Background¡G With the carrying on the step of the society and the changing of the health care insurance system, the medical behavior has changed. The health care organization should not only focus on professional field, but also looking for operating forever. Objective¡G 1.To understand the recent condition of health care organizational ethics in others counties by paper research. 2.To develop the questionary of health care organizational ethics. 3.To understand the recent condition of health care organizational ethics in Taiwan by questionary, and compare the importance and feasibility. Methods¡G The target of this questionary includes clinicians, nurses, the staff of medical laboratory and pharmacist, administrators and others. The location of the questionary includes medical center, territorial hospitals, regional hospitals and primary hospitals. The program SPSS 13.0 will be used for descriptive statistics, factor analysis¡Arelability test and t test in this research. Result and Conclusion¡G There was significant difference in the interviewee¡¦s consideration between importance and feasibility of health care organizational ethics survey, whatever in every aspect or item. Classify all interviewee by different level of hospital but same position, or same level of hospital but different positions, there was also significant difference in the interviewee¡¦s consideration of importance or feasibility by different level of hospital or positions, except nurses.

This thesis explores the story of the Frontier Nursing Service (FNS), a rural health care delivery system established in Hyden, Kentucky in 1925. It is particularly concerned with examining the colonial construction of the organization created by the founder, Mary Breckinridge. This construction created a conceptual framework for the technological infrastructure of the FNS, and influenced interactions of FNS employees and the Appalachians who lived in the area served by them. A case study concerning the clinical trials of the birth control pi11, Enovid, is used to highlight in influence of colonial constructions and mentalities in convincing the trial's investigators that the FNS was a suitable place for them to be conducted. And finally, this thesis critiques two theoretical models of colonialism of by scholars in Appalachian Studies and Science and Technology Studies, and suggests new directions which might be undertaken this area. / Master of Science

Depuis 30 ans a été mise en place, dans la plupart des pays européens, une politique de réduction des durées d'hospitalisation. Beaucoup d'études ont été conduites sur les conséquences de ce raccourcissement des durées d'hospitalisation mais par contre peu se sont intéressées aux caractéristiques cliniques et sociodémographiques des patients à l'admission qui pourraient influer sur ces durées. Une meilleure connaissance de ces facteurs permettrait d'adapter ces durées aux besoins spécifiques des patients et ainsi réduire les conséquences négative s de sorties prématurées. De plus, cela pourrait permettre une meilleure planification de la disponibilité en lit. L'objectif de notre étude est de mettre en évidence les déterminants cliniques et sociaux des durées d'hospitalisation et les conséquences de celles ci sur l'organisation des soins grâce à une étude prospective portant sur 121 patients hospitalisés pour un premier épisode psychotiques. A l'admission il n'est retrouvé aucun facteur prédictif des durées d'hospitalisation. Par contre la réponse au traitement et la symptomatologie à la sortie de l'hospitalisation sont significativement associés aux durées d'hospitalisation. Mais le facteur le plus prédictif est la préférence du psychiatre traitant pour une durée courte ou longue d'hospitalisation. Lors du suivi les courtes hospitalisations n'ont pas été compensées par plus de suivi par les services extra-hospitaliers de psychiatrie ou par les médecins généralistes. Ces résultats suggèrent la nécessité de développer des soins plus rationnels et standardisés pour la prise en charge des premiers épisodes psychotiques pour améliorer notamment le suivi post hospitalisation. / Since the middle of last century, there has been a transition in almost all western countries towards a policy of reduced periods of hospitalization. Although many studies have been carried out on the consequences of short versus long length of stay (LOS), less is known about the socio-demographic and clinical characteristics of patients on admission, which could influence LOS. A better knowledge of these factors could help adapt LOS to patients' specific needs and perhaps reduce the negative consequences of early discharge. Furthermore, predicting LOS could be helpful for planning bed availability. First-episode psychosis is a key moment to study with the importance of cares on prognosis. The aim of our study is to evaluate clinical and social determinants of LOS at admission and discharge in relation to 121 hospitalisations for first episode psychosis using standardized assessment measures and their consequences on care organisation. None of the clinical factors at admission were significant predictors of longer hospital stay. However, response to treatment and symptomatology at discharge were significantly associated with longer LOS as was the head psychiatrist's general preference for long or short hospitalisation. Furthermore our findings, during the one-year follow up, suggest that a shortening of hospital stay for first episode psychotic patients has not been compensated by an increased role of the general practitioner (GP) in providing post-discharge care or by psychiatric community care. This suggests a need for greater evidence-based rationalization of practice for the care of first psychosis episode with more interactions between hospital and community care

