Problem: Continuous improvement is important in modern healthcare to control increasing costs and fulfil the demand for higher quality. This requires interdisciplinary collaboration between healthcare professionals. However, these professions are seeking to maintain and improve their social status through a ‘professional project’. There are existing professional barriers based on historical privileges and boundaries, leading to nurses holding lower status. The extent to which this motivates medical professionals and nurses in particular to be involved in continuous improvement is unclear. Is it that nurses are driven to become involved in continuous improvement by their ‘professional project’, and is there any evidence that involvement in continuous improvement benefits their status? Purpose: This thesis explores (a) the effect that the ‘professional project’ of nursing, gaining relative equality with doctors, has on involvement in continuous improvement activities, and (b) how involvement in continuous improvement activities affects the status of nurses relative to doctors.  Method: This qualitative study has been performed through an interview study based on themes, on the topic of improvement in healthcare. The empirical data is gathered through semi-structured interviews conducted with professionals from Sweden, New Zealand and The Netherlands. The participants were active within Hospitals and Primary Care, and had the position of nurse, manager or doctor. Data was analysed using the Thematic Analysis approach as proposed by Braun & Clarke (2006).  Findings: The results of our research suggest that nurses’ status has certainly improved. However, rational status-seeking described by many other researchers, could be better described as ‘seeking a voice’. Nurses are driven by ambition and improving patient care, rather than seeking strict equality with doctors. Continuous improvement has given nurses the opportunity to take on more technical roles and have more input on the way medical tasks are conducted. Enhanced communication between all levels of healthcare organisations has given nurses the opportunity to show their knowledge. It has resulted in more understanding and respect by doctors of what nurses are capable of. Nurses are highly motivated to participate in continuous improvement, driven by the common logic of patient centricity. However, external factors such as limited time and financial support slow them down.

No description available.

Abstract Developments in information technology have had a big impact in healthcare, producing vast amounts of data and increasing demands associated with their secure transfer, storage and analysis. To serve them, biomedical data need to carry patient information and records or even extra biomedical images or signals required for multimodal applications. The proposed solution is to host this information in data using data hiding algorithms through the introduction of imperceptible modifications achieving two main purposes: increasing data management efficiency and enhancing the security aspects of confidentiality, reliability and availability. Data hiding achieve this by embedding the payload in objects, including components such as authentication tags, without requirements in extra space or modifications in repositories. The proposed methods satisfy two research problems. The first is the hospital-centric problem of providing efficient and secure management of data in hospital networks. This includes combinations of multimodal data in single objects. The host data were biomedical images and sequences intended for diagnoses meaning that even non-visible modifications can cause errors. Thus, a determining restriction was reversibility. Reversible data hiding methods remove the introduced modifications upon extraction of the payload. Embedding capacity was another priority that determined the proposed algorithms. To meet those demands, the algorithms were based on the Least Significant Bit Substitution and Histogram Shifting approaches. The second was the patient-centric problem, including user authentication and issues of secure and efficient data transfer in eHealth systems. Two novel solutions were proposed. The first method uses data hiding to increase the robustness of face biometrics in photos, where due to the high robustness requirements, a periodic pattern embedding approach was used. The second method protects sensitive user data collected by smartphones. In this case, to meet the low computational cost requirements, the method was based on Least Significant Bit Substitution. Concluding, the proposed algorithms introduced novel data hiding applications and demonstrated competitive embedding properties in existing applications. / Tiivistelmä Modernit terveydenhuoltojärjestelmät tuottavat suuria määriä tietoa, mikä korostaa tiedon turvalliseen siirtämiseen, tallentamiseen ja analysointiin liittyviä vaatimuksia. Täyttääkseen nämä vaatimukset, biolääketieteellisen tiedon täytyy sisältää potilastietoja ja -kertomusta, jopa biolääketieteellisiä lisäkuvia ja -signaaleja, joita tarvitaan multimodaalisissa sovelluksissa. Esitetty ratkaisu on upottaa tämä informaatio tietoon käyttäen tiedonpiilotusmenetelmiä, joissa näkymättömiä muutoksia tehden saavutetaan kaksi päämäärää: tiedonhallinnan tehokkuuden nostaminen ja luottamuksellisuuteen, luotettavuuteen ja saatavuuteen liittyvien turvallisuusnäkökulmien parantaminen. Tiedonpiilotus saavuttaa tämän upottamalla hyötykuorman, sisältäen komponentteja, kuten todentamismerkinnät, ilman lisätilavaatimuksia tai muutoksia tietokantoihin. Esitetyt menetelmät ratkaisevat kaksi tutkimusongelmaa. Ensimmäinen on sairaalakeskeinen ongelma tehokkaan ja turvallisen tiedonhallinnan tarjoamiseen sairaaloiden verkoissa. Tämä sisältää multimodaalisen tiedon yhdistämisen yhdeksi kokonaisuudeksi. Tiedon kantajana olivat biolääketieteelliset kuvat ja sekvenssit, jotka on tarkoitettu diagnosointiin, missä jopa näkymättömät muutokset voivat aiheuttaa virheitä. Siispä määrittävin rajoite oli palautettavuus. Palauttavat tiedonpiilotus-menetelmät poistavat lisätyt muutokset, kun hyötykuorma irrotetaan. Upotuskapasiteetti oli toinen tavoite, joka määritteli esitettyjä algoritmeja. Saavuttaakseen nämä vaatimukset, algoritmit perustuivat vähiten merkitsevän bitin korvaamiseen ja histogrammin siirtämiseen. Toisena oli potilaskeskeinen ongelma, joka sisältää käyttäjän henkilöllisyyden todentamisen sekä turvalliseen ja tehokkaaseen tiedonsiirtoon liittyvät haasteet eHealth-järjestelmissä. Työssä ehdotettiin kahta uutta ratkaisua. Ensimmäinen niistä käyttää tiedonpiilotusta parantamaan kasvojen biometriikan kestävyyttä valokuvissa. Korkeasta kestävyysvaatimuksesta johtuen käytettiin periodisen kuvion upottamismenetelmää. Toinen menetelmä suojelee älypuhelimien keräämää arkaluontoista käyttäjätietoa. Tässä tapauksessa, jotta matala laskennallinen kustannus saavutetaan, menetelmä perustui vähiten merkitsevän bitin korvaamiseen. Yhteenvetona ehdotetut algoritmit esittelivät uusia tiedonpiilotussovelluksia ja osoittivat kilpailukykyisiä upotusominaisuuksia olemassa olevissa sovelluksissa.

