Background: In November 2011, prisoner healthcare in Scotland became the combined responsibility of a partnership between the Scottish Prison Service and the National Health Service. Very little is known about the experience of male prisoners with regard to their health care while in prison and immediately following release. Aim: Against the backdrop of organisational restructure, the purpose of this study was to investigate the experiences of male prisoners in order that future policy developments can be more grounded in their experience. Methodology: The study was conducted from a phenomenological perspective. Data was gathered from semi-structured interviews with male ex-prisoners in the community. Interviews were audio-recorded and transcribed where consent was given; detailed field notes were made in interviews where consent was not given for audio-recording. Transcripts of the recorded interviews and field notes were analysed using inductive phenomenological analysis. Findings: Twenty-nine ex-prisoners participated in semi-structured interviews. Nine consented to being audio-recorded. Analysis revealed the following themes: 1. The meaning of health. Participants experienced their own health predominantly as a physical phenomenon related to their ability to function physically in the world. Mental ill-health had been experienced and was spoken about in terms of stigma and ensuring/maintaining personal safety. Substance misuse was not seen as a health issue but more as an issue of poor service provision. 2. Access to and use of healthcare provisions in prison and the outside community. Problems were experienced regarding medication and the prescribing practices of doctors. Participants’ experience of accessing healthcare services in prison was of a difficult and frustrating process that was controlled by nurses whose attitudes and use of power were perceived as a major factor in prisoners’ ability to access and use the services available. All participants described professionals' high level of mistrust in them and the issues surrounding their health status as a result of the phenomenon known as the credibility gap. This appeared to impact upon their perceived ability to access health care whilst in prison and the outside community. 3. Difficulties in interagency communication of care. Participants expressed experience of an increasingly bureaucratic process of access to health services characterised by form-filling. This was perceived to disadvantage and discourage prisoners with literacy difficulties. Participants expressed that new complaints procedures were not explained and appeared to be designed in a way to deliberately discourage and delay complaints. Participants expressed that the access arrangements for healthcare appointments were also bureaucratic, slow, and perceived to be designed to discourage them from accessing the healthcare services. 4. Vulnerability and hope. The role of the family and the support that they provide following liberation was stated to be important and helpful in preventing relapse into former health threatening behaviours. Such support was also described as helping to prevent participants from becoming embroiled in a revolving door syndrome of release and reoffending. The important mechanisms were identified as a source of accommodation and a permanent address, which was essential to access a number of healthcare services and benefits. Planned, consistent throughcare and opportunities were identified as helpful, especially those from the third sector. Discussion: This study provides a voice to the participants. Healthcare in prison was largely experienced in terms of physical health; mental health is seemingly experienced as stigmatising. Ex-prisoners experience a communication failure among services. Access to healthcare in prison is experienced as overly bureaucratic. Conclusion: Ex-prisoner participants' experiential accounts raise problematic issues relating to the effectiveness of 2011 policy changes that were intended to ensure equity in health services for prisoners and ensure that they received improved opportunities to benefit from NHS care. The changes have not translated into an improved experience for prisoners during and following their incarceration a renewed commitment to providing equivalency of opportunity in healthcare for prisoners is required.

Our health is what we value most. Medicine as a scientific branch has made a great step forward in the last decades. Due to this fact, the demographical structure of inhabitants changed significantly. People reach higher age, we are able to treat diseases, which used to cause death. Nevertheless, we are not anymore in a phase, when financial costs equal treatment needed for all people in Czech Republic. Therefore, the topic Ethics in healthcare is an actual one. The aim of this thesis is the description and following analysis of actual problems in Czech healthcare. There are stated the main problems in Czech healthcare, where the relationship between ethics and economics is mostly visible. The proposal for improving the actual situation, is to extend the Ethical code of Czech Medical Chamber, as the document, which brings the main ethical standards in healthcare. The next proposal for improving the actual situation in Czech healthcare, is to make new ethical codes for different medical specialties. It is also advised to place the Ethical code of Czech Medical Chamber on visible places. The used method is compilation of literature and interviews with professionals and medics for analytical approaches. In this thesis, data from Czech Institution for Health Information and Statistics are used. There are also used articles form healthcare magazines and from general periodicals.

