The research of this study was conducted at Malmö Hospital in collaborationwith Region Skåne. In this paper various methodologies from interactiondesign are used to explore how patient participation in hospital can be aidedand improved. It investigates what aspects of motivational design can bebeneficial to healthcare. The literature used in this study analyses the currentwork values of Malmö Hospital and how it relates to motivational and servicedesign. The study presents design findings based on a service mapping of thehospital along with an evaluation of the current working conditions. Finally,a concept is presented designed to enhance communication between patients and caregivers by visualizing patient water balance.

Despite a decade of public and private efforts to promote patient centricity in healthcare, there is still considerable ambiguity and skepticism regarding the concept and its business impact in the pharmaceutical industry. In this research, a novel methodology is developed to quantify firms’ strategic orientation using public 10-K reports. The Strategic Orientation Ratio (SOR) was developed and first validated to examine customer centricity for 9 non-pharmaceutical companies. The SOR is then extended from customer centricity to patient centricity, and it was applied to measure the extent of patient centricity in 10 multinational pharmaceutical firms. The method was successfully validated by identifying the strategic orientation of non-pharma firms such as Walmart, Apple, and Amazon. Next, by the same method, the extent of patient centricity is quantified in 10 big pharmaceutical companies for 2005-2015. This revealed the extent to which patient centricity exists in pharmaceutical companies, and how this has changed over time. The combination of an expressed patient-centric strategic orientation, personalized medicine (measured by oncology products), and patient access (measured by sales) is shown empirically to have a significant positive effect on firm performance. This implies that not only is patient centricity “the right thing to do,” it can also be a viable model for pharmaceutical firm competitiveness. / Business Administration/Strategic Management

Precision medicine (PM) is “the treatment and prevention of disease that takes into account individual variability in genes, environment, and lifestyle for each person” (NIH, 2015). PM was poised to transform clinical practice in 2003 when the Human Genome Project reached completion but resistance to implementation at virtually all health care providers provides the basis for novel study on the diffusion of innovation as well as operational strategy. Existing studies on resistance to PM explore the role of reimbursement, economics, regulatory affairs, and public policies. Investigation into the antecedent conditions for implementation at the physician and organizational levels has been overlooked, a gap this study fills. The research captures the reasons for resistance at the physician and organizational levels and identifies operational strategies for successful implementation at three health care institutions with fully integrated PM programs. The research produced 42 findings with managerial implications and six testable propositions for future research. The dynamics of resistance to PM has revealed key implications for theories of organizational change. These include the observation that the formulation processes of clinical standards of practice in PM are not predicted by prevailing organizational theory; that conventional theories of resistance to change do not fully anticipate the effects of Kuhnian level historic paradigm shifts; and, that communities of practice play a critical role in transformational clinical change. Further, the research demonstrated that PM implementation is characterizable through reproducible organizational and cultural actions; that positive clinical outcomes are measurable and persuasive; and that the needs of stakeholders can be reconciled by aligning physician standards of practice with patient expectations and organizational needs. / Business Administration/Strategic Management

Several factors are driving the transition from paper-based health records to electronic health record systems. In the United States, the adoption rate of electronic health record systems significantly increased after "Meaningful Use" incentive program was started in 2009. While increased use of electronic health record systems could improve the efficiency and quality of healthcare services, it can also lead to a number of security and privacy issues, such as identity theft and healthcare fraud. Such incidents could have negative impact on trustworthiness of electronic health record technology itself and thereby could limit its benefits. In this dissertation, we tackle three challenges that we believe are important to improve the security and privacy in electronic health record systems. Our approach is based on an analysis of real-world incidents, namely theft and misuse of patient identity, unauthorized usage and update of electronic health records, and threats from insiders in healthcare organizations. Our contributions include design and development of a user-centric monitoring agent system that works on behalf of a patient (i.e., an end user) and securely monitors usage of the patient's identity credentials as well as access to her electronic health records. Such a monitoring agent can enhance patient's awareness and control and improve accountability for health records even in a distributed, multi-domain environment, which is typical in an e-healthcare setting. This will reduce the risk and loss caused by misuse of stolen data. In addition to the solution from a patient's perspective, we also propose a secure system architecture that can be used in healthcare organizations to enable robust auditing and management over client devices. This helps us further enhance patients' confidence in secure use of their health data.