THESIS ABSTRACT For the past few years, the development of social welfare has a tendency of leading the managing concept of business administration, which emphasizes the connection between service and cost, and the requirement of efficiency. However, in spite of the increasing demand of long-term care, the nursing system has come across many difficulties. The competition from the related occupations, the increasing pressure, and the higher demand of nursing quality have seriously affected the maintenance of nursing organization, which also have obliged the manager of nursing organization to consider the possibility of cooperation of the same line. The intention of Strategic Alliance between the aged long-term care organization and some medical organizations has been promoted. In the near future, the manager of medical and long-term care enterprises will be up against the challenges and competitions from these organizations. And they are forced to unite and share their resources by Strategic Alliance. The manager must realize the changes inside and outside of their organizations. And it is the most important to adopt the prompt policy, management and control of their resources. Through this research, I hope there will be better understanding for the main managers on their long-term care services and evaluation of satisfaction. Also, I wish to study the elements that influence the quality of service. Therefore, the resources of long-term care might be efficiently used, and the quality will be improved as well. In experimental research, I make use of contrast of Strategic Alliance which influences the quality of service by analysis of 84 questionnaires investigation reports from Won-An and Won-Tai Nursing Centers. The experiments are independent and circuitous. . The result of this study indicates that Strategic-Alliance makes influence on either service quality or customers¡¦ satisfaction. Customers gave Won-An Nursing Center a higher appreciation because which practice Strategic-Alliance. At the end, this study offers concrete suggestions for management. Hopefully this will provide the government authorities a consultation of policy as well as a new direction of the long-term care organizations.

The purpose of this practice inquiry project is to create a model for implementing an outpatient palliative care clinic within an organization of healthcare providers who participate in shared savings for Medicare patients, also known as, an accountable care organization (ACO). The goal of this project is that it can be used by future health care administrators to successfully create and implement an outpatient palliative care clinic. The philosophical nursing foundation for palliative care is discussed to set the groundwork for the model proposed. The benefits of palliative care nursing for patients, families and the ACO are discussed to support the importance of opening an outpatient palliative care clinic. A step by step model has been developed and presented on how to plan and implement an outpatient palliative care program. Tools have been proposed to help successfully and effectively create, implement and evaluate outpatient palliative care clinics within an ACO.

Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 4 uppsatser.

This dissertation demonstrates how patients' mental illness treatment careers depend on the change and/or stability among differing levels of social structure. Theorists of the mental illness career tend to ignore the role that higher levels of social structural change have on individuals' mental illness career. Researchers using an organizational perspective tend to focus on the organizational environment but ignore the treatment process from the individual's point of view. Both perspectives neglect what the nation-state's broader socio-political and economic circumstances could imply for people seeking treatment for mental disorders. Organizational theory and theories of the mental illness career are independent theoretical streams that remain separate. This dissertation connects these independent theoretical streams by developing a unifying theoretical framework based on historical analysis. This historical analysis covers three phases of treatment beginning at the end of World War II to the present. This framework identifies mechanisms through which changes in larger levels of social structure can change the experience and career of mental patients. This new perspective challenges current conceptions of the mental illness career as static by accounting for the various levels of social structure that play a part in the mental illness treatment career. Taken together, the inclusion of differing levels of social structure and the subsequent reciprocal relationship between these levels of analysis produce a narrative that explains why and how stability and change within the mental health sector shape the mental illness treatment career. / Ph. D.

