This research study analyses a conceptual model investigating the relationship between the level of health insurer product innovation and entrepreneurial orientation (EO); the relationship between the level of health insurer product innovation and external collaboration between health insurers and healthcare service providers. This study also analyses whether low presence of perceived strategic regulatory factors, necessary for encouraging health insurer product innovation in the private healthcare industry in South Africa, weakens the relationship between the level of new health insurer product innovation and EO, as well as the relationship between the level of new health insurer product innovation and external collaboration between health insurers and healthcare service providers. The research study, focusing on major actors in both the demand and supply side structures of the private healthcare value chain, found that organisational-level EO is a very strong predictor of health insurer product innovation in the South African private healthcare industry. The research study also found that external collaboration between health insurers and healthcare service providers is a weak predictor of health insurer product innovation. An important finding of this study was that the low presence of strategic regulatory factors (which are necessary for encouraging health insurer product innovation in the South African private healthcare industry) means that the relationship between health insurer product innovation and EO is not moderated, and neither is the relationship between health insurer product innovation and external collaboration between health insurers and healthcare service providers. These findings contribute to the South African private healthcare industry in terms of innovation, regulation, external collaboration and entrepreneurial orientation literature and studies.

Este estudo teve como objetivo verificar na literatura como a mineração de processos tem sido utilizada na área de saúde. Método: Trata-se de Scoping Review. A busca foi realizada nas bases de dados National Library of Medicine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Search for anauthor profile (SCOPUS) e Scientific Electronic Library Online (Scielo), por meio da pergunta de pesquisa: \"Como tem sido aplicada a mineração de processos na área da saúde?\". Foram incluídas as pesquisas em inglês, espanhol e português, com abordagem quantitativa e qualitativa primárias, revisões sistemáticas, metanálises e/ou metasínteses, livros e guidelines, Resultado: As buscas foram executadas entre os meses de setembro à dezembro de 2017. Entre os 274 estudos, 15 foram incluídos na amostra. Os resultados demonstraram que o uso de mineração de processos na saúde têm sido utilizada com ênfase na área hospitalar, para distintas amostras de pacientes, analisando dados relacionados a protocolos, qualidade de atendimento, custos, performance dos serviços, mapeamento de processos e serviços epidemiológicos, temporalização de uso dos recursos, agendas de consultas, exames e procedimentos, diagnósticos, análise de complexidade do quadro clínico, além de possibilitarem a comparação entre dois serviços. Além disso, foram ainda identificados estudos de revisão de literatura que fomentam um processo de discussão sobre o tema em questão, com propósitos de descoberta, conformidade ou aprimoramento e desempenho. O processo de revisão demonstrou que esse é um tema promissor e de grande aplicabilidade na saúde / This study aimed to verify in the literature how process mining has been used in the health area. Method: This is Scoping Review. The search was conducted in the National Library of Medicine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Search for anauthor profile (SCOPUS) and ScientificElectronic Library Online (Scielo), through How has mining been applied processes in the area of health?\". The researches were conducted in English, Spanish and Portuguese, with a quantitative and qualitative approach, primary, systematic reviews, meta-analyzes and / or meta-analyzes, books and guidelines, Result: Searches were performed between September and December 2017. 274 studies, 15 were included in the sample. The results demonstrated that the use of process mining in health has been used with emphasis in the hospital area for different patient samples, analyzing data related to protocols, quality of care, costs, performance of services, mapping of processes and epidemiological services, timing of resource use, consultation schedules, examinations and procedures, diagnoses, complexity analysis of the clinical picture, and allow the comparison between two services. In addition, literature review studies have been identified that foster a process of discussion about the topic in question. For discovery, compliance, or enhancement and performance purposes. Although this is a promising topic of great applicability in health identified in this review, this study presents limitations related to the number of databases consulted, which may have influenced the context and the number of studies analyzed

"Multiple U.S. healthcare organizations have been recognized as successful in enterprise-level transformation to create healthcare delivery systems that are safe, effective, patient-centered, timely, efficient and equitable. Many of these organizations have specifically cited the development, deployment and integration of enterprise-level deployment of Lean Management Systems as key to their transformational efforts. Given the intense national interest in improving quality, efficiency and efficacy of healthcare delivery systems, a greater understanding of the strategies utilized by these organizations was required in order to provide an understanding of the mechanisms that drive successful, sustained, enterprise-level transformation. We conducted a realist review of large system transformation utilizing enterprise-level Lean Deployment methods within healthcare organizations. Synthesis and analysis of the results from this review indicate that there are five primary strategies associated with successful healthcare-based Lean deployments: Respect for People; Strategic Alignment; Strategic Deployment; Large Scale System Improvement Efforts; and Small-Scale, Local Improvement Efforts. Additional findings from this review indicate that the applications of the specific mechanisms with these strategies are emergent within multiple transitional phases spanning 6-8 years. To supplement the findings from the realist review, a series of dynamic hypotheses and system dynamics model was created in order to explore how the mechanisms and context interact to drive phase transitions within healthcare-based enterprise-level Lean deployments. The results from this model indicate that no steady state initial conditions exist that support sustained enterprise-level transformation and that the emergent nature of these deployments is necessary to overcome constraints related to the organizational capacity and capability. Additionally, we investigate the design and deployment of enterprise-level Lean programs in order to increase rate of success and decrease deployment cycles. "

