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.

Magistro baigiamajame darbe išanalizuoti LR egzistuojančių viešų ir privačių sveikatos priežiūros įstaigų veiklos skirtumai bei jų sąveiką. Ištirti tokie viešųjų ir privačių sveikatos priežiūros sektorių aspektai: sveikatos priežiūros sektoriai patys savaime, šių įstaigų institucinis išsidėstymas, teisinis reglamentavimas, finansavimas, konkurencingumas, prieinamumas pacientui. Pirmojoje darbo dalyje yra aptarta Lietuvos nacionalinės sveikatos sistema, kaip turinti vienyti viešąsias ir privačiąsias sveikatos priežiūros įstaigas, aptarta jos bendroji charakteristika. Antrojoje dalyje išsamiai išnagrinėtos, suklasifikuotos sveikatos priežiūros įstaigos, aptarta jų priklausomybė viena nuo kitos. Trečiojoje darbo dalyje kaip atskiros grupės išskirtos privačios ir viešosios sveikatos priežiūros: aptarta jų sąveika, pagrindiniai skirtumai, pamatiniai teisinio reglamentavimo ypatumai. Paskutinė ketvirta lyginamoji darbo dalis leido surasti tuos taškus, per kuriuos viešasis sveikatos priežiūros sektorius galėtų bendradarbiauti su privačiu. Palyginta šių sektorių finansavimo bazė, surasta papildoma alternatyva papildomojo sveikatos draudimo pavidalu. Kadangi sveiktos priežiūros sektoriuje centrinė figūra vis tik turi būti pacientas, pateiktas ir jo požiūris į privatų ir viešąjį sveikatos priežiūros sektorius, šių sektorių vertinimas. / The distinction and interface of health care institutions of Lithuania Republic are analyzed in this final master’s work Such public ant private health care institutions aspects are analyzed: health care institutions by themselves, deployment of these institutions, their legal regulation, sponsorship, competitive ability, accessibility for the patients. The first part of the work is concerned about national health care system of Lithuania, which must unify public and private health care institutions. The common characteristics of this system are discussed. The second part thoroughly reveals and classifies health care institutions; knock about their dependence on each other. In the third part as separate groups are divided private and public health care institutions: their interaction, main differences and basic legal regulation principles are discussed. The last fourth comparative part enabled to find those points, which could help for private health care sector to collaborate with public one. The comparison of financial basis of those sectors, allowed to found an additional assurance alternative. Since the patient is the central figure in a health care sector, his attitude towards the private and public health care institutions, and those sectors valuation is represented.

Narkotikų kontrolės ir narkomanijos prevencijos politiką įgyvendina narkotikų kontrolės departamentas, Vyriausybė tobulina teisinę bazę narkotikų prevencijos srityje, vykdomos visuomenės sveikatos priežiūros reformos kryptys, kuriomis siekiama daugiau dėmesio skirti sveikatos išsaugojimui, rizikos veiksnių poveikio sumažinimui. Prevencijos priemonės mokyklose glaudžiai siejasi su vaikų sveikos gyvensenos ugdymu – viena pagrindinių mokyklos sveikatos priežiūros specialistų veiklos krypčių. Per pastaruosius metus atlikta nemažai narkotikų paplitimo tarp mokinių tyrimų, vertinta ir prevencinės darbo grupės veikla. Nuo 2002 m. kasmet atliekamos mokyklose dirbančių slaugytojų veiklos studijos. Tačiau mokyklos sveikatos priežiūros specialisto veiklos tyrimas narkomanijos prevencijos aspektu dar nebuvo atliktas. Šio tyrimo tikslas: įvertinti mokyklos sveikatos priežiūros specialisto vykdomą veiklą narkomanijos prevencijoje. Tyrimas atliktas aštuoniose Lietuvos mokyklose apklausus 240 respondentų: 150 mokinių, 40 mokyklos darbo grupės narių ir 8 mokyklos sveikatos priežiūros specialistų, bei 42 mokyklos sveikatos priežiūros specialistai, dalyvavę Klaipėdos visuomenės sveikatos centro organizuotame seminare. Apklausai naudotos anoniminės anketos visoms trims respondentų grupėms, duomenys apdoroti panaudojant SPSS programinį paketą. Nustatyta, kad 11,3 proc. mokinių jau pabandė narkotinių medžiagų. Tyrimas atskleidė tokią tendenciją, kad 72,7 proc. mokinių nurodė, jog žino... [toliau žr. visą tekstą] / Policy of narcotic control and drug addiction prevention is realised by Drug control department, Government continuously improves juridical basis of drug addiction prevention, different reforms in public health care activities are implemented, by the help of which it is seeked to pay greater attention to health retention as well as reduction of risk factors impact. Prevention activities at schools are tightly connected with