Chan Ying Yang Emily. / Thesis (M.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 217-234). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Some appendixes in Chinese.

Chong, Ka Chun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 125-141). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

This study investigated the registered nurses' perceptions of the bureaucratic view of power in health care services in the Tshwane metropolitan region. The study further sought to describe how power affects the role of registered nurses in an organisation that is perceived to be predominantly bureaucratic in its' approach to management. A quantitative descriptive exploratory approach was adopted. Data was drawn from 121 respondents by random distribution of questionnaires to three selected health care services in the Tshwane metropolitan region. The findings revealed that registered nurses were largely divided in their perception of the bureaucratic view of power in health care services. Almost half of the respondents indicated that great strides had been taken by organisations in transforming health care services in accordance with the White Paper (1997) on Transformation of the Health System in South Africa and the recommendations of the 2001 Health Summit. The others indicated that registered nurses still needed to break out of the restraints of their dependant role towards taking ownership of health care services by equally bearing the burden of the organisation with management. / Health Studies / M.A.(Health Studies)

The purpose of this study is to explore and describe the challenges experienced by non-governmental organisations with regards to the roll-out of ART, with an aim to facilitate strategy development to overcome the challenges and enhance the success of ART rollout by the NGOs. A qualitative, exploratory and descriptive study was conducted. Data collection was done using in-depth semi-structured interviews. Three groups of respondents participated in the study; programme coordinators who directed and supervised ART programmes; doctors who were responsible for prescribing, monitoring and dealing with ART complications; and registered nurses who were responsible for monitoring, referring and providing nursing care to patients on ART. The findings revealed five broad areas of challenges namely; challenges related to sustainability, challenges related to adherence, challenges related to health systems, challenges related to stigma and challenges related to behavior. Of interest were the surge of whoonga and the infiltration of ART roll-out by crime and violence. / Health Studies / MA (Public Health)

