This thesis is a critical and post-structural exploration of the discourse of managerialism in the NHS secondary care sector in Wales. Its central intent is to destabilise the dominant thinking about NHS management practice and to evoke intellectual debate about alternative discourses of management that ontologically perceive the organisation as a complex adaptive human system. The emergent theoretical framework conjoins the discipline of Complexity with post-structural conjecture, posing a novel conceptualisation of a fractal self where relations of power are seen as essential for harmonising diverse influences and legitimising a local discourse that informs and regulates practice. Using Foucault’s insights on power and knowledge the thesis critiques the strategic nature of NHS discourse, exposing the discursive dominance of managerialism and its inherent relations of power and debates what this predicates for a local negotiation and a flexible, safe and innovative environment. The methodological approach employs a reflexive and micro-level interpretative strategy to emphasise the singularity of agents and to explore the way in which the discursive constitution of the self influences agent practice. My profound experience of the secondary care system requires I situate my self reflexively within the context where I explore and liberate my own voice in conjunction with my participants. The research adopts a biographical narrative method of data collection and uses Foucauldian discourse analysis as a framework for exploring the underlying discourse in agent stories. The findings demonstrate the polyphonic nature of the secondary care context and reveal the demonstrate the polyphonic nature of the secondary care context and reveal the diverse ways in which agents legitimise, negotiate or resist the conflicting truth claims of various discourse in order to strategically sustain an image of health care historically constituted in their self. The results portray a web of discourses that endorse conformity or complicity through oppressive mechanisms of disciplinary control and surveillance, perpetuating authoritative and dualist structures, dissipating relations of trust and removing intellectual thinking from the front-line. The conclusion asserts that this significantly jeopardises the ability of agents to legitimise local ‘discourse’, severely limiting their capacity for adaptive practice and the generation of new order.

Following in the footsteps of Neitzsche (1968) and Foucault (1980), Clegg et al (2006) and Haugaard and Clegg (2009) have argued that power is the most central concept in the analysis of organization and organizing. The desirability of further developing the theorization of power in health and social care policy in the United Kingdom has been identified in a number of recent publications (Hunter, 2008; Crinson, 2009; Ham, 2009). This critical overview analyzes relative power to connect policy at the macro level (ending the internal market in NHS Wales) with specific policy issues encompassed by the four projects within the portfolio on: • locality commissioning; • delayed transfers of care; • governance, incentives and integration; and • safeguarding adults. The contribution to knowledge that flows from this critical overview: identifies that theorizing power in health and social care policy may help to explain apparent disconnections between policy intent and the effect of policy in practice in the context of post-devolution Wales; • suggests that, at its most extreme, neglecting to take into account the role of power in the design, implementation and review of policy in this particular policy arena becomes a matter of life and death; and • proposes that exploring power in health and social care policy through Foucauldian-informed critical discourse analysis of relative power could to some extent facilitate translation of policy aspirations into practice.

No description available.

This thesis presents a brief history of medicine in Russia leading up to the institution of socialized medicine by the U.S.S.R. in 1917. It also details Soviet medicine in the socialist period up through World War II.

A research report submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, November 2015 / The aim of this study was to give an account of what it means to be a hospital consultant in a national health service that has been undergoing change for almost three decades. Classic grounded theory was used to identify the main concern of hospital consultants sampled for the study and how they resolved this concern on a routine basis. Data were obtained from three sources: interviews, observation and document analyses. Classic grounded theory procedures of constant comparison and theoretical sampling were used and Rolling with the Punches emerged as the pattern of behaviour through which the hospital consultants dealt with their main concern, which was managerialism. Rolling with the Punches involves four modes: Stabilising Temporarily, Resisting, Limiting the Impact and Adjusting to/Living with. The mode of behaviour was contingent on a central and on-going Weighing-up process, in which the hospital consultants used their personal narratives, beliefs and commitment structures to make sense of what was happening and what they could possibly do about it. Hence, the mode of behaviour was contingent, historicised and in flux. The Weighing-up process can set off triggers that can lead to a change of mode that need not be linear. Key words: doctors, managers, grounded theory, weighing up, stabilising temporarily, resisting, subverting, quibbling, limiting the impact, lying low, faking it, living with, adjusting to, going with the flow, complying, waiting it out. / MB2016

Thesis (Ph.D.)--Brown University, 2008. / Vita. Advisor : James A. Morone.

