by Lau Cheung Hoo, Gary. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references (leaves 66-68). / ABSTRACT --- p.i / ACKNOWLEDGEMENT --- p.i i / TABLE OF CONTENTS --- p.iii / Chapter / Chapter I. --- INTRODUCTION --- p.1 / Method of Study --- p.3 / Chapter II. --- REASONS FOR CHANGES --- p.5 / External Forces --- p.6 / Internal Forces --- p.7 / Chapter III. --- CHANGES UNDER THE HOSPITAL AUTHORITY --- p.10 / Establishment of the Hospital Authority --- p.10 / Changes Under the Hospital Authority --- p.12 / Chapter IV. --- STRATEGIES FOR THE PLANNED CHANGE --- p.17 / Structural Approaches to Changes --- p.17 / Technological Approaches to Changes --- p.18 / People Approaches to Changes --- p.19 / Comments --- p.22 / Chapter V. --- CASE STUDY： QUEEN ELIZABETH HOSPITAL --- p.24 / Background Information --- p.24 / Mission of QEH --- p.25 / Major Changes --- p.26 / Resistance and Problems --- p.29 / Results to-date --- p.35 / Overall Evaluation and Summary View --- p.43 / Chapter VI. --- CONCLUSION --- p.50 / APPENDIX --- p.55 / BIBLIOGRAPHY --- p.67

Submitted in fulfilment of the requirements of the Master's Degree in Technology: Radiography, Durban University of Technology, 2013. / ABSTRACT Escalating current healthcare needs coupled with the dire shortage of radiologists created a climate in countries abroad to extend the role of the radiographer (Williams 2006). The South African radiography profession demonstrates similar if not worse challenges within the radiology services (Gqweta 2012). The human resource needs in the healthcare sector creates a gap in the provision of radiology services (Brandt et al 2007). Often under these circumstances radiographers are asked by emergency department's personnel to comment on radiographic appearances (Hardy and Snaith 2007). Radiographers do provide opinions in order to facilitate patient management (Gqweta 2012). Since the chest x-ray is the most commonly performed x-ray examination in x-ray departments (Manning, Leach and Bunting, 2000), it is assumed that most requests for an opinion may be directed for the clarification of this x-ray examination. Therefore radiographers need to have an in-depth understanding of the knowledge and skills related to the identification of patterns on chest images. The aim of the study was to establish and describe the current chest image interpretation skills, knowledge and perceptions of diagnostic radiographers in eThekwini Health District of KwaZulu-Natal (KZN) with regard to image interpretation. METHOD: A quantitative study using a descriptive design with a qualitative aspect using an interpretive design was employed. A simple random sample of hospitals within the eThekwini health district that have x-ray departments was drawn. All diagnostic radiographers that met the inclusion criteria from within these hospitals were invited to partake in the study and all were registered with the Health Profession Council of South Africa (HPCSA). A questionnaire was utilised to collect data on the perceptions and knowledge of diagnostic radiographers on radiographic appearances. A reporting template was provided for the respondents to report on ten (10) chest images and to standardise responses . Accuracy , specificity and sensitivity measurements were utilised to determine the image interpretation knowledge and skills of radiographers without formal training on image interpretation. The SPSS (Statistical Package for the Social Sciences) version 21 was utilised for the raw data capture and analysis. RESULTS Forty two (42) radiographers participated in the study. Almost half (46%) of the respondents were chief radiographers and twenty four point four percent (24.4%) of the respondents were senior radiographers . X-ray department managers and community service radiographers each had twelve (12%) percent representation. The majority of the respondents frequently performed chest x-rays. Furthermore they regularly observe Pulmonary Tuberculosis (PTB) abnormal patterns more than those of pneumonia and lung cancer on chest radiographs. The respondents indicated that there is a need for them to extend their roles to include image interpretation. This will ensure that radiographers are responsive to current health care needs perpetuated by the absence of radiologists and the ever rapidly increasing population. The majority of the respondents were able to identify abnormal appearances on the radiographs (high sensitivity). However there was a proportional decrease on the identification and recognition of the normal appearances (specificity). There was no respondent that obtained a mark of eighty (80%) on the image interpretation knowledge assessment section. CONCLUSION Radiographers are able to identify abnormal patterns on chest images. However they are unable to adequately exclude an abnormality (low specificity). Furthermore they lack the ability to adequately describe abnormal radiographic/radio logical appearances. The image interpretation knowledge base of radiographers is limited and specific. Therefore there is a need for an intensive education and training for prospective reporting radiographers.

