published_or_final_version / Medicine / Master / Doctor of Medicine

Karoshi, or death from overwork, is a tragic modern work event. Continuous occurrence of karoshi in Japan offers an opportunity to reconsider the contemporary working environment, and especially the workers' compensation system. Strongly bound by the traditional notion of work accident, the Japanese workers' compensation system has shown difficulty handling karoshi cases. This fact calls into question the adequacy of the current workers' compensation scheme in the work environment it is meant to oversee. To analyze the issue, this thesis will use a comparative law method. The basis of comparison will be Ontario, Canada, which shares a system similar to Japan's, but does not produce karoshi cases. Particular emphasis will be put on stress claims and claims from women, since both share some similarities with karoshi claims. The findings from this comparison will offer a valuable basis for discussion of the current and the future of workers' compensation and other protection systems in Japan.

The challenges in human resource allocation drive the present project. Conducted at an office of the Workers' Compensation Board of British Columbia (the WCB), the project aims at developing a simulation model of claim management operations to facilitate decision-making in resource allocation. In this context, resource allocation refers to the alignment of staff to claims. The components of the problem include the number of staff required and the types of staff required, given targeted system performance. The volume of claims, the profile of claims, the Workers Compensation Act, the board's business guidelines and the board's operational targets all influence staffing requirement. It is far from straightforward to answer the following questions: what is the optimal level of staffing? What is the right mix of skills? And what is the proper alignment of staff with claims? How will the system perform given a certain staffing level? How will change in the profile of incoming claims influence staffing requirement? A discrete-event simulation model was developed as a decision support tool in this project. The model was used to evaluate several resource allocation scenarios. Simulation showed that timeliness measures such as time to decision and time to closure would improve with additional resources, but the improvement was not drastic. At the staffing level of 14, compared to the current level of 12, time to decision for unadjudicated claims would reduce by 6%. Simulation further showed that specialization of staff by claim type might have a negative impact on system performance measures, because economics of scale were compromised. Finally, simulation showed that if Site Visits, a required procedure for adjudicating claims related to Activity-Related Soft Tissue Diseases, could be conducted by dedicated personnel, time to decision for these claims might reduce by as high as 60%.

Compensation Services manages return to work, wage loss, pension and health-care benefits to injured workers, and those suffering from occupational diseases. This thesis presents the methodology and results of a comprehensive study conducted to determine the relationships between existing performance measures, quantify the factors influencing these performance measures, and deterrriine relative efficiencies across case management operations. We use principal components analysis, cluster analysis, and multiple regression to derive the relationships between performance outcomes and influencing factors. We then use data envelopment analysis, incorporating these multiple inputs and outputs, to assess overall relative efficiencies and set performance targets. The analysis has brought about an increased understanding of service delivery location performance and performance measurement. Results may be used to provide managerial decision support, communicate best practices, and serve as a basis for further efficiency or quality initiatives. The factors accounted for in the multivariate analysis can explain between 20% - 50% of the variability in key performance outcomes across case management desks. The overall efficiency analysis revealed strong performers both within case management offices and across regions. Four case management offices consistently contain strongperforming case management desks across several methods of evaluating efficiency. Transferring best practices has the potential to significantly increase relative efficiency improvements for case management desks across the province.

Thesis (doctoral)--Universität Frankfurt am Main.

Thesis (doctoral)--Universität Göttingen, 1970. / Bibliography: p. viii-xxxii.

Thesis (L.L.M.)--University of Hong Kong, 1991. / Xerox opy of typescript.

Thesis (M.P.A.)--University of Hong Kong, 1996. / Includes bibliographical references (leaf 126-132).

Thesis (M.B.A.)--Universidad Interamericana de Puerto Rico, Recinto de Ponce, 2007. / Digitized and made available on the World Wide Web by Interamerican University of Puerto Rico, 2007.

Thesis (M.P.A.)--University of Hong Kong, 1996. / Includes bibliographical references (leaves 126-132). Also available in print.