Thesis (MBA) --University of Limpopo, 2010

Doctor of Philosophy(PhD) / In the public hospital sector in Australia there is no dedicated scheme to offset costs associated with high cost medications (HCMs) to the institution or the public. (1) Concerns exist as to the equity of access and appropriate mechanisms to manage access to HCMs in public hospitals. (2) There are gaps in the literature as to how decisions are made, and in particular, decision-making processes by which ethical, clinical and economic considerations maybe taken into account. To date, limited work has been conducted regarding the use and funding of HCMs in public hospitals. There are no published data on perceptions, concerns and attitudes, among health care decision-makers or among the community-at-large about access to HCMs in public hospitals. The research reported in this thesis describes the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. The investigation triangulated quantitative and qualitative methods used to collect and analyse data. Four studies were conducted to describe the decision-making process and explore the perceptions, concerns and attitudes of health care decision-makers and the perceptions of members of the general public regarding access to HCMs in public hospitals. The first study, reported in Chapter Three, was a review of individual patient use (IPU) requests for non-formulary HCMs. This study showed that these requests had a significant impact on the capped expenditure of a public hospital. Subsequent to this review, a new policy and procedure for managing requests for HCMs for IPU was established. A high-cost drugs subcommittee (HCD-SC) operating under the auspices of the Drug and Therapeutics Committee (DTC) was created. The second study, reported in Chapter Four, described the operations of the newly formed HCD-SC. This study also evaluated the decision-making process using the ethical framework “accountability for reasonableness”. (3) Different factors were involved in decisions about access to HCMs and decisions were not solely based on effectiveness and cost. HCD-SC members considered it was important to have consistency in the way decisions were being made. The evaluation of this process allowed identification of good practices and gaps which were considered as opportunities for improvement. The third study, reported in Chapter Five, found that health care decision-makers in an Area Health Service echoed the concerns and agreed about the problems associated with access to HCMs expressed by the HCD-SC members. These studies concluded that the majority of decision-makers wanted an explicit, systematic process to allocate resources to HCMs. These studies also identified tensions between funding systems and hospital decision-making. According to participants there were no mechanisms in place to systematically capture, analyse and share the lessons learned between the macro level (ie. Federal, Pharmaceutical Benefits Scheme - PBS) and the meso level (ie. Institution, public hospital) regarding funding for HCMs. Furthermore, decision-makers considered there are strong incentives for cost-shifting between the Commonwealth and the States. Health care decision-makers also acknowledged the importance of public participation in decision-making regarding allocation of resources to HCMs in public hospitals. However the results of these studies showed that those decisions were not generally made in consultation with the community. Decision-makers perceived that the general public does not have good general knowledge about access to HCMs in public hospitals. A survey of members of the general public, reported in Chapter Six, was then conducted. The survey aimed to gather information about the knowledge and views of members of the general public about access to HCMs in public hospitals. Results of this fourth study showed that respondents had good general knowledge but were poorly informed about the specifics of funding of hospitals and HCMs in private and public hospitals. The results also offered support for the development of a process to involve community members in discussion on policy on the provision of treatment and services within health care institutions and specifically, to seek the views of members of the public on the provision of HCMs and expensive services within public hospitals. In summary, the research reported in this thesis has addressed the gaps in the literature as to how decisions are made, and in particular, the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. In a move towards more explicitness in decision-making regarding the allocation of scarce health care resources, the findings from these studies provide an evidence base for developing strategies to improve decision-making processes regarding access to HCMs the public sector.

