Appointment scheduling involves picking a strategy for sequencing patient appointments such that the wait time per patient is minimized and the idle time and overtime for the doctor are minimized. The goal of this project is to increase the number of scans per day at the echocardiogram clinic in the Hospital for Sick Children. The objectives were realized by performing simulations of the workflow of the echo clinic using simulation software. The simulation model did not precisely reflect the echo clinic, and the disparity was attributed to limitations in the simulation model. Nevertheless, the user accepted the model and six different policy change scenarios were explored. All six scenarios yielded significant increases in average scans per day per sonographer. Scenario IV, which eliminated the use of sonographer schedules, was recommended to be implemented due to ease of implementation and lack of negative effect on patient wait time and sonographer overtime.

Ohälsosamma levnadsvanor bland barn och ungdomar är ett folkhälsoproblem. Ett av skolhälsovårdens uppdrag är att verka för sunda levnadsvanor hos eleverna. Syftet med studien var att undersöka skolhälsopersonalens upplevelser av att främja sunda levnadsvanor hos skolbarn i 6-10 års ålder vid kommunala grundskolor i Västerås Stad. En kvalitativ studiedesign valdes för att uppnå syftet. Datainsamlingen skedde genom sex individuella semistrukturerade intervjuer med skolhälsovårdens personal och en manifest innehållsanalys tillämpades för att analysera insamlad data. Resultatet visade att samverkan mellan olika aktörer mot ett gemensamt mål samt en individbaserat arbetsmetod ansågs vara centrala förutsättningar för skolhälsopersonalen för att främja sunda levnadsvanor hos elever. Ojämlik resursfördelning, brist på kompetens hos skolsköterskor samt brist på effektiva evidensbaserade arbetsstrategier identifierades som utmaningar för att uppfylla målet. I resultatet framkom även att skolhälsopersonalen upplever sin roll både som vägledande och stödjande för beteendeförändringar mot sunda levnadsvanor. Studien visade dock att dessa roller behövde förstärkas. Det behövs mer forskning för att utveckla evidensbaserad kunskap och ett evidensbaserat ramverk för att bemöta de upplevda utmaningarna inom skolhälsovårdens hälsofrämjande arbete för att främja sunda levnadsvanor hos elever. / Unhealthy lifestyles are increasing among children and this has been identified as a public health problem. School is a key setting for promoting healthy lifestyles. The school health services have an ambition to promote healthy lifestyles among pupils. The aim of this study was to explore the experiences of school healthcare staff of promoting healthy lifestyles among school children 6-10 years old at the municipal primary schools in the city of Västerås. A qualitative study design was chosen and data collection took place through six individual semi-structured interviews with school healthcare staff. A content analysis was applied to analyze the collected data. The study showed that collaboration between various stakeholders towards a common goal as well as a person-centered approach were considered as main facilitators for the school healthcare staff to promote healthy lifestyles. Unequal distribution of resources, lack of knowledge and skills among school nurses and lack of practical evidence-based working strategies were considered as challenges for the school healthcare staff to promote healthy lifestyles. This study proved to be a guiding as well as a supporting role for the school healthcare staff in health behaviour changes in pupils and their families. This study, however, showed that these roles needed to be strengthened. More research is required to improve evidence-based knowledge and to develop an evidence-based framework to address the perceived challenges in school healthcare efforts towards promoting healthy lifestyles among pupils.

Syftet med denna uppsats är huvudsakligen att ta reda på hur det kommer sig att Lean har implementerats på Karolinska Universitetssjukhuset i Solna med stor framgång, medan det inte fått samma genombrott på Akademiska Sjukhuset i Uppsala. Empirin är baserad på  semistrukturerade intervjuer som genomförts med tre intervjupersoner från respektive sjukhus för att få både ledningens och medarbetarnas uppfattning. Empirin har sedan analyserats utifrån våran teoretiska referensram som omfattar New Public Management, Service Management Theory, Värdestjärnan, Lean, Lean Healthcare samt Värdebaserad Vård. Vi har kunnat urskilja skillnader mellan sjukhusens sätt att förbereda och implementera Lean samt effekterna av arbetet. Bland annat visar resultatet att Karolinska Universitetssjukhuset varit bättre på att utbilda och informera sina arbetare och därmed motivera och engagera dem, samt varit bättre på att mäta och därmed har konkreta resultat att visa på.