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Objective: The majority of information available on chiropractic patients originates from private practices in developed countries. However, recently reports describing chiropractic patients in South Africa have emerged, reporting on private practices and teaching clinics. Therefore, the overall purpose of this study was to determine the characteristics of patients presenting to a public chiropractic facility at the Kimberley Hospital Complex (KHC) in South Africa; and compare to the local and international private practices and teaching clinics. Methods: The period prevalence was three months in which information was extrapolated from patient files of the patients that presented to the KHC Chiropractic Clinic (KHCCC). Information that was collected included demographic data, common presenting complaints, patient history and common management protocols. Results: Data for 157 patients were recorded. The mean age of patients was 47.5 years, majority of the patients were female (70%), comprised of coloured and black patients (85%), where the greater part had a primary education level. Less than half the patients were employed in manual type of occupation, whilst almost one quarter of the patients were pensioners. By far, the greatest reason that patients visited chiropractors within the public health care sector at the KHCCC in South Africa was for chronic musculoskeletal complaints (68%). Majority presented with spinal complaints of the lower back (n=144), the most common diagnosis made was sacroiliac syndrome (48%). X-rays were the most common special investigation requested by KHCCC. The most common co-morbidities reported were hypertension, followed by diabetes and allergies. More than half the sample had undergone previous surgery. Thirty seven percent of patients received treatment for fewer than six visits. Contraindications to chiropractic treatment were indicated in only three patients. The treatment protocols that were predominantly used at the KHCCC were joint manipulation, followed by dry needling, kinesiotape and soft tissue therapy. Two thirds of all patients that were referred to the KHCCC were referred from within the medical profession. With regards to the chiropractic patients globally, similarities respect to patients in the public sector in South Africa to all sectors both locally and internationally, include factors such as majority female patients, top five anatomical locations of complaint, common usage of x-rays as a special investigation, similarities with co-morbidities including cardiovascular and endocrine, the repeated number of visits for the same complaint and manipulation remained treatment of choice. Conclusion: Although this was purely a demographic and descriptive study in nature, it gave a better understanding of patients that presented to a public hospital in a developing country like South Africa. With this demographic and descriptive information obtained in this study, it confirmed that although there is a unique population utilising chiropractic services within the public sector of South Africa, meaningful similarities have been found between patients in the different sectors in South Africa and internationally.

Submitted in fulfillment of the requirements for the degree of Master’s of Technology: Radiography, Durban University of Technology, Durban, South Africa, 2015. / Introduction Tuberculosis remains a leading cause of death, second to the Human Immunodeficiency Virus. The risk of latent tuberculosis infection and active tuberculosis disease is a known occupational hazard. In South Africa, a high tuberculosis burden country, the potential of Mycobacterium tuberculosis transmission to health care workers is high. This includes diagnostic radiographers and other radiology staff working in radiology departments. Purpose of the Study This study aimed to investigate the association of demographic and occupational factors with latent tuberculosis infection in radiology staff in public sector hospitals of the eThekwini Health District. Methodology This cross-sectional study was conducted from 26 February 2013 to 07 June 2013. Quantitative methods were used to test for associations of demographic and occupational factors with latent tuberculosis infection in participants. A sample size of 181 participants for an estimated population of 340 radiology staff was recommended at the proposal stage. The study consisted of two phases; the questionnaire survey (phase one) and the administration of a two-step tuberculin skin test (phase two). Data was obtained with regard to demographics, occupational history, social behaviours, medical history; and family and home histories. Demographic and occupational associations with latent tuberculosis infection were made in relation to the size of the first tuberculin skin test induration. Frequency distributions were developed to describe data categories. Pearson’s and Spearman rho’ correlation coefficients were used to test for correlations between the independent variables. The chi-square test was used to determine associations between the categorical independent variables and the dependent variable. Bivariate analyses were performed using these tests. The multivariate analysis was performed using logistic and linear regression on the dependent variable. Results A total of 182 questionnaires were returned from approximately 280 radiology staff. At the outset, all doctors working in the radiology department had to be excluded due to numerous failed attempts to enlist their participation. Fifty-three (29.12 percent) participants were excluded from phase one of the study and a further thirteen participants were excluded from phase two. The total sample was 116 participants. Of the 116 participants, 86.2 percent tested positive for latent tuberculosis infection at the first step of the two-step testing method used. One (0.86 percent) participant went on to convert at the second step, testing positive at this level. Demographic associations with latent tuberculosis infection included age (older) as an associated factor. A significant demographic association with latent tuberculosis infection was the use of alcohol (p-value 0.033 on the multivariate analysis). Occupational associations with latent tuberculosis infection included longer durations of employment. The annual income (higher income earners) displayed significant associations with latent tuberculosis infection (p-value 0.048 on the multivariate analysis). It is necessary in this study to note that participants include support personnel (lower income earners) making up 37.8 percent of the study, diagnostic radiographers making up 48.3 percent; and radiography managers/assistant managers (highest income earners) making up 13.8 percent of the study. Conclusion and recommendations The risk of transmission of Mycobacterium Tuberculosis to health care workers is a known occupational hazard. This study has described the prevalence of latent tuberculosis infection in radiology staff, at district and regional hospitals within the eThekwini Health District. With 23.62 percent of all participants already having active TB disease and 86.2 percent of the tested group displaying positive results for latent tuberculosis infection, using the tuberculin skin tests, the need for tuberculosis screening is essential. The findings of this study will be used as a health improvement mechanism for stakeholders, having identified potential gaps in medical screening in healthcare in Kwa-Zulu Natal. This study makes recommendations for the early detection of active tuberculosis infection and the monitoring of health care workers that are latently infected, thus assisting in reducing the rate of conversion of latent tuberculosis infection to active tuberculosis disease in radiology staff. This reduces long-term exorbitant costs related to health care associated infections, such as tuberculosis. It also reduces rates of transmission and cross infection to both co-workers and already immunocompromised patients, helping to curb the overall epidemic in South Africa.

