Progressive efforts within the healthcare design community have led to a call for architects to use relevant scientific research in design decision making in order to provide facilities that are safe, efficient, and flexible enough to accommodate evolving care processes. Interdisciplinary design project teams comprising architects, interior designers, engineers, and a variety of consultants struggle to find ways to deal with the challenge of incorporating the evidence base into the projects at hand. To date there has been little research into how these interdisciplinary teams operate in the real world and especially how they communicate and attempt to integrate evidence coming from different sources into the architectural design that is delivered. This study presents an investigation of a healthcare design project in situ by using methods of ethnographic inquiry, with the aim of developing an enhanced understanding of actual collaborative healthcare design practices. A major finding is that ‘evidence’, as used in practice is a richly textured notion extending beyond just the scientific research base. The description and analysis of the observed practices is presented around two core chapters involving the design process of 1) the emergency department and 2) the inpatient unit. Each design episode, which depicts the complex socio-cognitive landscape of architectural practice, introduces how evidence, with its various types and representational forms, was generated, represented, evaluated, and translated within the interdisciplinary design team. Strategically utilizing various design media, including layout drawings and mock-ups, the architects represented and negotiated a set of physical design attributes which were supported by differing levels of scientific research findings, anecdotes, successful precedents, in-house experimental findings, and intuition, each having different affordances and constraints in solving design problems over time. Individually, or combined into larger “stories” which were collectively generated, the set of relevant evidence provided a basis for decision making at various scales, ranging from minor details within rooms to broader principles to guide design work over the course of the project. Emphasizing the role of the architects in translation of evidence, the design episodes provide vivid examples of how various forms of evidence shape the design of healthcare environments. The case observed in this research demonstrated that the participants formulated and explained their design ideas in terms of mechanistic arguments where scientific research, best practices, and anecdotal evidence were integrated into segments that formed causal links. These mechanistic models, as repositories of trans-disciplinary knowledge involving design, medicine, epidemiology, nursing, and engineering, expand the scope of traditional understanding of evidence in healthcare design. In facilitating design processes architects are required not only to become knowledgeable about the available evidence on healthcare, but also to use their meta-expertise to interpret, translate (re-present), and produce evidence in order to meaningfully engage in interdisciplinary exchanges. In re-presenting causal models through layouts or mock-ups, architects play a critical role in evidence-based design processes through creating a platform that displays shortcomings of available evidence and shows where evidence needs to be created in situ.

No description available.

Facilities management is emerging rapidly as a distinct and critical field of study and professional practice for all sectors of the economy. In the past it has tended to be regarded as a service function and subsumed within other areas such as engineering, the built environment and business management. The health sector is an important part of the overall FM industry because it represents a driver of capital works that is both extensive and expensive. The health sector building requirements are growing, demand regular maintenance and upgrading, and are critical to core business. An extensive literature review revealed that there has been minimal published research into the development and implementation of a central feature of effective FM, namely, performance management. Performance management provides the primary evaluation and planning tool for FM, in that it identifies the performance indicators that are meaningful to FM and core business, provides measures for those indicators and enables projective planning and benchmarking to be undertaken. This research study assesses the possibility of developing a comprehensive performance measurement system for FM in the healthcare sector. The research has two main aims: - To identify the knowledge gaps in current FM performance measurement systems in general, and for the healthcare sector in particular. - To investigate the possibility of benchmarking FM performance across the healthcare sector using a weighted assessment across all categories of performance. In order to meet the research purpose and data collection requirements from the relatively limited number of FM experts who specialise in the health sector, the research methodology employs a combination of a case study approach as an exploratory tool, and a phenomenological approach as the main qualitative design. In achieving the aims and objectives, this research helps in improving FM practice in the healthcare sector through: - Providing facility managers with a comprehensive study which highlights the achievements and knowledge gaps in FM and its performance measurement - Providing top management with a study for the effectiveness of developing decision support strategy to make effective and efficient changes to their facility management practices - Facilitate the implementation of benchmarking techniques in the health sector, in order to improve the performance of the healthcare sector FM over time. The study concludes that developing aggregate/collective KPIs for each performance measurement category of possible measure (social/quality, financial, environmental, functional, and technical) is feasible. However, before being able to develop and implement that approach an improvement to the current FM practices is required. The improvement can be achieved via either a voluntarily or compulsory commitment from top management towards FM in the organizations. This commitment should be implemented with an appropriate hierarchy from the bottom to the top. The key components include: establishing the contribution of FM to the success of the overall business in financial terms; setting agreed FM objectives; deriving meaningful general KPIs; defining the data required for each KPI; establishing the system for collecting, analyzing and interpreting the data; and conducting the benchmarking process for continual improvement.