Introduction The clinical community in Western society has long practised medicine as organized by "two dominant principles: 1) the principle of essentialism which states that there is a fixed "natural" border between disease and health, and 2) the principle of specific treatment which states that having revealed a disease, the doctor can, at least in principle, find the one, correct treatment. These principles have served as the legitimization of the traditional, hierarchical organization of health-care" (Jensen, 1987:19). A main feature of medical practices based on these principles has been to address specific kinds of problems impeding or decaying health. This research is centrally concerned with essentialism and the institutional fixation of problems as two important nodal points of Canada's biomedical value and belief system. More specifically, I hope to show in an organized way how these principles shape staff knowledge of client and culture in a community health centre (CHC) in Lethbridge, Alberta. My analysis is based on four guiding points: 1) that in our polyethnic society health care institutions are massively challenged with actual and perceived cultural diversity and cross cultural barriers to which their staff feel increasingly obliged to respond with their services; 2) while the client cultural diversity is "real", institutional responses depend primarily on how that diversity is imagined by staff -often as a threat to a health institution's sociocultural world; 3) that problem-specific, medicalized thinking is central in this community health centre, even though its mandate is health promotion and this problem orientation often combines with medical essentialism to reduce "culturally different" to a set of client labels, some of which are problematic; and 4) while a "lifestyle model" and other models for health promotion are at present widely advocated and are to be found centrally in this institution's (CHC) charter, they have led to little institutional accomodation to cultural diversity. In this thesis my aim is to present an ethnographic portrait of a community health centre, where emphasis is given to the distinctive formal and informal "formative processess" (Good 1994) of social construction of certain perceived common core challenges facing the Canadian biomedical community today - challenges concerning cultural difference and its incorporation into health care perception and practice. I am particularly interested in institutions subscribing to a "health promotion model" of health care, a term I have borrowed from Ewles and Simnett (1992). Ewles and Simnett descrive the meaning of "health promotion" as earlier defined by WHO (World Health Organization): this perspective is derived from a conception of "health" as the extent to which an individual or group is able, on the on hand, to realise aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore seen as a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources, as well as physical capacities (Ewles & Simnett, 1992:20) Health is therefore concerned with "a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity" (Ewles and Simnett, 1992:6), I am interested in determing how threats to this defintion prevail in a community health centre's ideology of preventive care, and how that ideology encodes dimensions of diversity. I, however, want to go much further than this by exploring everyday staff discourse and practice, to understand how client cultural diversity is formed and informed by what staff do and say. How, in short, do individuals based in a health promotion organization socially construct their clients as objects of institutional concern? We need, as Young (1982) suggest, "to examine the social condition of knowledge production" in an institutionalized health care service provision subculture. There are, I believe, also practical reasons for conducting this research. Over the past ten years the Canadian health care system increasingly has had to focus on two potentially contradictory goals: reducing costs, and lessening persistent inequalities in health status among key groups and categories of persons in the Canadian population. Many now argue that one of the most central dimensions of the latter - of perisistent health inequalities in Canada - is ethnocultural. Few would seriously argue, for example, that Canadian First Nation health statistics are anything but appalling. Moreover, radical changes in immigration patterns over the past three decades have greatly increased urban Canadian cultural diversity. Caring "at home" now assumes international dimensions (McAdoo, 1993; Butrin, 1992; Buchignani, 1991; Indra, 1991, 1987; Galanti, 1991; Dobson, 1991; Waxler-Morrison, 1990; Quereshi, 1989). A growing voiced desire to provide more pluralistic health care and health care promotion has become persistently heard throughout the clinical community in Canada (Krepps and Kunimoto, 1994; Masi, 1993). Even so, for many health professionals cultural difference evidently remians either irrelevant or a threat to the established order of things. Applied research on health care institutions undertaken to investigate how better to meet these challenges nevrtheless remains very incomplete and highly concentrated in two broad areas. One of these is structural factors within the institution that limit cross-cultural access (Herzfeld, 1992; Hanson, 1980). Some of these studies have shown the prevalence of a strictly conservative institutional culture that frequently makes frontline agency workers gate-keeprs, who actively (if unconsciously) maintain client-institution stratification (Ervin, 1993; Demain, 1989; Ng, 1987; Murphy, 1987; Foster-Carter, 1987; de Voe 1981). In addition, extensive research has been conducted on disempowered minority groups. This research has examined the frequency, effectiveness and manner with which ethnic and Native groups make use of medical services. Some institutional research on cross-cultral issues shows that under appropriate conditions health professional like nurses have responded effectively to client needs by establishing culturally sensitive hiring and training policies and by restructuring their health care organizations (Terman, 1993; Henderson, 1992; Davis, 1992; Henkle, 1990; Burner, 1990). Though promising, this research remains radically insufficient for learning purposes. In particular, little work has been done on how such institutions come to "think" (Douglas, 1986) about cultural difference, form mandates in response to pressure to better address culturally different populations and work them into the institution's extant sub-cultral ideas and practice (Habarad, 1987; Leininger, 1978), or on how helping instiutions categorize key populations such as "Indians" or "Vietnamese" as being culturally different, or assign to each a suite of institutionally meaningful cultural attributes (as what becomes the institution's working sense of what is, say, "Vietnamese culture"). This is so despite the existence of a long and fruitful ethnographic institutional research tradition, grounded initially in theories of status and role (Frankel, 1988; Taylor, 1970; Parson, 1951), symbolic ineractionism (Goffman, 1967, 1963, 1961), ethnomethodology (Garfinkle, 1975), and organizational subcultures (Douglas, 1992, 1986, 1982; Abegglen & Stalk, 1985; Ohnuki-Tierney, 1984; Teski, 1981; Blumers, 1969). More recent work on anthropological social exchange theory (Barth, 1981), on institutional and societal discipline (Herzfeld, 1992; Foucault, 1984, 1977), on the institution-client interface (Shield, 1988; Schwartzman, 1987, Ashworth, 1977, 1976, 1975), and on framing the client (Hazan, 1994; Denzin, 1992; Howard, 1991; Goffman, 1974). I also hope that this study makes a contribution to the study of health care and diversity in southern Alberta. Small city ethnic relations in Canada have been almost systematically ignored by researchers, and similar research has not been conducted in this part of Alberta. Local diversity is significant: three very large Indian reserves are nearby, and the city itself has a diverse ethnic, linguistic and ethno-religious population. Also, significant province wide restructuring of health care delivery was and is ongoing, offering both the pitfalls and potentials of quick institutional change. Perhaps some of the findings can contribute to making the future system more responsive to diversity than the present one. / 202 p. ; 29 cm.

