CEO competence and development is a continuing concern in the NHS. As a key feature of any CEO leadership role is responsibility for organisationally critical decisions, and there is an increasing recognition of the role context plays in effective leadership behaviour. This study examines the role of contextual intelligence in relation to PCT CEO decision making behaviour. To do this, the research addresses four questions: a) what does the literature say about CEO contextual intelligence? b) what factors do PCT CEOs say they take into account in different decision making contexts? c) what contextual factors do they actually take into account? and d) what impact do the contextual factors have on their decision making behaviour. A systematic literature review resulted in a model of CEO contextual intelligence for CEO decision making. Semi-structured interviews with 24 PCT CEOs in a NHS region about factors influencing their decisions on generic strategies, national policies, regional strategies and local plans revealed a hierarchy among contextual factors applying to different decision strata. Semi-structured interviews and analysis of CEO diaries two months later of the same focal decisions show the real critical factors to be:- national policies themselves, the Strategic Health Authority and the decision making process, for regional strategies; and Top Management Team and structure for local plans. Altogether, the research reveals that the PCT CEO’s decision making context is rationally bounded; the relevant contextual factors differed significantly from the literature derived model; the actual factors in practice differed from what were espoused; choice of factors vary depending on decision trigger strata which links to degrees of CEO autonomy; and macro level factors which were indicated as significant from the systematic review were in fact ignored in practice. A PCT CEO model of contextual intelligence is developed together with a two dimensional model of underlying structures guiding PCT CEO decision making behaviour. The findings have implications for governance structures in the NHS, CEO decision making and senior leader development in ii the NHS in the context of the 2012 Health and Social Care Act. Areas for further research in public sector, NHS and contextual intelligence are also identified.

Problems concerning the planning and practicing of health care currently exist. Countries are spending more funds on medical care without making a discernible dent in the health status of their citizens. This lack of success in obtaining health is obviously a problem for everyone experiencing ill health or the effects thereof It also creates a personal problem for all health workers, because a halt is being called to profligate spending on health that will affect all. The problems underlying tl:e health care crisis are rising costs, unequal distribution, low productivity, poor heali..ii status, and a lack in sensitivity towards the communities it serves. The multi-disciplinary, complex nature of these problems in health care, their magnitude and their inter-relatedness indicate that traditional approaches to health care planning and management have been inadequate or have failed. An alternative approach to solve these problems is to adopt a holistic view, i.e., to see all parts (components) which contribute to the problem as parts of the whole. By viewing the problem as a whole, more enduring solutions may be formulated. The aim of this study was to employ and evaluate the adoption of a systems approach to solve "real life" problems. The Soft Systems Methodology of Peter Checkland was utilized to assess the situation within the Oral Health Service of the SAMS and to identify relevant systems to improve the situation. The need for a Preventive System and a Performance Measurement System was established. These two systems were planned, developed and implemented using and obeying systems rules and techniques. Both these systems were evaluated and found to be highly efficient, effective, cost-effective and made a positive net contribution to the Oral Health Service of the SAMS. It is finally concluded that the adoption of a systems approach to identify and solve "real life" problems was effective and efficient. It is therefore recommended that a systems approach to the management of oral health, and probably health too, should be embraced by the encumbered health industry. / Dissertation (MChD)--University of Pretoria, 1993. / gm2013 / Community Dentistry / unrestricted

This thesis aimed to examine service contact among children and young people with mental health problems, and has three complementary parts. The first is a secondary analysis of data from the British Child and Adolescent Mental Health Survey (BCAMHS) 2004, which explored mental health related service contact in relation to psychopathology over three years. The second and third parts focussed on young people with ADHD in transition from child services, which is a particularly challenging time. This involved a qualitative interview study of young peoples’ experiences, and an analysis of primary care prescribing of ADHD medication over the transition period using a cohort from the Clinical Practice Research Datalink from 2005-2013. Less than a third of children with a psychiatric disorder in BCAMHS reported contact with child mental health services. Instead, teachers were the most frequently used service, with two-thirds reporting mental health related contact. Interviews with young people with ADHD highlighted themes including concerns around medication management post transition and need for information. The prescribing analysis found that the majority of adolescents on ADHD medication at age 16 stopped during the transition period. This continuing disparity between estimates of symptom persistence and medication persistence suggests that many may be stopping medication from which they could still benefit; as various barriers have been identified to ongoing prescribing. In summary, the findings of these three linked studies suggest common themes in terms of unmet needs and gaps between policy and practice in mental health services for children and young people. One of the chief implications is the need for oversight and policy levers to ensure the implementation of best practice, accompanied by complementary efforts to better understand and overcome other barriers to providing optimal care, including research into knowledge and attitudes of different groups and the provision of targeted training.

Official-language minorities in Canada may face specific issues in accessing health care services that can lead to negative consequences on their health, utilization of health care services and satisfaction with the health care system. A secondary data analysis of the 2006 Survey on the Vitality of Official-Language Minorities revealed significant differences between the Anglophone minority (n=5,161) and the Francophone minority (n=12,029) with regards to general health, and access to and use of health care services. Important predictors of these outcomes included age, education level, household income, marital status and place of residence (urban/rural). Access to health care services in the minority language was associated with self-perceived health in the Anglophone minority only. Health policy recommendations elaborated in light of the findings include working on both the supply and the demand of health care services offered in the two official languages, while taking into consideration important contextual differences between regions.

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.