Multi-purpose clinically relevant measures such as the Child and Adolescent Needs and Strengths (CANS; Lyons, 2009) and the Global Appraisal of Individual Needs (GAIN; Dennis et al., 2003) can be useful for improving services at the individual client, program, organization, and system levels. Yet, emerging research suggests that such measures are often not used consistently or effectively (Mellor-Clark, Cross, Macdonald, & Skjulsvik, 2016), and that poor use of these measures can be in part attributed to how they were put into practice (de Jong, 2016). Systematically conducted, empirical research on the effective implementation of such tools is scarce (Boswell, Kraus, Miller, & Lambert, 2015). Thus, the current study examined the factors and processes that contribute to the effective implementation of clinically relevant measures, specifically the CANS and GAIN, in community-based mental health agencies serving children and adolescents. A second objective was to examine the role of staff participation in the implementation process. Three general research questions guided the study, including: (1) How can clinically relevant measures such as the CANS be implemented effectively? (2) What are the perceived consequences of staff participation in adapting and implementing a version of the CANS and how do these consequences come about? and (3) How does the implementation context affect the process and its outcomes? The study employed qualitative, multiple-case study methods. Four child and youth mental health agencies in Ontario participated, including a total of 44 staff with varying roles (e.g., frontline and management). Several cross-case and within case comparisons were made to examine the contribution of staff participation and tool features, such as tool adaptability, to implementation outcomes. Data was analyzed using guidelines developed by Yin (2009), Miles and Huberman (1994), and Thomas (2006). Results suggest that staff participation in the process of putting clinically relevant measures into practice contributes to effective implementation and increased uptake and use of the measures. When staff are engaged in the process, they have reasons and opportunities to interact, talk about the use of the measure, and “co-create fit” between the measure and their work context. This improved fit then facilitates increased staff commitment and ability to use the measure effectively. Agency leaders play a key role in enabling this fit-making process through: encouraging and supporting a participatory approach to implementation, creating implementation structures, following through with planned activities, and being open and responsive to staff feedback. Findings suggest that the implementation context provides incentives or reasons for implementing a measure, affects the initial fit between the measure and staff members’ work, and affects the feasibility of engaging staff in the fit making process. In conclusion, this study is one of the few empirical studies to examine implementation of clinically relevant measures. The findings have important implications for research and practice, which will be discussed.

My diploma work is about philosophy of CRM which is connecting tools for good quality customer care, insists on propriety and process efficiency, quality of staff and usage of IT technologies for recording all important facts which can have impact on relationship. Because of this is implementation of CRM suitable for health care as well. In my work deal with rules of process funciton CRM to activity of private gynecologist clinic. My aim is improve relation between company and consumer.

This thesis is dedicated to a specific scope of customer rights -- rights of the patient in providing of health care in Czech republic. It gives a survey of legislation in customer protection describing principal patient rights, ethical rules and means how these rights can be claimed. Compiling relevant topics of some branches of medicine, it deduces the consequences. Level of knowledge about customer rights among patients is evaluated by questionare.

The aim of the Diploma thesis is to evaluate the financial situation of the health facility Regional Hospital Jicin a.s., using selected methods of financial analysis. The work is divided into two parts: theoretical and practical. The theoretical part summarizes the principles and methodology of financial analysis. This part is also describing the specification in health field. The practical part is describing the analyzed healthcare-technical equipment. It is followed by practical implementation of financial analysis which analyses the management of Hospital Jicin, a. s. A partial aim of this Diploma thesis is to analyze the possibilities of medical equipment revenue, which is presented by the PEST analysis. In conclusion, based on evidence described in the analytical part of the thesis are proceeding some proposals and recommendations that could lead to more effective management of medical equipment

The goal of this work is to show particular conditions and problems according to Equality and Effecciency of Government Progammes and offer possibilities how to solve them, improve them or alternatives to those problems on particular examples. Theoretical part of this work is at first about the role of Public Sector in the National Economy, reasons why is this sector involved in some parts of economy, especially in Healthcare Services. This part is followed by concepts of Efficiency evaluation of particular Government Programmes and theoretical concepts about Equality. Practical part is then aimed on Regulative charges introduced in the Healthcare Services in the Czech Republic.

