<p>Canadian hospitals continue to adopt private sector strategies in an attempt to improve efficiency, accountability and quality. One such mandated efficiency is a computerized psychosocial assessment for mental health patients known as the Resident Assessment Instrument–Mental Health (RAI-MH). This thesis uses the RAI-MH as the gateway into exploring how neoliberal or private sector strategies are used to penetrate hospital care work resulting in the regulation and restructuring of work practices. The RAI-MH requires professionals to input specified, closed ended data about patients simplifying and narrowing their practice in an attempt to govern, measure and fund what is “value added” in the patient/professional encounter. This qualitative study uses interviews with social workers and nurses to examine the competing tensions experienced by professionals as they strive to provide client-centred care in a culture that promotes computer-centred care.</p> <p>My research findings reveal that the idealized portrayal of the 21^st century knowledge worker is in sharp contrast to the realities faced by many increasingly standardized and “leaned-out” health care professionals. Social workers and nurses report that standardization leads to increasing surveillance. A few professionals comply with the increasing standardization or regulation but most found ways to resist while striving to maintain professional autonomy. As certain areas of work become standardized some professionals find ways to increase autonomy in other areas of their work. The findings reveal differences between those who engaged in work tasks outside of paid work hours (boundary crossings) and those who did not (boundary refusals). <strong></strong></p> <p>Theoretically, this thesis contributes to the literature by illuminating the processes involved within the rapidly changing organization of hospital service delivery. Substantively, it adds to the literature on understanding the work of service providers and how they continue to find creative ways to resist the standardization process.</p> / Doctor of Philosophy (PhD)

Background: There is currently no standard method of diagnosing the presence or severity of concussion in acute primary care settings. This pilot project is part of a larger study to develop a Computerized Concussion Assessment Tool (CCAT). Methods: A prospective observational clinical study was conducted to explore the validity of the CCAT among patients presenting to the Emergency Department at Kingston General Hospital and at Hotel Dieu Hospital (Kingston, Ontario) with minor head injury. Twenty-two patients with concussion and eighteen patients with head injury (but not diagnosed with concussion) were recruited to the study. All participants completed a background questionnaire, several neurocognitive tests and the CCAT assessment. Performance on the CCAT was compared between these two groups. Data collected during the development phase of the CCAT from a Normal Volunteers group (n=68) were used in an additional comparison. CCAT Scores for Selective Attention, Divided Attention and Memory were compared with standard neurocognitive tests through correlational analyses. In addition, the validity and clinical yield of the CCAT were investigated relative to gold standard measures. Results: After adjustment for covariates, no statistically significant differences were found between the three participant groups for any of the three primary CCAT Scores (Selective Attention, Divided Attention and Memory). Correlational analyses showed that the CCAT Selective Attention Score and the CCAT Memory Score are moderately correlated with standard neurocognitive tests. There was no correlation observed for the CCAT Divided Attention Score and its associated neurocognitive test. Conclusion: The CCAT was unable to discriminate between concussed patients and non-concussed individuals. However, moderate correlations observed between the CCAT Scores for Memory and Selective Attention and their respective neurocognitive tests support a view that there should be optimism for the future development of the CCAT. Issues related to the feasibility of the study and its administration in the emergency department setting are discussed. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2008-09-23 10:40:20.199