National healthcare departments all over the world are facing the problem of rationing very limited resource to achieve acceptable levels of health care for their citizens. At the centre of healthcare challenges is the problem of an increasing disease burden, increasing pharmaceutical prices, increasing healthcare worker remuneration and the globalisation of healthcare services. Under such restrictive and competitive conditions, healthcare organisations need to find more efficient ways of working. This puts healthcare managers at the forefront of efforts to improve healthcare services and to find new ways to do more with shrinking resources. The need for well-trained managers is at its most critical level, especially in Third World countries like South Africa. This study set out to establish whether training needs existed amongst Medical Managers in public hospitals in the Province of KwaZulu-Natal, South Africa. Should training needs be found to exist, the aim was to establish where those needs may be. The study then identified what Medical Managers perceived as the preferred training methods for delivering the necessary training. The study had a sample size of 30 respondents out of the 54 potential respondents. This represents a response rate of 55.5 percent. The research method that was chosen for the study combined both the quantitative and qualitative methods through a questionnaire that listed 37 tasks. Each Medical Manager had to rate these tasks on their relevance, their own perceived performance of the task, the likelihood of receiving any required training through a formal training method like courses for each task and finally the likelihood of receiving training through on the job training for each task. The quest ionnaire also included an openended question that asked respondents to list up to ten additional training needs which had not been covered by the questionnaire. The study found that all the tasks which were audited were relevant, that the perceived level of overall performance was high and there was an almost equal preference for both formal and informal training method. Based on this study‟s findings, training initiatives targeting this group of managers should ideally combine both formal and informal training methods. A recommendation for further research with a more qualitative approach is being made to better understand the context within which the training needs exist. The minimisation of subjectivity of ratings through the involvement of Medical Manager Supervisors might also reveal a more objective overall outcome to the analysis of the problem. / Thesis (MBA)-University of KwaZulu-Natal, Durban, 2012.

Submitted in fulfillment of the requirements for the Degree of Master of Technology Hospitality and Tourism, Durban University of Technology, Durban, South Africa, 2014. / It has been accepted that health care within provincial hospitals has deteriorated. For most it has become routine to visit provincial hospitals and wait for majority of the day for basic treatment. Service delivery in provincial health care are confronted with challenges such as staff shortages, inadequate medical supplies and reduced budgets. The media contributes with letters and articles about poor patient treatment, the increase in deaths and diseases due to poor service delivery and weak hospital management. However, with the growing rate of poverty and unemployment, resources have become scarcer hence, adding to an already crippling economy. The rationale behind this research is to evaluate the role of hospitality within a Provincial Hospital in the southern area of Durban KZN that’s offering treatment to patients with more than just basic health care. And to establish a more effective and efficient delivery of services offered with scarce resources which enhances patient encounters within a provincial hospital. The aim of this research is to evaluate the current legislation around provincial hospitals for the efficient and effective practise of hospitality. In the form of a literature review a theoretical perspective was formulated around the study and an operational chapter detailing the Provincial Hospital in the southern area of Durban, KZN. The rationale was tested by research in the form of questionnaires and interviews with the Provincial Hospital. A target sample was selected with managers, senior management and patients. The major findings may be gravitated towards serious service delivery issues. The Provincial Hospital should therefore, consider the introduction of a hospitality approach in its attempts to improve the delivery of patient care. The study also found that hospitality management influences may improve employee output which impacts on the delivery of patient care. / M

