The target of dissertation's work is creation of optimal cooperation model between The Faculty of Management the University of Economics Prague and Nemocnice Jindřichův Hradec, a. s., based on present system of cooperation with a view to mutual utility and benefits. Output of our dissertation's work is set the parameters of cooperation and full made new contract and approval of it by both sides.

Indicadores de qualidade hospitalar correspondem a medidas que contém informações relevantes sobre determinados atributos e dimensões que caracterizam a qualidade de diferentes instituições de saúde. Tais medidas são capazes de sinalizar eventuais deficiências ou práticas de sucesso associadas à qualidade dos serviços de saúde. O presente estudo teve por finalidade desenvolver uma ferramenta computacional de análise, voltada para o gerenciamento hospitalar, com o objetivo de se obter um instrumento que possa ser utilizado para monitorar e avaliar a qualidade dos serviços oferecidos por instituições hospitalares através da análise e gerenciamento de indicadores de qualidade hospitalar. Os indicadores alvo para avaliar a qualidade dos serviços representaram um subconjunto de indicadores de qualidade denominados Inpatient Quality Indicators (IQIs) da Agency for Healthcare Research and Quality (AHRQ). A partir da revisão bibliográfica de textos científicos na área e com base nas dimensões de processo e resultado do Modelo Donabediano, foram selecionados vinte e dois indicadores da AHRQ, que avaliam a mortalidade por determinadas afecções e procedimentos cirúrgicos, bem como a quantidade e a qualidade dos procedimentos realizados nas instituições de saúde. A ferramenta foi construída em dois módulos: um módulo responsável pela geração dos indicadores a partir de dados coletados de um banco de dados relacional; e outro destinado ao estudo e análise das séries temporais dos indicadores, permitindo o acompanhamento da evolução dos mesmos de forma histórica. Os dados utilizados para a geração dos indicadores são oriundos da base de dados do Observatório Regional de Atenção Hospitalar (ORAH), que consiste numa entidade responsável pelo processamento de dados de internação de quarenta hospitais públicos e privados, distribuídos ao longo de vinte e seis municípios da região de Ribeirão Preto, São Paulo, Brasil, que compõem a Departamento Regional de Saúde XIII (DRS-XIII). A ferramenta computacional foi concluída e validade com êxito e suas funcionalidades foram disponibilizadas para gestores de saúde e acadêmicos através do portal web de conteúdo vinculado ao ORAH. Em adição, os resultados obtidos através do uso da ferramenta foram utilizados para analisar a situação da assistência hospitalar na região de Ribeirão Preto através da comparação histórica dos indicadores entre as três microrregiões de saúde que compõem a DRS-XIII: Aquífero Guarani, Vale das Cachoeiras e Horizonte Verde. A análise destes resultados também foi essencial para verificar a capacidade da ferramenta em prover informações relevantes para a gestão hospitalar. A partir da análise dos resultados obtidos, concluímos que a ferramenta permite a definição de um panorama geral da assistência hospitalar na região de Ribeirão Preto. De acordo com os achados deste estudo, também verificamos que os indicadores de qualidade hospitalar da AHRQ cumpriram seu papel como medidas sentinela e foram capazes de identificar certos aspectos associados à realidade. Entretanto, a análise dos resultados também remeteu à necessidade de introduzir novas variáveis que permitam conhecer o real estado dos pacientes e as condições estruturais das diferentes instituições de saúde, visto que os indicadores selecionados, por si só, não fornecem aos gestores de saúde uma avaliação final da qualidade das instituições hospitalares. / Inpatient quality indicators are measures that provide relevant inforrnation on the level of quality of care delivered by hospitals and healthcare services. These measures are capable of signaling eventual problems or successful practices associated with the quality of care provided by health services. This project was aimed to create an instrument to assess the quality of care delivered by hospitals by developing a web application whose functionalities focused on monitoring a subset of inpatient quality indicators (IQIs), extracted from the Agency for Healthcare Research and Quality (AHRQ). Based on literature review and on the components of process and outcomes defined by the Donabedian model, there were selected twenty-two AHRQ\'s inpatient quality indicators that are commonly used to evaluate the mortality associated with certain conditions and procedures, as well as the quantity and quality of certain medical procedures. The software is composed by two components: one is responsible for calculating the indicators using admission data extracted from an operational database; the other one is meant for the study and analysis of time series of the indicators, which allows the monitoring of its values over the years. The indicators were ca1culated using administrative data from the Observatory for Hospital Care\'s database (ORAH, from the acronyrn in Portuguese \"Observatório Regional de Atenção Hospitalar\"). The Observatory for Hospital Care is responsible for processing admission data collected from forty hospitals located throughout Ribeirao Preto region, in the Brazilian state of Sao Paulo. The management of hospitals located in the Ribeirao Preto region is conducted by the Regional Department of Health XIII (DRS-XIII, from the acronyrn in Portuguese \"Departamento Regional de Saúde XIII). The web application\'s