children education about healthy lifestyle upbringing and these are one of the main tasks for school health care specialists. During last years quite many research works in the field of spread of narcotics have been performed. Impact of prevention workgroup was analysed as well. Since 2002 every year different research studies of school nurses activities are carried out. Despite of wide range of such research studies activities of school health care specialist in the field of drug addiction prevention haven‘t been evaluated. The goal of the study was to evaluate role of school health care specialist in the field of drug addiction prevention. The study was performed in eight schools of Lithuania. 240 respondents were involved: 150 schoolchildren, 40 school workgroup members, 8 school health care specialists and 42 school health care specialists, who attended the seminar organised by Klaipėda public health centre. The questionnaires were anonymous for all three respondent groups. Statistical analysis was performed using SPSS statistical package. It was... [to full text]

This postgraduate thesis investigates legal aspects of human assisted reproduction‘s reimbursement from the Public Health Insurance Fund‘s Budget. Nowadays human assisted reproduction is not covered by the State Budget in Lithuania. That‘s why this thesis presents hypothetical model of reimbursement. The model is substantiated using historical anglysis of the probleme, worldwide practice in biomedicine and health care management. Legal aspects are analysed from the standpoint of intersection in different branches of sciences. The emphasis lays on imperfect legislation and controversies of reproductive health care, it‘s close connections with ethical problemes in human relationships, on human life and traditional family protection as priority in Lithuania‘s Fundamental Law. Legal propositions are linked with Evidence Based Medicine Gudelines (EBMG) and efficient assesment of State Budget resources as a basis of Public Health Insurance.

[pt] A presente dissertação de mestrado em metrologia relaciona- se à qualidade laboratorial do setor da saúde, notadamente da saúde pública, contribuindo para o desenvolvimento da confiabilidade metrológica do setor médico-hospitalar em pelo menos 4 aspectos básicos: (i) identificação da legislação metrológica disponível no Brasil, via de regra organizada de forma esparsa e não facilmente acessível ao profissional usuário final,cuja pesquisa bibliográfica explicita grande carência de literatura especializada; (ii) análise do acervo de normas e recomendações metrológicas para o setor; (iii)diagnóstico da qualidade laboratorial em um Laboratório Central de Saúde Pública (LACEN), como implementação de uma estratégia alternativa para implantação de sistema da qualidade em laboratório da saúde pública com base em uma nova abordagem que focaliza a qualidade laboratorial da Rede nacional de laboratórios Oficiais de Controle da Qualidade e Saúde, criando um mecanismo que permite ao laboratório demonstrar sua competência técnica; (iv) diagnóstico da conformidade metrológica de instrumentos médico-hospitalares fundamentado nos estudos de caso de balanças para controle da massa de neonatos e de instrumentos biomédicos para medição da pressão arterial, como exemplo de ação do controle metrológico de instrumentos de amplo uso no ambiente médico-hospitalar.A despeito da complexidade e abrangência do setor da saúde no Brasil, a pesquisa desenvolvida revelou não apenas carência e inadequação da literatura técnica disponível bem como forte vulnerabilidade no controle metrológico de laboratório e de equipamentos médico-hospitalares. O diagnóstico realizado em um laboratório típico da saúde pública evidenciou também grandes desafios para a implantação do sistema da qualidade laboratorial.A despeito dos complexos problemas de natureza política e econômica que afetam o sistema da saúde no Brasil, as limitações de caráter metrológicos relacionam-se (i) à falta de uma adequada cultura metrológica no setor, fator intrínseco que entrava a implementação do sistema da qualidade laboratorial, imprescindível à comprovação da competência técnica do laboratório (credenciamento) e (ii) uma surpreendente diversidade de modelos, tipos e quantidade de instrumentos/equipamentos em uso no setor, via de regra dependentes de calibração sofisticada que demandam complexa infra-estrutura laboratorial e métodos e práticas de calibração não disponíveis nos laboratórios credenciados que integram as redes laboratoriais implementadas no País. Sem a pretensão de exaurir tema de tal abrangência e