Yes / Public sector state funded organisations were initially constructed to deliver much needed services to their immediate community. Designed to meet the needs of societies and populations, public sector operations focussed originally on the provision of health, welfare and social services, which were often free at the point of delivery or incurred a nominal charge. Today the effectiveness of public sector service organisations is constantly challenged and threatened by factors such as funding cuts, austerity measures, competition from private providers and political changes (e.g. the departure of the UK from the European Union and the shrinking of the state in many countries). With a focus on public sector efficiency and economic gains, the boundaries between public and private operations are becoming increasingly blurred, fuzzy and complex. To maintain economically sustainable services, public providers need to become more strategic, transparent and innovative in their decision-making, funds allocation and expenditure, workforce development and operations management, whilst acting in an ethical and responsible manner to maintain public confidence and trust.

Tyrimo objektas – kaimo turizmo paslaugos Panevėžio rajone. Darbo tikslas – parengti kaimo turizmo paslaugų teikimo kryptis bei suformuluoti pasiūlymus kaimo turizmo paslaugų vystytojams dėl paslaugų teikimo tobulinimo Panevėžio rajone. Tyrimo uždaviniai: 1. Apibendrinti kaimo turizmo sampratą. 2. Atlikti kaimo turizmo paslaugų teikimo principų ir metodų analizę. 3. Atlikti kaimo turizmo paslaugų teikimo pasiūlos ir paklausos Panevėžio rajone tyrimą. 4. Remiantis kaimo turizmo paslaugų Panevėžio rajone tyrimo rezultatais, pateikti kaimo turizmo paslaugų tobulinimo kryptis šiame rajone. Tyrimo metodai: mokslinės literatūros, dokumentų analizė ir sintezė, duomenų analizė, loginė analizė, indukcija, dedukcija, grafinis vaizdavimas. Pirmoje magistrinio darbo dalyje atlikta mokslinės literatūros analizė leidžia teigti, kad kaimo turizmas yra susijęs su daugeliu turizmo rūšių, kurios persipina ir papildo vienos kitas. Tai ir pramoginis turizmas, kai keliaujama norint pasilinksminti, pašvęsti. Dar visai neseniai Lietuvoje šitokio pobūdžio kelionės į kaimą buvo dominuojančios. Antroje darbo dalyje atlikta turistų ir kaimo turizmo sodybų savininkų požiūrių į kaimo turizmo paslaugų svarbą ir jų teikimą išryškino pagrindines problemas, egzistuojančias Panevėžio rajono kaimo sodybose. Esminiai apibendrinimai gauti tyrimo metu: analizuojant turistų požiūrį į aptarnavimo paslaugų teikimą, reikia pastebėti, kad tai yra viena iš sričių, kuriai kaimo turizmo paslaugų teikėjams reikėtų... [toliau žr. visą tekstą] / The object of the research – country tourism services in Panevėžys region. The aim of the work – to prepare the guidelines for the provision of country tourism services and formulate the suggestions for the improvement of these services in Panevėžys region. The objectives of the research: 1. To summarize the concept of country tourism. 2. To carry out the analysis of country tourism provision principles and methods. 3. To research supply and demand of country tourism services in Panevėžys region. 4. On the basis of the research results, to formulate the guidelines for the improvement of country tourism service system in Panevėžys region. The methods of the research: analysis of the scientific literature, analysis and synthesis of the documents, data analysis, induction, deduction, diagrammatic depiction. The analysis of the scientific literature carried out in the first part of the work proposes that country tourism is related with many other kinds of tourism which intertwine and complement one another. This is entertainment tourism when people travel with a view to amusing themselves. Not long ago country trips of this kind were dominating. The second part of the work, which is designed for the analysis of the attitudes of the homestead owners to the importance of country tourism services, has revealed the main problems existing in the homesteads in Panevėžys region. The main conclusions of the research are as follows: with reference to tourists’ attitudes to the service... [to full text]