services were made available to health service administrators and academic personnel through the ORAH\'s website. The results provided by this computational tool were also used to analyze the situation of care delivered by the hospitals in Ribeirao Preto region, which is subdivided into three microregions: Aquifero Guarani, Horizonte Verde e Vale das Cachoeiras. The historic values of the indicators were compared between these three microregions. The analysis of these results was also important to verify whether the web application is actually able to provi de enough inforrnation to acknowledge the reality of the hospitals in Ribeirao Preto region. According to the results, we verified that the AHRQ\'s inpatient quality indicators have fulfilled their role in signalizing certain aspects related to the quality of care of the hospitals, but they do not provi de enough inforrnation to establish a defini tive quality assessment of hospital services. Therefore, we verified the need of introducing new attributes in order to understand and acknowledge the clinical condition of the hospitalized patients, as well as the structure and resources available in the hospitals.

Depuis la première révolution industrielle, « l'innovation » a été mentionnée à de nombreuses reprises. Ce terme a souvent été associé à « l'innovation technologique ». Récemment, un nouveau type d’innovation, l’innovation managériale, ainsi que son processus d’adoption sont au coeur de l’attention. Dans de nombreuses études sur les innovations organisationnelles, l'innovation technologique reste un sujet dominant et il convient de sortir des limites des études d'innovation technologique. Récemment, des thèmes diversifiés sur les innovations managériales ont été étudiés, montrant l’attrait particulier des innovations managériales pour les chercheurs dans ce domaine. Les chercheurs dans ce domaine ont exploré avec soin les processus de l'innovation managériale, en particulier la génération, la diffusion et l'adoption (avec ou sans adaptation) de l'innovation managériale. Cependant, les études sur l'adoption de l'innovation managériale semblent être négligées. En outre, l'adaptation mutuelle entre les innovations managériale et les organisations adoptantes doit également être étudiée. De manière plus concrète, il est essentiel d’étudier la tension qui peut apparaître lors de l’introduction d’une innovation managériale dans une organisation ainsi que de la pression mutuelle entre l’innovation managériale et l’organisation lors du processus d’adoption. Néanmoins, les études empiriques sur cette question restent encore insuffisantes. Par conséquent, nous nous concentrons sur les processus d'adoption d'une innovation managériale et les tensions entre cette innovation managériale et son organisation d'accueil pendant le processus d'adoption. Chaque innovation managériale comprend une philosophie de gestion alors que chaque organisation concerne certaines représentations. Par conséquent, les tensions potentielles pendant le processus d'adoption peuvent être considérées comme l'harmonie imparfaite entre la philosophie de l'innovation managériale et les représentations dominantes au sein de l'organisation « hôte ». À partir de cela, trois sous-questions importantes se dégagent : (1) comment identifier la philosophie d'innovation managériale et les représentations organisationnelles, (2) comment expliquer leurs accords / désaccords de valeurs pendant le processus d'adoption et (3) comment éviter les désaccords potentiels qui pourraient interrompre ce processus. / Since the first industrial revolution, “innovation” has been mentioned in numerous occasions. This term has often been associated with "technological innovation". Recently, a new type of innovation, management innovation, and its adoption process have been at the heart of attention. In numerous studies on organizational innovations, technological innovation is still a dominant subject and there is a need to go outside the limit of technological innovation studies. Diversified topics on management innovations have been studied, showing a particular attraction of this subject for scholars in this field. Management innovation processes have carefully been explored, in particular the generation, diffusion and adoption processes (with or without adaptation). However, the studies on management innovation adoption seem to be neglected. In addition, the mutual adaptation between management innovations and adopting organizations also need to be studied. In a more concrete way, it is essential to study the tension that can appear when introducing a management innovation into an organization as well as the mutual pressure between them during the adoption process. Nonetheless, the empirical studies on this issue still remain deficient. Consequently, we focus on the adoption processes of a management innovation and the tensions between this management innovation and its adopting organization during the adoption process. Every management innovation comprises a management philosophy while every organization pertains to certain representations. Consequently, the potential tensions during the adoption process can be viewed as the imperfect harmony between the management innovation philosophy and the dominant representations within the “host” organization. Hence, three important sub-questions emerge: (1) how to identify the management innovation philosophy and the organizational representations, (2) how to explain their agreements/disagreements of values during the adoption process and (3) how to avoid potential disagreements that can interrupt this process.

