A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Hospital Management, Johannesburg, September 2013 / ABSTRACT Background: Education, training and development plays a critical role in the socio-economic development of any nation. South Africa as a country is faced with ever growing challenges to produce the human resources (HR) that will contribute meaningfully to its economic stability and prosperity. In addition, for the Public Service to succeed in its mandate of providing effective and efficient service delivery for the citizens of the country, it needs to invest in training and development of its employees. For example, in terms of health services, a hospital is supposed to be comprised of multi skilled personnel so that it is able to deliver a package of health services to its population. In the Lehurutshe/Zeerust District Hospital Complex it is necessary to assess the skills of employees and develop them where necessary. Aims: To describe the levels of education and training of employees working in Lehurutshe/Zeerust Hospital Complex in 2011 and their future training needs to inform the skills development plan (SDP) for the Hospital Complex Methodology: A cross sectional study design based on a retrospective record review was used for this study. The setting of this study was Lehurutshe/Zeerust Hospital Complex in Ngaka Modiri Molema District in the North West Province. The study populations were the employees employed at the hospital complex at the time that the skills audit was conducted. This audit of hospital complex employees was conducted by the Human Resources Department (HRD) in April 2011. The data related to the study was retrieved from the skills audit documentation using a data collection tool. Data on the following variables was collected: profile of employees, their formal and informal education and their training needs. The collected, validated data was analysed using the Epi- Info 8 software. Results: Out of three hundred and fourteen (314) employees working at the hospital complex, only one hundred and twenty two (39%) completed the skills audit survey from the HRD. The data provided an overview of current training and education of employees and their future needs. Out of 122 employees who responded to the skills audit, sixty-two had post matric qualifications. Most of the post matric qualifications were in nursing field. Eleven employees (9%) are currently registered for post matric qualifications. Most of the employees completed grade twelve at 64.2 percent and only 1 (0.8%) was registered to advance their schooling. Twenty (16.4%) employees received informal training outside of the hospital whilst 52 (43%) employees received training that was inside the hospital, and training outside the hospital occurred less frequently. Sixty-two employees (51%) wanted to have more training and specified the type or types of training they wanted to have. Clinical type of training was at 65%, academic type of training was at 55% and management and communication types of trainings were at 60% each. Conclusion: The study did not only provide the hospital and provincial management with input in relation to the training and development of its staff, but will also serve as a basis for the department’s SDP. The SDP is meant to assist employees of the Hospital Complex, through training and education, to optimally provide patient care and ultimately improve services. The information and the recommendations made from the research will assist the health planners at various levels like the district, provincial and national level, in prioritizing training and development for health employees.

BACKGROUND: Lehurutshe Hospital is a district hospital situated in rural North West Province of South Africa. The Hospital offers basic radiological services such as X-rays of the chest, abdomen, extremities and skull according to the norms and standards set by the National Department of Health for a level one hospital. According to 2008/2009 data from the Hospital, it is evident that the number of patients requiring radiology services is increasing. However, no systematic study has been done to determine the reasons and effects of this increasing caseload on the Radiology Unit of the Hospital. This study seeks to establish the caseload and the resources utilised for the services rendered by the Radiology Unit in Lehurutshe Hospital with specific focus on the patient profile and material and human resources utilisation. AIM: To assess the utilization of the Radiology Unit at Lehurutshe Hospital in terms of caseload, profile of patients, and resource utilization from 01 January to 31 December 2009 METHODOLOGY: This was a cross sectional study. The setting was the Radiology Unit of the Lehurutshe Hospital in Zeerust town, Ngaka Modiri Molema District in the North West Province. A retrospective record review was done and information was extracted from the Hospital information system on various variables that are relevant to the functions and resource utilization of the Radiology Unit, including caseload, profile of patients, resource utilization and workload of staff. No primary data was collected. RESULTS: The study found that more than 5000 patients were seen and radiological examinations were done during this period with a total number of public patients being significantly higher than private patients. Nearly 500 radiological examinations were done per month. The wide variation in the number of examinations done per month was probably due to seasonality, which may affect operational planning and inventory management at the Unit. Almost 50% of the radiological examinations were chest X-rays. Other examinations include X-ray of the upper and lower extremities and ultrasound examination for obstetrics and gynaecology. These examinations were done based on various clinical indications. A significant number of public patients seen at the Unit were infants, children and teenagers. The private patients were from an older age group. The majority of patient were unemployed and indigent. The material resources used in the Unit includes X-ray films, chemicals (developers and fixers) and ultrasound gel. The Unit has two radiographer and one radiographer assistant. In addition, a medical doctor read the X-rays as and when necessary. The direct costs incurred at the unit include use of material resources, maintenance of equipments (service contract) and compensation of employees. Total direct cost during the study period was R 650 803.89, most of which were incurred due to compensation of employees and maintenance of radiological equipments. Patient to staff ratio at the unit was quiet low and it shows there is spare capacity at the Unit, which could easily be used for income generation by the provision of services to private patients. CONCLUSION: This is probably the first study conducted at a radiology unit of a district hospital in South Africa. This study documented important information, which was not published before.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Public Health (Hospital Management) Johannesburg, August 2014 / Background Tuberculosis (TB) remains a major cause of disease and death worldwide. In 2008, South Africa ranked third in the world in terms of the total numbers of new TB cases. Little is known about the profile of TB deaths at individual hospital level. Hence, the aim of the study was to describe the profile of TB deaths in Charles Hurwitz TB Hospital for the period January to December 2007. Methods A descriptive study was done, based on retrospective record review of all patients who died between January and December 2007 at Charles Hurwitz TB Hospital, irrespective of the date of admission. The data was analysed using Microsoft Excel. Findings The mean age at death was 41 years (standard deviation =10.9 years). Less than half of deceased individuals were employed (43.4%), more than one third had a history of smoking (42%) and the majority had a history of alcohol consumption (60.5%). Almost three quarters of the patients (75.3%) were being treated for the first time. The majority (85.1%) of deceased patients tested for HIV were HIV positive, but only 23.3% of those referred for treatment were actually on ART, indicating missed opportunities in treatment and care at the hospital. Conclusion There is need for ongoing vigilance and training to ensure that TB hospitals and individual health care providers comply with the national quality of care and TB management standards, and that missed opportunities are eliminated to reduce avoidable TB deaths.