PPSUS / A gestão de custos, em qualquer organização, proporciona uma série de benefícios, como a segurança na boa administração dos recursos, porém é pouco utilizada na área hospitalar pública, o que se configura como um paradoxo, frente à complexidade da organização hospitalar e à situação de subfinanciamento da saúde. Sendo assim, a questão de pesquisa que norteia este estudo é: Qual a contribuição de um modelo de custeio para a governança pública nas unidades hospitalares próprias do Estado do Paraná? Este estudo tem como objetivo propor um modelo de custeio para a gestão de custos em hospitais públicos administrados diretamente pelo Estado, como proposta de aprimoramento para controle, transparência, orçamentação e planejamento das ações estratégicas de saúde. Tal estudo mostra-se relevante, uma vez que a área hospitalar é bastante complexa, tornando-se ferramenta útil para tomada de decisão sobre investimentos, alterações de perfil de atendimento, utilização de capacidade ociosa, ampliações de serviços, entre outros. O sistema de saúde público brasileiro necessita de máxima eficiência, tendo em vista os direitos universais garantidos pela Constituição Federal. Assim, justifica-se pela complexidade hospitalar, um cenário de elevada evolução de custos, seja pela mudança do perfil demográfico e epidemiológico, como o envelhecimento da população brasileira e o crescente número de doenças crônicas, bem como pela crescente evolução tecnológica e seu incremento acelerado. Trata-se de uma pesquisa-ação com base no levantamento de resultados de pesquisas similares para análise da aplicação do modelo de custeio para organizações hospitalares, bem como a análise empírica das informações existentes em dois hospitais selecionados. Com base nos conceitos teóricos e empíricos da aplicação da metodologia de custo por absorção, gera elementos para melhor compreensão do problema para desenvolver o modelo de custeio. A avaliação dos resultados se constitui em importante instrumento de gestão dos hospitais e da Secretaria de Estado da Saúde, pois permite aos dirigentes maior segurança diante das dificuldades e desafios impostos nesse segmento, caso contrário há uma restrição ainda maior na gestão, no financiamento e operacionalização dos hospitais públicos. / Cost management brings about several benefits to any type of organization, such as the certainty that resources are well managed, but it is not much used by the public hospital sector, what is a paradox seeing that hospital management is complex and public health faces an under-financing situation. Based on the aforementioned facts, the present study aims at answering the following question: What is the contribution of costing models to public governance in the State of Paraná public hospitals? So, the study objective is to propose a costing management model addressed to improve health strategy control, transparency, budget and planning actions in public hospitals directly managed by the State of Paraná. Since the hospital sector is complex, our study is highly relevant as a helping tool to: investment decision-making processes, changes of healthcare profile, use of spare capacity and service improvement, among others. Considering the universal rights ensured by the Brazilian Federal Constitution, the country public health system needs to show maximum efficiency. In addition to hospital complexity, the sector increased costs are justified by the change of demographic and epidemiological profiles, Brazilian population aging, chronic disease growth, increased technological evolution and development. The research/action is based on the results of similar researches addressed to analyze the application of costing models addressed to hospital organization, as well as on the empiric analysis of data existing in two hospitals selected by the study. By applying the theoretical and empiric costing absorption methodology, our study provides elements to help understanding the problems involved in the costing model development. Result assessment is an important tool which permits Hospital and the State Health Department managers to deal with the sector challenges and difficulties more easily, since it helps lessen the restrictions imposed to public hospital management, financing and operation.

This study investigated the registered nurses' perceptions of the bureaucratic view of power in health care services in the Tshwane metropolitan region. The study further sought to describe how power affects the role of registered nurses in an organisation that is perceived to be predominantly bureaucratic in its' approach to management. A quantitative descriptive exploratory approach was adopted. Data was drawn from 121 respondents by random distribution of questionnaires to three selected health care services in the Tshwane metropolitan region. The findings revealed that registered nurses were largely divided in their perception of the bureaucratic view of power in health care services. Almost half of the respondents indicated that great strides had been taken by organisations in transforming health care services in accordance with the White Paper (1997) on Transformation of the Health System in South Africa and the recommendations of the 2001 Health Summit. The others indicated that registered nurses still needed to break out of the restraints of their dependant role towards taking ownership of health care services by equally bearing the burden of the organisation with management. / Health Studies / M.A.(Health Studies)

