study comparison suggested that success at the regional level relies on the application, at all levels, of forms and mechanisms of inter-governmental integration that are appropriate to the specific social contexts within which they are embedded.

Philosophiae Doctor - PhD / This thesis investigated the education support services provided by occupational therapists, physiotherapists and speech and language therapists in the Western Cape Province of South Africa. Changes in the education policy in South Africa to an inclusive education system have major implications for the way therapists provide support. Therapists have been challenged to move from a medical model of support with a focus on highly specialised treatment for a small number of individual learners with disabilities, to a systemic and health promoting model which focuses on support for the education system, including all learners, teachers and parents. The aim of this research was to develop an appropriate and integrated approach for therapists to support schools within an inclusive and health promoting schools framework in South Africa. Participatory action research using quantitative and qualitative methodology was used. Two surveys were conducted in the Western Cape Province. The first was a survey of all therapists to determine who was working with pre-school and school-aged learners and where. The second survey was of all therapists working in special schools and a small number of private practitioners to identify the roles of the therapists in providing direct and indirect support. In two of the seven education districts in the province, focus group discussions were held with 45 teachers from special and ordinary schools, and 21 parents of school-aged learners - to identify the support they needed. Workshops, incorporating focus groups, were also held with the therapists to, firstly, identify the support they needed to give to learners, teachers, parents and the education system and, secondly, to identify the competencies they needed to give this support. The data from the surveys were subjected to simple descriptive statistical analysis. These analyses reveal that therapists have a very wide range of roles relating to direct support, including: assessment, intervention with individual learners and learners in groups, and evaluation. Interventions include the development of hearing, speech and communication skills; skills for activities of daily living; life skills; home management skills; work related skills; motor function skills; and play and leisure skills. Therapists from different disciplines frequently provide the same type of support. Indirect support provided includes support for the schools system, teachers and parents. Thirty six percent of the therapists in this study want to increase the proportion of time they spent on indirect support. The study also revealed that multidisciplinary collaboration and teamwork were Teachers involved in the study identified that they need an enormous amount of support in fulfilling their crucial roles in identifying barriers to learning; identifying the support learners need; and addressing the barriers. This includes the need for support to teach a diverse group of learners; adapting content, presentation and evaluation of the curriculum; adapting the physical environment; accepting new roles of teachers and therapists; making changes to the school system; developing relationships with the parents; addressing challenges related to socio-economic problems; networking with the community; facilitating positive attitudes to diversity; developing supportive relationships with therapists; and further training poorly developed. Teachers involved in the study identified that they need an enormous amount of support in fulfilling their crucial roles in identifying barriers to learning; identifying the support learners need; and addressing the barriers. This includes the need for support to teach a diverse group of learners; adapting content, presentation and evaluation of the curriculum; adapting the physical environment; accepting new roles of teachers and therapists; making changes to the school system; developing relationships with the parents; addressing challenges related to socio-economic problems; networking with the community; facilitating positive attitudes to diversity; developing supportive relationships with therapists; and further training. Parents in this study indicated that they need access to education and support for their children, including direct support for their children; effective means of communicating with their children; specific competencies to facilitate caring for their children; emotional support; advocates to work with them in support of their children addressing environmental physical and attitudinal barriers, and developing a supportive community; and supportive relationships with therapists.