No description available.

Esta pesquisa psicanalítica é fruto dos questionamentos e inquietações que foram surgindo ao longo da prática e percurso teórico-clínico do autor como psicólogo da Clínica de Atendimento psicológico, órgão auxiliar do Instituto de Psicologia da Universidade Federal do Rio Grande do Sul, muito especialmente no que tange à sua trajetória no Núcleo de Ensino, Pesquisa e Extensão em Clínica das Psicoses – inicialmente como membro da equipe técnica e atualmente como membro da comissão de coordenação da ação de extensão referida – e a implantação de seu “hospital-dia”. Pode-se afirmar que ao longo de uma considerável parte da história da Psicanálise, a operacionalidade da transferência na psicose esteve questionada. Em sua época, Freud considerou que com a Psicanálise se podia entender muito melhor as psicoses, mas que não haveria como tratá-las. Ainda que Lacan, a partir de seu ensino, tenha legado operadores que ajudam o psicanalista a se situar nas especificidades dessa clínica tão delicada, resta perceptível que a questão da transferência na psicose se afigura ainda hoje como problemática em termos teóricos, ensejando discordâncias e questionamentos. Neste contexto, o autor considerou indispensável uma investigação que pudesse delimitar as especificidades da transferência em sujeitos estruturados pela via da psicose, delineando certos aspectos da posição do analista em relação ao sujeito psicótico e as possibilidades de intervenção desde o lugar a ele destinado. A contribuição de diversos autores filiados à Psicanálise sobre o tema, articulada às vivências potencialmente clínicas do autor nos diferentes dispositivos do hospital-dia, dão ensejo a uma série de ensaios relacionados à transferência na psicose, sendo o objetivo principal da pesquisa a apropriação, no sentido da Erfahrung (Laplanche apud Iribarry, 2003) deste conceito psicanalítico fundamental, buscando oferecer uma contribuição não limitada à confirmação da teoria. / This psychoanalytic research is result of questions and issues tha have emerged over the author´s theoretical and clinical experience as a psychologist in the Clínica de Atendimento Psicológico (Clinic of Psychological Care), Auxiliary Body of the Instituto de Psicologia (Psychology Institute) of the Universidade Federal do Rio Grande do Sul (Federal University of Rio Grande do Sul), notably referring to his professional path in the Núcleo de Ensino, Pesquisa e Extensão em Clínica das Psicoses (Nucleus for Teaching, Reaserch and Extension on the Psychoses Clinic)– initially as a member of the technical staff and currently as a member of the coordination commission of the above-mentioned extension action – and its Day Hospital implementation. One can affirm that, over a substantial part of Psychoanalysis History, the functionality of the transference on psychoses has been questioned. In his days, Freud has considered that by means of Psychoanalysis one could better understand the psychoses, but there was no possible treating. Although Lacan, through his teaching, had bequeathed operators that could help locating the psychonalist on the particularities of a such challenging clinics, it’s still evident that the matter concerning the transference on psychoses remains, even today, as a problematic issue in theorical terms, entailing disagreements and questionings. In this context, the author has considered imperative an investigation capable of delimiting the especificities of the transference on subjects structured by psychoses, delineating certain aspects on the analists’ position regarding to the psychotic subject and the possibilities of intervention from his fated place. The contribution of many authors affiliated to Psychoanalysis about the issue, articulated to the author’s potentially clinical experiences on the Day Hospital devices, lead to a number of essays related to the transference on psychosis, being the main focus of the reasearch the ownership, in the sense of an Erfahrung (Laplanche apud Iribarry, 2003) of this fundamental psychoanalytic concept, seeking to offer a contribution not limited to the confirmation of the theory.

