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.

Thesis (M.B.M. 1976) from the Department of Commerce, University of Adelaide.

Submitted to the School of Public Health, Faculty of Health Sciences. Thesis (Ph.D.) -- La Trobe University, 2004. / Includes bibliographical references (leaves 320-329). Also available via the World Wide Web.

Thesis (M.H.A.)--University of Michigan, 1960.

Thesis (M.H.A.)--University of Michigan, 1960.

Submitted by Tatiana Lima (tatianasl@ufba.br) on 2016-07-07T21:50:38Z No. of bitstreams: 1 Coelho, Silvana Márcia Pinheiro Santos.pdf: 1289246 bytes, checksum: 417616fb87867f1db1ab0960828497d6 (MD5) / Approved for entry into archive by Tatiana Lima (tatianasl@ufba.br) on 2016-07-08T18:25:12Z (GMT) No. of bitstreams: 1 Coelho, Silvana Márcia Pinheiro Santos.pdf: 1289246 bytes, checksum: 417616fb87867f1db1ab0960828497d6 (MD5) / Made available in DSpace on 2016-07-08T18:25:12Z (GMT). No. of bitstreams: 1 Coelho, Silvana Márcia Pinheiro Santos.pdf: 1289246 bytes, checksum: 417616fb87867f1db1ab0960828497d6 (MD5) / Este estudo analisa se os indicadores presentes nos contratos da gestão terceirizada de hospitais públicos realizados na Secretaria de Saúde do Estado da Bahia- SESAB favorecem a avaliação e o controle da gestão terceirizada. Parte-se do pressuposto de que os indicadores presentes ainda são elaborados de forma normativa, reforçando a fragilidade e insuficiência de práticas avaliativas sistemáticas no âmbito da administração pública, decorrente da ausência de uma cultura de avaliação do desempenho dos serviços públicos prestados à população. Para a análise pretendida, foi construída uma matriz analítica, propondo dimensões e critérios baseados na literatura que discute aspectos conceituais sobre a avaliação e a terceirização. Assim, a escolha das dimensões e dos critérios foi pautada nas premissas que justificam a utilização da terceirização da gestão pela administração pública. Esta matriz foi encaminhada a especialistas, utilizando-se de uma adaptação do método Delphi, para a avaliação dos indicadores presentes nos contratos de gestão e para sua validação como ferramenta metodológica para avaliar os indicadores dos contratos de terceirização realizados pelo poder público. Apesar de terem sido encontrados indicadores considerados consistentes para avaliar a gestão terceirizada, os resultados apontam para a falta de padronização na apresentação dos indicadores nos contratos, a dificuldade para compreender o que está sendo descrito como indicador, uma quantidade excessiva de indicadores inconsistentes, além de uma ausência de correlação dos indicadores com os objetivos pretendidos. Assim é possível concluir, que a seleção e formulação de indicadores ainda não vêm sendo precedida de escolhas fundamentais a exemplo do foco, dos agentes, do tipo e natureza da avaliação que deve ser realizada pela administração pública, ao transferir a gestão de hospitais públicos para entes privados, confirmando o pressuposto inicial. / This study examines whether the indicators present in the contracts of outsourced management of public hospitals performed at the Secretaria de Saúde do Estado da Bahia- SESAB (Bahia State Department of Health) favor the evaluation and control of outsourced management. It starts from the assumption that the present indicators are also designed in a normative manner, reinforcing the fragility and lack of systematic evaluation practices within the public administration, due to the absence of a performance evaluation culture of public services to the population. For the analysis, an analytical matrix was built, proposing dimensions and criteria based on literature that discusses conceptual aspects of the assessment and outsourcing. Thus, the choice of dimensions and criteria was based on the assumptions that justify the use of outsourcing management by government. This matrix was referred to specialists, using an adaptation of Delphi method for the evaluation of the indicators present in management contracts and its validation as a methodological tool to assess the indicators of outsourcing contracts signed by the government. Although they were found indicators considered consistent to evaluate the outsourced management, the results point to the lack of standardization in the presentation of indicators in contracts, difficulty understanding what is being described as an indicator, an excessive amount of inconsistent indicators, and a lack of correlation of the indicators with the intended objectives. Therefore, it is possible to conclude that the selection and formulation of indicators have not yet been preceded by fundamental choices such as the focus, the agents, the type and nature of the assessment to be carried out by the public administration, to transfer the management of public hospitals for private entities, confirming the initial assumption

