Submitted in fulfillment of the requirements for the Doctoral Degree in Nursing, Durban University of Technology, Durban, South Africa, 2016. / This mixed methods study aimed to assess the functioning and processes of the Fast Queue Service Point in order to analyse the quality of care rendered in primary health care (PHC) facilities in the eThekwini district of the KwaZulu­ Natal Province in South Africa. The Fast Queue Service Point provides service in PHC facilities for health care users requiring short consultations. Congestion of PHC facilities is a result of increased access to PHC services with the introduction of free PHC services. This congestion was aggravated by the decentralization of services from hospitals to PHC level such as the introduction on Nurse Initiated Management of Anti-Retroviral Therapy (NIMART). In 2010, the National Core Standards (NCS) for health establishments were formulated further to the PHC Service package, to address issues of quality. An explanatory sequential mixed methods study design was used and data collection was conducted in two phases; the quantitative data collection phase consisting of two subsets of observations namely; the retrospective record review and structured observations of the Fast Queue Service Point process. The Statistical Package for the Social Sciences (SPSS) version 22 was used to analyse data. During the second phase semi-structured interviews were conducted with PHC staff members to describe their experiences of the Fast Queue Service Point and to clarify issues from the quantitative phase. Although Fast Queue Service users received sufficient care, there were important care assessments that had been inadequately performed or omitted. These included discussing side effects of medications and or immunizations and management thereof. Childrens' weights were not interpreted, an important aspect for children under five years of age. There was also lack of supportive supervision coupled with shortage of resources and too many time-consuming written records that were required to compile accurate statistics. Retraining and in-servicing of health personnel and making resources available, would assist in strengthening patient assessment, management and recording thereof. While clinic managers require to offer supportive supervision to health care providers, provision of lower categories of staff would be beneficial in supporting PNs and ENs so that they have time to compile records for statistics purposes, which were found to be taking up the bulk of their time. The framework for continuous quality improvement in implementing a Fast Queue Service in PHC settings was developed based on the findings of the study / D

This research focuses on assessing the extent to which the Principles of Aid Effectiveness were followed and translated into action by taking the General Education Quality Improvement Programme (GEQIP) in Ethiopia as an example. Outcomes of the secondary reviews conducted on the selected government institutions and development partners documents demonstrate that these Principles are taken as overarching strategies to guide the undertakings on GEQIP. The study attests that a number of factors influence the realization of aid effectiveness in Ethiopia. These include, at the recipient level, existence of strong national development plans while demanding improvement on absorptive capacity. At the level of development partners, compliance with pledges made on the provision of resources and better coordination is needed. A common country framework to guide the aid effectiveness process including mutual accountably is important. The study most importantly identifies that beyond sector specific reviews, emphasis should also be given to assess the contribution of the Principles of Aid Effectiveness for efficient delivery of support to the GEQIP. / Development Studies / M.A. (Development Studies)

It is imperative to have quality assurance processes in place in division training to provide quality training to enable members of the South African Police Service (SAPS) to provide quality services to communities within their area of jurisdiction. The aim of the study was to determine the presence of and the need for implementation of effective quality assurance processes in education and training in the South African Police Service (SAPS). The concepts quality and quality assurance were explained in the literature review. Questionnaires were completed by the trainers in the South African Police Service (SAPS) at various training centers in the Northern Cape Province. The researcher advocates to promote and enhance quality assurance in education and training programmes in the South African Police Service (SAPS). Therefore, it is recommended that quality assurance programmes be introduced based on total quality management system for continuous improvement which can provide any training programme with a set of “tools” to meet and exceed the present needs and expectations of the adult learners in the South African Police Service (SAPS) context. / Teacher Education / M. Ed. (Education Management)

The purpose of the study is to explore the current policy and practice of the national and institutional QA system in public HEIs in Ethiopia in order to determine how the quality of teaching and learning might have been enhanced through the QA system. Two organisational theories – contingency and neo-institutional theory – provide a theoretical lens to explain how internal and external organisational environments affect the implementation of QA in the HEIs. The mixed-methods research approach was used in the study, including document analysis, semi-structured interviews and questionnaires. Three public universities were chosen as data source. At macro level, the HERQA was also included to examine the effect of the institutional environments on internal quality assurance practices. The findings revealed that there is little evidence of self-initiated quality enhancement activities in the public HEIs. They do not have adequate structures, systems, and written policies to assure quality. The quality assurance efforts were implemented without a clear sense of direction and purposes and therefore lacked effective coordination. The self-evaluations were symbolically took place at the higher levels of the