Thesis (M.S.)--Boston University

This dissertation looks beyond the asylum to consider the development of psychiatry in French Indochina as the product of everyday exchanges between lay people and experts. Drawing on archival research conducted over two years in Vietnam and France - including hundreds of patient case files - I trace the movements of patients in and out of asylums and between prisons, poor houses, youth reformatories, hospitals and family homes. Together, these individual patient itineraries challenge our notion of the colonial asylum as a closed setting where patients rarely left, run by experts who enjoyed broad and unquestioned authority. Instead, they reveal how ideas about what it meant to be abnormal, as well as normal enough to return to social life, were debated between psychiatrists, colonial authorities and the public throughout the early decades of twentieth century. By examining the dynamics of patient movements in and out of psychiatric care, this study shifts our perspective from the asylum itself to its relationship with the world beyond its walls. Colonial scholars have focused on the way psychiatry provided a new scientific discourse of racial difference and how it figured within a wider biopolitics of colonial rule. However the social histories of the asylums themselves, and how they functioned within colonial political systems, remain little explored. I argue that by situating the history of psychiatry within the local dynamics of colonial rule, the asylum emerges as less of a blunt instrument for the control and medicalization of colonial society than as a valuable historical site for reframing narratives of colonial repression and resistance.

Digitized by Kansas Correctional Industries

This research investigated a new community-based model of continuity of care provided collaboratively by a small team of midwives and obstetricians (St George Outreach Maternity Project or STOMP). The study considered whether STOMP improved maternal and neonatal clinical outcomes, resulted in a better experience for women and could be implemented within the current resources of a public teaching hospital in Sydney, Australia. A randomised controlled trial using a Zelen design was used to compare the STOMP model with standard care. One thousand and eighty-nine women were randomly allocated to either the STOMP model or standard hospital-based care. The Zelen design was used to increase the participation of women from non-English speaking backgrounds and to reduce disappointment bias in women allocated to the control group. The results suggest that the model of community-based continuity of care is associated with a lower caesarean section rate, more positive experiences for women and costs less than standard care. There were no differences in the number of medical complications experienced in either group, but more women in the control group were admitted to hospital during the antenatal period. There were four perinatal deaths in each group. Women in the STOMP group reported a higher quality of antenatal care compared with the control group. Women in the STOMP group also reported that the community-based service was accessible and convenient with reduced waiting times for appointments. Women in the STOMP group were more likely to have received adequate information about labour, birth and the postnatal period and felt more 'in control' during labour compared with the control group. Women from both groups reported problems with postnatal care, particularly when provided in the hospital. The study also examined the impact of the STOMP model on women from Chinese and Arabic-speaking backgrounds. The STOMP model appeared to reduce the rate of elective and emergency caesarean section in Chinese-speaking women compared with English-speaking women. Small numbers precluded statistical analysis on these data so the results must be interpreted with caution. Women from Chinese-speaking backgrounds reported receiving insufficient information. The STOMP model improved the provision of information, however Chinese-speaking women still reported inferior experiences. There were also differences in the method of infant feeding. The results indicate that the model provides effective, cost efficient and satisfying maternity care. New models of maternity care can be implemented within current resources when organisations have a strong commitment to change.

This research investigates adoption and integration of a range of building environmental systems in healthcare facilities in India. Based on detailed case studies of eight selected healthcare facilities developed at different times in India, this research traces the evolution of hospital designs in a specific geographic context through the lens of adoption of building environmental systems over the internal shell and external skins of healthcare buildings in India. By documenting and analyzing changes in building designs over time, the research develops a comparative understanding of trends of adoption of environmental technologies and their impacts on building form and performance.

The continued development of Facilities Management (FM) as a profession largely depends on it playing a stronger strategic role in the decision-making of organisations. This requires the capability of better understanding the clients' facility needs and requirements, which ultimately means that Facilities Managers must learn about the nature of clients' organisations and their organisational cultures. This study contends that in a project it is the briefing process that provides the greatest opportunity for cultural learning to occur, a process wherein it is important for the actors to converge upon shared understanding of facility needs and requirements. By focusing on culture at a cognitive rather than a behavioural level, this study has specifically attempted to identify the types of knowledge learned during a briefing process, to explore the process of cultural learning and the factors that encourage or impede such learning, and to produce an insight into the process. A hospital partnering project was adopted as a case study for investigating the process of cultural learning during the briefing process. Using Nonaka's (1994) theory of Knowledge Creation, this study portrays the briefing process as one wherein the social processes during briefing facilitate the conversion of tacit and explicit knowledge in a cyclical way. Sackmann's (1991) categorisation of knowledge has been used to analyse the social interactions during briefing by dissecting the different levels of knowledge being shared. In support of the cognitive perspective of learning and the conceptual understanding of culture as mindsets or cognitions, Laukkanen's (1996) Comparative Cause Mapping method was used to measure the cultural learning occurring among members of both the FM and their clients' groups, using an in-depth inquiry into five key concepts during the briefing process. Data was collected longitudinally during the briefing process using real-time observations and semi-structured interviews which maximised the comparative measures of similarities and differences in the Cause Maps depicting cultural learning. This integration of culture, learning, and briefing theories usmg Nonaka's (1994) knowledge creation theory, Sackmann's (1991) categorisation of knowledge, and Laukkanen's (1996) Comparative Cause Mapping method has produced interesting and useful insights into the process of cultural learning during the briefing process within a hospital partnering project. The study has found that significant cultural learning did take place during the briefing process and that partnering projects can present opportunities for this to occur. In particular, it is established that cultural learning is best conceived of as a process of social construction in which individuals, subgroups and groups engage in a collective approach to understanding facility needs and requirements. More specifically, briefing meetings were found to represent contexts for social interactions in which cultural learning took place. This learning occurred in constantly negotiated boundaries and through conflicts and disagreements, with actors competing in a dynamic process of social construction to have their version of understanding of the clients' needs and requirements prevail. The diverse client groups within the hospital context being studied provided a management opportunity for Facility Managers to act as 'mediators', which facilitated cultural learning. Finally, FM technical knowledge was shown to be an important tool for the FM group during the process of cultural learning as the participants negotiated their versions of knowledge.