This theses deals with leading change in the specific organization, gynecologycal obstetrician department. The main aim of this theses is to evaluate leading of this change from the manager point of view and also to evaluate its sustainibility in the organization. I was focused on the research of the proces and execution of this specific change. It was the change from the clasiccal model of obsetrics to the respectfull model of obstetrics with using alternative methods and support of the natural birth. I used the qualitative research methods, patricipating observation. I created the summary of the proces of the change and underlined the found problematic parts from the field notes, interview and analysis of social networks. I managed to answer all asked questions and evaluate the process of change and its sustainability. At the end I offered a practical guide of the specific change as a tool for other organizactions. Key words: Obestetrics, maternity center, perinatal care, concepts of leading birth, opinion differences, healthcare management, management of change, image change.

Dagens situation med en åldrande befolkning som leder till en större förekomst av allvarliga kroniska sjukdomar gör att sjukvården står inför nya utmaningar. Då de flesta vårdinrättningar har en mycket hög beläggning och begränsade resurser har man börjat använda sig av produktionsstrategier som traditionellt använts i mer industrinära miljöer, exempelvis Lean production. I denna studie har värdeflödet kartlagts och analyserats för besök vid hjärtakuten på Danderyds Sjukhus AB. Detta har genomförts med hjälp av fältstudieobservationer och intervjuer, för att undersöka verksamheten på en vårdinstitution som arbetar enligt Lean healthcare. Studien har genomförts för att identifiera potentiella förbättringsområden och förändringar inom dessa, som kan leda till effektivare patientflöde. Resultaten av vår fallstudie tyder på att det förekommer icke-värdeskapande inslag relaterade till Transport, Motion, Waiting, Overproduction & Over processing, Defects, Confusion och People på hjärtakuten. Den vanligaste orsaken till slöseri har upptäckts vara kopplad till arbetsrutiner och hur väl dessa rutiner följs, även om problem relaterade till kommunikation och arbetsplatskultur också har upptäckts. Vår främsta rekommendation för att effektivisera verksamheten på akuten är att skapa standardiserade rutiner som är lätta för personalen att följa. Studien och dess resultat kan ses som ett bidrag till den generella diskursen på områdena Lean healthcare, kartläggning samt analys av värdeflöden. Den kan även användas av vårdinrättningar liknande fallkliniken som är i stånd att genomföra en värdeflödesanalys. / The aging population and higher occurrence of chronic diseases today has healthcare facing a very high occupancy and limited resources. To meet rising demands, many healthcare institutions have adapted operational strategies traditionally used in more industrial settings such as Lean production. In this study, the value flow during emergency visits to the heart emergency at Danderyds hospital (Danderyds Sjukhus AB) was mapped and analysed through observations and interviews. The aim was to identify potential changes that might render a more efficient patient flow and improve the operations at a healthcare institution working in accordance with Lean healthcare. The findings from the study show that waste related to Transport, Motion, Waiting, Overproduction & Over processing, Defects, Confusion and People exists at the heart emergency. The most common source of waste is related to routines and compliance to them among the staff, all though some issues related to communication and workplace culture were also discovered. Our main suggestion is therefore to establish standardised routines that are easy to follow for the staff at the clinic, to make emergency visits and patient flow more efficient. The study and its findings can be seen as a general contribution to the discourse regarding Lean healthcare, value stream mapping and analysing. It can also be used by healthcare institutions similar to the case clinic, about to perform an analysis of the value stream.

