The purpose of this thesis is to investigate the ideal possibilities in planning an ideal medium-sized hospital, and to incorporate these possibilities into the design of a general hospital for Blacksburg and the surrounding communities. Before any planning can be done, the requirements of the hospital must be agreed upon. By making a thorough research, one is able to determine the hospital needs of a community; the problems relating to planning, maintenance and operation of the hospital; the number of beds required; and the types of services to be offered. All these requirements will be affected by the extent of other existing facilities in the community and by those facilities in surrounding communities. When the number of beds that will be required, and the services to be offered have been decided upon, a program is developed. This program will show with reasonable completeness the requirements of each department of the hospital as to its approximate area, its major equipment, and the number and classification of personnel employed in the department. When the program is complete, and the site for the hospital has been selected, we can proceed with the planning of the building and the preparation of drawings for it. The following program gives a complete compilation of the hospital’s requirements, and enough information so that they may be readily translated into the actual size, shape, and arrangement of the eventual building, and the building’s relationship to the site. / Master of Science

Thesis (MBA) --University of Limpopo, 2007 / If medical doctors are expected to function effectively and efficiently to provide the highest quality of care to the largest number of patients in rural hospitals, it is imperative that they derive job satisfaction from their work and thus perform well. The present study aimed to investigate whether the doctors in the target population have job satisfaction. The doctors were selected from the rural hospitals of the Waterberg District of the Limpopo Province. An exploratory qualitative research design was used, which included a self administered questionnaire enquiring about the demographic and work situation variables. Content analysis was used to analyse qualitative data. The main findings that emerged from the study were that the respondents were dissatisfied with their work environment. The most common theme that emerged was related to the bad working conditions, lack of support from management, lack of proper equipment, and the salary or incentives in proportion to the workload. These findings highlighted the issues that can be addressed by the employing organisation.

Introduction Health-care service in South Africa, especially in the public sector, is fraught with numerous problems, including ineffective operations management in health care facilities. This contributes to poor service delivery and a lackluster work environment. Non-value-adding activities result in, inter alia, long cycle and waiting times, and low staff morale. With Lean thinking, health care managers could tackle specific issues to improve operational efficiency. Aim The purpose of the study was to apply Lean thinking, and to determine its effect on efficiency and staff morale within the outpatient department at Catherine Booth Hospital, in order to inform recommendations to improve operational efficiency in rural district hospital outpatient departments. Methods An operational action-research study design was used. The study sample consisted of all service nodes and employees of the outpatient department in Catherine Booth Hospital. Cycle and waiting times were iteratively measured for all service nodes. Statistical analyses on pre- and post-intervention results were carried out. Results Cycle and waiting time targets were met and exceeded in three service nodes, but only the Investigations node showed statistically significant results (cycle time reduced from 16.7 to 12.2 minutes; p=0.04; and waiting time reduced from 11.93 to 10 minutes; p=0.03). The waiting time for Consulting Rooms improved significantly (80.95 to 74.43 minutes; p<0.0001). Significant decreasing trends in waiting times over the study period were found in Patient Administration (p=0.04), Patient Screening (p<0.0001) and Consulting Rooms (p<0.0001). The trend in average operational efficiency improved over time from 16.35% to 20.13%. The implementation of Lean had a positive impact on the proportion of OPD staff satisfied with their jobs (increased from 21.1% to 77.8%; p<0.0001) and proportion of staff that felt motivated (increased from 15.8% to 77.8%; p<0.0001). Discussion Rural public sector hospitals require a novel and evidence-based approach to improving operational efficiency and staff morale in OPDs and other departments. Lean implementation had a positive impact on cycle and waiting times in all service nodes. Attitude towards teamwork and communication strength are positively impacted by the process of Lean implementation. However, factors such as differing priorities and logic among staff in the OPD and management negatively affect the outcomes of Lean implementation. Conclusion and recommendations The application of Lean principles, tools and techniques is possible in a rural district hospital OPD, without any demands on staff in terms of learning and adopting a new quality-improvement management approach by which to improve operational efficiency. The lessons learnt from the implementation of Lean thinking at a rural hospital used in this study may be emulated for quality improvement across similar hospitals and its sustainability can be assessed further. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

Rural health care has been affected by health care changes. Twenty-seven percent of the U.S. population live in rural areas (Adams, 1993; Weinert & Long, 1991). The purpose of this study was to examine the tenure of rural Directors of Nursing (DONs) in the DON position, to examine the tenure of rural DONs in the organization, and to profile the personal system of the DON in a rural hospital. The significance of the study was that little is known about rural DONs.The Neuman Systems Model (Neuman, 1989) provided the theoretical. framework for the study using the personal system level. The sample included all rural acute care DONs in one midwestern state. The Assessment of DON Tenure Questionnaire (Rowles, 1992) was the instrument used to collect data. Thirty-three questionnaires were mailed to rural acute careDONs with a return rate of 100%.Rural DONs were found to have a longer tenure in the DON position than the tenure data in the nursing literature. Tenure in the organization was also found to be longer. The typical DON was found to be female, married, with children,45 years old, with a BSN in nursing. The rural DONS were found to be slightly dissatisfied with the job.The return rate of questionnaires demonstrated the rural DONs interest in nursing education, practice and research. The research implication called for further investigation into the tenure measure of rural DONs in other geographic location along with urban DONs tenure measure for comparative analysis. Rural DONs have limited education opportunities based on geographic location. Continuing education programs in nursing administration and practice that are accessible in the rural setting via TVs or computers would be beneficial. / School of Nursing

Thesis (M.H.A.)--University of Michigan, 1957.

