Abstract This thesis set out to achieve the following objectives: (1) To identify the priorities and expectations that the Geelong community has of its public health care system. (2) To determine if there is a common view on the attributes of a just health system. (3) To consider a method of utilising the data in the determination of health care priority setting in Barwon Health. (4) To determine a model of community participation which enables ongoing input into the decision making processes of Barwon Health. The methodology involved a combination of qualitative and quantitative research. The qualitative work involved the use of focus groups that were conducted with 64 members of the Geelong community. The issues raised informed the development of the interview schedule that was the basis of the quantitative study, which surveyed a representative sample of 400 members of the Geelong community. Prior to reporting on this work, the areas of distributive justice, scarcity and community participation in health care were considered. The research found that timely access to public hospitals, emergency care and aged care services were the major priorities; for many people, the cost was less relevant than a quality service. Shorter waiting times and increased staffing levels were strongly supported. Increased taxes were nominated as the best means of financing the health system they sought. Community based services were less relevant than hospital services but health education was supported. An egalitarian approach to resource distribution was favoured although the community was prepared to discriminate in favour of younger people and against older people. There was strong support for the community to be involved in decision making in the public health care system through surveys or focus groups but very little support was given to priorities being determined by politicians, administrators and to a lesser extent, medical professionals.

<p>The possibility to be able to better manage the Swedish public health care has been a focus from way back to the middle of the 20th century. This study focuses on a middle managerial position called Base-unit Executive Officer, which we feel is of great influence to the public health care. Because of the changes to the public health care organisations over a long period of time we find it important and interesting to research a managerial role in the midst of these changes. By going through information containing opinions, attitudes, and other information from employees within a CCDO we will try to enlighten what we feel are informational currents of opinions surrounding the notion of competence, leadership and management. The purpose of our study is to be able to help create an environment of open reflections and new ideas of what sort of competencies are required for the manager role.</p><p>The study is defined by our research problem which give use the following question:</p><p>What room is there for a broader comprehension of what kinds of competencies are desirable and useable in the role as a Base-unit Executive Officer?</p><p>To be able to interpret the primary data of the study a theoretic framework was created in the purpose to function as a tool for continuation of the study. The study was done with the use of hermeneutical paradigm together with a compromise between deductive and inductive approach.</p><p>The primary data of the study was collected with a qualitative method through semi-structured interviews with six employees of whom three were Base-unit Executive Officers. The reason for the use of a qualitative method was that it gives us conditions to gather the opinions, thoughts, values etc. of the respondents.</p><p>By merging the tools of our theoretic framework and the collected data we were able to establish an analysis. We concluded that the analysis consisted of both congruence and discrepancy related to our theoretical framework. The discrepancy showed that there exist a room for a broader comprehension of what kinds of competencies are desirable and useable in the role as a Base-unit Executive Officer. There is room to develop the comprehension of competence in areas such as management and leadership as defined by our theoretical framework.</p><p>Because of our path between deductive and inductive approach the reader should carefully evaluate the truth criteria in the study. Validation in the inductive sense is a tough task for a short and small study such as this one. We do however believe that give our preconditions have reached an acceptable level in the truth criteria. When taken into practical application we have hope that our initial thoughts of enlightment will enable a positive development of the managerial role of the Base-unit Executive Officers.</p>

Work conditions within the public health care sector are physically and psychosocially demanding. This means that balancing work with recovery is essential for employees in order to avoid ill health and stay healthy. This thesis is based on four studies. Study I investigated the prevalence of upper extremity disorders (UED) in female dental personnel. Results showed that 81% reported UED. Consequently, interventions aimed at reducing these risks were called for. Study II investigated the health-related effects of two work-place interventions, physical exercise (PE) and reduced working hours (RWH). Health-improvements were more consistent in the PE group, suggesting that PE may be an appropriate intervention to reduce health-risks. However, there were no effects on recovery from work or fatigue, which may result from other factors, such as overcommitment (OC), that prolong or sustain stress-related activity. Study III showed that high OC was associated with poorer next-day recovery and increased fatigue. Also, OC was a more important predictor of lack of recovery and fatigue than were psychosocial work characteristics. This highlights the importance of considering perseverative cognitions in relation to recovery from work and fatigue, and has implications for interventions targeting work-related ill health. Study IV related lack of recovery and fatigue to cumulative biological risk, allostatic load (AL), and to individual biomarkers. Women with a profile characterized by fatigue, sleep difficulties and lack of short-term recovery had a 2.9 increased risk of AL. This was not shown in analyses of individual biomarkers. In sum, this thesis shows that recovery from work is an important factor in relation to women’s work-related health. Fatigue and recovery should be considered interrelated but distinct concepts and recovery should be assessed as an early risk factor for stress-related disease with early risk being investigated using AL rather than individual biomarkers.