The aim of this study is to identify green logistics (GL) best practice leading to the efficient management of resources and waste in Thai public hospitals. This work is influenced by and is aligned with the Thailand’s 2nd National Logistics and Supply Chain Research Strategies (2012-2016). The GL practices of six public hospitals were investigated, chosen to give coverage of the different types/sizes, locations and a range of environmental performance issues. Hospital visits were undertaken to collect data by interview, documentation and observation approaches. The GL best practices were principally identified by using developed indicators and a cross-case analysis method. The results of this study showed that resource and waste flows appeared very complicated within Thai hospitals. Thus, effectively introducing and managing GL within these settings requires the coordination of all staff (clinical and other), and the consideration of all environmental impacts from product purchasing through to waste disposal. Many beneficial practices for successfully reducing resource consumption and waste were identified. Key findings were that green initiatives need to be supported by: sufficient environmental education; two-way communication; effective evaluation and recording systems; and Director-level support. Importantly, GL adoption in the Thai context should be grounded in the Sufficiency Economy Philosophy concept (e.g. moderation, wisdom, and happiness), as well as contemporary hospital logistics theory and practice. Finally, it is recommended that the current Hospital Accreditation process is changed to integrate sustainable best practices, and that some pertinent government regulations and policies should be reviewed and changed as they were seen to be counterproductive and indeed in many cases it was proven that the enactment of the policies themselves actually increased waste.