complexidade, porém com o propósito de exemplificar duas importantes áreas que apresentam nítida vulnerabilidade em setores tradicionais cujo envolvimento metrológico não se constitui em barreira ao profissional- usuário do equipamento, a pesquisa analisou (a) o desempenho de dezesseis balanças disponíveis em seis hospitais maternidades, utilizadas para controle da massa de recém- nascidos, como estratégia de orientação do diagnóstico médico e (b)resultados do desempenho de esfigmomanômetros para controle da pressão arterial no ambiente hospitalar. O presente trabalho constitui parte de um esforço mais amplo, desenvolvido em articulação com a Agência Nacional de Vigilância Sanitária (ANVISA), para fortalecer a qualidade laboratorial no setor da saúde pública brasileira. / [en] The present dissertation for a Master`s degree in metrology is related to laboratory quality in the health care sector in general and to public health services in particular, and its purpose is to contribute to the development of reliable measurement practices in the hospital care section within the scope of at least 4 basic aspects: (i) identification of the available metrology legislation in Brazil which, as a rule, is sparsely organized and is not easily accessible to the end-user/practitioner, whose bibliographical research reveals an explicit lack of specialized literature; (ii) analysis of the compiled measurement standards and recommendations for the sector; (iii) diagnosis of laboratory quality in a Central Public Health Care Laboratory (Laboratório Central de Saúde Pública - LACEN)as a means by which to implement an alternative strategy for introducing a quality system in a public health care laboratory based on a new approach that focuses on the quality of the laboratories that comprise the National Network of Official Quality and Health Care Control Laboratories, and the subsequent creation of a type of mechanism that will allow a laboratory to demonstrate its technical competence; (iv) diagnosis of instruments that are employed in hospital services in terms of their conformity to measurement standards based on case studies of scales for controlling the mass of neonates, and of biomedical instruments for measuring blood pressure, as an example of how measurement is controlled in the case of instruments that are widely used in the hospital care environment.Despite the complexity and reach of the Brazilian health care sector, the research that was carried out not only revealed that the technical literature available is insufficient and unsuitable, but also that the measurement provided by laboratories and hospital care equipment are controlled in a high vulnerable manner. The diagnosis that was performed in a typical health care laboratory also brought to light a number of major challenges for the introduction of a laboratory quality system. Apart from the complex political and economic problems that affect the Brazilian health care system as a whole, the limitations associated with measurements are related to (i)the lack of a suitable metrology culture within the sector because this intrinsic factor hampers the implementation of a laboratory quality system and the latter is an essential requirement for proving that a laboratory is technically competent (accreditation), and (ii) the astonishing variety and number of models and types of instruments/equipment that are in use in this sector, which, as a rule, depend on sophisticated calibration procedures and require complex laboratory infrastructures and calibration methods and practices that are not available in the accredited laboratories within the laboratorynetworks that have been implemented in the country. This paper does not propose to exhaust such a broad and complex topic. Rather, its purpose is to consider the examples of two important areas that are clearly vulnerable in traditional sectors whose involvement with metrology does not represent an obstacle to the practitioner/user of the equipment. To this end, the research has focused on (a) the performance of sixteen scales that are available in six maternity hospitals and are used for controlling the mass of newborn infants as a strategy for the orientation of medical diagnoses and (b) the performance results of sphygmomanometers that are used for controlling blood pressure in hospital environments. This paper is part of a more encompassing initiative towards the improvement of laboratory quality in the Brazilian public health care sector and has been developed as a joint effort with the National Agency of Sanitary Vigilance (Agência Nacional de Vigilância Sanitária - ANVISA).

