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An organisation's accumulation of knowledge has been identified as a key factor in its progress and survival. This is particularly the case for a business that involves service delivery and is very pertinent to the construction industry. The key to success in managing organisational knowledge is recognising the importance of managing (and maintaining) the knowledge of the staff in the face of staff retention challenges. Knowledge retention is integral to ensuring that the experience and tacit knowledge acquired by the staff during their service will not be lost when the staff leave the organisation. The concept of Knowledge Management (KM) is seen as the solution through the inculcation of knowledge sharing via various tools and techniques in managing the knowledge within parties in construction. The aim of this research is to identify where and how KM initiatives being used within PFI-FM healthcare projects as a result of the unique character of the associated PFI contracts and a wide range of FM services. The complexities involved in managing and delivering services at the operational stage of PFI projects and the vast amount of tasks and services stipulated in the FM context, particularly regarding the planning, types of services, time, place, tools and resources needed, make it a suitable area for KM adoption. This research, which involved exploratory studies, literature reviews, analyses of three case studies involving PFI-FM healthcare projects and structured interviews with the Facilities Managers, has managed to discover the adoption of KM tools in managing FM healthcare services among Facilities Managers in PFI healthcare projects. However, KM has not been used to its fullest potential; the incomplete application of KM initiatives has, thus, created some problems with regard to delivering PFI-FM healthcare services. The outcome has resulted in the formulation of a framework that combines the best practices of KM initiatives with practical approaches of managing organisational knowledge of FM healthcare services which derived from the case studies. The framework has been validated by experts evaluated from the industry and refined to ensure that the framework developed is practical. The most pertinent achievements of this research include demonstrations of the needs for KM initiatives in delivering PFI-FM healthcare services and the development of a framework to enable better service delivery among the PFI-FM healthcare service providers, particularly with regard to addressing the challenges derived from PFI contracts and the vast scope of FM healthcare services. Overall, the study provides a clear justification and indication from a theoretical point of view and empirical evidence from the facilities managers perspective of the significance of KM initiatives in delivering PFI-FM healthcare services in the UK. Furthermore, recommendations have been made to improve and enable comprehension of the framework application and facilitate its implementation in the construction industry.

The healthcare service sector has recently entered the global arena and many nations sectors has opened up for private initiatives, which is explained by the rapid development and structural changes within the industry. However, regardless of considerable interest in the area among academics, very little has been concluded in terms of investigating internationalization of healthcare related services. The purpose of this study is to contribute with an enriched understanding regarding how Swedish medical service SMEs internationalize and what factors influence how - and in what way - the process unfolds. A conceptual model is developed, extending the theoretical discussion by integrating established SME and entrepreneurship literature with extant IB literature relevant for political salient industries. Conducting an exploratory multiple case study, rich empirical data is collected and analyzed in the light of the conceptual model. The research findings indicate that knowledge, networks, and institutional factors influence how the internationalization process of medical service SMEs unfolds to a large extent. The research contributes by concluding that the nature of the service as well as the home market institutional context constitute pivotal influential factors on the firms’ internationalization process and are added to the refined conceptual framework.

Social science research on third sector organisations in the last two decades has emphasised their growing presence and importance in healthcare. This has occurred alongside significant reorganisation of health systems in the UK, including a continued policy emphasis on partnership-working between the public sector and the third sector. However, unanswered questions in the literature remain with regard to the specific roles that these organisations fulfil within partnership arrangements. This thesis examines the role of third sector organisations within Scottish services for the chronic, neurodegenerative condition Huntington’s disease (HD). The closely connected nature of Scottish healthcare and the multitude of professionals involved in HD mean these services are an important, but currently understudied, example of professional interaction around complexity. A multi-methods qualitative research framework was used to gather perspectives of key individuals working in the Scottish HD and wider health scene. Making use of the key concepts of expertise and boundary work, this thesis argues that third sector organisations have an extensive shaping role in 1) the positioning of healthcare organisations, 2) the identities of healthcare professionals, and 3) the meanings around illness and the remit of support. The research findings revealed that organisations and professionals in HD partnership arrangements engaged in processes of boundary work in the negotiation of the roles of themselves and others. Third sector professionals occupied many positions within services, as both experts and supporters of patients. In the process they and other professionals often took on identities as ‘key, committed professionals’. Understanding around HD was also shaped by these professionals as the wider aspects of illness and its support were brought into focus. Building on these findings, it is argued that third sector professionals in coordination roles are well placed to develop a type of expertise that I term ‘aggregate know-how’ (Pols 2014), based around both their professional skills and their extensive contact with patient experiential knowledge. The research builds on and extends influential previous models of third sector ‘partnership’ in healthcare (Rabeharisoa 2003), emphasising the key role of third sector organisations in knowledge production. It also offers insights of both theoretical and practical use with regard to service delivery in healthcare, showing the potential for genuine third sector/public sector partnership around expertise when there is adequate cultural support and resources.