Hospitals come under the focus of health planners and policy makers because they invariably consume large and increasing amounts of health care resources and performance is commonly believed to fall short of that possible. The common response by governments to this situation has been to implement hospital reforms. However, emerging evidence from impact evaluations of such reforms shows little clear evidence of performance enhancement. It is argued in this study that hospital reforms in most countries are implemented without enough understanding of current performance, or knowledge of hospital behaviour. Such information is necessary for effective design, implementation and evaluation of reforms. The aim of the study was to measure hospital performance and contribute to the understanding of its determinants. The role of internal organisation and management to hospital performance has been underplayed in most studies such that the workings of the hospital remain a "black box". The study sought to demonstrate that understanding hospital performance entails understanding not only the technical relationships of dimensions of hospital performance but also the institutional context, and behaviour of individuals or groups within it who ultimately shape hospital behaviour. A multiple case study approach was used to study six tertiary hospitals in Zimbabwe. Hospital performance was first assessed through analysis of utilisation statistics. This was followed by an assessment of two dimensions of hospital performance: costs and quality of inpatient services. Costs were measured using standard cost accounting methods at hospital, ward and patient level. At patient level, a combination of. prospective micro-costing and top-down costing methods was applied to cohorts of patients suffering from selected tracer diseases: 207 malaria and 158 pulmonary tuberculosis cases. The quality of hospital inpatient services was also measured at hospital and patient level using structural and process approaches. The relationship between cost and quality of services was then explored at patient level using tracer conditions. A triangulation of methods was then used to explore internal organisation and management: staff interviews, observations, attendance at hospital meetings and review of administrative records. Analysis of activity statistics showed that the six hospitals had different levels of activity although they had similar roles in the referral hierarchy. Distinctive unit cost patterns were observed across the hospitals. Unit cost variation across hospitals was generally similar at hospital, ward and patient level. The results from the analysis of activity statistics were predictive of hospital cost classifications. The quality of hospital services varied across hospitals from both structural and process perspectives. There was little convergence in results from hospital level structural quality assessment, and process quality assessment. Cost-quality relationships in inpatient care showed a distinct pattern across tracer diseases, which permitted classification of the six hospitals into three performance categories. These classifications were used to relate quantitative and qualitative results of the study. The institutional contexts within which public hospitals in Zimbabwe operate is explored and described. There are fundamental policy design weaknesses related to the way hospitals are financed, governed and managed, which affect hospital performance. Hospital staff appears apathetic about hospital performance because of lack of appropriate incentives. Several hospital internal factors were reported as impinging on hospital performance. These factors can broadly be summarised as lack of management capacity and skills, inappropriate internal organisational and management structures, and staff reward systems. The current incentive structure at individual and institution level does not engender performance improvement. Relative hospital performance did not vary systematically with different institutional characteristics. For instance, compliance or non-compliance with mandated organisation and management structures did not account for performance differences whilst weak associations were found between relative performance, and differences in management capacity and skills. The absence of direct relationships between institutional characteristics and relative performance was not unexpected given the exploratory nature of the study and the possible multiple interrelationships between these factors Nonetheless, the study systematically describes and exposes current weaknesses in the internal structure of public hospitals in Zimbabwe, and identifies those internal organisational and management features considered important to performance. The study concludes that there is considerable scope for improving hospital efficiency and quality of services (with available resources) by changing internal organisation and management of hospitals. Of particular importance is the need to change and align incentives (monetary and nonmonetary) at both individual and institution level in ways that promote performance improvement.