This dissertation examines the effects of physician ownership of hospitals on the quality of patient-centric care in the U.S. The health care sector in the U.S. is becoming more aligned with markets and in turn, with consumers’ preferences. In consumer driven service industries, consumer satisfaction is considered a key criterion to judge quality. In the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction surveys, physician-owned hospitals (POHs) get more top 5-Star ratings than other hospitals. However, it is not known whether higher perceived patient satisfaction is because of better inpatient experience or due to better health related outcomes. Ratings also do not clarify variations between specialty and general service POHs. The study compares the quality of care in POHs with that in other major forms of hospitals (corporate-owned, and not-for-profit). The Affordable Care Act (ACA) regulated physician ownership of hospitals due to concerns that physicians’ profit motive might negatively affect the quality of care. This non-experimental study used bivariate and multivariate analyses to examine variation in the quality of care among types of hospitals in 2017 and 2018 using patient satisfaction and clinical outcomes as indicators of quality. This study used two samples, a full and a restricted sample. Full sample compared all POHs (specialty and general service) with other hospitals. Restricted sample included only general service hospitals. Patients in POHs were found to have higher perceived satisfaction, and viewed providers’ practices more favorably in the full sample. In the restricted sample, however, not-for-profit (NFP) hospitals provided relatively better care. Corporate-owned hospitals had lowest patient satisfaction and poorest outcomes. Results indicate POHs are competitive with not-for-profit hospitals on patient satisfaction dimension of quality care. Multivariate analyses suggest that the effects of physician ownership go away when mediation by providers’ practices is considered. NFP hospitals, however, continue to provide better overall value of care. The results do not support reconsideration of the ACA restrictions on POHs. Patient satisfaction may be contingent upon patient-centric practices than type of hospital, but hospital ownership may affect preference for some practices over others. Outcomes may not matter when patients’ perceptions measure quality. / Ph. D. / The health care sector is becoming more closely linked to markets, and consumer experience and satisfaction, like any other consumer services industry due to growing influence of for-profit hospitals and hospital forms. Physician-owned hospitals are a relatively new form of hospitals in the U.S. Along with more traditional not-for-profit and corporate-owned hospitals; physician-owned hospitals compete for patients and patient dollars. Many physician-owned hospitals are specialty and surgical hospitals, in addition to general service hospitals. According to federal government surveys, patients usually perceive medical care provided by physician-owned hospitals to be of superior quality to that of other kinds of hospital. However, physician-owned hospitals are a type of for-profit hospital, and it is not clearly known if general service physician owned hospitals provide similar care as specialty hospitals. This research compared possible quality differences between specialty and general service physician-owned hospitals as well as with corporate-owned and not-for-profit hospitals. The results indicate that patients’ perceptions of quality of care are not consistent for physician-owned specialty and general service hospitals; the higher patient perception ratings for physician-owned hospitals reflect the better performance of specialty hospitals. In comparison with other hospitals, not-for-profit hospitals seem to provide better quality of care (tapped by both patient satisfaction and clinical outcomes) than for-profit hospitals. Corporate-owned hospitals were found to have lowest quality of care. Patients should consider tradeoffs between having better inpatient experiences and better outcomes of care.

No description available.

No description available.