Submitted by Tatiana Lima (tatianasl@ufba.br) on 2015-05-04T20:38:30Z No. of bitstreams: 1 Santana, Douglas Nascimento.pdf: 3136561 bytes, checksum: 73cc9a24a5aeb897962d63db03a8e2ea (MD5) / Approved for entry into archive by Tatiana Lima (tatianasl@ufba.br) on 2015-05-05T20:02:26Z (GMT) No. of bitstreams: 1 Santana, Douglas Nascimento.pdf: 3136561 bytes, checksum: 73cc9a24a5aeb897962d63db03a8e2ea (MD5) / Made available in DSpace on 2015-05-05T20:02:26Z (GMT). No. of bitstreams: 1 Santana, Douglas Nascimento.pdf: 3136561 bytes, checksum: 73cc9a24a5aeb897962d63db03a8e2ea (MD5) / No Brasil, no período pós-edemocratização, o aumento das exigências quanto à prestação de serviços públicos pela população, bem como os custos crescentes de produção decorrentes das incorporações tecnológicas desafiaram o modelo burocrático de administração pública nacional. A partir de meados da década de 1990, a Segunda Reforma Administrativa do Estado foi iniciada, sob a égide do Novo Gerencialismo e com foco na máxima eficiência na prestação de serviços públicos. Onipresentes na estrutura do Estado, essas mudanças ocorreram no setor saúde com a adoção de Políticas Públicas que aproximaram os serviços públicos de saúde dos entes privados mediante a criação de estruturas gerenciais mistas, como Organizações Sociais e Parcerias Público-Privadas e pela adoção de programas de incentivo ao desempenho. Este trabalho tem por objetivo avaliar em que medida o desempenho dos diferentes hospitais públicos de ensino, organizações estruturantes da rede de saúde pública, respondem, ao longo do tempo, aos estímulos trazidos pelos programas focados no aumento da eficiência. Para tanto, foram realizadas revisão bibliográfica e um estudo empírico, quantitativo, retrospectivo, de 2008 a 2012, no grupo de 44 hospitais credenciados ao Sistema de Avaliação dos Hospitais de Ensino do Estado de São Paulo. Os resultados demonstram que, quando categorizados quanto às estruturas gerenciais, os hospitais da Administração Direta, Autarquias e Organizações Sociais, os três grupos da amostra, apresentaram diferenças no padrão de evolução do desempenho assistencial ao longo dos cinco anos do estudo. Os hospitais da Administração Direta apresentaram padrão de evolução do desempenho predominante estacionário e não responsivo aos estímulos, as Organizações Sociais apresentaram padrão predominante crescente, enquanto as Autarquias apresentaram padrão estacionário em alguns indicadores e crescente em outros. A produtividade das Organizações Sociais foi significativamente maior que a dos demais grupos para todos os indicadores selecionados. O grupo de hospitais da Administração Direta apresentou taxa de infecção hospitalar significativamente menor que a os demais grupos. Entre os hospitais públicos estudados e ao longo do período selecionado, as Autarquias foram os grandes repositórios de alunos e de produção de conhecimento científico do estado de São Paulo. Uma possível explicação para as diferenças no padrão de evolução do desempenho assistencial pode estar na estrutura gerencial dos hospitais públicos, quando categorizados por autonomia administrativa e financeira, regime de vinculação de pessoal e modalidade de contratações. Hospitais sem autonomia administrativa e financeira, com trabalhadores estatutários e obrigados legalmente a contratar por licitações, como os da Administração Direta, ocuparam o polo estacionário do desempenho, enquanto hospitais com autonomia total, trabalhadores celetistas e com diferentes possibilidades para contratações, como as Organizações Sociais, ocuparam o polo crescente do desempenho. In Brazil, in the post-democratization period, increased demands for public services for the population and rising costs of production, resulting from technological developments, challenged the bureaucratic model of national administration. From the mid-1990s, the Second State Administrative Reform was started under the aegis of the New Public Management and focusing on maximum efficiency in delivering public services. Ubiquitous in the State structure, these changes occurred in the health sector by the adoption of Public Policies that brought together the public health services and private entities through the creation of joint management structures, such as Social Organizations and Public-Private Partnerships, and also by the adoption of performance incentive based programs. This paper aims to assess to what extent the performance of different public teaching hospitals, structuring organizations of public health network, respond, over time, to stimuli brought by programs focused on increasing efficiency. For this purpose, literature review and an empirical study, quantitative, retrospective, 2008-2012, in the group of 44 hospitals accredited to the System for the Evaluation of Teaching Hospitals of the state of São Paulo were held. The results show that, when categorized by its managerial structures, Direct Administration hospitals, Autarchy and Social Organizations, the three groups found at the sample, showed differences in the pattern of evolution of healthcare performance over the five years of the study. Direct Administration hospitals showed a predominant steady pattern of performance evaluation and unresponsive to stimuli, Social Organizations showed increasing predominant pattern, while the Autarchy showed a steady pattern in some indicators and growing in others. Productivity of Social Organizations was significantly higher than that of other groups for all selected indicators. The group of Direct Administration hospitals showed markedly lower nosocomial infection index, when compared to other two groups. Among the public hospitals and throughout the selected period, the Autarchy were main repositories of students and production of scientific knowledge of the state of São Paulo. One possible explanation for the differences in the evolution of the performance patterns of healthcare may be management structure of the public hospitals, when categorized by administrative and financial autonomy, workers hiring regime and modality of aquisition of insumes and services. Hospitals without total administrative and financial autonomy, with statutory workers and legally obligated to hire by bids, such as the Direct Administration hospitals, occupied the pole of steady performance, while hospitals with complete autonomy, non statutory workers and market-free possibilities to buy insumes and services, such as Social Organizations hospitals, occupied the increasing performance polo.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-07-15T14:44:28Z No. of bitstreams: 1 arquivototal.pdf: 3907403 bytes, checksum: 48a62437a457a732c241fb5fc6c8404b (MD5) / Made available in DSpace on 2016-07-15T14:44:28Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3907403 bytes, checksum: 48a62437a457a732c241fb5fc6c8404b (MD5) Previous issue date: 2014-09-29 / About 36% of the northeastern states’ population has some kind of disability that can be motor, hearing, visual, or mental / intellectual in different degrees of difficulty (IBGE, 2010). It is known that these people face daily difficulties, especially in access to health, which is the right of every citizen. It’s known that those people face daily difficulties especially in health access which is their civil law. In this sense architectonics, technological, behavioral or socials obstacles prevent that this civil right has been fulfilled. A public or private affordable place frequently contributes to a more inclusive life and also provides social interaction and personal encouragement to all users. An element that provides the spatial accessibility application is Wayfinding resources, which refers to a set of elements (visual, hearing, tactile, and others one.) that facilitate the spatial orientation of people, especially in a hospital environment where the level of anxiety that disturbs this orientation. Public hospitals ate important centers of medical assistance in various specialties. But the clinic is a functional unit of the establishment of health care for the outpatient care for diagnosis and treatment. The population that frequents these establishments is wide, including physicians, employees from different sectors, visitors, providers, caregivers and patients, who are usually the mostly debilitated. This study has as a purpose to evaluate the physical-spatial accessibility through user’s perception with disabilities. For this reason a case study was conducted in the outpatient Lauro Wanderley University Hospital-UFPB. The methodology was divided into five stages: bibliographical and documentary research, recognition and characterization of the area, assessment of user’s perspective and finally, analysis and systematization of the results. It was possible to identify the problems encountered by users and map the most critical points but especially to understand how patients are oriented in environments. Finally, adjustments are proposed for improvements of space and wayfinding. / Cerca de 36% da população nordestina declara possuir algum tipo de deficiência, seja motora, auditiva, visual ou mental/intelectual em diferentes graus de dificuldade (IBGE, 2010). Sabe-se que estas pessoas enfrentam dificuldades diariamente, especialmente no acesso à saúde, que é direito de todo cidadão. Neste sentido, a presença de barreiras arquitetônicas, tecnológicas, atitudinais ou sociais impede que esse direito seja cumprido. Um espaço acessível, público ou privado, muitas vezes contribui para uma vida mais inclusiva, proporciona convívio social e estímulo pessoal, para todos os usuários. Um elemento facilitador da acessibilidade espacial é a aplicação de recursos de Wayfinding, que se refere a um conjunto de elementos (visuais, auditivos, táteis, entre outros) que facilitam a orientação espacial das pessoas, especialmente em ambiente hospitalar onde nível de ansiedade atrapalha essa orientação. Hospitais públicos são importantes centros de assistência médico-hospitalar em diversas especialidades. Já o ambulatório é uma unidade funcional do Estabelecimento Assistencial de Saúde destinado à assistência a pacientes externos para diagnóstico e tratamento. O público que frequenta esses estabelecimentos também é amplo, incluindo médicos, funcionários de diferentes setores, visitantes, fornecedores, acompanhantes e pacientes, que em geral estão com a saúde mais debilitada. Este trabalho tem como objetivo avaliar as condições de acessibilidade físico-espacial através da percepção do usuário com deficiência. Para isso, foi realizado um estudo de caso no ambulatório do Hospital Universitário Lauro Wanderley-UFPB. A metodologia foi dividida em cinco etapas: pesquisa bibliográfica e documental, reconhecimento e caracterização da área, avaliação na perspectiva do usuário e, por fim, análise e sistematização dos resultados. Foi possível identificar as dificuldades encontradas pelos usuários e mapear os pontos mais críticos, e principalmente entender como os pacientes se orientam no espaço. Por fim, são propostas adequações para melhorias do espaço e wayfinding.