The topic of this diploma thesis is the compliance with legislation in an area of competencies of general nurses and special nurses working in intensive care units (ICU). The aim of the investigation was to map out, how nurses in the ICU comply with legislation in the area of their competencies and whether their work is influenced by anything. The results showed two trends - situation within a specific unit, that means whether nurses contravene their competencies; whether nurses are aware about their competencies and about competencies of doctors and in addition why nurses are contravening their competencies and what is the opinion of doctors on compliance of competencies for medical professionals, what is the position of management towards contravention of competencies by nurses . Furthermore, the situation overall, that means existence of further regulatory measures, which impact on the conduct of nurses within units. On the basis of those findings the following recommendations are made for leaders of department. The first part explains the legislation that relates to the topic of the work, description of the performance, overview of the management of quality system in health care. The analytic investigation part describes the process, result of investigation, and recommendations based on the...

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The aim of the study was to evaluate whether home health care is a better choice of care from an economic and quality of care perspective than conventional care for people over 65. To answer this, the costs for the two care models were estimated using parametric cost estimation. The quality of care and the cost were evaluated with the "Fuzzy Analytic Hierarchy Process" to determine which of the care models was the best fit. The cost estimate showed that conventional care is cheaper than home care. However, a sensitivity analysis shows that a minimal efficiency in the number of home visits per patient is sufficient for home health care to become the most advantageous alternative from an economic point of view. In addition, a sensitivity analysis also shows that home health care is preferable in five cases out of six, when the weights obtained from the "Fuzzy Analytic Hierarchy Process" are varied. In this preference system, both the cost and the characteristics that make up quality of care are weighted to be summed up to a comprehensive list of priorities of the two care options. Main process maps of the two care models were made to help find significant cost parameters for the two care models. The preparation of the main process maps was done by studying similar process maps to compile two complete overall process maps. However, no significant cost parameters were found when studying the process maps, but they are still included in the study to show the reader an overall difference between the two models. The study shows that home health care is usually more expensive than on-site care, but that home health care is, from a quality point of view, preferable to conventional care. / Studiens mål var att utvärdera om hemsjukvård är ett bättre vårdval ur ekonomisk- och vårdkvalitets synpunkt än konventionell vård för personer över 65. För att besvara detta uppskattades kostnaderna för de båda vårdmodellerna med hjälp av parametrisk kostnadsuppskattning. Vårdkvaliteten samt kostnaden utvärderades med ”Fuzzy Analytic Hierarchy Process” för att avgöra vilken av vårdmodellerna som lämpade sig bäst. Kostnadsestimeringen visade på att konventionell vård är billigare än hemsjukvård. Dock påvisar en känslighetsanalys på att en minimal effektivisering för antalet hembesök per patient är tillräckligt för att hemsjukvården ska övergå till att vara det mest fördelaktiga alternativet ur ekonomisk synpunkt. Utöver detta visar en känslighetsanalys dessutom på att hemsjukvård är att preferera i fem fall utav sex, när de framtagna vikterna från ”Fuzzy Analytic Hierarchy Process” varieras. I detta preferenssystem viktas både kostnaden samt egenskaperna som utgör vårdkvalitet för att summeras till en övergripande allomfattande prioriteringslista av de båda vårdalternativen.  Huvudprocesskartor över de båda vårdmodellerna framställdes för att hitta betydliga kostnadsparametrar för de båda vårdmodellerna. Framställningen av huvudprocesskartorna utfördes genom att studera likande processkartor för att sammanställa två fullständiga övergripande processkartor. Dock hittades inga betydliga kostnadsparametrar när processkartorna studerades, men finns ändå med i studien för att visa läsaren en övergriplig skillnad mellan de två modellerna. Studien visar på att hemsjukvård vanligtvis är dyrare än vård på plats, men att hemsjukvård ur kvalitetssynpunkt är att föredra framför konventionell vård.