In this thesis I develop a new, wider and richer understanding of wellbeing, through developing a process of reflective practice, with healthcare professionals within their challenging work culture. As a healthcare chaplain, having witnessed poor staff morale, I conducted a critical examination of NHS wellbeing reports and strategies, which revealed an understanding of staff wellbeing that ironically follows simply a health model. Challenging this, I argue for a broader interpretation of wellbeing that, in addition to focusing on health, is more holistic, relational and contextual. I develop reflective practice to nurture this, the use of which extends in healthcare beyond education and professional development. In my action research, knowledge was generated through ethnographic participation and observation, over a year, reflecting as chaplain with eight teams of healthcare professionals. This used my simple and memorable HELP Wellbeing Reflection Cycle (building on Kolb's (1984) model of experiential learning) that combines reflection on work and personal development. My project also responds to Rolfe's call (2014) for greater use in healthcare of Schön's (1980) "reflection-in-action". Building on these works, I develop reflection for healthcare professionals to nurture their wellbeing. My encouragement of the participants to self-facilitate their own reflective groups, when familiar with this method of reflection, is also a contribution to reflective practice, healthcare and the chaplain's role. Thematic data analysis emerged from the reflexive field notes of our shared experience as co-reflective practitioners. The themes include healthcare professionals making the human connection between themselves and with their patients. They also value the space to reflect together, realising their desire for team support and a shared goal, as well as job satisfaction in this demanding culture. These themes, I argue, are consistent with the broader definitions of wellbeing, giving them the opportunity to be both a healthcare professional and human. Further data analysis also reveals consistency with wider wellbeing interpretations (including personal wellbeing measurements and data from the Office for National Statistics (2014, 2015)). I develop the role of chaplain as the healthcare professionals' co-reflector, sharing their reflective space as a pastoral encounter and a source for learning. This combines the images of "empty handed" (Swift, 2009) "welcoming guest" and "mutual hospitality" (Walton, M., 2012). I offer to national healthcare the wider understanding of wellbeing, and the value of creating provision for reflective space to nurture it, in the care of healthcare professionals. This research offers the potential for exciting further developments in a wider constituency both in and beyond healthcare.

The thunderstorm encroaches, the smoky raven like clouds float over my spirit. This writing takes place at a time of mourning, a deep and lonesome sadness for family relations who have passed over the last few years, many having died of kidney disease. Yet, I cannot escape this feeling that has filled the silent spaces and the deeper meanings that lie behind spoken words. These are the words of my relations, the words that fill these empty pages, the words of an enduring past and present. As I begin, I wonder, how will I shape these passages into an articulation that may bring an illumination of all that has happened over the last few months since the inception and then ethics approval of this work. So here I shall offer an understanding of the background that brought this study forward. I will recount the progression of thought that precipitated the methodology. Like water that flows and is fluid, this writing has become realized to be ever changing, boundless and repelling conventionality. It is not just a story about living with kidney disease, this is a passage that motions and travels through history making interconnections amidst the broader social, political and contextually traditional and creative ways of being. Through the methodology of the sweetgrass porcupine quill box, living stories came forth within the context of a First Nations community. Sharing circles involving ten participants conveyed the living stories of kidney disease that illumined the significance of Indigenous Knowledge, relationality, cultural safety and equitable access. / Graduate / 2020-04-19

Sustainability is an important consideration in today’s society and all areas of textiles contribute to a negative environmental impact; in production, during the ‘in use’ phase and importantly, at the end of life. The use of fibres with alternative end of life options, such as recycling, to divert from landfill disposal, along with reduced temperatures for domestic laundering are becoming of increasing importance. However, concern arises when applied to the healthcare market, in particular, healthcare uniforms which could be contaminated with harmful microorganisms. It is common practice for healthcare uniforms in the United Kingdom to be laundered domestically by staff and, therefore, to establish current practices undertaken, a questionnaire to healthcare staff was distributed and resulted in 265 responses. Results were analysed to determine the most commonly used temperatures, detergents, frequency of laundering and items laundered with healthcare uniforms. The data showed that uniforms are not always laundered after every shift and the use of 40°C was common (33%, n=265). The survival of two frequently observed healthcare associated infections in hospitals, Escherichia coli and Staphylococcus aureus, on the surface of polyester and cotton was established and the attachment analysed using Scanning Electron Microscopy. These results demonstrated that polyester had the lowest survival of both microorganisms and less attachment was seen on the surface of the fibre when compared to cotton. Polyester was selected for textile testing and a range of development fabrics were created using variations in yarn type and fabric structure. Conventional test methods were used to determine the comfort properties of the fabrics created, with results indicating that equal or better performance can be achieved when compared to current fabrics used for healthcare uniforms. To determine the optimal laundering process to achieve removal of microorganisms from the surface of textile items, three household detergents along with a standard reference detergent were tested for their efficacy against E. coli and S. aureus at three temperatures (40°C, 60°C and 71°C) and three times (3, 10 and 15 minutes). A domestic laundering cycle was then simulated whereby an inoculated swatch of fabric was washed and tested for recovery of bacteria to determine the most appropriate temperature for use in the home. The results of the investigation indicated that a standard 40°C domestic wash cycle was ineffective at achieving complete removal of microbial contamination and could allow cross contamination to occur. The use of a 60°C standard domestic wash cycle was found to be significantly more effective, achieving complete removal of microbial contamination.