Thesis (M.H.A.)--University of Michigan, 1957.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

Introduction: Limited facilities exist at rural hospitals for the management of newborn infants with respiratory distress syndrome (RDS). Furthermore, the secondary and tertiary hospitals are under severe strain to accept all the referrals from rural hospitals. Many of these infants require intubation and ventilation with a resuscitation bag which must be sustained for hours until the transport team arrives. Not only is lung damage inflicted by the prolonged ventilation, but transferring the infant by helicopter and ambulance is expensive. CPAP (continuous positive airway pressure), a non-invasive form of ventilatory support, has been used successfully at regional (Level 2) and tertiary (Level 3) neonatal units, to manage infants with RDS. It is cost-effective for infants with mild to moderate grades of RDS to be managed at the rural hospital instead of being transferred to the regional secondary or tertiary hospital. CPAP was introduced to Ceres Hospital, a rural Level 1 hospital, in February 2008 for the management of infants with RDS. Aim: To determine the impact of CPAP on the management of infants with RDS in a rural level 1 hospital and whether it can reduce the number of referrals to regional hospitals. Study setting: Nursery at Ceres District Hospital, Cape Winelands District, Western Cape. Study design: Prospective cohort analytical study with an historic control group (HCG). Patients and Methods: The study group (SG) comprised all neonates with respiratory distress born between 27/02/2008 and 26/02/2010. The infants were initially resuscitated with a Neopuff® machine in labour-ward and CPAP was commenced for those with RDS. The survival and referral rates of the SG were compared to an historic control group (HCG) of infants born between 1/2/2006 to 31/01/2008 at Ceres Hospital. Results: During the 2 years of the study, 51 neonates received CPAP (34 <1800g, 17>1800g). Twenty (83%) of the SG infants between 1000g and 1800g and 23 (68%) of the infants between 500g and 1800g survived. Those <1800g that failed CPAP, had either a severe grade of RDS which required intubation and ventilation or were <1000g. Seventeen (33%) of the infants that received CPAP, were in the >1800g group. Thirteen (76%) of these infants were successfully treated with CPAP only. The four infants that failed CPAP suffered from congenital abnormalities and would not have benefited from CPAP. There was no statistically significant difference in the survival between the SG and HCG (80%) (p=0.5490) but the number of referrals decreased significantly from 21% in the HCG to 7% in the SG (p=0.0003). No complications related to CPAP treatment, such as pneumothorax, were noted. The nursing and medical staff quickly became proficient and confident in applying CPAP and were committed to the project. Conclusion: CPAP can be safely and successfully practised in infants with mild to moderate RDS in a rural Level 1 hospital. The survival rate stayed the same as the HCG, even though a higher risk infants were treated in the SG. The transfers were significantly reduced from 21% to 7%. This resulted in significant cost savings for the hospital.

Introduction: The US Health Care and Social Services sector (North American Industrial Classification System 'sector 62') has become an extremely important component of the nation's economy, employing approximately 18 million workers and generating almost $753 billion in annual payrolls. At the county level, the health care and social services sector is typically the largest or second largest employer. Hospital employment is often the largest component of the sector's total employment. Hospital employment is particularly important to non-metropolitan or rural communities. A high quality healthcare sector serves to promote economic development and attract new businesses and to provide stability in economic downturns. The purpose of this study was to examine the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations. Methods: Estimates for county-level hospital employment are not commonly available. Estimates of county-level hospital employment were therefore generated for all counties in the USA the Census Bureau's County Business Pattern Data for 2010. These estimates were used to generate location quotients for each county which were combined with demographic data to generate a profile of factors that are related to the magnitude of location quotients. The results were then used to draw inferences regarding the possible impact of the Patient Protection and Affordable Care Act 2010 (ACA) and the possible imposition of aspects of the Budget Control Act 2011 (BCA). Results: Although a very high percentage of rural counties contain medically underserved areas, an examination of location quotients indicates that the percentage of the county workforce employed by hospitals in the most rural counties tends to be higher than for the nation as a whole, a counterintuitive finding. Further, when location quotients are regressed upon data related to poverty, county demographics, and the percentage of the population insured, a relationship between the proportion of the population over 65 years, the percentage of the population living in poverty, the percentage of the population without insurance and county density was found. Conclusion: The results of the analysis suggest that hospital employment in rural communities is higher than would be expected in the absence of programs that provide external funding to support hospital hiring. The most important public programs providing this support are Medicare and Medicaid. Social Security is another source of federal funding important for rural populations. Sequestration and other cuts in funding could impact rural communities significantly. This can be even worse in states that fail to expand Medicaid and in states that fail to increase Medicaid reimbursements for services important in rural communities.