This research is characterised by its overlap of research from management and healthcare. This research is an attempt to contribute to the existing body of knowledge on the linkages between three multidisciplinary research themes; healthcare management concepts, information and communication technology (ICT) and knowledge management (KM). The objective of this research is to examine the feasibility of incorporating the KM paradigm in healthcare. This research discusses whether it would be beneficial for healthcare institutions (HIs) to adopt the KM paradigm so as to facilitate effective decision-making in the context of healthcare delivery. This research contends that the key to success of healthcare in the twenty first century is an effective integration of technology with the human clinical decision-making process. It is therefore important to develop a conceptual KM health framework that encompasses technological, organisational and managerial perspectives. The research design, guided by a qualitative philosophy, was inductive in nature and used the case study methodology for accomplishing the research objectives. Empirical data was gathered via a main case. The findings from the main case, in conjunction with inputs from the literature review, formed an iterative process. The analysis of the collected data resulted in a first level conceptual KM framework for Healthcare organisations. Data was then gathered from five additional case studies to (1) validate the findings obtained from the main case and (2) to carry out a cross-case analysis. Data was collected from personnel at the five cases by way of structured and semi-structured interviews, observations, archival records, telephone and virtual interviews. The analysis of the data obtained from the five cases lead to a revision of the first conceptual KM framework, resulting in a revised (and final) KM-Healthcare framework, complemented by a user guide which included a structured "walk-through" for Healthcare institutions.

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The ISO 9000 series of standards for international quality control and quality assurance, released by the International Standard Organization (ISO) on March 15, 1987 for establishing universal quality standards as a basis for international division of administrative responsibilities, had caught international attention. The second edition of ISO 9001-9003 standards was revised and released in 1994 to address the transition in entrepreneurial environment. The third edition of ISO 9001 standards was further revised and released on December 15, 2000. The manufactory and construction industries have demonstrated significant outcomes in improving corporate cultures and systems, reducing cost while increasing productivity, enhancing quality and market competition, and gaining clientele satisfaction after investing in vast amount of human resources and funds to introduce the ISO. The healthcare organizations had been less cognizant of the ISO series. The comprehensive national health insurance, which has been put into practice for six years since March 1995, has forced the healthcare organizations into fierce competitive edge. Hospitals take client-satisfaction as a competitive advantage for ongoing management and survival by providing higher quality medical services. This study investigates a case of hospital experiences in establishing international quality assurance system, such as : the definition and content of ISO, the reasons for establishment, education and training, control policy for persistence, auditing and perpetual improvements. Further, a detailed introduction is given following a review of literature to depict the successful experiences of the case hospital. Through surveys and interviews, practical knowledge and applicable experience can be identified. It is firmly believed more hospitals and healthcare centers will adopt ISO and benefit from adoption. The research findings are as follows : 1. Promoting ISO motivates hospital quality management and increases client confidence and satisfaction. 2. Success to certification basically lies in decisiveness, supportiveness of high-level management, and consensus among staff. 3. Most common obstacles in certification process are : insufficient manpower, heavy workload, and employee repulsiveness. 4. Perpetual participation in quality control practices is based upon leadership and team cooperation. 5. Significant improvements are demonstrated in standardization of documentation and workflow and elevation of management levels. 6. Hospital induction requires the management emphasis, educational training of the employees, accumulation of ISO-relevant information, and in-field observation of certified and successful hospitals. Keywords : ISO 9000s, healthcare management system, quality assurance

Healthcare organizations are moving towards the use of dashboards for presenting performance data and away from the use of balanced scorecards, but there is little research that addresses whether dashboards are better than balanced scorecards. This study gathers qualitative and quantitative data from interviews with decision makers, 6 directors and 10 managers, from a large healthcare organization. Decision makers were presented with the most commonly used graphic formalisms from both the dashboard and the balanced scorecard, which were a gauge and tabular format respectively. The presentation contained information about healthcare decision making scenarios. Neither of the formats affected the decision maker’s ultimate decision on whether to take action and for both display formats the decision maker requested more information than what was presented to them. However, it was found that the gauge format was perceived as being easier to understand, better supported decision making and that it contained more complete information. Overall, the analysis reveals that 94% of participants preferred the graphic formalisms from a dashboard to the graphic formalisms in the balanced scorecard. This study shows that decision makers prefer dashboards to balanced scorecards when comparing the most common graphic formalisms found in balanced scorecards (tabular format) and dashboards (gauge format). The results are consistent with a move towards greater use of dashboards in healthcare. Theoretical implications of the work are discussed. / Graduate / 769 / hjenning@uvic.ca

