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Background & Purpose: Sustaining an acquired brain injury (ABI) can often lead to admission to an inpatient rehabilitation program. The purpose of inpatient rehabilitation is to provide individualized, patient-centered therapy in order to facilitate community re-integration. Considering the patient perspective is beneficial for informing patient-centered care because clinicians and program administrators may develop greater awareness and understanding of patient needs and preferences. There is a lack of qualitative research investigating patient experiences and perspectives of ABI inpatient rehabilitation, and the majority of existing research was conducted in non-Canadian contexts. The present study was thus designed to describe and interpret patient experiences of an ABI inpatient rehabilitation program in urban Ontario. The purpose was to contribute to a patient lens that inpatient rehabilitation staff could consider in their work. Methods: An interpretive description approach was adopted for this qualitative study. Twelve participants were purposively sampled from a regional ABI rehabilitation program. They completed semi-structured interviews about their experiences. Interviews were transcribed, coded, and analyzed to identify major themes. Results: Three major themes were identified from the analysis and arranged around three time points. At the time point prior to admission to inpatient rehabilitation, the theme was “Life Rerouted,” where participants described their lives being diverted from what was “normal” after sustaining an ABI. Inpatient rehabilitation was seen as a way to return to their pre-injury life. The second theme described experiences within inpatient rehabilitation and was entitled, “Autonomy within Rehab.” Under this theme, participants emphasized the importance of personal autonomy over their choices and abilities while in rehabilitation, with three related sub-themes: interactions with clinicians, perceptions of institutional policy, and the involvement of family members. Under a minor theme, not directly related to aspects of autonomy, entitled “social comparisons,” participants also made comparisons of their recovery progress to other patients. The third and final theme reflected participants experiences just after discharge and was entitled, “Life (and Recovery) Go On.” Under this theme, participants described an ongoing recovery process leading to sentiments of both frustration and hope for the future. Discussion: An overarching key message was developed from these themes: “re-establishing personal identity is important to the recovery process.” Two theories (biographical disruption and relational autonomy) are used to interpret this message and describe the strategies and perspectives adopted by patients during inpatient rehabilitation as they attempted to cope with the psychosocial impacts of ABI on their lives. Conclusions: The findings of this study provide knowledge and a theoretical lens in which program staff can view and understand patients’ experiences, needs and preferences. These findings may enhance patient-centered care within the context of ABI inpatient rehabilitation. / Thesis / Master of Science (MSc)

The Affordable Care Act of 2010 proposed a new integrated care model for individuals with chronic mental illness and multiple medical comorbidities by using Behavioral Health Homes (BHH). The purpose of this doctoral project was to evaluate the effectiveness of the BHH in reducing emergency department (ED) use in the community mental health outpatient setting. Guided by the American Association for Critical Care Nurses synergy model for patient care a cross-sectional, post-test only with comparison group quasi-experimental research design was used. A de-identified data set of 68 patient records in the BHH group and 73 patient records in non-BHH as a control group were analyzed using logistic regression. The analysis revealed that participants in the BHH were statistically less likely to visit the ED. Sensitivity was 16.2%, specificity was 95.2%, positive predictive value was 54.5%, and negative predictive value was 76.2%. The Homer-Lemeshow and omnibus test of model coefficients showed the model was a good fit (p=.726, p=.007). Participants in BHH were .225 less likely to visit the ED. For every year of reduction in age, the odds of visiting the ED increased by a factor of 1.0. Females had a 1.8 higher odds of visiting the ED than males. This study provides evidence for the effectiveness of the BHH in reducing visits to the ED. Standard measures to track ED use in BHH are essential to understanding reasons for ED use and reducing nonurgent use. The BHH has the potential to transform health care delivery toward an all-inclusive model of care. Providers can utilize the findings of this project to promote social change by targeting patients with serious mental illness and reducing health disparities by emphasizing preventive care and eliminating barriers to care.