The possibility to be able to better manage the Swedish public health care has been a focus from way back to the middle of the 20th century. This study focuses on a middle managerial position called Base-unit Executive Officer, which we feel is of great influence to the public health care. Because of the changes to the public health care organisations over a long period of time we find it important and interesting to research a managerial role in the midst of these changes. By going through information containing opinions, attitudes, and other information from employees within a CCDO we will try to enlighten what we feel are informational currents of opinions surrounding the notion of competence, leadership and management. The purpose of our study is to be able to help create an environment of open reflections and new ideas of what sort of competencies are required for the manager role. The study is defined by our research problem which give use the following question: What room is there for a broader comprehension of what kinds of competencies are desirable and useable in the role as a Base-unit Executive Officer? To be able to interpret the primary data of the study a theoretic framework was created in the purpose to function as a tool for continuation of the study. The study was done with the use of hermeneutical paradigm together with a compromise between deductive and inductive approach. The primary data of the study was collected with a qualitative method through semi-structured interviews with six employees of whom three were Base-unit Executive Officers. The reason for the use of a qualitative method was that it gives us conditions to gather the opinions, thoughts, values etc. of the respondents. By merging the tools of our theoretic framework and the collected data we were able to establish an analysis. We concluded that the analysis consisted of both congruence and discrepancy related to our theoretical framework. The discrepancy showed that there exist a room for a broader comprehension of what kinds of competencies are desirable and useable in the role as a Base-unit Executive Officer. There is room to develop the comprehension of competence in areas such as management and leadership as defined by our theoretical framework. Because of our path between deductive and inductive approach the reader should carefully evaluate the truth criteria in the study. Validation in the inductive sense is a tough task for a short and small study such as this one. We do however believe that give our preconditions have reached an acceptable level in the truth criteria. When taken into practical application we have hope that our initial thoughts of enlightment will enable a positive development of the managerial role of the Base-unit Executive Officers.

Darbo tikslas. Ištirti pacientų požiūrį į pirminės sveikatos priežiūros įstaigose (PSPĮ) teikiamas paslaugas. Uždaviniai: 1. Ištirti privačios ir viešosios PSPĮ pacientų požiūrį į teikiamas paslaugas. 2. Palyginti privačios ir viešosios PSPĮ pacientų nuomonę apie gydytojo teikiamą informaciją susijusią su ligos diagnoze ir gydymu. 3. Palyginti privačios ir viešosios PSPĮ pacientų požiūrį į teikiamas paslaugas. Tyrimo metodika. Viešosios ir privačios pirminės sveikatos priežiūros įstaigų pacientų anoniminė anketinė apklausa, kurios metu išdalinta 800 anketų (350 privačioje ir 450 viešojoje gydymo įstaigoje). Privačioje gydymo įstaigoje atsako dažnis 92,6 proc., viešojoje – 63,1 proc. Anketiniai duomenys apdoroti ir analizuoti naudojant statistinį duomenų analizės paketą SPSS 13.0. Rezultatai. 94,4 proc. pacientų teigiamai vertina bendrosios praktikos gydytojų darbą. 30,2 proc. pacientų mano, jog šeimos gydytojo konsultacijos laukia per ilgai ir 36,5 proc. mano, jog gydytojo specialisto konsultacijos laukia per ilgai. 39,4 proc. sutinka jog laukimo eilės prie gydytojų kabinetų susidaro dėl prasto darbo organizavimo. 15,1 proc. nuomone, visada sunku gauti siuntimą pas gydytoją specialistą, kartais sunku - 43,9 proc. Viešojoje (68,7 proc.) ir privačioje (64,0 proc.) įstaigoje teigia, jog šeimos gydytojas visada tariasi dėl gydymo galimybių pasirinkimo, tačiau viešosios (6,7 proc.) o privačios (0,3 proc.) įstaigos pacientų teigia, jog gydytojas niekada nesitaria. 53,8 proc... [toliau žr. visą tekstą] / Aim of the work. To examine patients attitude towards services provided in primary health care institutions (PHCI). Objectives: 4. To investigate patients attitude towards services provided in primary health care institutions. 5. To compare patients of private and public primary health care institutions opinion about the information on their diagnosis and cure that doctors provide. 6. To make a comparison of the private and public primary health care institutions to provided services. Research methodology. It was done an anonymous questionnaire survey of public and private primary health care institutions patients, distributed 800 of questionnaires ( 350 in private and 450 in public primary health care institutions). In private health care institution 92,6% of answers were received, in public institution - 63,1%. Data of the questionnaire were processed and analysed using statistical data analysis packet SPSS 13.0. Results. 94,4% of patients positively evaluated the work of family doctors. 30,2% of patients think, that they have to wait too long for family doctors consultations, 36,5% think, that they wait too long for the consultation of specialist. 39,4% agree that they have to wait long because of bad work planning. 15,1% of respondents think that, it is always difficult to get a committal to the specialists, sometimes difficult - 43,9%. 68,7% of public and 64,0% of private institutions respondents says that, family doctor always consults about choosing a cure, but 6... [to full text]