The underlying philosophy of patient-centred care (PCC) advocates for patients to have an active role in all areas of their care, including broader areas of the health care system such as planning and evaluation. Despite efforts made in the past decade that would see greater patient engagement, conventional evaluation approaches continue to dominate the landscape in health services evaluation. To date, limited empirical research has examined the effects of patient engagement or the best approach to engage patients (Abelson et al., 2015; Baker, 2014; Baker, Judd, Fancott, & Maika, 2016). Furthermore, a relative lack of collaboration and shared knowledge exists between the evaluation community and health sector in the rapidly developing area of patient engagement and the development of best practices. Consequently, health organizations continue to struggle with how best to involve patients (i.e., process) in health service improvement initiatives, as well as learn from patient experience (Baker, 2014; Baker, Judd, et al., 2016; Luxford et al., 2011). This dissertation responded to some of these challenges and through this intervention study, the specific purpose of the thesis study was to gain a better understanding of the process of patient engagement in planning and evaluation by addressing the following research questions: 1. What are the facilitators and barriers of engaging patients in planning and evaluation of health services and why? 2. What did the process of engagement look like with respect to Cousins and Whitmore’s (1998) three dimensions of collaborative inquiry? 3. What are the observed effects of the engagement process? This longitudinal qualitative case study began with the creation of the Patient and Family Engagement Committee (PFEC) at the Ottawa Hospital Psychosocial Oncology Program (PSOP) and completed an evaluation project over a period of six months. The research study occurred in parallel with the evaluation project and was designed to gain a better understanding of the process of patient engagement and the role that evaluation plays in this context. The study consisted of three phases and data collection relied on multiple sources. Facilitators that influenced the patient engagement process include: accommodating participant needs, commitment, orientation meeting, designated lead with evaluation skills, homework between meetings, and mutual respect. Having a designated lead, mutual respect, and commitment to the project were the three most highly endorsed facilitators at the end of the project. Conversely, barriers identified include time and resources, imbalanced participation, change in health status, and living at a distance. Time and resources was endorsed as the most significant barrier to the patient engagement process across all three phases of the study. Motivations for participant involvement revolved around giving back, improving health services, learning, commitment to research/evaluation, and providing or hearing a unique perspective. The study examined participatory aspects of the focal evaluation using Cousins and Whitmore’s (1998) three fundamental dimensions of process in collaborative approaches to evaluation: stakeholder diversity, control of evaluation process, and depth of participation. Findings revealed that intended benefits of participant involvement included reach to decision-makers, improved health services, increased diffusion of patient/family engagement, improved access/awareness of services, and a follow-up to assess influence of engagement. Participants’ experiences of being involved invoked enthusiasm for the project, were personally rewarding, instilled a sense of optimism that the project would have an influence, closed the loop on healing, contributed to a shift from a personal to broader health care focus, and contributed to learning. Further research is needed to gain a better understanding of the processes involved or evaluation approaches that could contribute to translating patient engagement into improved outcomes. The findings of this study have enhanced understanding of key contributions that patients, family members, health professionals, and evaluators bring to the patient engagement process, and enriched understanding of key facilitators and barriers to ensure successful patient engagement.

Yes / Background: Adoption of telehealth has been slower than anticipated, and little is known about the service improvements that help to embed telehealth into routine practice or the role of frontline staff in improving adoption. This paper reports on participatory action research carried out in four community health settings using telehealth for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods: To inform the action research, in-depth case studies of each telehealth service were conducted (May 2012–June 2013). Each service was then supported by researchers through two cycles of action research to implement changes to increase adoption of telehealth, completed over a seven month period (July 2013–April 2014). The action research was studied via observation of multi-stakeholder workshops, analysis of implementation plans, and focus groups. Results: Action research participants included 57 staff and one patient, with between eight and 20 participants per site. The case study findings were identified as a key source of information for planning change, with sites addressing common challenges identified through this work. For example, refining referral criteria; standardizing how and when patients are monitored; improving data sharing; and establishing evaluation processes. Sites also focused on raising awareness of telehealth to increase adoption in other clinical teams and to help secure future financial investment for telehealth, which was required because of short-term funding arrangements. Specific solutions varied due to local infrastructures, resources, and opinion, as well as previous service developments. Local telehealth champions played an important role in engaging multiple stakeholders in the study. Conclusions: Action research enabled services to make planned changes to telehealth and share learning across multiple stakeholders about how and when to use telehealth. However, adoption was impeded by continual changes affecting telehealth and wider service provision, which also hindered implementation efforts and affected motivation of staff to engage with the action research, particularly where local decision-makers were not engaged in the study. Wider technological barriers also limited the potential for change, as did uncertainties about goals for telehealth investment, thereby making it difficult to identify outcomes for demonstrating the added value over existing practice. / This study was funded by a grant from the Assisted Living Innovation Platform, with support from the Technology Strategy Board and the Economic and Social Research Council.