M.Tech. (Operations Management) / This study has demonstrated that continuous quality improvement and total quality management are the names for a philosophy of management that aims to help outcomes in both the individual and organizations of all kinds, eliminating quality waste during health care delivery service. In an effort to make a contribution to addressing the current challenges, areas of poor patient and lack of quality health care are explored in this study. Patients and healthcare professionals‟ views on Quality Management (QM) practices are also explored. Therefore, for the purposes of this dissertation, the researcher has expanded the QM definition. The poor patient care and shortage of skilled nursing practitioners‟ in nursing has indicated the need for top management commitment to measure, improve and provide high-quality health care for all its citizens. This is mainly due to lack of quality knowledge and skills, patients‟ education, and communication skills. In addition, no formalised framework exists on how quality of care in the context of nursing should occur, despite policy on quality health care being a legal requirement (National Department of Health, 2007:11). The purpose of this dissertation was to evaluate quality management practices in the Ekurhuleni Metropolitan Municipality public hospitals. Quality management for health care delivery in public hospitals in Gauteng Department of Health was determined and conceptualised and a framework developed on which the improvement of a quality strategy could be based. Altogether three (3) public hospitals throughout Gauteng Ekurhuleni region participated in this dissertation. A triangulation approach was adopted to collect data, analyse and answer the research questions. In this dissertation both quantitative and qualitative methods of data analysis were employed to analyse data derived from self-administered (open and closed) questionnaires, whilst semi-structured interviews were also conducted with the hospital unit manager (see Annexure 1 & 5).This, in turn, increased the validity of the empirical study part of this dissertation and enhanced the rigorous use of both quantitative and qualitative data.