Made available in DSpace on 2016-06-02T19:46:29Z (GMT). No. of bitstreams: 1 6019.pdf: 797578 bytes, checksum: 4fc53c2f4e13e11bff760ff517a2ef95 (MD5) Previous issue date: 2014-04-10 / Universidade Federal de Minas Gerais / Primary prevention aims to identify, remove or reduce the incidence of risk factors that produce conditions of adversity. These conditions enable the link with Special Education required, since researches on strategies that can minimize or prevent the impact and occurrence of environmental events in the typical child development are essential to prevent possible deficiencies. This research was divided into two studies, Study 1 and Study 2, wich aimed to develop, implement and assess an intervention with pregnant parents about child development and prevention of domestic violence against children. Study 1 participants were a teenager couple, both 20 years old and pregnant. It was used the CAP - Inventory (Children Abuse Potential) and KIDI (Knowledge of Infant Development Inventory), a Qualitative Inventory regarding differents aspects of the intervention from the parents point of view, and a field notebook for various notes during the intervention. The intervention program consisted of two thematic blocks: 1) Child Development (CD); and 2) Parental Practices (PP). 6 2- hour meetings have been conducted with the couple at their home. The meetings began and ended with the administration of the inventories in order to assess the intervention through pre, post, and followup test scores. Therefore, the two blocks had the same structure, namely: 1) pretest administration, 2) CD theoretical explanation, 3) CD practical approach, 4) PP theoretical explanation; 5) PP practical approach; and 6) posttest administration. Three months after the posttest, the instruments were readministered - that was referred to as the follow-up score. It was used a laptop, overhead projector, some illustrative videos, some toys such as dolls and their apparatus. The overall KIDI scores showed no changes from pre to posttest for both Father and Mother. Regarding the results of the CAP, both performances were low-risk at the three assessments. The qualitative data from the questionnaire showed that the intervention was assessed with the highest score on all criterias. Regarding Study 2, 8 pregnant mothers were recruited from a public healthcare system in a suburb of the city where the research was conducted, separated into experimental group (EG) and control group (CG) participated. Three mothers of GE and GC reported experiencing some form of violence during childhood. Regarding KIDI, three mothers of GE showed an increase in overall score on the post-test and two at follow-up had their scores even higher. In CAP, two GE mothers had scores above the cutoff score on the post-test, while at follow-up; three mothers were above the cutoff. Mothers of GE evaluated the intervention as "good" to "very good" in all aspects and the note given to group was 10. Two GC mothers in KIDI presented at posttest an increase in overall score and in the follow-up two mothers had overall scores increased. In CAP, two participants scored above the cutoff score at post-test, however at follow-up, all mothers had scores above the cutoff. The performance of GE participants in the KIDI may indicate that the intervention helped in some acquisition of knowledge about child development. GC Mothers, in contrast, had all the scores of the CAP Abuse above the cutoff score at follow-up, which may indicate a very positive point for intervention, since it can be attributed to participation in the group that some GE mothers had their scores reduced below the cutoff. On quantitative data, is perceived that the EG performed better than the GC, and whereas the means of GE in the post-test and follow-up are better than the pre-test. About the correlations of the categories of instruments KIDI and CAP, there was a negative correlation between standards and Abuse, Sorrow and Loneliness. The demographic data, there was a negative correlation between education and Abuse, Sorrow and Loneliness and positive between education level and Ego and Norms.Because of that, it is reiterate the importance of approaching mothers with knowledge about child development and appropriate parenting practices. It is noticed that for both the teen couple and the