The underlying philosophy of patient-centred care (PCC) advocates for patients to have an active role in all areas of their care, including broader areas of the health care system such as planning and evaluation. Despite efforts made in the past decade that would see greater patient engagement, conventional evaluation approaches continue to dominate the landscape in health services evaluation. To date, limited empirical research has examined the effects of patient engagement or the best approach to engage patients (Abelson et al., 2015; Baker, 2014; Baker, Judd, Fancott, & Maika, 2016). Furthermore, a relative lack of collaboration and shared knowledge exists between the evaluation community and health sector in the rapidly developing area of patient engagement and the development of best practices. Consequently, health organizations continue to struggle with how best to involve patients (i.e., process) in health service improvement initiatives, as well as learn from patient experience (Baker, 2014; Baker, Judd, et al., 2016; Luxford et al., 2011). This dissertation responded to some of these challenges and through this intervention study, the specific purpose of the thesis study was to gain a better understanding of the process of patient engagement in planning and evaluation by addressing the following research questions: 1. What are the facilitators and barriers of engaging patients in planning and evaluation of health services and why? 2. What did the process of engagement look like with respect to Cousins and Whitmore’s (1998) three dimensions of collaborative inquiry? 3. What are the observed effects of the engagement process? This longitudinal qualitative case study began with the creation of the Patient and Family Engagement Committee (PFEC) at the Ottawa Hospital Psychosocial Oncology Program (PSOP) and completed an evaluation project over a period of six months. The research study occurred in parallel with the evaluation project and was designed to gain a better understanding of the process of patient engagement and the role that evaluation plays in this context. The study consisted of three phases and data collection relied on multiple sources. Facilitators that influenced the patient engagement process include: accommodating participant needs, commitment, orientation meeting, designated lead with evaluation skills, homework between meetings, and mutual respect. Having a designated lead, mutual respect, and commitment to the project were the three most highly endorsed facilitators at the end of the project. Conversely, barriers identified include time and resources, imbalanced participation, change in health status, and living at a distance. Time and resources was endorsed as the most significant barrier to the patient engagement process across all three phases of the study. Motivations for participant involvement revolved around giving back, improving health services, learning, commitment to research/evaluation, and providing or hearing a unique perspective. The study examined participatory aspects of the focal evaluation using Cousins and Whitmore’s (1998) three fundamental dimensions of process in collaborative approaches to evaluation: stakeholder diversity, control of evaluation process, and depth of participation. Findings revealed that intended benefits of participant involvement included reach to decision-makers, improved health services, increased diffusion of patient/family engagement, improved access/awareness of services, and a follow-up to assess influence of engagement. Participants’ experiences of being involved invoked enthusiasm for the project, were personally rewarding, instilled a sense of optimism that the project would have an influence, closed the loop on healing, contributed to a shift from a personal to broader health care focus, and contributed to learning. Further research is needed to gain a better understanding of the processes involved or evaluation approaches that could contribute to translating patient engagement into improved outcomes. The findings of this study have enhanced understanding of key contributions that patients, family members, health professionals, and evaluators bring to the patient engagement process, and enriched understanding of key facilitators and barriers to ensure successful patient engagement.