A saúde é direito de todos e dever do Estado. O Sistema Único de Saúde (SUS) possui como princípios a universalidade, integralidade e igualdade, que estão pautadas nas diretrizes de descentralização, regionalização e hierarquização. Isto demonstra a importância da perspectiva territorial no planejamento das ações de saúde. A estratégia privilegiada para a implantação do SUS foi a descentralização, pois houve a responsabilização dos municípios pelo provimento dos serviços e organização dos sistemas municipais de saúde, entretanto a regionalização, ou seja, a integração de serviços, instituições e práticas não foi abordada de maneira satisfatória, o que comprometeu a capacidade resolutiva dos sistemas de saúde, gerando disputas entre os municípios por recursos financeiros, ao invés de desenvolver uma rede interdependente e cooperativa. Evidencia-se, desta forma, a importância de analisar o potencial da regionalização em saúde como instrumento de governança pública. Assim, este estudo se propõe a responder o seguinte problema de pesquisa: Quais as contribuições da regionalização de leitos hospitalares para a governança pública em saúde no Estado do Paraná? E possui o objetivo geral de avaliar a regionalização em saúde no Estado do Paraná, identificando os vazios assistenciais como subsídio à ação do Estado mediante emprego dos princípios de governança pública em saúde. Para tanto, foi desenvolvida uma pesquisa quanti-qualitativa, exploratória e descritiva, que utilizou como procedimento de coleta de dados secundários a pesquisa bibliográfica e documental. Foi realizada a análise do cenário atual da distribuição de leitos hospitalares comparativamente ao ideal regulamentado, o que permitiu a identificação dos vazios assistenciais de leitos hospitalares, nas regionais de saúde e por especialidades no Estado do Paraná. Desta forma, foi possível concluir que a regionalização em saúde é uma importante ferramenta para redução dos vazios assistenciais de leitos hospitalares. Além disso, ela permite a aplicação de 7 (sete) dos 10 (dez) princípios de governança pública em saúde estabelecidos por este estudo, evidenciando que a regionalização em saúde é um importante instrumento de governança pública em saúde. / Everyone has a right to health and the State’s duty is to provide it. SUS (unified health system) main principles are universalization, integrality and equality which are based on the decentralization, regionalization and hierarchization directives and shows the importance of a territorial perspective for planning healthcare actions. Decentralization was the strategy chosen to implant SUS, since municipalities were in charge of providing and organizing the municipal healthcare services. Nevertheless regionalization, that’s to say service, institution and practice integration, was not performed satisfactorily, thus jeopardizing the health system decision making process and causing disputes between municipalities over financial resources instead of developing an interdependent and cooperative net. This way, it is important to analyze if health regionalization has a good potential for being used as public governance tool. The present study aims at giving answers to the following research problem: What are the contributions of regionalism to the State of Paraná public governance applied to health? Besides that, it also aims at assessing the State of Parana health regionalization to identify healthcare gaps and help the State actions through public governance principles applied to healthcare. Therefore, the study used a quantitative-qualitative, exploratory and descriptive research, plus secondary data concerning bibliographic and documental research. The present study analyzed the current hospital bed distribution by compared to the ideal distribution allowing the identification of healthcare gaps in the regional healthcare centers, besides considering medical specialties in the State of Paraná. The study conclusion is that health regionalization is an important tool for reducing healthcare gaps concerning hospital beds permitting the use of seven to ten public governance principles applied to healthcare, as established in the present study, and shows health regionalization is an important pubic governance tool.

