This master’s thesis elaborates a design of water heating and heating system for a building of a rehabilitation center in Horný Hričov. The theoretical section describes operational efficiency of gas boilers and associated calculation methods. The experimental section covers measurements of condensing gas boiler at various temperatures of heating water conducted in university laboratory. Operational efficiency was then calculated using indirect method based on the measurement results. Subsequently, calculated values and values measured by an operational efficiency analyzer were compared. The comparison revealed minor deviations in operational efficiency values and different values of condensing heat utilization between the calculations and the analyzer results. The analytical section of the thesis consists of complex designs of two versions of the heating system and the water heating. The first design version uses condensing gas boilers as a heat source while the second version uses a water-air heat pump instead. The project section of the thesis is executed in the scope for a building permit and consists of a technical report and a design documentation.

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Introduction : Le cadre de la gouvernance clinique a été développé afin d’atteindre de hauts standards de qualité de soins et de services, en conjuguant les notions d’amélioration continue de la qualité, d’excellence clinique et d’imputabilité corporative. La présente démarche doctorale avait pour objectif de comprendre le processus d’institutionnalisation de la gouvernance clinique dans un centre de réadaptation. Méthodologie : Une synthèse méta-narrative de 65 documents répertoriés dans 4 bases de données bibliographiques sur la conceptualisation et la mise en œuvre de la gouvernance clinique a été menée. Une étude qualitative de cas unique a été menée dans un centre de réadaptation en déficience intellectuelle et en troubles du spectre de l’autisme, au Québec (Canada). En mobilisant les cinq construits du cadre conceptuel basé sur théorie du processus de normalisation (cohérence, participation cognitive, action collective, suivi réflexif et contexte organisationnel), une analyse thématique des entrevues individuelles auprès de 22 participants (5 administrateurs, 11 gestionnaires et 6 cliniciens) et de 3 groupes de discussion auprès de 8 cliniciens et de 4 proches d’usagers a été menée. Enfin, une analyse d’une centaine de documents administratifs du Centre a été effectuée. Résultats : L’analyse de la littérature a permis de constater que le cadre de la gouvernance clinique est un concept en évolution et encore perçu comme une avenue intéressante pour l’amélioration de la qualité des soins. Toutefois, la confusion autour de sa définition et de sa conceptualisation ainsi que les difficultés de sa mise en œuvre demeurent des enjeux pour les organisations. Par la mobilisation du cadre de gouvernance clinique, la haute direction du centre de réadaptation à l’étude a souhaité systématiser le processus d’amélioration continue de la qualité des services offerts aux usagers et à leurs proches par l’adoption des bonnes pratiques de gouvernance. Ce virage a été bien reçu par les administrateurs et les gestionnaires, résultant sur une participation active et un fort engagement aux activités de leur part. La complexité du cadre et l’absence d’implication des cliniciens dans le processus de mise en œuvre ont créé chez ces derniers une appréhension quant à l’apport de la gouvernance clinique pour la pratique clinique et le bien-être des usagers. Les cliniciens ont dénoncé l’absence d’arrimage entre la théorie et les réalités de la pratique clinique ; la grande vitesse d’implantation et une approche décisionnelle de type top-down comme des enjeux de l’institutionnalisation de la gouvernance clinique. Pour les gestionnaires, les défis ont été la mise en place des moyens de communication efficaces ; l’arrimage des mécanismes de gestion et la disponibilité des ressources humaines. Pour les administrateurs, l’enjeu principal a été l’instabilité des contextes organisationnels interne et externe qui a ralenti la mise en œuvre et freiné l’élaboration d’un processus évaluatif. Conclusion : L’institutionnalisation de la gouvernance clinique dans les établissements non hospitaliers offrant des services sociaux passe par la valorisation de ce concept comme un projet commun au bénéfice de l’usager en vue de renforcer la participation et l’engagement de tous et l’adoption d’une approche de partenariat entre les usagers, leurs proches et les autres acteurs de l’organisation. / Introduction: Clinical governance framework was developed in order to achieve high standards of quality of care and services, by combining the concepts of continuous quality improvement, clinical excellence and corporate accountability. The aim of this doctoral thesis was to understand the implementation process of clinical governance in a rehabilitation center. Methods: A meta-narrative synthesis on the conceptualization and implementation of clinical governance was conducted. 65 tittles screened in 4 international databases were analysing. A qualitative single case study was conducted in a rehabilitation center for intellectual disabilities and autism spectrum disorders, in Quebec (Canada). By mobilizing the five constructs of the conceptual framework based on normalization process theory (coherence, cognitive participation, collective action, reflexive monitoring and organizational context), a thematic analysis of individual interviews with 22 participants (5 administrators, 11 managers and 6 clinicians) and tree focus groups with 8 clinicians and 4 relatives of users were conducted. Finally, an analysis of around hundred administrative documents from the Center was conducted. Results: The literature revealed that the clinical governance framework is an evolving concept and still seen as an interesting avenue for improving the quality of care. However, confusion over its definition and conceptualization, and the difficulties of its implementation remain challenges for organizations. By mobilizing the clinical governance framework, the senior management of the rehabilitation center under study wished to systematize the process of continuous improvement of quality of services offered to users and their families, by adopting good governance practices. This shift was well received by administrators and managers, resulting in active participation and a strong commitment to activities. The complexity of the framework and the absence of involvement of clinicians in the implementation process have created in them an apprehension regarding the contribution of clinical governance to clinical practice and the well-being of users. Clinicians have criticized the lack of alignment between theory and the realities of clinical practice; the high speed of implementation and a top-down decision-making approach as issues of the implementation of clinical governance. For managers, the challenges have been the establishment of effective communications; the alignment of management mechanisms and the availability of human resources. For administrators, the main issue was the instability of the internal and external organizational contexts which slowed down the implementation and the development of an evaluation plan. Conclusion: The implementation of clinical governance in non-hospital facility requires the promotion of this concept as a joint project for the benefit of the user with a view to strengthening the participation and commitment of all and the adoption of a partnership approach between users, caregivers and other actors in the organization.