group of mothers, the intervention was positive, especially with the qualitative data, and the speeches of the participants of the two studies showed that the intervention had relevance. / A prevenção primária tem como objetivo identificar, remover ou reduzir a incidência de fatores de risco que produzem condições de adversidade. Essas condições tornam a ponte com a Educação Especial necessária, uma vez que a investigação a respeito de estratégias que possam minimizar ou impedir o impacto e a ocorrência de eventos ambientais para o desenvolvimento típico da criança são imprescindíveis para que haja a prevenção de possíveis danos ao desenvolvimento. A presente pesquisa foi dividida em dois estudos, que tiveram por objetivo elaborar, implementar e avaliar uma capacitação para pais gestantes, acerca de temas sobre o desenvolvimento infantil e da prevenção de violência intrafamiliar contra crianças. Os participantes do Estudo 1 foram um casal adolescente, ambos de 20 anos, gestantes. Foram realizados seis encontros em domicílio com o casal (Mãe e Pai). Em ambos os estudos, a intervenção iniciou e finalizou com a aplicação dos instrumentos KIDI e CAP, a fim de avaliar a intervenção com medidas de pré e pós-teste e posteriormente no follow-up. Ainda foi aplicado um questionário qualitativo de avaliação da intervenção ao fim da primeira etapa e da segunda, bem como utilizado um diário de campo para as eventuais anotações durante a intervenção. Nos encontros dos dois estudos, foram passados vídeos, exibições em PowerPoint® e realizados roleplays e atividades para melhor ilustrar o conteúdo das exibições. Os escores do KIDI não mostraram mudanças do pré para o pós-teste de Pai e Mãe, a qual obteve um aumento no followup. Em relação aos resultados do CAP, ambos os desempenhos foram de baixo risco nas três avaliações. Os dados qualitativos do questionário mostraram que a intervenção foi avaliada com pontuação máxima em todos os quesitos. Em relação ao Estudo 2, participaram oito mães gestantes selecionadas em uma Unidade Saúde da Família de um bairro periférico da cidade em que a pesquisa foi conduzida, separadas em quatro participantes do Grupo Experimental (GE) e quatro do Grupo Controle (GC). Três mães do GE e uma do GC relataram ter sofrido algum tipo de violência durante a infância. Com relação ao KIDI, três mães do GE apresentaram um aumento no escore geral no pósteste e duas no follow-up tiveram seus escores ainda maiores. No CAP, duas mães do GE tiveram escores acima da nota de corte no pós-teste, enquanto no follow-up, três mães ficaram acima da nota de corte. As mães do GE avaliaram a intervenção de bom a muito bom em todos os quesitos e a nota dada a grupo foi 10. Duas mães do GC, no KIDI, apresentaram no pós-teste um aumento no escore geral e no follow-up, duas mães tiveram escores gerais aumentados. No CAP, duas participantes tiveram escores elevados no pós-teste, entretanto no follow-up, todas as mães tiveram seus escores elevados. O desempenho das participantes do GE no KIDI pode indicar que a intervenção ajudou na aquisição de conhecimentos sobre o desenvolvimento infantil. As mães do GC, em contrapartida, tiveram todos os escores gerais do CAP de Abuso acima da nota de corte no follow-up, o que pode indicar um ponto bastante positivo para a intervenção, já que pode ser atribuída a participação no grupo que algumas mães do GE tenham seus escores diminuídos para baixo da nota de corte. Sobre os dados quantitativos, percebe-se que o GE teve melhor desempenho que o GC, ainda que as médias do GE no pós-teste e follow-up são melhores que no pré-teste. Sobre as correlações das categorias dos instrumentos KIDI e CAP, houve correlação negativa entre Normas e Abuso, Sofrimento e Solidão. Nos dados sociodemográficos, houve correlação negativa entre escolaridade e Abuso, Sofrimento e Solidão e positiva entre escolaridade e Ego e Normas. Reitera-se a relevância de se aproximar mães aos conhecimentos sobre o desenvolvimento infantil e práticas parentais adequadas. Percebe-se que tanto para o casal adolescente, quando para o grupo de mães, a intervenção foi positiva, sendo que principalmente os dados qualitativos, com as falas dos participantes dos dois estudos, apresentaram que a intervenção teve relevância. Assim, indica-se que pesquisas com a temática da prevenção da violência sejam realizadas.