universities and that the results of the evaluations were rarely used in a structured way in improvement of teaching-learning, faculty decision-making and planning processes. It is far from clear that whether the internal quality assurance contributed to the teaching and learning or transformed the student learning experience. It can be concluded that the HERQA’s quality assurance policy and practices seems to be de-coupled from internal initiatives to improve quality in the higher education institutions. It is recommended that HEIs should develop QA policy, mobilise resources for institutional quality improvement, establish full-fledged QA structures at all levels, and furnish the structures with necessary human resources. The HEIs should initiate and undertake effective self-assessment of their activities, own it and work towards achieving their own stated objectives. It is important that the HERQA should develop accreditation procedures, particularly at programme level, for the public HEIs. The HERQA should consider playing more active roles in communicating with HEIs regularly about QA; pay more attention to a follow-up of the audits, the punctual development and delivery of the SEDs. The HERQA should be more independent, have more autonomy and sufficient resources to become a viable professional agency informing the HE sector on the quality of its performance. / Educational Management and Leadership / D. Ed. (Education Management)

The study identifies how different stakeholders perceive service quality improvement initiatives in public higher education institutions in Ethiopia. For this purpose, a mixed research methodology was employed. Furthermore, secondary data were collected from a variety of literature and primary data were collected from academic staff and final year students at public higher education institutions using the SERVQUAL scale and through focus group interviews. The collected data were analysed using both descriptive and inferential statistics. The research findings indicated that all dimensions of the service quality improvement initiatives were perceived by academic staff and studentsto be verypoor. The reasons for these poor or low perceptions were: the high expectationsof the stakeholders, the government’s intention to expand, lack of adequate knowledge regarding the implementation of the BPR process, the lack of motivation by service providers, poor management and the lack of good governance by the universities, inexperienced workers, non-empowered and task specific frontline employees, the low quality of the infrastructure, non-value adding hierarchical structures and approval systems, ethical problems with some service providers, the high staff turnoverand the lack of experienced staff. In addition, at all new universities, construction is underway and as a result,there are problems such as the poor state of the dormitories, classes,bathrooms, recreation areas, lounges, TV rooms, sport fields and internet connectivity, while the libraries are not well stocked with books and periodicals either. This study has recommended that the institutions should have standardised instruments that can be used to measure the status of service quality improvement and deliveryperiodically and to identify the areas that have the highest perceived performance gap scores in order to redeploy some of the resources. It also needs to be pointed out that the service providers lack sufficient knowledge and skillsconcerning the implementation of BPR, thus training is recommended in this regard.It is further recommended that for effective implementation of the BPR process, the importance of the provision of different guiding documents, continuous monitoring of activities and top management support should be kept in mind. / Educational Leadership and Management / D. Ed. (Educational Management)

Despite the unprecedented improvement in child health in last 15 years, burden of stillbirth and neonatal death remain the key challenge in Nepal and the reduction of these deaths will be crucial for reaching the health targets for Sustainable development goal by 2030. The aim of this thesis was to explore the risk factors for stillbirth and neonatal death and change in perinatal outcomes after the introduction of the Helping Babies Breathe Quality Improvement Cycle (HBB QIC) in Nepal. This was a prospective cohort study with a nested case-control design completed in a tertiary hospital in Nepal. Information were collected from the women who had experienced perinatal death and live birth among referent population; a video recording was done in the neonatal resuscitation corner to collect information on the health workers’ performance in neonatal resuscitation.  Lack of antenatal care had the highest association with antepartum stillbirth (aOR 4.2, 95% CI 3.2–5.4), births that had inadequate fetal heart rate monitoring were associated with intrapartum stillbirth (aOR 1.9, CI 95% 1.5–2.4), and babies who were born premature and small-for-gestational-age had the highest risk for neonatal death in the hospital (aOR 16.2, 95% CI 12.3–21.3). Before the introduction of the HBB QIC, health workers displayed poor adherence to the neonatal resuscitation protocol. After the introduction of HBB QIC, the health workers demonstrated improvement in their neonatal resuscitation skills and these were retained until six months after training. Daily bag-and-mask skill checks (RR 5.1 95% CI 1.9–13.5), preparation for birth (RR 2.4, 95% CI 1.0–5.6), self-evaluation checklists (RR 3.8, 95% CI 1.4–9.7) and weekly review and reflection meetings (RR 2.6, 95% 1.0–7.4) helped the health workers to retain their neonatal resuscitation skills. The health workers demonstrated improvement in ventilation of babies within one minute of birth and there was a reduction in intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and first-day neonatal mortality (aOR 0.51, 95% CI 0.31–0.83).  The study provides information on challenges in reducing stillbirth and neonatal death in low income settings and provides a strategy to improve health workers adherence to neonatal resuscitation to reduce the mortality. The HBB QIC can be implemented in similar clinical settings to improve quality of care and survival in Nepal, but for primary care settings, the QIC need to be evaluated further.