O direito à saúde abriga um feixe de atribuições, dentre elas encontra-se a assistência farmacêutica. Atualmente, as ações judiciais de medicamentos funcionam como via alternativa ao acesso pelo Sistema Único de Saúde. Este tipo de ação tem como objeto tanto os medicamentos previstos na rede pública como aqueles não incorporados ao sistema público. O presente trabalho teve como objetivo analisar a desprogramação causada pelo fornecimento de medicamentos não padronizados e consequentemente não previstos no orçamento público aprovado, sendo custeados pelos cofres públicos em razão das demandas judiciais. O trabalho aborda o tema por uma perspectiva que evidencia a lógica da Assistência Farmacêutica federal. / The right to health houses a bundle of tasks, among which is pharmaceutical care. Currently, lawsuits involving medicines work as an alternative access to the Sistema Único de Saúde. This type of legal action has as object both drugs provided in the public system and those not incorporated into the public system. This study aimed to analyze the deprogramming caused by nonstandard drug supply and therefore not included in the approved government budget, being funded by the public purse because of lawsuits. This paper addresses the issue from a perspective that emphasizes the logic of public pharmaceutical care.

This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market of health care, including externalities, inperfect information and elasticity of supply and demand at this market. There is also the problem of financing health care as a mix of public and private payments, which is different in every health care system. The main focus is laid on the situation in the Czech republic. As a comparison there are described situations in Denmark, Germany, Great Britain and United States. The size of private sector in every health care system is different and it depends on different circumstances in particular state, including social-economic development, regulation of health care market from the state and the attitude of patients to private health care.

Stroke is today one of the most common causes of death in the world. In Sweden, approximately 25-30,000 people die in stroke annually, of which about 10,000 suffer from transient ischemic attack (TIA). (See Annex I) Studies also show that stroke is something that is increasing in young adults. Of these, it is mainly women who are in the middle of life who are affected.¹ Many of their activities and dreams are adversely affected by the disease. Healthcare professionals visit the stroke patients continuously to support them. However, when more patients are prescribed home rehabilitation, healthcare professionals must prioritize according to the greatest need. The project aims to find new ways to rehabilitate stroke patients in their homes as the number of patients increases and staff resources decrease.  The goal is to be able to visualize a concept that uses motivation and insight as a key word for the patient’s drive for independent and continuous rehabilitation. The aim is to create a system or physical aid that can be used without the physical presence of medical personnel. The geographical framework for the project / Stroke är idag en av de vanligaste dödsorsakerna i världen. I Sverige insjuknar cirka 25-30 000 personer i stroke årligen varav cirka 10 000 insjuknar i transitorisk ischemisk attack (TIA). (Se bilaga I)  Studier visar även att stroke är något som ökar hos unga vuxna. Av dessa är det främst kvinnor som är mitt uppe i livet som drabbas.¹ Många av deras aktiviteter och drömmar påverkas negativt av sjukdomen. Sjukvårdspersonal besöker strokepatienterna kontinuerligt för att stötta dem. När fler patienter ordineras hemrehabilitering måste dock sjukvårdspersonalen prioritera efter störst behov. Projektet syftar till att finna nya sätt att rehabilitera stroke-patienter i sina hem då antalet patienter ökar och personalresurser minskar.  Målet är att kunna visualisera ett koncept som använder sig av motivation och insikt som ledord för patientens drivkraft till en självständig och kontinuerlig rehabilitering. Strävan är att skapa ett system eller ett fysiskt hjälpmedel som skall kunna användas utan fysisk närvaro av sjukvårdspersonal. De geografiska ramarna för projektet innefattar Sverige med fokus på region Västerbotten.