Abstract The aim of this dissertation is to analyse the process of change in management accounting in public-sector health care. The change is examined through the implementation of a nationally homogeneous Diagnosis Related Grouping (DRG) system. The DRG system is used to classify health-care diagnoses into groups for service productisation and pricing. The system has been proposed as a solution for cost accounting and budgeting. The practical motivation of the dissertation is to analyse the embedding of change in organisations´ practises. The theoretical motivation of the dissertation is to extend the investigation of change by analysing the process of implementation of a nationally homogeneous system. The research data comprise 39 interviews conducted between 2006 and 2011 with hospital district representatives, the representatives of the company managing the DRG system, the DRG system supplier, and the representatives of the National Institute for Health and Welfare and the Association of Finnish Local and Regional Authorities. In addition to interviews, the data consists of participative observations, telephone inquiries, and newspaper articles. This dissertation consists of four essays that analyse the data through the lens of two theories: the Actor Network (ANT) and Institutional theory (NIS). The results indicate how the use of multiple theories (ANT ja NIS) as a methodology enriches and extends the insight into the change process in management accounting. For instance, the analysis of the homogeneous use of the DRG system, without investigating the practices of actors by making use of the ANT, the results could have been different in this respect. Especially, this dissertation indicates how important it is that actors’ actions are also examined in the processes of change in the implementation of public-sector management accounting systems. The idea for the DRG system was introduced to Finland almost twenty years ago. However, the results indicate that it has spread very slowly. According to earlier research, an institutional environment is considered to exercise pressure on organisations in order to make them adopt new practices that are homogeneous with other institutional practices. There is indirect pressure in decentralised health care in Finland, though its power for change is weak. This dissertation shows how the decentralisation of responsibilities in large-scale institutions, such as the health-care system in Finland, also slows down and decentralises reforms. As institutional power becomes weaker, the power of organisations to promote things seems to grow stronger, however. / Tiivistelmä Tämän väitöskirjatyön tarkoituksena on analysoida johdon laskentatoimen muutosprosessia julkisen sektorin terveydenhoidossa. Muutosta tarkastellaan kansallisesti yhtenäisen diagnoosiperustaisen ryhmittelyjärjestelmän (Diagnosis Related Grouping, DRG) käyttöönottoprosessin kautta. DRG on järjestelmä, jossa luokitellaan terveydenhoidon diagnoosit ryhmiin palvelujen tuotteistusta ja hinnoittelua varten. Järjestelmää on esitetty ratkaisuna kustannuslaskentaan ja budjetointiin. Väitöskirjatyön käytännön motivaationa on analysoida muutoksen asettumista organisaatioiden käytäntöihin. Väitöskirjatyön teoreettisena motivaationa on laajentaa muutostutkimusta tarkastelemalla kansallisesti yhtenäisen järjestelmän käyttöönottoa. Tutkimuksen aineisto koostuu 39 haastattelusta, joita on kerätty vuosien 2006 ja 2011 välillä. Tutkimuksessa on haastateltu sairaanhoitopiirien henkilökuntaa, DRG-järjestelmän hallinnoiman yhtiön edustajia, järjestelmän toimittajaa, Terveyden ja hyvinvoinnin laitoksen sekä Kuntaliiton edustajia. Aineisto sisältää haastattelujen lisäksi osallistuvaa havainnointia, puhelinkyselyjä sekä lehtiartikkeleita. Tämä väitöskirjatyö koostuu neljästä esseestä, joissa analysoidaan aineistoa kahden eri teorian, toimijaverkostoteorian (ANT) ja institutionaalisen teorian (NIS), avulla. Tulokset tuovat esille, kuinka kahden teorian (ANT ja NIS) metodologinen käyttö rikastuttaa ja laajentaa näkemystä johdon laskentatoimen muutosprosessista. Esimerkiksi analysoitaessa DRG-järjestelmän yhtenäistä käyttöä tutkimatta toimijoiden toimintaa toimijaverkostoteoriaa hyödyntäen, tulokset voisivat tältä osin olla erilaiset. Erityisesti tämä väitöskirjatyö osoittaa, kuinka tärkeää julkisen sektorin johdon laskentajärjestelmien käyttöönoton muutosprosessia tutkittaessa on tutkia myös toimijoiden toimintaa. Idea DRG-järjestelmästä esitettiin Suomessa melkein kaksikymmentä vuotta sitten. Tulokset osoittavat kuitenkin, että sen leviäminen on ollut hyvin hidasta. Aikaisempien tutkimusten mukaan institutionaalisen ympäristön katsotaan painostavan organisaatioita, jotta ne ottaisivat käyttöön uusia menetelmiä, jotka ovat yhdenmukaiset muiden institutionaalisten käytänteiden kanssa. Suomen hajautetussa terveydenhoidossa esitetään epäsuoraa painetta, mutta sen voima muutokseen ei ole vahva. Väitöskirjatyö tuo esille miten suurien instituutioiden, kuten Suomen terveydenhoidon, vastuun hajautuessa myös reformit hidastuvat ja hajautuvat. Institutionaalisten voimien heikentyessä organisaatioiden voima ajaa asioita näyttää kuitenkin vahvistuvan.