Thesis (Ph. D.)--Virginia Commonwealth University, 2007. / Prepared for: Dept. of Health Administration. Bibliography: leaves 175-186.

PPI has been growing considerably in the last 15 years in the UK's National Health Service (NHS) following shifts in the relationship between institutions and the public. Various legislative changes during this period have moved the NHS towards a consumerist model of delivery with a greater emphasis on the voice of their service users and the public. High profile cases, such as the severe failings at the Mid-Staffordshire NHS Foundation Trust (Francis, 2013), have provided impetus for PPI. However, despite increases in PPI-related activities, research into PPI methods and their impact have indicated that both methods and impact are difficult to evaluate (e.g. Conklin et al., 2012). Many existing models of PPI appear to over simplify what is a complex social phenomenon. Relatively simple early models such as the ladder of participation (Arnstein, 1969) are still widely referenced. Many studies have focused on individual PPI activities and individual stakeholder perspectives but have paid less attention to the commonalities and differences across and within stakeholder groups and PPI contexts. This study explored the complexities of PPI by collecting detailed observational, documentary and interview data from three different healthcare provider organisations (a mental health trust, a social enterprise, and an acute hospital trust). A range of methods (observations, semi-structured interviews, and document reviews) were used to explore in depth the complex nature of PPI and capture detailed data about contextual and organisational factors. Furthermore, whilst this study aimed to explore a range of activities and individual perspectives across multiple organisations, the ultimate outcome of this research was to produce a conceptual framework that extends theory by placing greater emphasis on the influence of contextual and societal factors. This study identified a plethora of factors that contribute to successful PPI; some of which had been found in previous research (such as personal barriers for laypeople). The constraining role of organisational structures and hierarchies; the strong influence of Government policies and initiatives; and the gatekeeping role of PPI facilitators were novel to this research, or added nuances to existing literature. With regards to the latter, a key finding was the significant role PPI facilitators play in both the implementation and success of PPI work. Their role is essentially a mediator between their employer and patients and the public. This study identified that the role of the voice of patients and the public is negotiated via PPI facilitators, making these key to the success of PPI. PPI facilitators were both responsible for facilitating PPI activities and reporting back the results of that work to senior management (including Board members); the ultimate goal of which was to influence service improvements as well as long term organisational strategies. These findings indicate that a conceptual framework of PPI is needed that considers not just individual perspectives and methods of PPI, but also the process of negotiation via PPI facilitators in making PPI a success.

Lean techniques are tools that reduce waste in the process and create value for the end-customer. Initially, the concept of lean thinking started in manufacturing, but with the tremendous advantages it offers in terms of value creation for the customer, defect reduction, increase of profits for corporations, it has been recognized as an important tool across a wide spectrum of industries. Although Healthcare industry has started applying these techniques, there is very little work published on how to apply these techniques to this particular industry. In this study, a framework for applying lean thinking to healthcare industries is presented. The framework depicts a systematic methodology for identifying value streams. The framework was developed specifically for the healthcare industry, but it can be applied to service industry in general. A case study is presented on how to apply this framework. Value stream mapping has been conducted at a clinic to identify areas of improvement. The components of the developed framework have been used to define a future state of process based on input from process owners, nurses, physicians, and patient surveys. The study has identified factors that influence the success of implementation of lean techniques in healthcare. Also the potential for future work has been identified.

Mobile applications (“apps”) are increasingly used in medical education and practice. However, many medical apps are of variable quality, lack supporting evidence and fall outside the remit of regulators. In this thesis, I explore how the quality and credibility of apps for healthcare practitioners could be improved. I argue that interdisciplinary collaboration throughout the app life-cycle is critical and discuss how this can be facilitated. My argument rests on prior work in eHealth and neighbouring disciplines, and on original research in transfusion medicine. Blood transfusion can be a life-saving medical treatment. However, it also carries risks. Failures to provide irradiated and cytomegalovirus-negative blood components according to guidelines are frequently reported in the UK. Such incidents put patients at risk of serious complications. Haemovigilance data indicates that enhancing practitioner knowledge may reduce mistakes. Thus, I worked with medical experts to develop and evaluate the Special Blood Components (SBC) mobile learning app. To facilitate this work, I created two tools: the Web App Editor (WAE) and the Web App Trial (WAT). The former is a collaborative editor for building apps in a web browser and the latter is a system for conducting online randomised controlled app trials. The results are reported in five studies. Studies 1 and 2, based on interviews with seven practitioners, revealed shortcomings in an existing transfusion app and the SBC prototype. Study 3 demonstrated how students using theWAE were able to collaborate on apps, including an app in stroke medicine. Study 4, an evaluation of the revised SBC app with 54 medical students, established the ease of use as acceptable. In study 5, a WAT pilot study with 61 practitioners, the SBC app doubled scores on a knowledge test and was rated more favourably than existing hospital guidelines. In conclusion, creating high quality medical apps that are supported by evidence is a considerable undertaking and depends on a mix of knowledges and skills. It requires that healthcare practitioners, software developers and otherswork together effectively. Hence, the WAE and WAT are key research outcomes. They enabled participants to contribute improvements and assess the usability and efficacy of the SBC app. The results suggest that the SBC app is easy to use and can improve practitioner knowledge. Further work remains to pilot and evaluate the SBC app in a hospital setting.