Lietuvos Respublikos pacientų teisių ir žalos sveikatai atlyginimo įstatyme yra įtvirtinta paciento teisė gauti ne bet kokias, o kokybiškas sveikatos priežiūros paslaugas. Minėtame įstatyme apibrėžta, kad kokybiškos sveikatos priežiūros paslaugos – tai prieinamos, saugios, veiksmingos sveikatos stiprinimo, ligų prevencijos, diagnostikos, ligonių gydymo ir slaugos paslaugos, kurias tinkamam pacientui, tinkamu laiku, tinkamoje vietoje suteikia tinkamas sveikatos priežiūros specialistas pagal šiuolaikinio medicinos ir slaugos mokslo lygį ir gerą patirtį, atsižvelgdami į paslaugos teikėjo galimybes ir paciento poreikius bei lūkesčius, juos tenkindami ar viršydami. Darbo tikslas – įvertinti Vilniaus miesto ambulatorinių asmens sveikatos priežiūros įstaigų paslaugomis besinaudojančių asmenų nuomonę apie asmens sveikatos priežiūros paslaugų kokybę Vilniaus mieste, o uždaviniai: ištirti asmens sveikatos priežiūros paslaugų kokybę, įvertinti Vilniaus miesto ambulatorinių asmens sveikatos priežiūros įstaigų paslaugomis besinaudojančių asmenų pasitenkinimą gautomis asmens sveikatos priežiūros paslaugomis ir nustatyti sąsajas tarp teikiamų asmens sveikatos priežiūros paslaugų kokybės ir respondentų pasitenkinimo gautomis asmens sveikatos priežiūros paslaugomis. Vykdant sveikatos priežiūros įstaigų teikiamų paslaugų vertinimo pacientų požiūriu Vilniaus mieste momentinį tyrimą, buvo Vilniaus miesto ambulatorinėse asmens sveikatos priežiūros įstaigose – Šeškinės, Antakalnio ir Centro... [toliau žr. visą tekstą] / The Law on the rights of patients and compensation for the damage to their health of the Republic of Lithuania establishes the right of a patient to receive not just any healthcare services but the services of high quality. The abovementioned law defines the high quality health care services as accessible, safe, efficient health improvement, disease prevention, diagnostic, patient treatment and nursing services which are provided to an appropriate patient at an appropriate time and place by an appropriate health care professional according to the level of modern medical and nursing science and good practice, taking into account the service provider’s possibilities and the patient’s needs and expectations by satisfying or exceeding them. The objective of the paper is to evaluate the opinion of individual persons who are using ambulatory personal health care institutions in Vilnius on the quality of the services they are rendered and the tasks of the paper involved examination of the quality of the healthcare services, evaluation of the satisfaction level of the individual persons who are using the services of the personal healthcare institutions in respect of the personal healthcare services they have received and establishing the correlation between the service quality of the personal healthcare institutions and the satisfaction of the respondents in relation to the personal healthcare services they have received. During the instant survey of the quality of healthcare... [to full text]

Information technology (IT) is empowering consumers, service providers, and inventor teams with superior services. Various IT innovations are enabling diverse groups of people to search, exchange, and learn from information. In healthcare services, the context of the three essays of this dissertation, information resources are often not equally accessible to consumers, not transparent between patients and physicians, and hard to locate across technological domains that may be relevant to the development of breakthrough innovations. Focusing on empowering roles of IT in healthcare services, I develop a three-essay dissertation to study how IT can enable information access to (i) address health inequalities in developing regions of the world, (ii) strengthen the physician-patient relationship where patient trust in the physician has atrophied, and (iii) energize inventor teams in the development of medical device innovations. Essay 1 examines consumers’ awareness and use of mobile health that can empower consumers to access health advice information. Essay 2 investigates how online health consultation communities can empower physicians to build trust with patients, and gain social and economic advantages in competitive healthcare services. Essay 3 studies the role of digital capabilities to empower inventor teams in medical device companies by converting expertise of inventor teams into broad and deep knowledge capital and expanding knowledge production regarding medical device innovations. I adopt a pluralistic approach to collect data (surveys administered in multiple languages for Essay 1, scraping web data from online communities for Essay 2, and constructing a multisource archival panel dataset for Essay 3) and analyze data (multivariate analysis for Essay 1, multilevel modeling and econometrics for Essay 2 and Essay 3). The essays contribute to our understanding about the acceptance of empowering IT innovations, the empowering role of user-generated content in online communities for providers of credence services, and the empowering role of IT for inventor teams of healthcare innovations.