United Nations has lately stated ambitious health targets for 2030 in the Sustainable Development Goal agenda, following the already achieved progress between 1990 and 2015 when the number of children dying before the age of five was reduced by more than half. However, the mortality reduction in the first month of life after birth has not kept the same pace. Furthermore, a large number of stillbirths have previously not been accounted for. The aim of this thesis was to evaluate the impact of clinical training in neonatal resuscitation, and to identify strategies for an effective implementation at a maternal health facility in Nepal. Focus group discussions were used to explore the perceptions of teamwork among staff working closest to the infant at the facility. A prospective cohort study with nested referents was applied to determine effect on birth outcomes after an intervention with Helping Babies Breathe, a simplified protocol for neonatal resuscitation. Sustainability of the acquired skills after training was addressed by employing a quality improvement cycle. Video recordings of health workers performance were collected to analyse adherence to protocol. Midwives described the need for universal protocols in neonatal resuscitation and management involvement in clinical audit and feedback. There was a reduction of intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and neonatal mortality within 24 hours of life (aOR 0.51, 95% CI 0.31–0.83) after the intervention. Ventilation of infants increased (OR 2.56, 95% CI 1.67–3.93) and potentially harmful suctioning was reduced (OR 0.13, 95% CI 0.09–0.17). Neonatal death from intrapartum-related complications was reduced and preterm infants survived additional days in the neonatal period after the intervention. Low birth weight was not found to be a predictor of deferred resuscitation in the studied context. This study confirmed the robustness of Helping Babies Breathe as an educational tool for training in neonatal resuscitation. Accompanied with a quality improvement cycle it reduced intrapartum stillbirth and mortality on the day of delivery in a low-income facility setting. Improved postnatal care is needed to maintain the gains in survival through the neonatal period. Increased management involvement in audit and quality of care could improve clinical performance among health workers.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-06-23T14:32:23Z No. of bitstreams: 1 Marcelo Antunes Marciano.pdf: 3212195 bytes, checksum: d0978d66fd9d22e11d99ba2207b6a553 (MD5) / Made available in DSpace on 2015-06-23T14:32:23Z (GMT). No. of bitstreams: 1 Marcelo Antunes Marciano.pdf: 3212195 bytes, checksum: d0978d66fd9d22e11d99ba2207b6a553 (MD5) Previous issue date: 2014 / Nenhuma / Este trabalho investiga como aumentar a qualidade dos serviços entregues à população pela gestão de operações em serviços de saúde, tanto no sistema público quanto na saúde suplementar, mais especificamente, em operadoras de plano de saúde e em hospitais do estado do Rio Grande do Sul (RS). O objetivo principal do presente trabalho consiste em analisar possibilidades de elevar a qualidade do sistema de saúde público e suplementar do estado do Rio Grande do Sul à luz do sistema dinâmico em que se inserem. Os objetivos específicos são: Mapear o sistema de saúde, por meio do pensamento sistêmico, e propor pontos de alavancagem à qualidade do sistema de saúde pública do RS; e Analisar a aderência aos critérios do Managed Care e de inovações em gestão de saúde, pelos atores “operadora de plano de saúde” e “hospital”. A dissertação é formada por dois artigos, cada um entregando um objetivo específico, e por capítulos adicionais que consolidam a entrega do objetivo geral. Quanto aos procedimentos metodológicos, a pesquisa parte de um paradigma positivista e orienta-se qualitativamente, fazendo uso de entrevistas, análise documental, coleta de dados secundários em bancos de dados de acesso público, análise por julgamento em dinâmica de grupo multidisciplinar e modelagem. Como resultados obteve-se a construção de um mapa que evidencia os atores e as relações desse sistema dinâmico, possibilitando a identificação de possíveis cenários, pontos de alavancagem e a sugestão de estratégias para auxiliar no aumento da qualidade do sistema de saúde pública do RS, bem como a construção de uma ferramenta, no caso, um questionário, por meio do qual foi possível verificar que os atores hospitalares contatados encontram-se mais aderentes do que as operadoras de plano de saúde contatadas com relação às boas práticas de gestão orientadoras do estudo. Argumenta-se que um sistema integrado de gestão, padronizado, empregado de forma sistêmica, com auxílio de estratégia organizacional, de inovações e com foco na cadeia de valor, contempla aspectos assistenciais, econômicos e competitivos, desses atores e, como consequência, pode