O sistema de produção que foca na geração de valor para o cliente e na eliminação de desperdícios já demonstrou seu poder no setor manufatureiro e agora começa a chamar a atenção do setor de bens e serviços. Um enfoque crescente, em particular, está sendo dado à aplicação dos conceitos lean no setor de saúde, sendo comumente denominado lean healthcare. A literatura apresenta diversos casos de hospitais que iniciaram sua jornada lean e já colhem seus resultados. Este trabalho visa analisar alguns desses casos, acompanhar e relatar uma aplicação prática conduzida pelo autor e, como resultado, contribuir com recomendações para condução de futuras implantações de conceitos lean em hospitais. / The production system that focuses on eliminating waste and generating value for the customer has already demonstrated its power on manufacturing sector and now is beginning to draw the attention of industry goods and services. An increasing focus, in particular, is being given to the application of lean concepts in the health sector, commonly known as Lean Healthcare. The literature contains several cases of hospitals that began their lean journey and most have good results. This paper aims to examine some of these cases, report a practical application conducted by the author and, as a result, to contribute with recommendations for future implementations of lean concepts in hospitals.

Os hospitais são grandes organizações de serviços responsáveis pelo bem estar da população. Desempenham um papel importante na sociedade e também são responsáveis por boa parte dos recursos financeiros destinados a saúde. Diante deste cenário, os hospitais tem demandado um aumento no uso de ferramentas de gestão e melhoria de seus processos de negócio. Uma proposta para auxiliar neste processo, tem sido reportada na literatura como Lean Healthcare. Desse modo, o objetivo deste trabalho constituiu na proposição de uma abordagem estatística dos tempos para a análise das atividades nos processos hospitalares, de modo a identificar as variações existentes e contribuir com o gerenciamento do processo. A proposta foi desenvolvida utilizando a pesquisa teórica. Este método orientou o processo de desenvolvimento da AET- Abordagem Estatística dos Tempos, uma vez que a motivação para a sua elaboração estava alicerçada em uma proposta que pudesse contribuir com o aprimoramento do Lean Healthcare em hospitais. Os resultados teóricos da AET foram apresentados em três simulações (cenários I, II e III) para dois setores do hospital. Essas simulações atestaram que a variabilidade existente pode afetar diretamente os esforços de melhoria envolvidos, principalmente quando realizada a comparação de tempos de atividade em plantões diferentes Foi também realizada uma aplicação piloto em um processo de atendimento ambulatorial de um hospital regional no Estado de Mato Grosso do Sul. Na aplicação piloto foram utilizados os parâmetros comparativos, que ilustraram, de forma quantitativa, a influência que a variabilidade dos tempos pode desencadear na dinâmica do processo. Esta aplicação ocorreu em um pronto socorro, onde foi possível observar a variabilidade dos tempos em uma situação real. Essa aplicação demonstrou uma melhora na quantificação da variabilidade, pois analisou a variabilidade com base no comportamento dos dados, e não apenas pela média dos tempos ou pelos valores inferiores e superiores de uma amostra de tempos. Dessa aplicação resultou também a identificação de que a padronização do trabalho em ambientes hospitalares pode demandar mais esforços do que em ambientes de manufatura. Isto pode ser observado quanto ao distanciamento no atendimento da demanda, identificado pelo parâmetro LMV - Limite Máximo da Variação. Assim, a AET contribuiu para avaliar melhor a capacidade em atividade que agregam valor, e em relação as atividades que não agregam valor, ela auxiliou na identificação das possíveis causas dos desperdícios. A AET pode ajudar no planejamento das ações de melhoria, pois trouxe para a discussão um importante aspecto de o processo hospitalar: a variação existente nos tempos das atividades. / Hospitals are big organizations services responsible for the welfare of the population. They play an important role in society and are also responsible for much of the financial resources for health. In this scenario, the hospital has demanded an increase in the use of management tools and improves their business processes. A proposal to assist in this process has been reported in the literature as Lean Healthcare. Thus, the objective of this work consisted in proposing a statistical approach of the times for the analysis of activities in the hospital processes in order to identify existing variations and contribute to the management of the process. The proposal was developed using theoretical research. This method guided the development process of SAT- Statistical Approach of the Times, since the motivation for its development was founded on a proposal that could contribute to the improvement of Lean Healthcare in hospitals. The theoretical results of SAT were presented in three simulations (scenarios I, II and III) for two hospital sectors. These simulations testified that the variability can directly affect the improvement efforts involved, especially when performed comparing activity times in different shifts. A pilot application was also performed in an outpatient service process of a regional hospital in the state of Mato Grosso do Sul. In the pilot application were used comparative parameters, which illustrated, in a quantitative manner, the influence of the variability of time may initiate the dynamics of the process. This application was in an emergency room, where it was observed in real situation. This application showed an improvement in quantification of variability because analyzed the variability based on data behavior, and not just the average of the time or the lower and upper values of a sample times. This application also resulted in the identification of the standardization work in hospital settings may require more effort than in manufacturing environments. This can be seen as the distance in meeting demand, identified by MLV parameter - Maximum Limit Variation. Thus, the SAT contributed to better assess the capacity of activity that add value, and in relation to activities that do not add value, it assisted in the identification of possible causes of waste. The SAT can help in the planning of improvement actions, as brought to the discussion an important aspect of the hospital process: the variation in the times of activities.