Since the 1960s, researchers have been exploring how the design of the built environment impacts the health and well-being of occupants and users. By the 1980s, further research began to focus on healthcare facilities in particular and how design could influence patient healing and medical staff performance (Alfonsi, 2014). Evidence-Based Design (EBD) is "the process of basing decisions about the built environment on credible research to achieve the best possible outcomes" (CHD, 2016). The desired outcomes of Evidence-Based Design recommendations include improvements in the following: patient healing, patient experience and comfort, medical staff performance, and medical staff job satisfaction (CHD, 2017). Extensive research has been done on the subject of EBD; however, the question remains whether or not the latest research findings are being utilized by the design and construction industries in practice. The purpose of this research is to determine whether or not the latest scientific knowledge and research findings are being implemented into hospital renovation projects by the healthcare design and construction industries. A list of recommendations from existing EBD literature was compiled. Construction documents from 30 recent healthcare facility renovation projects across the United States were then obtained and analyzed. The findings indicate that EBD recommendations are being adopted in practice at consistently high levels. These findings also reveal that there are still areas of potential improvement which could inform those who influence or determine building and design codes, standards, and guidelines. The results are instructive to owners, designers, and contractors by providing a glimpse into how well the industry is recognizing and implementing known best practices. The findings likewise open up new opportunities for further research which could lead to additional improvement in the healthcare facilities of the future.

As transgender medicine developed in the course of the 20th century, medical professionals have slowly followed the lead of their clients. Patients during the early decades of transgender medicine sought to switch from one gender to another. Medical providers developed treatment protocols to guide this transition. In recent decades patients are no longer as quick to desire a switch from one gender to another. Rather, many younger transgender patients are more likely to explore the ambiguities of gender and adopt a gender-fluid identity. Healthcare professionals have, for the most part, accommodated their patients' changing ideas about treatment outcomes. But these currents towards a patient-centered approach are in contrast with transgender health organizations that seek professionalization through treatment protocols and standardization. Examining these socio-historical processes reveals how a nascent field of medicine negotiated the sometimes competing demands of standardization and patient desire. Three questions guide my research: 1) How do trans-identified people experience and resist social sanctioning, make meaning of a transgender identity within a limiting transnormative narrative, and actively seek to create new identities? 2) How do healthcare providers construct scientific discourse and make meaning of gender in the process of working with transgender people in this emergent field of medicine? And 3) How has the history of medical and mental health interventions shaped the contemporary experiences of providers? I used a mixed-methods approach including the analysis of archival documents from the Kinsey Institute in Bloomington, Indiana, in-depth interviews with 40 transgender-identified people and 23 healthcare providers, and participatory observations in community spaces. In part one of my dissertation I consider the nuances of transgender identities and the consequences of living in a society as a transgender person. Our society is organized in a two-gender system - individuals are either women or men. While some transgender people identify within these binary categories, as trans women or trans men, others resist a binary gender identification. Instead, they construct diverse gender identities like "genderqueer" or "genderfluid" that lack culturally agreed-upon definitions. Despite the diversity of identifications within transgender communities, most social scientific accounts adopt the binary model and position transgender people as moving from one gender to the other. This limits our understandings of transgender people and their own self-perception. Additionally, "transitioning" is understood as a process in which individuals move neatly from one stage to the next, and passing as women or men becomes the ultimate goal. Transgender people are creative in negotiating their identities within this system. Some resist binary systems and strategically deploy cultural resources to redefine gender categories in ways that fit their self-understanding. In part two of my dissertation, I consider the emergence of transgender medicine, the ways that scientific discourse shapes medical practice, and how providers - who are situated within this dialogue in several distinct ways - must work with conflicting interests. The standardization of transgender medicine runs parallel with many contemporary currents related to the changing structure of our healthcare system. Evidence-based medicine has become ubiquitous in systems of healthcare, and is coupled with the creation of professional guidelines for standardizing healthcare. However, providers gave voice to the idea that transgender people have unique healthcare needs that may not be met in a system structured by binary modes of thought and in general, are wary of standardizing transgender medicine. In these contexts, providers must learn to how to balance their professional responsibilities and client-driven needs, which sometimes are in contradiction.

Learning Objectives: (1) Identify three primary care friendly screening tools useful for identifying behavioral health concerns in adolescents. (2) Describe how a "champion" (quality improvement) team can help facilitate implementation of a screener in a primary care.

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