The purpose of this study was to provide an in-depth explanation of the development of coordinated services during the last four years at a selected number of Project Success pilot sites, and to identify critical factors that emerged which are associated in the literature with effective school-linked strategies. The research questions guiding this study were: (1) What common elements developed that crossed all selected sites, and what individual differences emerged among the sites? (2) What organizational structure emerged among the multi-agencies at the selected sites? (3) What collaborative processes emerged across selected sites that facilitated the project? (4) In what ways did parents become involved in the implementation of the project? (5) What barriers or support were encountered in establishing and operating the sites? The data collection for this study occurred in three parts: individual interviews with the Project Coordinators, focus group interviews with appropriate representatives of the pilot site projects, and notes from meetings of the Local Governing Board. A questionnaire that consisted of seven questions was used to collect data for this study. Materials gathered during in-depth interviews were transcribed and analyzed after the interviews were completed. First, the researcher read the transcribed interviews and hand coded the consistencies and emerging themes on a large chart. Second, a matrix was made of the hand coded data using a word processor. Third, the researcher used the Ethnograph Computer Software Program to organize and code the data. From this data, the researcher identified themes, common patterns, and important stories shared by the participants regarding their experiences with developing coordinated services to meet the needs of children and families during the last four years. A narrative summary was written for each selected pilot site. Recommendations for further research are provided at the conclusion of chapter five. / Ed. D.

Tableau d'honneur de la Faculté des études supérieures et postdoctorales, 2016 / Des contraintes d’accessibilité aux services de physiothérapie en clinique externe ont été rapportées dans les établissements publics au Canada. Celles-ci se traduisent souvent par un temps d’attente élevé avant d’obtenir des services. Différentes stratégies ont été proposées afin de gérer les listes d’attente, mais leur impact sur le temps d’attente est méconnu, notamment dans le contexte des services de physiothérapie au Québec. Le but de cette étude était de documenter l’accessibilité aux services de physiothérapie en clinique externe dans les centres hospitaliers au Québec. Les objectifs spécifiques étaient de 1) décrire les caractéristiques organisationnelles en lien avec l’accessibilité aux services de physiothérapie, 2) quantifier le temps d’attente pour accéder aux services et 3) explorer l’association entre les caractéristiques organisationnelles et le temps d’attente. Une enquête a été réalisée dans les cliniques externes de physiothérapie des centres hospitaliers publics du Québec offrant des services à des adultes souffrant de troubles musculosquelettiques. Des données ont été obtenues auprès de 97 (99%) centres hospitaliers. Au moment de l’enquête, 18 245 personnes étaient sur les listes d’attente. Le temps d’attente médian était de plus de six mois dans 41% des centres hospitaliers. Parmi les pratiques organisationnelles et les stratégies de gestion de listes d’attente évaluées, les politiques en cas d’annulation ou d’absence (99%) et la priorisation des demandes (96%) étaient les plus utilisées. Selon les résultats d’analyses multivariées, seule l’utilisation d’une méthode de priorisation comprenant une rencontre d’évaluation et une intervention initiale était associée au temps d’attente (p=0,008). Les résultats de cette étude démontrent qu’une grande quantité de personnes sont inscrites sur les listes d’attente des services de physiothérapie et que le temps d’attente peut être très élevé. D’après nos résultats, l’implantation d’une méthode de priorisation comprenant une évaluation et une intervention pourrait permettre d’améliorer l’accès en temps opportun aux services de physiothérapie. / Problems with access to outpatient physiotherapy services have been reported in Canadian publicly funded facilities. The limited access to services often translates into extensive waiting times. Different strategies aimed at managing waiting lists have been proposed, but their association with waiting times is not fully understood, especially in the context of physiotherapy services in Quebec. The purpose of this study was to document access to outpatient physiotherapy services in publicly funded hospitals in Quebec. Specific objectives were 1) to describe organizational characteristics regarding access to outpatient physiotherapy services, 2) determine waiting times, and 3) explore organizational characteristics associated with waiting times. We surveyed outpatient physiotherapy clinics offering services for adults with musculoskeletal disorders in publicly funded hospitals in Quebec. A total of 97 sites responded (99%) to the survey. At the time of the survey, 18,245 patients were waiting for outpatient physiotherapy services. Median waiting time was more than six months in 41% of outpatient physiotherapy services. Among the organizational practices and waiting list management strategies described in this study, attendance and cancellation policies (99%) and referral prioritization (96%) were the most frequently used. Based on the results of multivariate analyses, the use of a prioritization process with an initial evaluation and intervention was the only variable associated with waiting times (p=0.008). Our findings provide evidence that a large number of persons are on waiting lists for publicly funded physiotherapy services in Quebec and that waiting times can be very long. Based on our results, the implementation of a prioritization process including an initial evaluation and an intervention could help improve timely access to outpatient physiotherapy services.

Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis (M.S.P.H.)--University of Michigan, 1940.

No description available.

The thesis considers the characteristics of the nursing labour market in which the National Health Service operated from 1948 until I983 and presents econometric estimates of the supply functions of nursing staff. The monopsony of the central government in the market for nurses permits it to depress the pay of nurses. Together with the peculiar budgeting system of the N.H.S., this resulted in a 'shortage' of nurses, in the economic sense of excess demand, from 1948 until 1976, when the market became demand constrained Until 1976, the number of nurses employed was determined by supply. This permits the observed number of nurses employed by the N.H.S. until I976 to be treated as observations on a supply function. The time series of observations until I976 is used to estimate supply functions for six different groups of nursing staff employed in non-psychiatric hospitals in England and wales. These groups are: whole-time and part-time Registered Nurses: whole-time and part-time Enrolled Nurses: whole-time and part-time Nursing Auxiliaries, These six groups are distinct in their response to pay and other factors affecting nurse labour supply. Separate consideration is given to nurse training. Entry to student and pupil nurse training is considered separately. Econometric estimates of the impact of pay, unemployment and the number of young women in the population on entry to nurse training are presented. There are sections devoted to the problem of withdrawal during training. A separate study of midwifery staff uses data which is seldom available to estimate the impact of pay and other factors on the survivor function. The thesis concludes by considering the impact of changing the pay negotiating procedures of the N.H.S. on its cost.

Information technology (m has become crucial to the functioning of modern hospitals. It includes a range of human elements, infornlation, equipment, knowledge and systems. It is important to hospitals, as these are complex environments including many systems with diversity of functions, sub-systems, and professionals. The adoption of technology can be explained by four general theories: economic, political, social and globalization theory. Based on these theories five sets of reasons can account for the adoption of IT in a hospital environnlent. They are, practical; to solve existing problems, economic/business; to achieve d profit or reduce costs or both, rational; to achieve efficienL1' and effectiveness, social; to respond to pressure from society for political reasons and to increase positive image, and supply driven forces by which IT producers seek to sell their products and services. However, no one theory or set of reasons can by itself explain the precise drive for use of IT because nluch depends on each hospital's needs and surrounding drcunlStances. The purposes of this research are to investigate the extent to which IT is being used in Gulf Corporation Council (GCC) public hospitals, why IT has been adopted, and the impact of IT on hospital managementThe methods used in conducting this research were based lllainly on three established methods for searching and collecting infomlation; a literature review, the surveyor questionnaire, intervie,,'s and case studies. Five case studies in Qatar, the United Arab Emirates (UAE) and Bahrain were undertaken to cover Gee hospitals and medical centres populations. Most health and medical services in Gee Countries are provided by public hospitals which account for approximately 64% of total hospital provision, employ most medical professionals, mainly expatriates, and contain most patient beds. In Gee hospitals, IT is still in the early stages of implementation. IT has been found to be adopted at a low level due to reasons such as lack of awareness, other priorities in health policy strategies, and the low level of funding allocated. IT can provide hospitals with many benefits, solve many problems and has many inlpacts on human and functional systems, internal power balances and on the social status of hospitals. The benefits are found to be mostly in the areas of processing work. Therefore, the areas which were given priority for IT implementation were medical records, finance, and personnel areas. No significant impacts v"ere found on hospital structure, chain of conlllland, span of control and nUlllber of employees, however, itwas found that IT increased management power, hospitals' social in1age and hospital political power, while there were disagreements about IT impacts on employees' social relations. The evaluation of IT impacts on Gee hospital management shows that the impacts were not at the same level of intensity or direction, for example, sonle impacts ,",'ere positive and some negative; some significant, moderate or nurunlal, some ambiguous or obvious, were some were slow and some fast. Some efforts at Gee States level were made to develop a model of adopting IT but no real results were detected. However, the future role of IT in Gee public hospitals will be increasing perhaps at a slower pace, but two strategic issues should be given proper consideration; first; the role of the education system, research centers, and industrictl foundation, and the second strategy concerns hospital systems and services structure. This later is related to increased privatization of medical services, economic pressure, and changes in governments' employment strategy. The importance of this thesis is to draw the attention of decisionmakers to the role of IT as an efficient managerial tool in some respects and to provide a foundation for future studies