A saúde é direito de todos e dever do Estado. O Sistema Único de Saúde (SUS) possui como princípios a universalidade, integralidade e igualdade, que estão pautadas nas diretrizes de descentralização, regionalização e hierarquização. Isto demonstra a importância da perspectiva territorial no planejamento das ações de saúde. A estratégia privilegiada para a implantação do SUS foi a descentralização, pois houve a responsabilização dos municípios pelo provimento dos serviços e organização dos sistemas municipais de saúde, entretanto a regionalização, ou seja, a integração de serviços, instituições e práticas não foi abordada de maneira satisfatória, o que comprometeu a capacidade resolutiva dos sistemas de saúde, gerando disputas entre os municípios por recursos financeiros, ao invés de desenvolver uma rede interdependente e cooperativa. Evidencia-se, desta forma, a importância de analisar o potencial da regionalização em saúde como instrumento de governança pública. Assim, este estudo se propõe a responder o seguinte problema de pesquisa: Quais as contribuições da regionalização de leitos hospitalares para a governança pública em saúde no Estado do Paraná? E possui o objetivo geral de avaliar a regionalização em saúde no Estado do Paraná, identificando os vazios assistenciais como subsídio à ação do Estado mediante emprego dos princípios de governança pública em saúde. Para tanto, foi desenvolvida uma pesquisa quanti-qualitativa, exploratória e descritiva, que utilizou como procedimento de coleta de dados secundários a pesquisa bibliográfica e documental. Foi realizada a análise do cenário atual da distribuição de leitos hospitalares comparativamente ao ideal regulamentado, o que permitiu a identificação dos vazios assistenciais de leitos hospitalares, nas regionais de saúde e por especialidades no Estado do Paraná. Desta forma, foi possível concluir que a regionalização em saúde é uma importante ferramenta para redução dos vazios assistenciais de leitos hospitalares. Além disso, ela permite a aplicação de 7 (sete) dos 10 (dez) princípios de governança pública em saúde estabelecidos por este estudo, evidenciando que a regionalização em saúde é um importante instrumento de governança pública em saúde. / Everyone has a right to health and the State’s duty is to provide it. SUS (unified health system) main principles are universalization, integrality and equality which are based on the decentralization, regionalization and hierarchization directives and shows the importance of a territorial perspective for planning healthcare actions. Decentralization was the strategy chosen to implant SUS, since municipalities were in charge of providing and organizing the municipal healthcare services. Nevertheless regionalization, that’s to say service, institution and practice integration, was not performed satisfactorily, thus jeopardizing the health system decision making process and causing disputes between municipalities over financial resources instead of developing an interdependent and cooperative net. This way, it is important to analyze if health regionalization has a good potential for being used as public governance tool. The present study aims at giving answers to the following research problem: What are the contributions of regionalism to the State of Paraná public governance applied to health? Besides that, it also aims at assessing the State of Parana health regionalization to identify healthcare gaps and help the State actions through public governance principles applied to healthcare. Therefore, the study used a quantitative-qualitative, exploratory and descriptive research, plus secondary data concerning bibliographic and documental research. The present study analyzed the current hospital bed distribution by compared to the ideal distribution allowing the identification of healthcare gaps in the regional healthcare centers, besides considering medical specialties in the State of Paraná. The study conclusion is that health regionalization is an important tool for reducing healthcare gaps concerning hospital beds permitting the use of seven to ten public governance principles applied to healthcare, as established in the present study, and shows health regionalization is an important pubic governance tool.

Submitted in fulfillment of the requirements for the Degree Mast in Technology: Public Management, Durban University of Technology, Durban, South Africa, 2017. / The South African healthcare sector stands at the threshold of major restructuring in an attempt to address inadequacies as a result of fragmentation of health services in apartheid South Africa. The level of health services, particularly in rural areas, has decreased and has led to reduced quality and productivity of health services. For individuals residing in rural communities, access to health services can be arduous. Delivery of essential services has to meet the needs of marginalised people who live in remote areas. In light of the above, the department of health is faced with growing expectations from citizens to use resources efficiently and effectively and to ensure that healthcare is affordable and accessible to all. National Health Insurance (NHI) is intended to bring about reform that will improve service provision. The researcher undertook this study to explore healthcare challenges faced by South Africa and its people and how far progressive realisation of access to healthcare, as enshrined in the 1996 Constitution, is being implemented. A case study using a mixed method approach was adopted. The literature reviewed indicated that issues of remuneration, ageing infrastructure and general management challenges, including financial management, are among the challenges that continue to hamper the public health system in South Africa. In addition, the HIV/AIDS epidemic has created more demand for healthcare as many more people become sick. The Green Paper outlining the government’s broad policy proposals for NHI, released in August 2011, makes it clear that NHI is a long-term project that will be rolled out over 14 years. It aims to promote efficiency and equity to ensure that all South Africans have access to affordable, quality healthcare. The findings of this study are useful not only to the case study institution, but to all District Hospitals, especially the department of health and the public management sector and may assist in taking the NHI forward. / M