contribuir para que as operadoras e hospitais possam aumentar a qualidade dos serviços prestados. / This work examines how to improve quality in health services, both in the public system and in supplementary health, more specifically, in health insurance companies and hospitals in the state of Rio Grande do Sul (RS). The main goal of the present work is to improve quality for the public and supplementary health systems in the state of Rio Grande do Sul under the dynamic system they are included into. Specific goals are: Mapping the health system through systemic thinking, proposing points of leverage regarding the quality of the public health system in RS; and analyzing the compliance with the Managed Care criteria and innovation in health management by the players, namely, “health insurance companies” and “hospitals”. The work is composed of two articles, each delivering a specific goal, and by additional chapters that consolidate the delivery of the general goal. As for the methodological procedures, the research develops from a positivist paradigm and it is based on a qualitative perspective, making use of interviews, document analysis, secondary data collection in public-access databases, analysis based on multidisciplinary group dynamics assessment and modeling. As a result, this led to the creation of a map that highlights players and relations of this dynamic system, allowing for the identification of possible scenarios, points of leverage, and the suggestion of strategies to help improve the quality of the public health system in RS, as well as the awareness that contacted hospital players were found to be more compliant than the contacted health insurance companies as far as good management practices that guided this study are concerned. We argue that a integrated and standardized management system, which is systematically used, with the help of organizational strategies, innovation, and a focus on the value chain, takes into account assistance-related, economic, and competitive aspects of these players and, as a consequence, it may contribute to improve quality to services provided.

Tillgänglighet är ett stort problem inom svensk sjukvård. Produktionsplanering skulle kunna bidra till att korta ned ledtider och på så sätt öka tillgängligheten, men det saknas kunskap om hur detta påverkar arbetsmiljön för personalen. Ett förbättringsarbete genomfördes på en psykiatrisk öppenvårdsmottagning med syfte att med hjälp av produktionsplanering korta ledtiden mellan två steg i den diagnostiska processen. Förändringen innebar att patienterna fick möjlighet att boka tid till nästa besök direkt i samband med det första besöket. Arbetet utgick från Nolans förbättringsmodell. En studie av förbättringsarbetet, med induktiv ansats, genomfördes med syftet att undersöka hur denna förändring påverkade arbetsmiljön. Intervjuer genomfördes med berörda medarbetare och analyserades med innehållsanalys. Förbättringsarbetet resulterade i att ledtiden mer än halverades, med befintliga resurser. Medarbetarnas delaktighet bedömdes ha haft betydelse för det lyckade resultatet. Studien visade att arbetsmiljön ej påverkades negativt, utan tvärtom att arbetstillfredsställelsen ökade. Viktiga förklaringar till detta var att medarbetarna upplevde det som tillfredsställande att kunna erbjuda patienterna en snar tid för nästa besök, att förändringen ledde till minskad administration och att medarbetarna fortfarande hade kontroll över sina tidböcker. Slutsatsen är att det är möjligt att öka produktionen med hjälp av produktionsplanering utan att det får negativa effekter för arbetsmiljön. / Accessibility is a major problem in Swedish healthcare. Production planning could help to shorten waiting times and improve accessibility, but there is insufficient knowledge of how this affects the working environment. An improvement project was initiated with the purpose to shorten the lead time between two steps in the diagnostic process at a psychiatric outpatient clinic, with the help of production planning. The change meant that patients were offered to book a time for the next visit during the first visit. A study of the project was initiated to investigate how the change affected the working environment. Interviews were conducted and analysed with content analysis. The improvement project led to lead times being more than halved. Employee participation was important for reaching this result. The study showed that the working environment was not adversely affected, on the contrary job satisfaction increased. Explanations for this was the satisfaction of being able to offer patients to book a new visit directly, less time spent on administrative tasks and staff retaining significant control over their schedule. The conclusion is that it is possible to increase production by means of production planning without this having negative effects on the working environment.