Στις μονάδες υγείας το ανθρώπινο κεφάλαιο είναι ο σημαντικότερος παραγωγικός συντελεστής και αποτελεί τον πιο σημαντικό ρόλο στην παραγωγή και διανομή των υπηρεσιών υγείας των οποίων η αποδοτικότητα είναι συνισταμένη της ικανοποίησης του από την εργασία, των συνθηκών εργασίας, των κινήτρων, τις εξέλιξης του αλλά και τις δια βίου επιμόρφωσης του (Σταυροπούλου. Κ, 2010, σελ 280-295) και ο λόγος για τον οποίον επιλέχθηκε το συγκεκριμένο θέμα είναι γιατί το ανθρώπινο δυναμικό σε επιχειρήσεις όπως σε νοσοκομείο που είναι εντάσεως εργασίας, αποτελεί το πιο πολύτιμο κεφάλαιο και η συμβολή του στην επίτευξη των στόχων είναι καθοριστική. Από την εισαγωγή του το 1983 το Ελληνικό Εθνικό Σύστημα Υγείας βρίσκεται υπό συνεχείς προσπάθειες με στόχο τη βελτίωση της αποτελεσματικότητας και της ποιότητας των παρεχομένων υπηρεσιών. Παράλληλα η γνώση των προβλημάτων τα οποία αντιμετωπίζει ένα δημόσιο νοσοκομείο θα είναι απαραίτητη για την επιτυχία τις διοίκησης του, λαμβάνοντας υπόψη ότι το ανθρώπινο κεφάλαιο έχει άμεση συσχέτιση με την ποιότητα και την αποτελεσματικότητα του οργανισμού, η ικανοποίηση από την εργασία, θα πρέπει να αποτελεί έναν από τους πιο σημαντικούς και αντικειμενικούς στόχους της διοίκησης για την εύρυθμη λειτουργία του οργανισμού και πως η σημαντικότητα αυτής τις παραμέτρου πόσο θα συμβάλει στο παραγόμενο έργο. Οι μονάδες παροχής υπηρεσιών υγείας όπως είναι τα νοσοκομεία, οι οποίες βασίζονται κυρίως στο συντελεστή της εξειδικευμένης εργασίας, οφείλουν να ενδιαφέρονται πρωτίστως για το εργασιακό περιβάλλον, τις εργασιακές σχέσεις και την επαγγελματική ικανοποίηση των εργαζομένων τους. Επιπρόσθετα το καλό εργασιακό περιβάλλον αποτελεί τη θεμελιώδη παραγωγική συνιστώσα προσφοράς ποιοτικών ιατρονοσηλευτικών υπηρεσιών.(Νιάκας, 2004, σελ112). Σύμφωνα με το ισχύον θεσμικό πλαίσιο του εθνικού συστήματος υγείας τα δημόσια νοσοκομεία έχουν χαρακτήρα ιατροκεντρικό και η λειτουργία του οργανισμού στηρίζεται στις αρχές του δημοσιοϋπαλληλικού κώδικα. Οι σχέσεις εργασίας των εργαζομένων με τον οργανισμό, οι αμοιβές του, η εξέλιξη του και άλλα θέματα που έχουν σχέση με την υπηρεσιακή του κατάσταση ρυθμίζονται από το δημοσιοϋπαλληλικό καθεστώς, γεγονός το οποίο δεν αφήνει περιθώρια στις διοικήσεις των οργανισμών ώστε να ασκήσει μια διαφορετική πολιτική στην διαχείριση των ανθρωπίνων πόρων. Υπάρχει περιορισμένη ικανότητα για παροχή επιπλέον οικονομικών κινήτρων στο προσωπικό του δημόσιου τομέα και ιδιαίτερα κατά την περίοδο της οικονομικής κρίσης όπου οι πόροι είναι περιορισμένοι, θα πρέπει να δίνονται έμφαση στους μη υλικούς τρόπους παρακίνησης, προκειμένου να διατηρηθεί το ηθικό των εργαζομένων σε υψηλά επίπεδα γεγονός που είναι πολύ αναγκαίο για την διασφάλιση παροχής υπηρεσιών και για τους ίδιους τους εργαζομένους. / --

Thesis (MBuilding) -- University of South Australia, 1998

Thesis (MBuilding) -- University of South Australia, 1998

Doctor of Philosophy(PhD) / In the public hospital sector in Australia there is no dedicated scheme to offset costs associated with high cost medications (HCMs) to the institution or the public. (1) Concerns exist as to the equity of access and appropriate mechanisms to manage access to HCMs in public hospitals. (2) There are gaps in the literature as to how decisions are made, and in particular, decision-making processes by which ethical, clinical and economic considerations maybe taken into account. To date, limited work has been conducted regarding the use and funding of HCMs in public hospitals. There are no published data on perceptions, concerns and attitudes, among health care decision-makers or among the community-at-large about access to HCMs in public hospitals. The research reported in this thesis describes the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. The investigation triangulated quantitative and qualitative methods used to collect and analyse data. Four studies were conducted to describe the decision-making process and explore the perceptions, concerns and attitudes of health care decision-makers and the perceptions of members of the general public regarding access to HCMs in public hospitals. The first study, reported in Chapter Three, was a review of individual patient use (IPU) requests for non-formulary HCMs. This study showed that these requests had a significant impact on the capped expenditure of a public hospital. Subsequent to this review, a new policy and procedure for managing requests for HCMs for IPU was established. A high-cost drugs subcommittee (HCD-SC) operating under the auspices of the Drug and Therapeutics Committee (DTC) was created. The second study, reported in Chapter Four, described the operations of the newly formed HCD-SC. This study also evaluated the decision-making process using the ethical framework “accountability for reasonableness”. (3) Different factors were involved in decisions about access to HCMs and decisions were not solely based on effectiveness and cost. HCD-SC members considered it was important to have consistency in the way decisions were being made. The evaluation of this process allowed identification of good practices and gaps which were considered as opportunities for improvement. The third study, reported in Chapter Five, found that health care decision-makers in an Area Health Service echoed the concerns and agreed about the problems associated with access to HCMs expressed by the HCD-SC members. These studies concluded that the majority of decision-makers wanted an explicit, systematic process to allocate resources to HCMs. These studies also identified tensions between funding systems and hospital decision-making. According to participants there were no mechanisms in place to systematically capture, analyse and share the lessons learned between the macro level (ie. Federal, Pharmaceutical Benefits Scheme - PBS) and the meso level (ie. Institution, public hospital) regarding funding for HCMs. Furthermore, decision-makers considered there are strong incentives for cost-shifting between the Commonwealth and the States. Health care decision-makers also acknowledged the importance of public participation in decision-making regarding allocation of resources to HCMs in public hospitals. However the results of these studies showed that those decisions were not generally made in consultation with the community. Decision-makers perceived that the general public does not have good general knowledge about access to HCMs in public hospitals. A survey of members of the general public, reported in Chapter Six, was then conducted. The survey aimed to gather information about the knowledge and views of members of the general public about access to HCMs in public hospitals. Results of this fourth study showed that respondents had good general knowledge but were poorly informed about the specifics of funding of hospitals and HCMs in private and public hospitals. The results also offered support for the development of a process to involve community members in discussion on policy on the provision of treatment and services within health care institutions and specifically, to seek the views of members of the public on the provision of HCMs and expensive services within public hospitals. In summary, the research reported in this thesis has addressed the gaps in the literature as to how decisions are made, and in particular, the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. In a move towards more explicitness in decision-making regarding the allocation of scarce health care resources, the findings from these studies provide an evidence base for developing strategies to improve decision-making processes regarding access to HCMs the public sector.