O Desenvolvimento de Novos Serviços (DNS) tem recebido atenção crescente, tanto por parte de gestores de operações de serviço, quanto por parte dos acadêmicos do setor. Esta dissertação parte do pressuposto que os modelos DNS, desenvolvidos a partir de experiências com serviços em massa e loja de serviços, não abordam na sua totalidade os desafios de operações de serviços marcadas por maior dinamismo, especialmente serviços profissionais. Partindo de um referencial teórico montado com o objetivo de identificar quais são as características dos serviços profissionais que potencialmente influenciam positivamente ou negativamente o desenvolvimento de novos serviços, esta dissertação utiliza uma metodologia de pesquisa baseada em estudos de caso múltiplo para avaliar se o panorama teórico construído anteriormente é condizente com dois casos de inovação em serviço profissional público. A partir destas conclusões, destacamos algumas implicações práticas que pudemos observar e analisamos de que forma o modelo DNS proposto por Edvardsson et al (2000) está preparado ou não para lidar com estas questões. / New Service Development (NSD) has received increasing attention from either service managers or service marketing researchers. This dissertation firstly discuss that NSD models developed from mass services or services shop experiences, do not totally comprehend more dynamic services challenges, specially professional services. Following a literature review that aims to identify which professional services characteristics may influence positively or negatively the new service development process, this dissertation uses a multiple case study research to evaluate if the theoretical framework built before is related to two public professional services innovations case. From theses conclusions, we point out some practical implications that we could observe and after that we analyze if the NDS model proposed by Edvardsson et al (2000) is or is not prepared to deal with theses questions.

Sammanfattning   Bakgrund: Inom skolsköterskans arbetsfält ingår hälsofrämjande arbete med sexuell hälsa. I utbildningen till skolsköterska saknas antingen ämnet helt eller ges bristfälligt. Kunskap kring sexuell hälsa samt utformningen av det hälsofrämjande arbetet inhämtas istället via vidareutbildning som arbetsplatsen erbjuder. Tidigare studier har visat att utbildningsinterventioner inom arbetsområdet sexuell hälsa kan ge skolsköterskor ökad kompetens, liknande studier saknas i Sverige.   Syfte: Syftet var att beskriva om en utbildningsintervention om sexuell hälsa påverkat skolsköterskornas arbetssätt med det hälsofrämjande arbetet inom sexuell hälsa.   Metod: Studien var en enkätstudie bestående av slutna och öppna frågor och utgjordes av en jämförelse av svaren från två identiska enkäter som skickades ut före respektive efter en utbildningsintervention. De slutna frågorna i enkäten analyserades med hjälp av deskriptiv statistik och de öppna frågorna med hjälp av konventionell innehållsanalys.   Resultat: Utbildningsinterventionen bidrog dels till att skolsköterskorna fick ökad kunskap i olika områden inom sexuell hälsa samt dels en känsla av ökad trygghet i samtalet kring sexuell hälsa. Skolsköterskorna ansåg även att samverkan med andra professioner var betydelsefullt för ett framgångsrikt hälsofrämjande arbete med sexuell hälsa.   Slutsatser: Utbildningsinterventioner av liknande slag kan öka kompetensen och därmed öka tryggheten i arbetet kring sexuell hälsa.   Nyckelord: distriktsköterska, elevhälsa, kompetenshöjning, sexuell hälsa / Summary   The school nurse’s health promoting work with sexual health. A survey study.   Background: The school nurse's field of work includes health promotion work concerning sexual health. In school nurse education, either the subject is completely missing or given deficiently. Previous studies have shown that educational interventions in the area of sexual health can increase competence, similar studies are lacking in Sweden.   Objective: The aim was to describe how an educational intervention on sexual health effect school nurses´ work procedure in the health enhancing work in sexual health.   Method: The study was a questionnaire consisting of closed and open questions and consisted of a comparison of the answers from two identical questionnaires that were sent out before and after an educational intervention. The closed questions in the questionnaire were analyzed by using descriptive statistics while the open questions were analyzed using a qualitative, conventional content analysis.   Results: The educational intervention has helped the school nurses to gain increased knowledge in various areas of sexual health, as well as having created a sense of increased security in talking about sexual health. The school nurses also considered that a collaboration with other professions was important for successful health promoting work within sexual health.   Conclusions: Education interventions can increase competence and thus increase security in work on sexual health.   Keywords: district nurse, increase competency, school health service, sexual health