Bakgrund    Enligt Sveriges Kommuner och Landsting så ska vårdpersonal inom regioner, kommuner och landsting arbeta för införandet av personcentrerad vård (PCV) som arbetssätt. PCV har tre grundpelare: partnerskap, patientberättelse samt dokumentation. Vårda i samråd med personen som behöver vård är grunden i hela den personcentrerade vården. Syfte                                   Syftet med studien var att beskriva sjuksköterskans tillämpning av personcentrerad vård inom den kommunala hemsjukvården i vården av personer 65 år och äldre. Metod                                 Studien har en beskrivande design med kvalitativ ansats. Huvudresultat                   Ingen av de inkluderade kommunerna tillämpade PCV fullt ut idag. De förutsättningar för en god PCV som sjuksköterskorna beskrev var att de arbetade för att ha personen i fokus. De försökte också skapa en relation till personen och dess anhöriga genom kontinuitet, partnerskap och patientens levnadsberättelse. Hinder för att kunna tillämpa PCV var brist på organisatorisk ledning gällande PCV, bristande kontinuitet, tidsbrist och orealistiska önskemål från personen samt kunskapsbrist om PCV.   Slutsats                              Sjuksköterskorna saknar kunskap om vad PCV innebär inom kommunal hemsjukvård och hur PCV skall tillämpas i det dagliga vårdarbetet. Studien visade på att det är ledningen som präglar vilken vård som ges till dem som vårdades. En ledning som guidar, stöttar och ger förutsättningar till sina sjuksköterskor för att de skall kunna tillämpa PCV är den största förutsättningen för att PCV skall kunna implementeras inom den kommunala hemsjukvården. Det borde vara en rättighet för alla som vårdas att få PCV. / Background                  According to the Swedish Association of Local Authorities and Regions should all healthcare professionals within the regions, municipalities and county council work for an introduction of person-centered care (PCC). PCC has three fundamental pillars: partnership, the patient´s story and documentation. Healthcare should be in agreement with the person needing care, it´s the foundation of PCC. Objective                      The objective of the study was to describe the nurse's application of person-centered care in the municipal home healthcare in the care of people aged 65 years and older. Method                              The study has a descriptive design with a qualitative approach. Main results                      The results showed that none of the participating municipalities applied PCC to full extend currently in daily work. The nurses described good conditions for PCC like having focus on the person. The nurses also tried to create a relationship with the patient and their relatives, through continuity, partnership and patient´s life story. The study identified obstacles in the application of PCC like lack of organizational management, continuity and time, unrealistic requests of care from the person and knowledge deficit regarding PCC. Conclusion                         The nurses within municipal home healthcare lacked knowledge regarding PCC and how to apply PCC in daily work. The study showed that it is the management who characterizes the care given. In the application of PCC a necessity is a management who guides, supports and offers relevant conditions for PCC to the nurses. It should be a right for all people receiving care to obtain PCC.

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.

Magister Curationis - MCur / The nurse preceptors underwent a preceptorship training programme offered by the University of the Western Cape, School of Nursing, which prepared them for this teaching role. A quantitative study was done following this preceptorship training programme but no qualitative study since. It is vital to explore the experiences of these trained nurse preceptors regarding clinical teaching practice post the training programme. The aim of the study was to explore trained nurse preceptors‟ experiences regarding their clinical teaching practice in the Western Cape. The objective was to describe trained nurse preceptors‟ experiences of their clinical teaching practice in the service settings in the Western Cape. An exploratory, descriptive, contextual design was used to describe the experiences of trained nurse preceptors in the Western Cape. A purposive sample was selected from three levels of healthcare service settings. Semi-structured interviews were conducted by the researcher with nine individual nurse preceptors who voluntarily agreed to participate in the study. Data analysis was done following Collaizi‟s‟ steps which led to coding of categories and themes. The findings indicated that preceptorship training programme had changed the nurse preceptors‟ perceptions. These nurse preceptors were prepared by the programme and ready for the preceptor role. Their teaching skills were strengthened and improved. They accepted the training programme as adequate preparation to facilitate clinical teaching and learning of students and found it to be effective for their self-development. These findings will inform v the managers about clinical teaching practice, assist the offering institution with the evaluation of the preceptorship training programme and add to an existing literature about the experiences of nurse preceptors. This research recommends that the education institutions, in collaboration with the clinical facilities initiate a qualitative study to explore the experiences of students preceptored by trained nurse preceptors. Such a study will further explore the effectiveness of the preceptorship training programme from the perspective of the students. With the positive feedback from the participants, it is essential that the training of preceptors remains one of the continuing education programme offered by the University of the Western Cape. Permission to conduct this research was obtained from the University of Western Cape, Senate Higher Degrees Committee, and Western Cape of Provincial Department Research Team in Western Cape as well as from the Chief Executive Officers of the three levels of healthcare service settings.