Made available in DSpace on 2014-06-11T19:30:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-11-14Bitstream added on 2014-06-13T18:40:26Z : No. of bitstreams: 1 ferreira_er_me_prud.pdf: 3465149 bytes, checksum: d4b907818d7fc1febae25de48dc86fdf (MD5) / Este trabalho procurou analisar os aspectos da gestão e do gerenciamento interno e externo dos RSS na cidade de Presidente Prudente. A realização do trabalho coincidiu com um período intenso de negociações entre os estabelecimentos geradores e a companhia responsável pela limpeza pública na busca por uma melhor alternativa para o solucionamento do problema. O município possui um caráter centralizador, oferecendo inúmeros serviços na área médica, dispondo de hospitais, laboratórios e demais estabelecimentos que atraem além dos moradores locais, pessoas advindas de cidades próximas e de até mesmo de outros Estados tais como: região sul do Mato Grosso do Sul e região norte do Estado do Paraná, gerando assim uma significativa quantidade de RSS. Para analisar o gerenciamento interno nos estabelecimentos geradores, foram elaborados e aplicados questionários em seis hospitais e sete laboratórios e no ambulatório da Faculdade de Ciências e Tecnologia – UNESP Campus de Presidente Prudente, abordando uma série de questões sobre: adoção de classificação para a realização da segregação, acondicionamento, armazenamento temporário, formas empregadas de coleta e transporte interno, segurança ocupacional, implantação do Plano de Gerenciamento de Resíduos de Serviços de Saúde, dificuldades na elaboração deste plano e existência do mesmo. Diante destes dados foi efetuada uma avaliação com base na RDC nº. 306/04 da ANVISA, buscando traçar um panorama do gerenciamento interno dos RSS nestes estabelecimentos. / This work has analysed the aspects of the management and the internal and external management of the HCW in the city of President Prudente. The accomplishment of the work coincided with an intense period of negotiations between the generating establishments and the responsible company for the public cleanness in the search for a better alternative for the solution of the problem. The city possesss a centraliser character, offering innumerable services in the medical area, making use of hospitals, laboratories and other establishments that they attract beyond the local inhabitants, people from cities the closest and even though of other States such as: south region of the Mato Grosso do Sul and northern of Paraná, generating a significant amount of HCW. To analyze the internal management in the generating establishments, questionnaires were elaborated and applied in six hospitals and seven laboratories and the clinic of the College of Sciences and Technology - UNESP Campus of President Prudente, approaching a serie of questions on: adoption of classification for the accomplishment of the segregation, preservation, temporary storage, used forms of collection and internal transport, occupational security, implantation of the Plan of Management of Healthcare Waste, difficulties in the elaboration of this plan and existence of it. Faced with these data the RDC was effected an evaluation on the basis of nº. 306/04 of ANVISA, tracing a panorama of the internal management of the HCW in these establishments. Moreover, aspects referred to the external management of the HCW adopted in the city had also been referred analyzed, such as: collection and transport, used technologies of treatment and analysis of external residues disposal place.

Recently, the H-1B visa program has been a target of reform under the Trump administration. This study explores whether the employment of H-1B physicians in U.S. hospitals has any effect on the quality of healthcare provided. As indicators of quality, I use patient survey scores as well as mortality and readmission rates. This new econometric evidence suggests that patient perception of quality is not influenced by prejudice toward nonimmigrant physicians, but provides inconclusive results for the rate-based measures of healthcare quality.

La thèse porte sur les aspects théoriques des réformes de santé des pays développés. Elle a pour objectif d'identifier les mécanismes d'optimisation des dépenses de santé en garantissant l'accès et la qualité des services de soins. A travers l'analyse complète des réformes du système de santé en France, elle vise à identifier les mécanismes efficaces de régulation du système de santé et proposer des dispositions originales pour la réforme su système de santé en Russie, en tenant compte des spécificités du pays. / The thesis provides an overview of theoretical approaches to health care systems reforming. It is aimed to solve the contradictions in the reduction and optimization of total expenditure on health and the increase in life expectancy and also the quality of life with an comprehensive analysis of main tools of reforming in health care system in France, as welle as to make the proposals using constructive French experience in reforming teh economic ans asministrative mechanisms of teh health care system in Russia.