Text in English with summaries in English, Afrikaans and Zulu / Bibliography: leaves 102-115 / The study investigated the management of medical records in the Primary Health Care services (PHCs) of Diepsloot. The study investigated the regulatory framework, records infrastructure, records security, records management staff skills and the filing system. A qualitative design guided by the interpretive paradigm was used to guide the case study. Interviews, focus groups, and observations generated data from 50 participants. The study revealed that the regulatory instruments used to manage records lack implementation and compliance. There was a lack of security measures, a shortage of records management infrastructure and inconsistency in the filing system. There is a low level of skill in the records management staff. The study recommended the implementation of a regulatory policy that will guide and ensure effective governance of records in PHCs. Records should be secure from misuse by unscrupulous individuals. PHC records need to be managed by experienced professionals. The filing system should be easily accessible. / Die studie het ondersoek ingestel na die bestuur van mediese rekords in die Primêre Gesondheidsorgdienste (PHC's) van Diepsloot. Die studie het ondersoek ingestel na die regulatoriese raamwerk, rekord van infrastruktuur, rekord sekuriteit, vaardighede vir rekordbestuur en die liasseerstelsel. 'n Kwalitatiewe ontwerp gelei deur die interpretatiewe paradigma is gebruik om die gevallestudie te lei. Onderhoude, fokusgroepe en waarnemings het gegewens van 50 deelnemers gegenereer. Die regulatoriese instrumente wat gebruik word om rekords te bestuur, het geen implementering en nakoming nie. Die studie het aan die lig gebring dat daar 'n gebrek aan veiligheidsmaatreëls was, 'n tekort aan infrastruktuur vir rekordbestuur en teenstrydigheid in die liasseringstelsel. Die personeel in rekordbestuur het 'n lae vlak van vaardigheid. Die studie het die implementering van 'n regulatoriese beleid aanbeveel wat die doeltreffende bestuur van rekords in PHC's sal lei en verseker. Rekords moet beskerm word teen misbruik deur gewetenlose individue. PHC-rekords moet deur ervare professionele persone uitgevoer word. Die liasseerstelsel moet maklik toeganklik wees. / Lolu cwaningo luphenywe ngokuphathwa kwamarekhodi ezokwelashwa emnyangweni Wezokunakekelwa kwempilo okuyisisekelo (i-PHCs) eDiepsloot. Ucwaningo luphenywe ngohlaka lokulawula, ingqalasizinda yamarekhodi, ukuphepha kwamarekhodi, amakhono okuphathwa kwamarekhodi nohlelo lokufayila. Umklamo olungaqanjwa uqondiswa yi-paradigm yokutolika wasetshenziselwa ukuqondisa ucwaningo lwesigameko. Izingxoxo, amaqembu okugxila kanye nokubukwa kukhiqize idatha evela kubahlanganyeli abangu 50. Izinsizakusebenza zokulawula ezisetshenziselwa ukuphatha amarekhodi zingenakho ukusebenza nokuhambisana. Ucwaningo luveze ukuthi bekukhona ukuntuleka kwezindlela zokuphepha, ukushoda kwengqalasizinda yokuphathwa kwamarekhodi kanye nokungahambelani ohlelweni lokugcwalisa. Kunezinga eliphansi lekhono kubasebenzi bokuphathwa kwamarekhodi. Ucwaningo lincome ukusetshenziswa kwenqubomgomo yokulawula ezohola futhi iqinisekise ukuphathwa kwamarekhodi kuma-PHCs ngendlela efanele. Amarekhodi kufanele avikeleke ekusetshenzisweni kabi ngabantu abangathembekile. Amarekhodi we-PHC adinga ukuqhutshwa ngochwepheshe abanolwazi. Uhlelo lokufayila kufanele lutholakale kalula. / Information Science / M. Inf.

An in-depth analysis of organizational risk management in health care, and in particular the concepts of Enterprise Risk Management (ERM), has identified a five part model that can be used by Canadian health care leaders as an evidence supported approach to successful organizational risk management. The Model for Organizational Risk Management has been developed as a basis for linking the components of an ERM framework into a Canadian health organization in order to overcome the barriers that commonly disrupt strategic risk management. The Model addresses how an ERM framework can fit within an existing health organization by building off of and enhancing existing processes and resources in order to ensure familiarity, acceptance, and sustainability of the risk management program. By approaching the Model in a stepwise fashion (based on individual organizational context) health care leaders are provided with a roadmap from which to advance their own organizational risk management program.