This thesis analyses the policy of curative health service delivery in North Darfur State, Sudan. Several authors have analyzed health service delivery issues, mainly focusing on controlling the spread of common diseases. No work has been done that focuses on the health policy aspect and its contribution to improving curative health service delivery, especially in areas affected by conflict since 2003. This study contributes to the body of knowledge on the nature and the evolution of health service delivery systems management, as well as policy implementation, thereby widening the discussion about the further projections of this field of study. The main purpose of this thesis is to investigate how to enhance the effectiveness and efficiency of curative health service delivery systems management, as well as policy implementation, in fostering socio-economic development in North Darfur State. The study focuses on how the national health system and national health policy of Sudan have been managed and implemented in North Darfur State. This thesis identifies the different health sectors, public, private and international NGOs, that provide curative health services in North Darfur State, and the difficulties that have been facing the population in accessing these health facilities. Investigations showed that curative health services are not adequate in the public sector, and that they are very expensive in the private sector. The exception is the NGO sector but it is not guaranteed to be sustainable in providing curative health services to poor and conflict-affected people. This thesis also identifies the mechanisms of health system management and policy implementation, by means of co-ordination and collaboration between the various government sectors, federal, state and district, in a decentralized system working in concert with international NGOs. The results show that there is poor co-ordination between the three levels of government, especially at district level, as well as poor collaboration between government and international NGOs, caused by government‟s lack of human and financial capacity. The potential for improvement in curative health service delivery are explored, particularly at district level. This is essential so that quality curative health services can be delivered to the population, thereby contributing to socio-economic development in North Darfur State. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

The Department of Health (DOH) has embarked on a noble initiative to address the disproportionate distribution of resources and spending within the public and private healthcare sectors. Social Health Insurance (SHI) has thus been mooted as the vehicle to obtain a more equitable healthcare dispensation. This thesis explores the state of preparedness of the DOH, for the implementation of SHI. Ten aspects of health have been identified which will assist in determining if sufficient reforms have been implemented to facilitate the successful implementation of SHI. The prospective mechanism of financing of SHI is compared to the highly acclaimed model employed by the Australian Department of Health. Two research methodologies have been utilized viz. the case study approach and semi structured interviews, to provide comprehensive data. This enabled the researcher to adequately answer the research question. The responses from the respondents on the 10 aspects of healthcare have been arranged into themes to facilitate a greater understanding of the issues being highlighted. Established strategic management instruments have been utilized to analyze the data obtained and evaluate the preparedness of the DOH for the implementation of SHI. Following the data analysis, recommendations are proposed that would facilitate the successful implementation of SHI, thereby promoting its viability and sustainability in providing quality healthcare to all who call South Africa home. / Thesis (MBA)--University of KwaZulu-Natal, 2006.

The purpose of this research was to investigate the implications of networked public management on the design, implementation, and utilization of federal performance measurement systems. A multiple, instrumental case study of four public health programs funded by CDC and implemented nationally through vertical and horizontal network structures was conducted. Cross-case findings suggest that the networked implementation structures for the four federal-level, public health programs have important implications for the design of the performance measurement systems. Specifically, the performance measurement systems were affected by four consequences of the implementation networks: the political influence of collaborative stakeholders; network variability; dependencies on voluntary, horizontal network partners to achieve outputs and outcomes; and jointly produced outcomes that compromise assigning agency-specific attribution and accountability. While these four factors did not deter the use of performance measurement by any of the programs, all had important consequences for the development and subsequent design of the performance measurement systems, including limiting the choice and types of measures, level of measurement, potential uses of the measures, and resources needed to implement and support the systems.

Thesis (Ph. D.)--Virginia Polytechnic Institute and State University, 1994. / Vita. Abstract. Includes bibliographical references (leaves 204-213). Also available via the Internet.