Bakgrund: Under de senaste decennierna har den offentliga svenska sjukvården genomgått stora förändringar. Ett av de begrepp som implementeras är Lean Healthcare. Begreppet bör ses som en filosofi och strategi. Verksamhetsstyrningen bör anpassas efter vald stra-tegi, som exempelvis Lean Healthcare. Det finns dock inte en universell metod för hur styrningen bör anpassas efter Lean Healthcare, utan styrningen bör vara individuellt anpas-sad. Syfte: Syftet med denna studie är att genom att studera sex sjukhus utreda hur sjukhusens verksamhetsstyrning stödjer strategin Lean Healthcare. Metod: Vi uppfyllde vårt syfte genom att göra en multipel fallstudie på sex sjukhus tillhö-rande två landsting, Skåne och Jönköping Vi har intervjuat personer med olika befattningar på sjukhusen för att skapa oss en uppfattning om hur Lean Healthcare stöds i sjukhusens verksamhetsstyrning. Datainsamlingen skedde med hjälp av semistrukturerade intervjuer. Resultat/Slutsats: Vi har med utgångspunkt i den teori som sammanställts och den empiri som insamlats kommit fram till att olika delar av verksamhetsstyrning i olika stor utsträck-ning stödjer Lean Healthcare. I analysen av de fem kategorierna framgår det att de olika delarna på olika sätt stödjer Lean Healthcare.

Handover from one healthcare professional is an essential component of patient care. This can be a challenge in community care where staff provide interventions in the patient’s home and do not have the benefit of face-to-face interactions with colleagues. The purpose of this quantitative study was to explore the perceptions of nurses working in community care about handover and their views on using an electronic handover tool as opposed to their current email system. The goal of the study, to assess whether nurses would have a greater understanding of their patients’ needs through standardized reporting as opposed to emailed narratives of time and tasks was studied. Nurses completed a pre, post likert-type survey, and reviewed an electronic handover tool. Both surveys were analyzed by nursing professional designation and age to explore whether either factor influenced opinions. Nurses reported that handover was important and they supported a standardized communication tool as opposed to relying on an email system without structure. / Graduate / 0569 / nmichaudhamilton@gmail.com

Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility.

The existence of workplace violence in remote and isolated nursing station settings has been an area of limited knowledge to date. This descriptive study explored the phenomena of workplace and occupational aggression (WPOA), an operational definition of workplace violence created to capture all exposures to verbal and physical aggression in the 21 First Nations and Inuit Health (FNIH) managed Nursing Stations in Manitoba. Using the Manitoba Region Occurrence Reports from 2008, it was found that nurses in nursing stations experience a range of WPOA exposures with verbal incidents being more commonly reported than physical incidents. Quantitative findings related to patterns of reported WPOA with respect to timing, type, perpetrators and concurrent substance use. Themes related to the impact of WPOA on nursing staff and responses of managers to reported incidents were generated from the qualitative analysis. Recommendations for policy, administration, education and future research were generated.

The Winnipeg Children’s Hospital encounters delays within the surgical patient flow and cancellations due to a lack of available resources in the Pediatric Intensive Care Unit (PICU). Applying the concepts of lean thinking and the practices of simulation and statistical analysis, these problems were better understood and solutions were developed. Improvement projects were performed centralized on lean concepts and utilizing the tools of value-stream mapping and 7 forms of waste. Building and running a simulation model provided a capacity versus demand measure for the overall performance of the PICU. Simulation allowed for the study of hypothetical situations such as varying department resources and fluctuating patient levels. Statistical calculations were used to create a prediction tool to determine the probability of a PICU bed being available. This would enable a reduction in last-minute cancellations of surgical cases requiring a PICU bed.

During the past two decades, there has been an explosive volume of software applied in the field of heath care. As medical software becomes pervasive in all facets of health care services, the risk of software related patient injuries and patient deaths is also on the rise. To assure the quality of medical software, rigorous validation and verification methods must be employed to analyze all phases of development and final products. In this thesis, a systematic review was conducted to examine and summarize research in the area of medical software certification, which is the primary quality assurance approach taken by regulatory bodies. Key findings indicate that research in the field of medical software certification is sparse, with a limited range of focus and research methodologies. Greater effort using empirical research approaches is necessary for the improvement of current research in medical software certification. / Graduate

Handover from one healthcare professional is an essential component of patient care. This can be a challenge in community care where staff provide interventions in the patient’s home and do not have the benefit of face-to-face interactions with colleagues. The purpose of this quantitative study was to explore the perceptions of nurses working in community care about handover and their views on using an electronic handover tool as opposed to their current email system. The goal of the study, to assess whether nurses would have a greater understanding of their patients’ needs through standardized reporting as opposed to emailed narratives of time and tasks was studied. Nurses completed a pre, post likert-type survey, and reviewed an electronic handover tool. Both surveys were analyzed by nursing professional designation and age to explore whether either factor influenced opinions. Nurses reported that handover was important and they supported a standardized communication tool as opposed to relying on an email system without structure. / Graduate / 0569 / nmichaudhamilton@gmail.com