This master´s thesis elaborates a project documentation of sports rehabilitation center in Brno–Bystrc. The building object is four-storeyed and a partial basement. On the basement floor there is a pool with sauna, gym and fitness with support to assist for all activities offered. On the ground floor there is an entrance, reception for accommodation, restaurant and kitchen for the restaurant. The 2nd overground floors is determined by the rehabilitation clinic. On the grand and overground floor are designed sanitary appliances for the restaurant and patient surgeries. There are projected 9 apartments for weekend accommodation. Apartments allow access to the terrace. Foundations are made strip foundations. The building object is bricked and insulated with ventilated facades. Load bearing structure of the roof create roof trusses.

The diploma thesis deals with the design of a rehabilitation center, which is located in the cadastral area of the village Mušov on the border of the village Pasohlávky. It is a two-storey rehabilitation center with a gym and a partial basement. The thesis deepens the initiative of Thermal Pasohlávky, which plans to build a spa resort in the same section, combining elements of spa care, recreation and sports use. The object fulfills the function of a rehabilitation medical facility. The center is designed for up to 50 patients and is functionally divided into three parts. The first part consists of rehabilitation. We will find here several exercise rooms, hydrotherapy, electrotherapy, doctor's office with waiting room and reception. Rehabilitation also includes a gym with access to the terrace and park. On the second floor we can find specialized department of ergotherapy for people with different types of disabilities and second functional part of the bulding designed for staff facilities. It is made up of staffing facilities, dressing rooms, offices and meeting rooms. The third functional part consist from the technical background of the building and is located on the ground floor. The object is designed as a wall system, built from sand-lime bricks km beta Sendvix and insulated with the ETICS thermal insulation made from mineral wool. Horizontal supporting structures are designed as reinforced concrete. The entire building is roofed with a flat roof. Wooden windows and doors are used in the building to fill the holes. Before the building is a parking lot for employees and visitors of the rehabilitation facility. The design respects the principles of barrier-free solutions. The bachelor thesis is elaborated in the form of a project documentation for the execution of the construction.