Thesis equivalent (M.P.H.)--University of Michigan, 1944.

Thesis equivalent (M.P.H.)--University of Michigan, 1944.

Yes / Purpose Pharmaceuticals are a key input into healthcare operations and so their effective management is vital. This issue is of key importance in Thailand and is aligned with the Thailand’s 2nd National Logistics and Supply Chain Research Strategies (2012-2016) focusing on healthcare green logistics. Pharmaceuticals in hospitals account for more than 50% of the total hospital purchasing budget. Moreover, the overuse of medicine was generally found to be prevalent in Thai hospitals despite serious financial concerns. The aim of this study was twofold: Phase (i) to investigate the movement and lifecycle of pharmaceuticals within Thai hospital sites and Phase (ii) identify the GL practices that effectively control/minimize the use of pharmaceuticals. Research Approach Using a case research method six hospitals were examined, to give coverage of the different types/sizes, locations and a range of environmental performance issues. Hospital visits were undertaken during January to July 2014, to obtain data by using a multi-method approach: interviews, documentation reviews and in situ observation. Purposive respondent sampling was undertaken to ensure that data was collected from staff with experience of pharmaceutical management and a bespoke form of content analysis used for the data review before further cross-case analysis. Findings and Originality The result of Phase (i) revealed that pharmaceutical flows appeared to be sophisticated and problematic, caused by issues such as limited budget allocation, ineffective governmental processes, and the over-prescribing of medicine for chronic patients. The findings also identified effective GL practices such as: (i) prescribing medicines for only 1-2 months for some patient conditions/drug types and increasing the frequency of follow-up reviews, (ii) conducting a medicines return programme and (iii) having a clearly defined system of pharmaceutical product review. The outcomes of the study proposed key practices to support a Sustainable Health System at both policy and hospital levels. Within this were: (i) a representation of stakeholder views, (ii) the provision of healthcare education and communication, (iii) addressing self-health management issues and (iv) planned system review and improvement. The design and execution of such a system should be grounded in Thailand’s Sufficiency Economy Philosophy (SEP) concept. Research Impacts In the GL research paradigm public healthcare, developing nations, human elements and life-cycle products have received limited attention; this study therefore contributes to the reduction of these gaps. The SEP concept was highly recommended by the United Nations, instead of Sustainable Development, in addressing GL practices in Thai culture to promote sustainable health standards and this underpins the focus and the originality/impact of this study. Practical Impacts This study recommends that staff in Thai hospitals focus on effective pharmaceutical management to contribute to the sustainability of good GL practices (as identified) and to the design and delivery of a Sustainable Health System in Thailand. The study presents guidance and support to do this.

Yes / The effective reverse exchange of healthcare products such as laundry within a hospital environment can support the health system, for achieving the highest goal: ‘to provide regular and timely supply of clean linen to the satisfaction of patients and staff’ (Srikar et al., 2015, p. 593). Previous studies by Bandoophanit et al. (2015, 2017) assert there are constant shortages of linen availability in many Thai public hospitals which can undermine the efficacy of laundry management and quality of medical treatment. This study investigates the practices, culture, and operational performance of three large-sized public hospitals (700-2,000 beds) located in Thailand reflecting on the application of Reverse Exchanges (R/E) theory. This study contributes to the Thai healthcare agenda, a core mission of which is to “Develop the health system with quality, efficiency and equality; with participation of the people, communities and all sectors for good health of all Thai people in order to achieve a good and sustainable society following the King’s Sufficiency Economy philosophy” (Ministry of Public Health, 2018).