The study examines and identifies the perceived favourable conditions needed for employees readiness to support improvements. In the context of Brunei, readiness research in public service organisations is underrepresented if not, non-existent. There is a need for a more comprehensive study that integrates the combined perspective of the interrelated conceptual elements of readiness, its climate and the organisation. Four key findings were identified based on 119 interviews and 665 surveys. Firstly, it was found that as employees self-organise to cope with chaos, an unintended conducive climate that is specific to the Brunei context evolves out of employees readiness to adapt and survive. Secondly, the essential climatic factors that trigger the minimum level of employee readiness are identified. Thirdly, the influential climatic factors that further amplify a higher level of employee readiness are identified. Finally, based on the shared multilevel perspective of employees, the statistical analysis result confirm the hypothesis that there is a positive relationship between the identified climatic factors and employees readiness in terms of the way employees believe in, feel about and act towards improvement. Supported by qualitative findings, the essential climatic factors were identified as being communication, participation, clear task roles and responsibility, and top management s trust in subordinates. Similarly, the influential climatic factors were identified as being efficacy, organisational trust, organisational trusts in top management and top management support and participation. It is concluded that employees readiness can be incrementally developed towards improvement success; however, the contextual conditions need to be recognised and well-tailored. The development of a novel conceptual framework and model demonstrates how employees multidimensional readiness can be triggered and influenced to support improvements in a complex and adaptive organisation.

為提升台灣溫泉渡假村服務品質，本研究提出一套內外資源分析方法。針對台灣溫泉度假村及溫泉旅館之服務品質，包含：內部硬體、外部硬體與經營環境等層面，分析溫泉渡假村之服務需求與改善機會。本方法設計以台中市谷關區某溫泉度假村為例，自消費者廣泛蒐集溫泉旅館服務需求、自溫泉業者瞭解溫泉旅館成功案例滿足服務需求的條件，首先整理出在消費者的心中，對於台灣區溫泉旅館的服務條件，由整體環境面、旅館內外部硬體設備面，以及旅館軟體服務面的標準需求滿足為何。接著透過積分評比的方式，整理出一套用來協助個案公司各項服務需求的評分標準，並交叉比對台中市谷關區兩間成功案例個案公司的服務經營方針。進而了解個案公司相對服務品質與優缺點，並提出改善建議。期望這一套消費者需求分析與服務經營比對方法及企業轉型的建議，可以作為台灣溫泉產業未來發展提升服務品質的參考。 / In order to improve the service quality of Hot Spring resorts in Taiwan, this research analyzed internal and external resources and proposes a methodology to help Hot Spring resorts in Taiwan understand their customer needs and evaluate their competitiveness. The resources for service offering in Hot Spring resorts include internal hardware (building structures and facilities), external environment (geographic locations). Using case company A, this study collected service needs from customers, evaluated and organized the data to build customer insights. Then, by cross-case analysis on competitors the study learned success factors of service provided. Finally by consolidating customer needs, competitor strategies, and evaluation of company competitiveness improvements were initiated. It is hoped that the proposed methodology can be a useful quality improvement approach for Hot Spring resorts in Taiwan.

Department of Advanced Nursing Science / MCur