<p>This essay’s focus lies on the collaboration that takes place in hospitals and called a care-plan (vårdplanering) between the two organisations: Health-care (landsting) and social-care (kommun). According to the Swedish-law are these organizations responsible for the care of elderly individuals in Sweden. The aim of this essay has been to study closely this collaboration in order to see which partner has the most influencing power.</p><p>This essay is of a qualitative character, which means that the results that are presented are based on six individual interviews with employees from the two organizations. The employees chosen for this essay all have job experiences from the collaboration that takes place during care-plans in hospitals.</p><p>One of the main results of this essay has been that the two organizations are not equal collaboration-partners. All the interviewed individuals talked highly about the importance of collaboration while in reality they end up in an subliminal battle against each other. The main conclusion of this essay is that the focus of a care-plan meeting appears to be on gaining the most power, in order to influence the outcome of a care-plan, rather than giving priority to the elderly individual’s needs and concerns.</p>

This essay’s focus lies on the collaboration that takes place in hospitals and called a care-plan (vårdplanering) between the two organisations: Health-care (landsting) and social-care (kommun). According to the Swedish-law are these organizations responsible for the care of elderly individuals in Sweden. The aim of this essay has been to study closely this collaboration in order to see which partner has the most influencing power. This essay is of a qualitative character, which means that the results that are presented are based on six individual interviews with employees from the two organizations. The employees chosen for this essay all have job experiences from the collaboration that takes place during care-plans in hospitals. One of the main results of this essay has been that the two organizations are not equal collaboration-partners. All the interviewed individuals talked highly about the importance of collaboration while in reality they end up in an subliminal battle against each other. The main conclusion of this essay is that the focus of a care-plan meeting appears to be on gaining the most power, in order to influence the outcome of a care-plan, rather than giving priority to the elderly individual’s needs and concerns.

Syftet med denna kvalitativa studie var att förstå och sammanfatta hur första linjens chefer (FLC) i en vårdorganisation upplever sin egen psykosociala arbetsmiljö, vad de tycker fungerar bra, vilka utmaningar de ser, och vilket stöd de behöver för att kunna förbättra den egna psykosociala arbetsmiljön. Jag genomförde semi-strukturerade intervjuer för att samla in data och två klassiska modeller inom psykosocial arbetsmiljöforskning: krav-kontroll-stöd och ansträngning-belöning, har fungerat som teoretiska tolkningsramar. Tematisk analys användes för att analysera data och identifiera teman för resultatet. Resultatet visade på sju teman som respondenterna upplevde påverkade deras egen psykosociala arbetsmiljö: chefsrollen, arbetsbelastning, styrning av den dagliga verksamheten, påverkan/beslutsutrymme, information/kommunikation, arbetsrelationer/samarbete och stödfunktioner. Några utmaningar för FLC är: orimligt höga krav, stora arbetsgrupper, bemanningsproblem, tidskrävande administration, brist på långsiktig planering och förbättringsarbete, mycket övertid och behov av mer stöd för att minska arbetsbelastningen. En närliggande tolkning av resultatet är att flera delar behöver förändras för att förbättra FLCs psykosociala arbetsmiljö och förutsättningarna för chefsuppdraget. / The purpose of this qualitative study was to understand and summarize how first-line managers (FLM’s) in a healthcare organization is experiencing their own psychosocial work environment, what they think works well, what challenges they see, and what support they need to improve their own psychosocial work environment. I conducted semi-structured interviews to collect data and two classic models in the psychosocial work environment research: demand-control-support and effort-reward, have served as theoretical frameworks of interpretation. Thematic analysis was used to analyze data and identify themes for the result. The result showed seven themes that the respondents experienced affected their own psychosocial work environment: the manager role, workload, control of daily operations, impact/decision latitude, information/communication, working relationships/cooperation and support functions. Some challenges for FLM are: unreasonable high demands, large workgroups, challenges with staffing, time-consuming administration, lack of long-term planning and improvement work, a lot of overtime and more support needed to reduce workload. An interpretation of the result is that the organization needs to change several parts to improve FLM’s psychosocial work environment and conditions for the manger role.