Magister Public Health - MPH / Background and Rationale The World Health Organization (WHO) has shown that the provision of Water Sanitation and Hygiene (WASH) in Health Care Facilities (HCFs) of many low and middle-income countries is poor. This is compounded by the lack of national plans and consolidated data on WASH in HCFs. This study assessed the availability and adequacy of Water Sanitation and Hygiene (WASH) infrastructure in 13 mission hospitals spanning 13 districts in Zambia. The objectives of this study were to identify the different kinds of WASH infrastructure available, and their adequacy, and factors influencing the status of WASH infrastructure and services in the selected hospitals. Methodology This study had a mixed methods design with semi-quantitative, descriptive and qualitative components. Assessments were conducted of the WASH infrastructure on the hospital property, and specifically in the male medical wards and outpatient facilities as two tracer areas, using a WHO checklist adapted and administered by the researcher. Checklist items were assigned scores (0=absent/bad to 2=on target/good) and total WASH scores for each facility compiled. For the qualitative component, individual semi-structured interviews using an interview guide were conducted, also by the researcher, with the facility managers and the head staff of the male medical wards. Results Overall coverage with an improved water source was reasonably good with 11 of the 13 hospitals reporting availability of improved water sources within the facilities. Hand washing basin coverage was similarly good. In contrast, coverage by well-functioning toilets was not as high, with 5 hospitals reporting toilets that were either broken, blocked, or having no running water and no toilet paper. Facility WASH scores varied from 22 (38%) to 57 (97%) out of a possible total of 58 points. Most of the Facility Managers indicated that the hospital WASH infrastructure was old, and with frequent breakdowns. This was worsened by lack of readily available spares and materials for repairing once there was a fault. Conclusion This study reveals an uneven coverage of WASH across facilities and elements, with poor sanitation a challenge across facilities. This is compounded by ongoing challenges in WASH infrastructure maintenance. Moving forward, there is need for government to develop a clear policy on WASH in HCFs. A national plan with resources and a monitoring framework need to be in place for streamlined support and tracking of progress by all stakeholders.

Thesis (MPH.) -- University of Limpopo, 2012

Thesis (MPH.) --University of Limpopo, 2015 / BACKGROUND: There were perceptions that doctors as Medical Superintendents were unable to provide proper financial management of hospitals, thus administrators were appointed to manage hospitals irrespective of qualifications. The aim of the study was to determine how public hospitals are managed in Waterberg district (Limpopo province). METHOD: A cross sectional survey was conducted among 27 hospital managers in the Department of Health Limpopo province, in Waterberg district hospitals. A self -administered questionnaire was used for data collection. Data were analyzed using SPSS version 22.0, where both descriptive and inferential analysis was conducted. RESULTS: Of the 27 managers, 59.3% were females 40.7% compared to males. 96.3% of managers reported that they did not correctly implement PMDS and polices on RWOP were not applied. There was no statistical difference in management styles, according to gender (p>.05) and managers had a fair working relationship among themselves. CONCLUSION: According to the study, there is a great need to train hospital managers in management skills and other related policies, and giving them support in terms of resources such as: staffing especially health professionals, financial and working resources.

Background “Over-crowding” in Accident and Emergency (A&E) departments of Hong Kong public hospitals with primary care cases not only threatens the service quality of emergency care and prolongs patients’ waiting time for treatment in the A&E departments, but also causes inefficient utilization of resources and deprives true emergency cases of quality care. A local study suggested that 57% of A&E attendances would have been managed better by general practitioner (GP) care. Reasons of the “over-crowding” include: lacking overnight outpatient services in the community, the convenience of A&E departments and the comprehensiveness of emergency services provided in the departments. As a result, there are urgent needs of patients, the society, A&E departments of Hong Kong public hospitals for a feasible solution to divert non-emergent A&E patients to more appropriate primary care services. Objectives To compare the costs and benefits of setting up the proposed 24-hour public emergency clinic inside the A&E department of Prince of Wales Hospital (PWH) for stable ambulatory non-emergent Categories IV and V A&E attendances by conducting a cost-benefit analysis. Methodology Retrospectively compare the costs and benefits of healthcare service provision to A&E attendances in PWH from Feb 2013 to Jan 2014 by cost-benefit analysis. By estimating the patients’ utilization rate of the emergency clinic, the total cost of the proposal is calculated by summarizing the estimated costs of employees’ salaries, capital costs, costs of equipments and treatments provided in the clinic in monetary values. The total benefit of the proposal is calculated by summarizing the estimated benefits of revenues, productivity gain from prevention of prolonged waiting and benefit from emergency diversions in monetary values. Results With the patients’ utilization rate of the clinic estimated as 44%, the total cost of the proposal is estimated as HKD $ 868,863 per month; while the total benefit is estimated as HKD $2,366,695 per month. The net benefit is estimated as HKD $1,497,832 per month with cost-benefit ratio greater than 2.72 of total benefit over total cost. Conclusions The proposal of setting up the 24-hour public emergency clinic in the A&E department of PWH is economically beneficial, and the results are generalizable to other A&E departments of similar acute urban public hospitals in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health