Background: Emerging adulthood (18 to 29 years old) is a critical age group in relation to the Human Immunodeficiency Virus (HIV) epidemic and to mental health. A major public health concern globally, in management of HIV, is that emerging adults have suboptimal antiretroviral therapy (ART) adherence, yet they are the largest group initiating ART. In addition, common mental disorders (CMDs), including depression and anxiety have their peak incidence during this period and they have been found to increase risk of non-adherence to ART. Those with CMDs may have different types of barriers than those without CMDs. Furthermore, those with CMDs might be more likely to have a greater number of barriers to adherence than those without because of the way symptoms of CMDs impact on memory, problem solving skills and concentration. Aims: The main aim of this study was to describe barriers to adherence to ART in emerging adults living with HIV with probable CMDs (i.e. depression and/or anxiety) and accessing HIV treatment at a government clinic in Harare, Zimbabwe, compared to emerging adults living with HIV without probable CMDs. The specific objectives were: a. to determine the prevalence of probable CMDs among emerging adults living with HIV, b. to describe the prevalence, severity and common barriers to ART adherence, measured using the 22-item Barriers to Adherence (BARTA scale) in emerging adults living with HIV with probable CMDs and to compare this with those without probable CMDs. Methods: A representative sample of 223 emerging adults aged 18 to 29 years were recruited in a crosssectional study using the random sampling technique. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Barriers to Adherence Scale (BARTA scale) were used to assess probable depression, probable anxiety and barriers to adherence respectively. Data Analysis: Univariate Descriptive statistics were used to describe the socio-demographic, prevalence of probable CMDs, prevalence of barriers to adherence, overall median of total BARTA score (severity of barriers to ART adherence) for the whole sample and overall median number of barriers to ART adherence for the whole sample. Chi-square analyses were used to compare the prevalence of barriers (no barrier vs. at least one) between participants with and without probable CMDs. Non-parametric Wilcoxon rank-sum tests and Kruskal Wallis tests (for variables with more than two categories) were used to I. Compare the number of barriers to ART adherence between participants with and without a probable CMDs; II. Compare the severity of barriers to ART adherence between participants with and without probable CMDs, using overall scores on the BARTA scale III. Assess the relationship between demographic variables, HIV related variables, Substance Use Disorders (SUD) and total BARTA scores. Variables which were significantly associated with BARTA scores were entered into a negative binomial regression model, to assess the relationship between CMDs and severity of barriers to ART adherence, this time controlling for possible demographic confounding factors. Results: The prevalence of probable CMDs (i.e. probable depression and/or probable anxiety) was 33.2%. Specifically, 31.8% had probable depression and 16.1% had probable anxiety. Results: showed that 76.2 % of the sample experienced at least one barrier to ART adherence and that 94.5% of those with CMDs experienced at least one barrier to adherence compared to 67.1% of those without CMDs (p>0.001). We found a significant difference (U=-7.209, p<0.001) between the number of barriers experienced by participants with and without CMDs: participants with a CMD reported a greater number of barriers (median (md) =5, IQR=3-7) compared to those without CMDs (md= 1, IQR=0-4). A statistically significant difference was also found in total BARTA scores between participants with and without CMDs: participants with a CMD reported a greater BARTA score (md=7, IQR=4-12) compared to those without a CMD (md= 2, IQR=0-4; U=-7.415, p<0.001). The most frequent barriers reported by emerging adults living with HIV with probable CMDs were 'forgetting' (68.0%), 'thinking too much' (49.0%), 'having to take ART in front of others' (41.0%) and 'not having a reminder' (39.0%). The most frequent barriers for emerging adults living with HIV without probable CMDs were 'forgetting' (30%), 'not having medications with them' (21%), 'not wanting others to know their status' (20%) and 'not having a reminder' (19%). Although 'forgetting' and 'not having a reminder' were among the top barriers in both groups, those with probable CMDs reported them more frequently. Conclusion: This study has shown that firstly, CMDs and barriers to ART adherence are prevalent among emerging adults living with HIV. Secondly, emerging adults living with HIV with probable CMDs experience a high number of barriers to ART adherence and more severely than those without probable CMDs. Finally, emerging adults with CMDs reported barriers such as forgetting and not having a reminder more frequently than those without CMDs. This calls for routine screening for probable CMDs and barriers to ART adherence in HIV clinics. Furthermore, there is need to come up with tailored psychological interventions that can simultaneously treat CMDs and reduce barriers to ART adherence among emerging adults living with HIV.