Den mänskliga resursen är en organisations viktigaste tillgång då organisationen är beroende av mänsklig aktivitet för att existera. Chefer blir i avseendet viktiga då de kan ses som organisationens företrädare samt då de bidrar till och formar processer och arbetsförhållanden. Det blir därav av vikt att skapa förutsättningar för dem att hantera sin roll och vilja stanna i den. Tidigare forskning visar att organisatoriska förutsättningar påverkar chefsrollen, men inte specifikt hur den organisatoriska kontexten får betydelse för deras intention att stanna i rollen. Syftet med den här studien är att undersöka hur första linjens chefers intention att stanna i rollen kan förstås utifrån den organisatoriska kontexten. Vidare är syftet att skapa förståelse för hur cheferna upplever sina förutsättningar att hantera rollen. För att besvara syftet har en kvalitativ metod i form av semistrukturerade intervjuer med första linjens chefer inom vården i offentlig sektor legat till grund för empiri. Resultatet visar att chefsrollen är komplex med förväntningar från flera håll, vilket tydliggör varför den organisatoriska kontexten är betydelsefull för att förstå chefernas upplevelser och deras intention att stanna i rollen. Ur chefernas berättelser kan uttydas att arbetstillfredsställelse och organisatoriskt engagemang är betydelsefullt, vilket främst härleds till den kliniska verksamheten och medarbetarna. Vidare framgår att organisatoriska förutsättningar som samspel, kommunikation och stöd får betydelse för hur de hanterar krav och förväntningar. Sammantaget bidrar studien till en ökad förståelse för hur en organisation, genom den organisatoriska kontexten, kan verka för att behålla första linjens chefer. / The human resource is an organization's most important asset as the organization depends on human activity to exist. In this reference, managers become important as they can be seen as the organization's representatives as well as they contribute to and shape processes and working conditions. It therefore becomes important to create an environment for them to manage their role and a will to stay in it. Previous research shows that organizational conditions affect the managerial role, but not specifically how the organizational context will have an impact on their intention to stay in the role. The aim of this study is to investigate how the first-line managers' intention to stay in their position can be understood from the organizational context. Furthermore, the aim is to develop an understanding of how the managers experience their ability to handle the role. To answer the aim, a qualitative method in the form of semi-structured interviews with first-line managers in public healthcare sector has been the source for empirical data. The result shows that the managerial role is complex with expectations from several directions, which explains why the organizational context is important for understanding the managers' experiences and their intention to stay in their position. From the managers' stories it can be read that job satisfaction and organizational commitment are important, which is mainly attributed to the clinical activities and the employees. Furthermore, it appears that organizational conditions such as interaction, communication and support will have an impact on how they handle requirements and expectations. In summary, the study contributes to an increased understanding of how an organization, through the organizational context, can work to retain first-line managers.