Foi analisada a totalidade das saídas (105.116) de pacientes dos 31 hospitais de assistência hospitalar geral da 3a. Região Administrativa do Estado de São Paulo, no ano de 1975, segundo as variáveis: hospital, procedência, idade, sexo, condição de saída, fontes de financiamento e tempo de permanência, sempre relacionadas ao diagnóstico principal. As causas de internação mais freqUentes foram em primeiro lugar as relativas à gravidez, parto e puerpério (27,1 por cento ), seguidas pelas doenças do aparelho respiratório (11,4 por cento ), doenças do aparelho circulatório (8,9 por cento ) e doenças infecciosas e parasitárias (8,2 por cento ). A grande maioria dos atendimentos foi feita no próprio município de residência (83,8 por cento ); os porcentuais de residentes fora do município de atendimento mais significativos foram os referentes às neoplasias e doenças do sistema nervoso e órgãos dos sentidos. Não houve diferença no comportamento das internações quanto ao sexo, quando excluídas as doenças da gravidez, parto e puerpério, sendo que os maiores coeficientes de saídas foram dos grupos etários extremos: menores de 1 ano e maiores de 65 anos. Nos primeiros, o grupo de causas mais importante foi o das infecciosas e nos últimos, o das doenças circulatórias. O coeficiente de mortalidade hospitalar do Vale do Paraíba foi 2,8 por 100 saídas, variando bastante na dependência dos diagnósticos, das idades e fontes de financiamento. Estas se mostraram com distribuição diferenciada nas internações do Vale, mesmo quando analisadas\'por diagnósticos ou idade. O tempo médio de permanência se mostrou diferente nas internações pagas pelas várias fontes, assim como na dependência de cada hospital, de grupos etários (os extremos foram maiores), sexo e condição da saída. O fato de serem ou não os pacientes procedentes do próprio município de atendimento, não interferiu no resultado da duração média de permanência. / The total of 105.116 hospital discharges from 31 hospitals belonging to the Third Administrative Region of the State of São Paulo (Vale do Paraiba), Brazil, ocurred in 1975, were analyzed according to the following variables: hospital, origin (patient\'s place of residence), age, sex, health status of the patient discharged, sources of financing and length of stay, always related to the main diagnose. The leading causes of hospitalization were (ICD-9): - complications of pregnancy, childbirth and the puerperium (27.1 per cent ) - diseases of the respiratory system (11.4 per cent ) - diseases of the circulatory system (8.9 per cent ) - infective and parasitic diseases (8.2 per cent ) The majority of the attendances was done in the same city of the patients\' residence (83.8 per cent ) except for neoplasms and diseases of the nervous system and sense organs. No difference was found in the analysis of the hospitalizations by sex, when\'excluded complications of pregnancy, childbirth and the puerperium. The group of patients under one year and 65 years and over showed highest hospitalization rates. The leading cause of hospitalization within the first group was infective and parasitic diseases and within the second group, diseases of the circulatory system. The hospital mortality rate was 2.8 deaths per hundred discharges for the Vale do Paraiba as a whole, having a large variability according to the diagnoses, the patients age and the financial source. The average length of stay varied with financial source, the hospital, patients\' age (the more prolonged stays were those of the youngest and oldest age group), sex and health status at the moment of discharge. Average length of stay did not vary when taking into account the fact that patient was or was not hospitalized in his own city of residence.

Thesis (M Med (Psychiatry))--University of Limpopo (Medunsa Campus), 2010. / The aim of the study was to establish a profile of psychiatric illnesses that are encountered during consultation-liaison (C-L) psychiatry and to describe interventions undertaken. The objective was to identify referral patterns, establish the referral rate, and to profile the diagnoses & describe the actions taken by the consulting doctor. This was a retrospective cross-sectional descriptive study conducted on all inpatients that were referred to psychiatry from other disciplines in the hospital for the 12 month period January to December 2009. The study was conducted at Dr George Mukhari Hospital, which is a tertiary psychiatric unit which caters for mental health care users in the Garankuwa , Soshanguve and Mabopane region. The study found that the referral rate to psychiatric C-L services was lower than at other institutions. Amongst the referred patients, there was a high incidence of organic brain syndrome diagnoses, but a low rate of depression. The study proposed further investigation into the reasons behind the low rate of referral and low rate of depression, so as to improve C-L service delivery in the hospital.

Thesis (B.Sc)--University of Hong Kong, 2006. / Includes bibliographical references (p. 94-102)

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: School of Allied Health Professions. Bibliography: leaves 140-150.