Healthcare has recently begun a push towards more lean practices and management. Healthcare accounting, in an effort to reflect business practices, must change to accurately reflect reality. This research seeks to explore how healthcare providers improve their accounting systems to keep up with an ever-changing lean environment. By examining both healthcare and accounting literature, this comprehensive literature review seeks to answer the question, “How does healthcare accounting adapt to lean philosophies?”.

In May of 2014 the Financial Accounting Standards Board (FASB) and the International Accounting Standards Board (IASB) issued a long-awaited joint updated standard on revenue recognition, ASU 2014-09 – Revenue from Contracts with Customers. While almost all entities will be affected to some extent by the new standard, particularly the changes in required disclosures, this research seeks to examine the impact the new standard will specifically have on the healthcare industry. By highlighting areas of significant challenge a better understanding will be gained of the impact health care service entities will experience as they transition to a new standard.

Objective: The primary objective of this study was to examine the relationship between hospital structural characteristics and penalization status (penalized or not penalized) in any given hospital acquired condition (HAC) Reduction Program year, FY 2015 through 2018. Structural characteristics included hospital type, case mix index, average daily census, bed size, ownership, disproportionate share percentage, location, and American Nurses Credentialing Center Magnet status. The secondary objective of the study was to determine whether a hospital's penalization status across one or more HAC Reduction Program years is related to quality performance (Total HAC Score) in subsequent years. These objectives were achieved through retrospective, longitudinal, multivariate regression analysis using 4 publicly available data sources. Background: The intention of pay-for-performance programs, including the Centers for Medicare and Medicaid HAC Reduction Program, is to improve the quality of care delivered; however, the theoretical and conceptual basis of pay-for-performance programs and their efficacy in improving care are widely debated. This study was designed to address the gap in knowledge related to the efficacy of value-based reimbursement as a means of motivating providers and organizations to improve healthcare quality. Results: Higher average daily census, disproportionate share percentage, and case mix index were associated with increased likelihood of receiving a penalty in the HAC Reduction Program. Approximately half (49%) of who did not experience a penalty at all improved their Total HAC Score. 51% of hospitals with 1 year of penalty improved their Total HAC Score; 54% of hospitals with 2 years of penalty improved their Total HAC Score; 73% of hospitals with 3 years of penalty improved their Total HAC Score. Conclusions: Despite the inability of some hospitals to meet the benchmark to avoid penalty, the vast majority of hospitals improved their performance over time. This finding holds promise for value-based reimbursement as a means for improving HAC incidence.

