Canadians are worried about the future of the health care system, and provincial governments are questioning the ability of the existing system to support Canadians health care needs in the 21st Century(Industry Canada, 2011). Health care providers and system administrators are both driving and experiencing a paradigm shift; moving away from paternalism and toward an egalitarian approach. In order to practice patient centredness, health care providers must prioritize patient needs; provide information regarding treatments while taking patient preferences into account (Romanow, 2002). While there is a growing body of literature regarding patient centredness, there is scant information from the patient perspective. If the most effective and acceptable health services are those that realize the expectations of the users, this is an important area of study. Using phenomenological research methods and the theory of planned behaviour as a theoretical framework, the purpose of the study was to explore the influence of beliefs, attitudes and experiences on behaviour from the perspective of patients in primary health care or stroke rehabilitation. A second purpose was to explore the degree to which beliefs, attitudes and behaviour were similar between clinical contexts. The theory of planned behaviour was unsuitable for understanding peoples’ beliefs, attitudes and behaviour about being a patient. Being a patient was not a single, observable behaviour, but rather a set of contextually dependent strategies patients’ directed at a particular goal. The goal for each participant group was different; rehabilitation patients focused on the specific goal of recovery and discharge, while PHC patients focused on a broader goal of accessing and receiving best health care possible. These goals were reflected in their respective approaches to accessing health care services, an experience they described as socially oriented, governed and reinforced. Although patients described themselves as actively engaged, they did not approach each interaction with health care with a set of behavioural beliefs about being a patient. During the course of their participation, patients identified, developed and adopted strategies to assist in achieving the target; and evaluated those strategies more positively.

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The vast majority of children with cerebral palsy (CP) are surviving into adulthood due to improved surgical and health care practice. Thus, the expiration of paediatric services means that a new population of adults with CP has emerged that must transition into an ill-equipped adultoriented system. Informed by the perspective of complexity theory, this case study used both quantitative and qualitative data to examine the primary healthcare transition of youth with CP living in Sault Ste. Marie, Ontario. Analysis of Ontario Health Insurance Program claims showed service use changes due to both the expiration of paediatric services and the changing health needs of individuals with CP as they age. Physicians commented on challenges due to the complexity of the CP disease process and the benefits of shared care and teamwork in discussing transition. Future research and clinical practice designed to address transition barriers need to be informed by complexity theory.

This thesis focuses on the work in primary health care enterprises within two municipals which have organised their services after new organisational models attuned to New Public Management ideologies. The organisational model, i.e. the purchaser – provider model, had features in common with tayloristic principles, including the separation between planning and execution of work, and it brought about a loss of opportunities for the employee’s flexibility. For this reason, the employee's control over their own work was focus of the study. Method The data are based on a comparative intensive case study of four organizations, i.e. enterprises that performed nursing and care services. The respondents in the study were home assistants, care workers, auxiliary nurses and registered nurses; all of which performed the work, i.e. practical assistance and primary health care services. The data was collected using participant observation, individual interviews and focus group interviews. Findings Employees often did more work than was expected by organisational standards. This work is called “hidden services” and categorised as organisational misbehaviour, since it was neither expected nor desired by the organisation. Five types of work were performed in addition to their expected work: surplus work, additional work, forbidden work, inappropriate basic work and collective work. The rationale for doing so diverged among occupations, since different occupations called upon dissimilar types of rules to legitimize their misbehaviour. Three types of rules legitimized the overriding of organisational rules, all based on distinctive work relations among employees, including employees’ work relations to clients. First, there were situational rules based on informal work relations with clients – situational work relations. Although these rules were established across all occupations in the study, situated rules were most active in long-lasting work relations between employees and clients. Second, there were collective rules, developed in consequence of employees’ social position at the workplace, bringing employees together in work teams and thereby establishing collective work relations. Collective rules included rules that modified organizational rules on how to provide service to clients, and rules that legitimized the breaking of administrative rules. Finally, professional rules, as a result of professionals’ socialisation through formal education and work relations among professionals at the workplace, provided the last distinct type of rules to legitimize organisational misbehaviour. Conclusion The thesis concludes that there are distinct work relations in the social structure of organisations that explains employees' execution of hidden services. Formal, private, collective and professional work relations are part of the social structure in organisations. These work relations generates mechanisms, i.e. norms, that modifies and legitimises the work in primary health care services

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Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.

Thesis (M. of Public Health) -- Univ. of Adelaide, Department of Public Health, Adelaide, 1998. / Funded by the Primary Health Care Initiatives Program. Bibliography: p. 161-170.