The purpose of the study was to explore perceptions of PLWHA towards using traditional medicines (TM) together with antiretroviral therapy (ART). The study was conducted in two ART health facilities in the Manzini Region in Swaziland. Audiotaped individual interviews were conducted to collect data. The study population was PLWHA using TM and ART and were aged 18-49 years. Voice recording was used to capture data during the in-depth interviews until saturation was reached. One grand tour question was asked and follow-up probing questions were asked dependent on participant responses and study objectives. Findings of the study revealed that PLWHA are still searching for a cure, and the preexistence of TM prior to ART is influencing them to combine TM and ART. Several reasons for combining the two treatment modalities were, to boost the immune system, enhancing appetite, to treat opportunistic infections and ART side effects. There was stigma associated with long-life ART and discrimination for using TM experienced by PLWHA. It could benefit the country to repeat the similar research at National level, to include all the four regions, in both rural and urban settings. / Health Studies

SAMMANFATTNING Introduktion: Barnhälsovården i Sverige når nästan alla barn och föräldrar. Föräldrastöd är en av de viktigaste insatserna samhället kan bistå med för att minska negativa utfall hos barn och unga. Implementering av föräldrastöd i grupp är komplext och modellen kan behöva utvärderas utifrån komponenterna faciliterare, innovation, kontext och mottagare.  Syfte: Syftet var att beskriva främjande och hindrande faktorer för deltagande i föräldrastöd i grupp i svensk BHV utifrån kontext, föräldrastödets innehåll, samt erfarenheter från föräldrar och BHV-sjuksköterskor. Metod: Litteraturstudie med deduktiv ansats. Implementeringsmodell i-PARISH användes i en riktad innehållsanalys. Artikelsökningar gjordes i CINAHL och PubMed. Sammanlagt inkluderades 18 vetenskapliga artiklar.  Resultat: Resultatet presenteras under fyra kategorier och 13 subkategorier utifrån i-PARIHS. Ledaren var avgörande för att gruppen skulle utveckla en sammanhållning och delta aktiv. För att lyckas med detta behövde ledaren vara bekväm i sitt ledarskap, påläst och uppdaterad. Föräldrarna uppskattade när de hade en ledare som uppmuntrade dem att prata i gruppen och som såg till att diskussion flöt på. Föräldrar uttryckte flera skäl och förklaringar till varför de inte ville eller kunde delta i en föräldrastödgrupp. Slutsats: Både främjande och hindrande faktorer med föräldrastöd i grupp i svensk BHV framkom. BHV behöver få fler föräldrar att känna sig inkluderade i föräldrastödsutbildningen samt vara lyhörd för deltagarna olika behov. Det är också viktigt att BHV-sjuksköterskors behov av utbildning och fortbildning tillgodoses för att kunna leda grupperna på ett professionellt sätt. / ABSTRACT Background: The child health services (CHS) in Sweden reach almost all children and parents. Parental support is one of the most important initiatives society can assist in reducing negative outcomes in children and young people. Implementation of parental support in groups is complex and the model may need to be evaluated on the basis of the component facilitator, innovation, context and recipient. Aim: The aim was to describe promoting and hindering factors for participation in parental support in group format in the Swedish CHS based on context, the content of parental support, and experiences from parents and CHS nurses. Method: Literature study with deductive approach. The implementation model i-PARISH was used in a targeted content analysis. Articles were searched for in CINAHL and PubMed. A total of 18 scientific articles were included. Results: The results are presented under four categories based on i-PARIHS. The leader was crucial for the group to develop cohesion and participate actively. To succeed in this, the leader needed to be comfortable with the leadership, read and updated. The parents appreciated when they had a leader who encouraged them to speak in the group and who made sure that discussion flowed. Parents expressed several reasons and explanations to why they did not want or could not participate in a parent support group. Conclusion: Both promoting and hindering factors regarding Swedish parental support in group format emerged. CHS needs to make more parents feel included in the parental support education and be sensitive to the participants' different needs. It is also important that CHSnurses' needs for education and training are met in order to be able to lead the groups in a professional manner.Keywords: Parent education, Child health service, experiences, implementati