Why do the healthcare facilities incur debt? What troubles the managers most? In what conditions do the healthcare professionals work? Is there space for improvement? Is it possible to deliver higher quality care? Nowadays, the healthcare providers are looking for solutions, which could help them satisfy more patients, reach lower costs and therefore increase own financial results and answer the abovementioned questions. Key element of such a solution is a business intelligence system, which supports decision-making and aligns enterprise objects with its progress and improves the overall performance. The thesis elaborates on the topic of business intelligence software QlikView in selected hospitals, which already implemented or are about to implement the business intelligence software. The intention was to find out ways in which the software is used in the hospitals, what key performance indicators the software usually measures and what could be the possible opportunities for its further use in the selected facilities. Research results indicate that the software significantly increased the work efficiency and that it contributes to more effective hospital management. However, such improvement in efficiency has also its drawbacks, namely it is the higher price per personal licence in comparison to the other business intelligence software on the market. Research also confirmed the fact that only usage of such software alone will not help to improve the overall bad state of Slovak healthcare system -- systematic measures such as DRG system have to be implemented in the first place in order to also effectively use the business intelligence software.

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This is a qualitative study that uses structured interviews and observations as the methods for collecting data. The purpose of this study is to examine if caregivers in elderly care perform tasks at work that they do not have time for, and also how the caregivers manage communication with the caretaker's relatives. It is a well known problem that personnel working in care are overworked, which can lead to negative effects on the quality of the care that is given. The data collected from the interviews and a thematic analysis present the daily routines performed in connection to the visits at the caretakers. Process maps are created of these visits from the personnel. By breaking down the activities, technical indicators are presented that could suit each activity. It is vital that these technical indicators do not add workload to the caregivers. The results show that there are problems regarding communication between caregivers and the caretaker's relatives. Furthermore eight activities in the process were found that previous research has shown could be turned into technical indicators. / Denna studie är av kvalitativ ansats och använder strukturerade intervjuer samt observationer som datainsamlingsmetod. Syftet med denna studie är att undersöka om vårdgivare utför arbetsuppgifter som de inte anser sig ha tid med. Detta eftersom det är ett redan känt problem att många vårdgivare känner sig överbelastade, vilket exempelvis kan leda till att kvaliteten på vården blir sämre. Utifrån intervjuerna och observationen skedde en tematisk analys för att undersöka vilka dagliga rutiner som sker i vårdgivarnas hem i samband och i anknytning till hemtjänstbesöken, för att kartlägga den processen. Detta för att kunna presentera ett alternativ som kan minska på arbetsbördan för vårdgivare. Resultatet från denna studie visar på att det finns problematik gällande återkoppling till anhöriga samt att det fanns en aktivitet i processen som skulle kunna elimineras/minskas med stöd av tekniska indikatorer.

A Gestão de Riscos Corporativos (ERM), a partir das publicações da ISO 31000 em 2009 e do guia do COSO em 2007, vem sendo aplicada e adaptada às especificidades de múltiplos mercados. O contexto hospitalar, caracterizado pela necessidade de avanços em sistemas e métodos gerenciais que permitam maior acurácia de informações e sustento na orientação à tomada de decisão, passou a, também, interessar-se pelo valor da ERM. Influenciado pelos programas de qualidade e segurança do paciente e de gestão de riscos assistencial, presentes na cultura hospitalar mundial, gestores estratégicos à frente de organizações de saúde começaram a procurar por metodologias que possam ser adaptadas à complexidade de um hospital e apoiem a implementação da ERM. A literatura prévia ao desenvolvimento desta tese não apresenta um modelo que consolida e orienta a operacionalização da ERM em organizações de saúde, mas destaca em múltiplas publicações a necessidade que os hospitais têm de atentar a metodologias que permitam gerir de forma proativa e estratégica seus negócios, que estão expostos a riscos internos e externos. Motivada pela lacuna descrita, esta tese explorou o mercado brasileiro e norte americano através de entrevistas, estudos de caso e survey, e propôs um modelo global de ERM para organizações de saúde: o E2RMhealthcare. Este sugere requisitos para a operacionalização global da ERM e é fragmentado em 4 níveis: risk baseline, education, quantitative e governance que orientam uma implementação gradual, considerando a maturidade de gestão da organização. Formas de como explorar as características do hospital e capital humano para exercer a ERM também foram estudadas, sendo proposto uma relação entre as equipes de avaliação de tecnologias de saúde hospitalar e de ERM no processo de criação de valor da organização através de um mapa de causa e efeito. Como destaque do negócio saúde, essa tese inova propondo o primeiro inventário de riscos corporativos orientado a organizações de saúde que foi validado por gestores de múltiplos países, identificando o risco de ataques cibernéticos como o principal. Por fim, o uso de métodos de análise multicriterial e de custeio por atividade são aplicados como soluções inovadoras para a priorização e avaliação econômica de riscos ao longo dos níveis Baseline e Quantitative do E2RMhealthcare. O avanço do E2RMhealthcare com estas metodologias incorporadas para um software com capacidade de inteligência artificial é deixado como sugestão de trabalhos futuros além da sua real aplicação em múltiplos casos. / Since the ISO 31000 publication in 2009 and the COSO guide in 2007 Enterprise Risk Management (ERM) has been applied and adapted to the specificities of different business markets. The hospital context characterized by the demand for advances in management systems and methods that allow to improve information accuracy and to support the decision-making process, also became interested in the value of ERM. Influenced by quality and patient safety and healthcare risk management programs presents in the global hospital culture, managers at the top of healthcare organizations started to look for methodologies that can be adapted to the hospital management complexity to support the ERM implementation. The literature, prior to the development of this thesis, does not present a model that consolidates a guide to operationalize ERM in healthcare organizations. Although emphasizes, in multiple publications, the urgency for methodologies that enable proactive and strategic management of healthcare businesses, which are exposed to internal and external risks. Motivated by the described gap, this thesis explored the Brazilian and American healthcare market through interviews, case studies and survey, and proposed a global ERM model for healthcare organizations: E2RMhealthcare. It suggests requirements for global operationalization of the ERM and is organized in 4 levels: risk baseline, education, quantitative and governance that guide a gradual implementation, considering the maturity of the organization management. Different manners to explore the features of the hospital and human capital to operate the ERM were also studied, and it was proposed a relation between the hospital healthcare technology assessment teams and the ERM in the value creation process of the organization through a cause and effect map. Focusing on the healthcare business, this thesis innovates by proposing the first enterprise risk inventory aimed at healthcare organizations that was confirmed by risk managers from different countries. Cyber-attack was identified as the main enterprise risk in healhtcare. Finally, the use of multicriterial analysis methods and activity-based costing are applied as innovative solutions for prioritization and economic assessment of risks throughout the Baseline and Quantitative levels of E2RMhealthcare. The progress of E2RMhealthcare with these incorporated methodologies for a software with artificial intelligence capacity is left as a suggestion for future studies, in addition to its actual application in multiple cases.