by Tse Kai Fat, Tsui Ping Tim. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 55-56). / ABSTRACT --- p.ii / TABLE OF CONTENT --- p.vi / LIST OF ILLUSTRATIONS --- p.viii / LIST OF TABLES --- p.ix / CHAPTER / Chapter I. --- INTRODUCTION / The Hong Kong Hospital Authority --- p.1 / What is Quality of Health Care Service? / Four Dimensional Approach --- p.3 / Quality -- Standard Medical Practice(A) --- p.4 / Quality -- Good Medical Outcome(B) --- p.5 / Quality -- Customer Satisfaction(C&D) --- p.6 / Quality and Cost Containment / Trade-off between Quality and Cost --- p.9 / Quality Management Reduces Healthcare Cost --- p.10 / Methodology --- p.11 / Malcolm Baldrige National Quality Award(MBNQA) --- p.12 / Chapter II. --- CORPORATE QUALITY MANAGEMENT IN THE HOSPITAL AUTHORITY / Corporate and Hospital Missions --- p.14 / Strategic Quality Management --- p.15 / Continuous Quality Management --- p.17 / Specific Corporate Quality Improvement Programs --- p.20 / Core Value Success Scheme --- p.21 / Dilemma Faced by the Hospital Authority --- p.23 / Chapter III. --- QUALITY MANAGEMENT IN PRINCESS MARGARET HOSPITAL / Hospital Background --- p.24 / Organisational Structure --- p.24 / Quality Management System --- p.25 / Leadership --- p.26 / Information and Analysis --- p.27 / Strategic Planning --- p.29 / Human Resource Development and Management --- p.31 / Process Management --- p.32 / Organisation Performance Results --- p.34 / Patient Satisfaction --- p.35 / Chapter IV --- QUALITY MANAGEMENT IN SHATIN HOSPITAL / Hospital Background --- p.36 / Quality Management System --- p.36 / Leadership --- p.39 / Information and Analysis --- p.39 / Strategic Planning --- p.40 / Human Resource Development and Management --- p.40 / Process Management --- p.41 / Organisation Performance Results --- p.42 / Patient Satisfaction --- p.43 / Chapter V. --- CRITIQUE AND RECOMMENDATIONS / Princess Margaret Hospital versus Shatin Hospital --- p.44 / The Hong Kong Hospital Authority --- p.46 / Corporate Strategy --- p.46 / Measurement of Quality --- p.47 / Staff Motivation --- p.48 / Total Quality Management and Cost Containment --- p.49 / APPENDIX --- p.50 / BIBLIOGRAPHY --- p.55

Patient-centred care has become an important model for health-care delivery, especially in cancer care. The implementation of this model includes patient-centred communication between the clinician and his or her patient. However, most research on patient-centred communication focuses on the clinicians’ initiative: what clinicians should do and what information they should seek to elicit from patients. It is equally important to recognize what each individual patient can contribute about his or her unique perspective on the disease, its treatment, and the effects on what is important to this patient. This thesis reports the development of a system for analyzing over 1500 utterances made by patients in eight video-recorded oncology consultations at the British Columbia Cancer Agency, Vancouver Island Centre. The analysis distinguishes between biomedical information that the patient can provide and patient-centred information, which contributes the individual patient’s unique perspective on any aspect of his or her illness or treatment. The resulting analysis system includes detailed operational definitions with examples, a decision tree, and .eaf files in ELAN software for viewing and for recording decisions. Two psychometric tests demonstrated that the system is replicable: high inter-analyst reliability (90% agreement between independent analysts) on a random sample of the data set and cross-validation to the remainder of the data set. A supplemental idiographic analysis of each consultation illustrates the important role that patient-centred information played in these consultations. This system could be an important tool for teaching clinicians to recognize the individual information that patients can provide and its relevance to their care. / Graduate / 0992 / 0451 / 0350 / shealing@uvic.ca

This thesis focuses on the role of middle managers in the transfer of a humanistic approach to management, care and services in a physical rehabilitation center.This thesis should interest decision makers and researchers who are paying attention to humanistic approaches to management, care and services. The design of this multi-case qualitative, exploratory and constructivist research includes six cases, representing the six middle managers of the studied organization. The multi-case study allows us to contrast cases of successful middle managers from the ones who were not really able to transfer the humanistic approach in their program. Data production and analysis are done with methods used in grounded theory. Here are the main findings generated by this thesis. Firstly, our analysis reveals that, in spite of top management efforts to disseminate a humanistic approach to management, care and services throughout the organizations the transfer process sometimes clashes against the absorptive capacity of the middle manager within the program. When the middle manager has the capacity to absorb the humanistic approach, often because it is compatible with his profound convictions, this capacity is first expressed through his behavioral exemplarity. In the eyes of his employees, the middle manager primarily represents an embodied example of the humanistic approach through his behavior. Therefore, the behavioral exemplarity of the middle manager came out as a sine qua non condition through which is possible the co-construction of new humanistic care and services practices to be offered to clients of the program. Secondly, our analysis sheds light on the importance, at the beginning of the transfer process, to explain to employees the necessity to adopt a humanistic approach to management, care and services and to recognize existing humanistic practices in the organization. Thirdly, the results bring to the forefront the importance of macro and micro contexts as determinant variables in the transfer of a humanistic approach to management, care and services. Lastly, an intervention model illustrating the key role of middle managers in the transfer of a humanistic approach to management, care and services emerges from the results. The model also includes contextual elements which facilitate the transfer. On a more practical note, the model can guide organizations in the dissemination process of such an approach by providing a rich description of the stages of the dissemination process, the actors involved, the dissemination strategies and the goals of these strategies.