本研究是要探討IT硬體服務專案的管理過程，因硬體系統專案建置計劃 在時間上總是被壓縮的，因此有效的專案管理是解決專案過程的變更及不確定性，運用先期的溝通取得共識，並提供專案即時資訊給客戶，可以讓客戶事先了解專案遇到障礙，縮短彼此溝通的時間，進而使案件順利進行，更能得到客戶的滿意。 在本文有提到專案管理的各種流程方法，關於專案主要議題，最重要的是關於管理人的問題，專案的成功就是人在專案的掌控，只要責任工程師(Owner)在專案進行中能有能力做一位控盤手在加上有一套完善的專案流程控管系統，則專案要產生大狀況、變更、延誤的機率就可降低很多，如本文個案為例就是施行嚴格的專案控管，專案進行期間雖有小狀況發生但都很快速的解決，建置期及實際演練期只耗用2個月就完成驗收，也不影響客戶的業務營運有中斷現象。 本研究強調協同運作，在專案進行中，必須讓專案團隊是認同在Virtual Team的結構下，將專案執行資訊隨時發佈讓Virtual Team所有組織成員都能瞭解專案進行狀況，適時加入修正偏差，且適時提出解決方案措施。本研究重心也在一個專案管理施作過程中驗證，將專案管理要素中的架構、程序、時間結果等等，透過一套專案管理流程系統和客戶的高層、決策者，在取得一定的共識後，立刻將專案過程進度即時資訊顯示讓客戶瞭解，而專案管理團隊也充份發揮專案技術能力完成專案，讓專案驗收，且獲得客戶對專案品質的最高滿意度。 / This study is for investigating the management process of IT hardware services projects。 Since the time is always in shortage for those hardware system project implementation plans，project management is an effective way to solve the problems related to project process changes and uncertainties。 Utilizing prior communication to reach a common view and providing real time project information can allow customers to know the project status and problems in advance and shorten the communication time。In addition，the projects can then be processed on schedule and customers can be better satisfied。 In this paper，various workflow methods of project management are mentioned。In regards to the issues related to projects，the most important thing is the problems associated with the project manager。 The success of a project relied on the managerial skills。As long as the responsible owner of a project has the ability to administrate the project and uses a complete project management and control system, the chances of large problems、alternations and delays will be lower significantly。The case on this paper can be used as an example of rigid implementation of project management。Although there were small issues during the project，problems got solved quickly。 Setup and configurations period and live testing period only took two months to credit the customer acceptance。No operation interruption had occurred on the customer side。 This study emphasizes on collaboration。 In the progress of the project， we must make sure that members of the project cooperate in the infrastructure of Vitual Team，We fully disclose the information of the project implementation so that members of Virtual Team have a fully understanding of the project progress and status。Timely adjustments can be applied。In addition，proper solutions can be offered。The essential points of this study is verified during a project implementation。Via a project management system，information of a project such as infrastructure、process、and time is provided for customer's top management and decision makers。After reaching a consensus，we immediately provide information to the customer。Moreover，the project management team work professionally with proficient skills to finish the project and credit the project acceptance。The customer is earned with highest satisfactions in terms of project quality。