ABSTRACT:Healthcare management is a field that is related to management, leadership, and service of anorganization. Due to high competition and change in the environment of healthcare organizations,managers need to embrace the innovation to respond to those changes and make the organizationsuccessful by improving the process, structure, and culture of the organization as well as to provideefficient and effective care that will lead to achieve patient satisfaction. Service quality is one ofthe key factor among the service innovations that contribute to business development and leadingposition in the business world with high competition. Patient satisfaction is important for anyhealthcare organization. Patient satisfaction improves hospital/clinic image, which changes into anincrease in the use of services provided by the healthcare systems and increases market share.Patient satisfaction is dependent on the service quality which is the main factor in healthcareinnovations.Purpose: The purpose of this study is to understand experience levels of the patient satisfaction ofservice quality in Swedish dental clinics, based on the factors affecting dental service quality.Data Sources: Interviews with staff from six clinics in Sweden, 240 patient surveys from twopublic and two private Swedish dental clinic, group interviews with three Swedish dental clinics,Science-Direct, Research Gate, ABI Inform, Google Scholar, Academia.edu.Method: This study is based on the quantitative and qualitative analysis (i.e., mixed methodapproach) and abductive approaches to measure patient satisfaction in Swedish dental clinicsthrough service quality. The problem is analyzed through interviews with the staff in private andpublic dental clinics. The factors affecting the dental service quality are analyzed throughtheoretical and empirical analysis. The patient’s satisfaction was measured by SERVQUAL toolthrough using patients’ survey that consists of 12 questions based on the four factors (tangibility,empathy, responsiveness, and Assurance). Patient survey is conducted in four dental clinics. SPSSwas used to calculate mean and standard deviation for the survey’s result. After analyzing the result,group interviews with clinic 1, clinic 3 and clinic 5 was conducted to understand different valuesin the tool i.e., the value created, value destroyed, and value missed based on the customerperception to analyze the service quality of the dental clinics.Findings: The result from the surveys showed that the factor empathy has highest positive affectand responsiveness has the lowest effect in four dental clinics. The lowest effect in the factorresponsiveness is based on the waiting time to meet a dentist. The group interviews gave us thedifferent values which are based on the idea of the value mapping tool in customer perspective.The value that the clinics gained trust from their patients. The value missed\destroyed is the waitingtime to meet a dentist. The new opportunities are to improve the services by installing newtechnology products and changing the appearance of the clinic.

The intellectual impulsiveness of man to understand the unknown and the continual need of the society to improve healthcare have encouraged extensive investigation on numerous and diverse cause-and-effect relationships. The nature of this endeavor, however, renders the inability of investigator at all levels to escape beyond the narrow conceptual boundary described by an early French philosopher as the vicious cycle. To enjoy the theoretically plausible benefits of refined labor division, data-driven healthcare management, and real-time evidence-based practices, it must first be acknowledged that co-occurrence is better than cause-and-effect in explaining how an observation takes place at a particular time. This paper details a co-occurrence framework, and discusses its implications for the global healthcare system.