The purpose of this study was to explore senior leaders integration of the National Center for Healthcare Leadership (NCHL) competency model within their employee evaluation system. This case study was conducted to explore how the NCHL leadership competency model is used within their organization's employee evaluation system. The NCHL leadership competency model guided this study. The research was an exploration of themes in leadership competencies used in the healthcare organization. Data collection included in-depth interviews with 10 healthcare junior leaders in a single healthcare organization in the Midwestern United States who had at least 1 year of experience as a leader and a review of secondary data related to their job skills and annual evaluations. Using Saldana's method of data analysis, 4 primary themes emerged: leaders are transformed by vision and focus, leaders need continuous training, leaders like accountability, and leaders like influence goal creation. The 4 themes indicated that participants perceived NCHL leadership competencies integrated in their performance evaluation system to be of benefit. The findings revealed senior leaders might benefit from integrating the NCHL competency model in new leader orientation competencies, leadership training, and performance assessment tools. Positive social change may result by successful implementation of the NCHL leadership competency model strategies from this study, improving societal healthcare through efficient healthcare delivery.

. Abstract Health reform is forcing healthcare administrators to make rapid changes. A tendency to resist change can present problems for these organizations, including the large, not-for-profit Catholic healthcare systems. In order to make positive contributions towards healthcare, it's important to recognize the nature of the organization's involvement to change. The transformational leadership style has been shown to be positively correlated with change however, the relationship among leadership styles, employees' behaviors, and motivation to change are still not well understood and require further study. Further, although Oreg's Resistance to Change (RTC) approach has been researched in direct patient care areas, RTC research in non-patient settings is lacking and necessary in delivering the full spectrum of patient care. This study focused on the relationship of transformational leadership to RTC and if the relationships leaders' have with subordinates' influence change. A customized survey that included the Multifactor Leadership Questionnaire, RTC, and Leader Member Exchange (LMX 7) was emailed to 500 random individuals of various ages and races from 3 non-patient areas. Thirty leaders and 133 raters responded. The regression analysis showed a strong correlation between transformational leadership and RTC. Additionally, each of the variables from the LMX 7 section of the survey showed associations indicating the relationship leaders develop with their subordinates and leader transformational scores were positive. This study may contribute to the awareness of RTC and utilizing transformational leadership style to move change in a positive direction for a healthcare setting.

Compared to their typically developing peers, adolescents, and emerging adults with special healthcare needs (AEA-SHCN) disproportionately experience healthcare transition (HCT) disparities and poor access to adult care. Theoretical models that describe how access gaps develop and strategies to address unmet HCT needs are not well understood. While HCT researchers describe both system and patient healthcare barriers, a comprehensive approach that discovers how these factors interact and interfere remains misunderstood. An integrative review (IR) was conducted to understand the multiplicity of these factors. An intersectional theory (IT) provided further clarity on how key findings influence patient HCT experiences. Several themes were found to intersect and thus increase the HCT complexity, particularly for patients with social disadvantages. Communication gaps, mismatched goals/expectations, and poorly defined roles were common themes. Poor health equity, disparities in access, and inadequate HCT support intersected with poor patient HCT experiences, while youth with stigma-related diseases were most at-risk for poor provider-relationships. The thematic synthesis provided granularity to these experiences with characterizations as fear, loss, and uncertainty with access change. Social change implications underscore the need to reframe poor patient HCT experiences as potential opportunities for health policy advocates and clinicians to address unmet HCT needs.