The continued development of Facilities Management (FM) as a profession largely depends on it playing a stronger strategic role in the decision-making of organisations. This requires the capability of better understanding the clients' facility needs and requirements, which ultimately means that Facilities Managers must learn about the nature of clients' organisations and their organisational cultures. This study contends that in a project it is the briefing process that provides the greatest opportunity for cultural learning to occur, a process wherein it is important for the actors to converge upon shared understanding of facility needs and requirements. By focusing on culture at a cognitive rather than a behavioural level, this study has specifically attempted to identify the types of knowledge learned during a briefing process, to explore the process of cultural learning and the factors that encourage or impede such learning, and to produce an insight into the process. A hospital partnering project was adopted as a case study for investigating the process of cultural learning during the briefing process. Using Nonaka's (1994) theory of Knowledge Creation, this study portrays the briefing process as one wherein the social processes during briefing facilitate the conversion of tacit and explicit knowledge in a cyclical way. Sackmann's (1991) categorisation of knowledge has been used to analyse the social interactions during briefing by dissecting the different levels of knowledge being shared. In support of the cognitive perspective of learning and the conceptual understanding of culture as mindsets or cognitions, Laukkanen's (1996) Comparative Cause Mapping method was used to measure the cultural learning occurring among members of both the FM and their clients' groups, using an in-depth inquiry into five key concepts during the briefing process. Data was collected longitudinally during the briefing process using real-time observations and semi-structured interviews which maximised the comparative measures of similarities and differences in the Cause Maps depicting cultural learning. This integration of culture, learning, and briefing theories usmg Nonaka's (1994) knowledge creation theory, Sackmann's (1991) categorisation of knowledge, and Laukkanen's (1996) Comparative Cause Mapping method has produced interesting and useful insights into the process of cultural learning during the briefing process within a hospital partnering project. The study has found that significant cultural learning did take place during the briefing process and that partnering projects can present opportunities for this to occur. In particular, it is established that cultural learning is best conceived of as a process of social construction in which individuals, subgroups and groups engage in a collective approach to understanding facility needs and requirements. More specifically, briefing meetings were found to represent contexts for social interactions in which cultural learning took place. This learning occurred in constantly negotiated boundaries and through conflicts and disagreements, with actors competing in a dynamic process of social construction to have their version of understanding of the clients' needs and requirements prevail. The diverse client groups within the hospital context being studied provided a management opportunity for Facility Managers to act as 'mediators', which facilitated cultural learning. Finally, FM technical knowledge was shown to be an important tool for the FM group during the process of cultural learning as the participants negotiated their versions of knowledge.

Thesis (M. Nurs.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 117-132).

published_or_final_version / Public Health / Master / Master of Public Health

The existing financing model is not going to be sustainable for the ageing demographic in the future Hong Kong. In regards, Government suggested a voluntary and government-regulated health insurance scheme to provide more choices with better protection for those who are able and willing to pay for private healthcare services. However, performance of the Hong Kong health system is rarely discussed despite vast health expenditure has been spent. The objective of this project is to identify the strength, weakness, opportunities and threats of the hospital performance management system in Hong Kong. The project involves a literature search for key success factors for performance management systems in healthcare. The SWOT analysis of the hospital performance management systems in Hong Kong are then analyzed with reference to the findings. Findings: Six success factors could be identified: position in the policy process and defined objectives, process of development, indicator validity, reliability, responsiveness and feedbacks. The public hospital system has partially incorporated these factors in its system but a structured performance monitoring and management system is lacking for the private sector. The current Hong Kong hospital performance systems are not able to provide adequate information for the payers to make the appropriate choice. There is an urging needs to develop a robust and transparent performance management system in Hong Kong in order to support healthcare reform. / published_or_final_version / Public Health / Master / Master of Public Health