This thesis identifies the constraints to FP utilisation at the policy, service, community and household levels based on the perspectives of policy makers, providers of services, and men and women in different communities of Jordan. It contributes strategies to widen access to FP that are transferable to other countries of the Middle East and the developing world. The policy environment is analysed to assess whether it encourages or deters FP utilisation. The National Population Strategy is highlighted. Improving co-ordination between the different policy players is a major challenge faced in its implementation. FP utilisation is portrayed in four clinics using different models of provision. Service statistics, clinic observations, in-depth interviews, focus and natural group discussions are used to compare the degree of access to FP. Strengthening co- ordination mechanisms between the service providers is an important strategy to increase FP utilisation. The findings suggest that FP decisions are mostly influenced by men who remain concerned, to a varying degree, with the permissibility of FP utilisation in Islam. A culturally competent strategy proposed to increase utilisation is to communicate to men that FP is permissible in Islam. Religious men are proposed vehicles for implementing this communication strategy, basing their discourse on socio-cultural tradition, namely Islamic jurisprudence. The thesis has three sections introduction, findings and conclusions. Chapter One explores the literature. Chapter Two reviews the Jordanian setting. Chapter Three sets out the methods used in this research. Chapter Four examines the policy environment and policy makers' perspectives. Chapters Five to Eight explore the models of service provision concluding with an evaluation of the strengths and weaknesses of the different models. Chapter Nine elaborates on the community's perspectives. Chapter Ten is the concluding chapter that sets out strategies to widen access to FP, by utilising the socio-cultural context of the region.

This thesis examines the roles adopted by clinical pharmacists in the United Kingdom (UK), the evidence for the effectiveness of the interventions arising from these roles, and the challenges to and opportunities for future developments in clinical pharmacy. The research was undertaken in four phases: problem definition; national survey of services currently provided; in-depth interviews on roles; and a review of literature on effectiveness. A literature search provided background information on the evolution of pharmacy and of clinical pharmacy, particularly in the UK. These developments in have been set in the context of changes in health care provision and in the roles of the other health care professions and occupational groups. Preliminary interviews, meetings and group work were carried out to facilitate clarification of the research questions and to assist in the choice of methods. Two nationwide postal questionnaire surveys were conducted. One inquired about the provision of clinical pharmacy services to the primary care sector and the other about service provision within secondary care facilities in the National Health Service (NHS). The response rates were 91% and 90% respectively. The results show some diversity in the provision of clinical pharmacy services and provide possible explanations for this variation. Subsequently, semi-structured interviews were conducted with pharmacists, pharmacy technicians, doctors, nurses and managers at eight sites selected to represent different characteristics of hospitals. These qualitative data were analyzed by constant comparison. The results provide a picture of the clinical roles that hospital pharmacists are, and should be, providing. In addition, they indicate the potential barriers to, and opportunities for, future role development. An assessment of the evaluative literature on clinical pharmacy services was undertaken. Most literature is descriptive and much of the evaluative literature has shortcomings. The results present the evidence for the effectiveness of clinical pharmacy services in improving patient care and financial outcomes in the UK NHS. Finally, quantitative information gathered in the questionnaire survey, qualitative information from the interviews and the literature evidence were combined to create models of the future role of the hospital clinical pharmacist in the UK.

Two central themes were assessed in this thesis involving children with cancer. First, the relationship between the child's medical functioning and their overall quality of life (QOL). Second, how the child's illness and subsequent QOL related to parental mental health and parenting behaviours. These themes were explored using the Risk and Resilience model developed by Wallander et al. (1989b). Study one involved children diagnosed with acute lymphoblastic leukaemia (ALL), the most common form of childhood cancer. Results showed that the child's medical functioning (e.g., time since diagnosis) did not relate to the child's QOL, but did relate to parental mental health. Furthermore, child QOL was significantly related to both parental mental health (depression) and parenting behaviours (endorsement of force). In an attempt to explore these themes in greater detail, Study two involved two groups of cancer survivors, those with ALL or tumours of the central nervous system (CNS). Medically, these groups have different prognoses, treatments, and long-term consequences. Results showed that those with poorer medical functioning, i.e., CNS tumours, had poorer QOL than both the ALL group and population norms, confirming the relationship between the child's medical and psychological adaptation. Furthermore, the child's adaptation was strongly related to both parental mental health and parenting behaviours, again providing evidence for the relationship between child and parent functioning. The results of both studies in this thesis go some way to demonstrate the wide-ranging effects that cancer can have on both the child and family. The child's QOL can be compromised by the illness. Moreover, cancer has a detrimental effect on the family life, from pervasive feelings of depression and worry, to longterm concerns about child-rearing. This thesis has shown that those children with CNS involvement, and their families, are particularly at-risk. To conclude, a section outlining clinical interventions which can help reduced the impact of childhood cancer on the family are discussed.