It is important for nurses to show acceptable behaviour when interacting with the patients. The purpose of this study was to explore and describe the factors that contribute to nurses’ negative behaviour when rendering patient care and to determine the effects of nurses’ behaviour on patient outcomes. The study used a non-experimental explorative and descriptive quantitative design. Data collection was done using a structured questionnaire. The sample comprised of 64 respondents which consisted of 25 registered nurses and 39 enrolled nurses. The study found that besides the known contributing factor, that is, the shortage of nurses, further identified contributing factors to nurses’ negative behaviour when rendering patient care are failure to retrain nurses identified with negative behaviours, poor condition of employment and patients’ behaviours and cultural beliefs. These results suggested a need to train more nurses, improve conditions of employment, as well as support and retrain nurses identified with negative behaviours. / Health Studies / M.A. (Public Health)

Comprehensive management in the neonatal nursery involves medical treatment of the infant, as well as developmental care and the provision of guidance, counselling and information to the family who are part of the decision-making process regarding the infant’s care. Neonatal communication intervention is of utmost importance in a country such as South Africa, which has an increased prevalence of infants at risk for disabilities and where the majority of these infants live in poverty. Speech-language therapists fulfil an important role in the neonatal nursery and are an integral part of the team involved with the high risk neonatal population. Local literature showed a dearth of information on the current service delivery and roles of speech-language therapists and audiologists in neonatal nurseries in the South African context. From an asset-based perspective it appears that the South African population receiving services in neonatal nurseries have unique characteristics. This provides speech-language therapists with ample opportunity to intervene, providing that intervention is well-timed in the neonatal nursery context. The country-wide initiative to implement the evidence-based technique of kangaroo mother care indicates that speech-language therapists should recognise its importance and develop communication based materials and tools to complement this successful neonatal intervention. The aim of the research was to establish whether speech-language therapists have needs for assessment and intervention tools/materials in this context. The study furthermore aimed to compile a locally relevant neonatal communication intervention instrument/tool for use by speech-language therapists in the neonatal nurseries of public hospitals in South Africa in order to propose a solution to address the shortage of tools in the public health context. The study entailed descriptive, exploratory research. During Phase 1, a survey was received back from 39 speech-language therapists and two audiologists in six provinces. The data revealed that participants performed different roles in neonatal nurseries, which were determined by the environment, tools, materials and instrumentation available to them. Many participants were inexperienced, but were resourceful in their attempts to develop and adapt tools/materials. Participants expressed a need for culturally appropriate and user-friendly instruments for parent guidance and staff/team training on the topic of developmental care. During Phase 2 a tool for parent guidance titled “Neonatal communication intervention programme for parents” was compiled for use by speech-language therapists and justified by participants’ roles and needs as well as current early communication intervention (ECI) literature. The programme was piloted by three participants. Certain suggestions for enhancements of the programme were made such as providing a glossary of terms, adapting the programme’s language and terminology, and providing more illustrations. The programme complied with the guiding principles for best practice in ECI (ASHA, 2008) and can therefore contribute to neonatal care of high risk infants in South Africa. Speech-language therapists and audiologists must contribute to neonatal care of high risk infants to facilitate optimal health and development and to support their families. AFRIKAANS : Omvattende intervensie in die neonatale sorgeenheid behels mediese behandeling van die neonaat, sowel as ontwikkelingstoepaslike sorg en die verskaffing van leiding, berading en inligting aan die gesin wat deel is van die besluitnemingsproses rakende die baba se sorg. Neonatale kommunikasie intervensie is van uiterste belang in Suid-Afrika aangesien daar ‘n hoër prevalensie van babas is wat ‘n risiko het vir ontwikkelingsafwykings en aangesien die meerderheid van hierdie babas in armoede leef. Spraak-taalterapeute vervul ‘n belangrike rol in die neonatale sorgeenheid en is ‘n integrale deel van die span wat betrokke is by die hoërisiko neonatale populasie. Plaaslike literatuur dui op ‘n tekort aan inligting rakende die huidige dienslewering van die spraak-taalterapeut en oudioloog in neonatale sorgeenhede in die Suid-Afrikaanse konteks. Vanuit ‘n bate-benadering kom dit voor of die Suid-Afrikaanse populasie wat dienste in neonatale sorgeenhede ontvang, unieke eienskappe het. Dit bied genoegsame geleenthede aan spraak-taalterapeute om intervensie te verskaf, solank die behandeling betyds in die neonatale sorgeenheid konteks aanvang neem. Daar is ‘n landswye inisiatief om die bewysgerigte tegniek van kangeroe moedersorg toe te pas. Spraak-taalterapeute moet dus die belang daarvan herken en kommunikasie gebasseerde terapiemateriaal ontwikkel om hierdie suksesvolle neonatale intervensie te komplementeer. Die navorsing se doel was om vas te stel hoe wyd spraak-taalterapeute en oudioloe ‘n behoefte aan evaluasie en intervensie instrumente en –materiaal in hierdie konteks het. Die navorsing het verder ten doel gestel om ‘n relevante terapie instrument saam te stel vir spraak-taalterapeute in die neonatale sorgeenhede as ‘n moontlike oplossing vir die tekort aan relevante terapiemateriaal in die plaaslike publieke gesondheidsorgkonteks. Die studie het beskrywende, eksplorerende navorsing behels. Gedurende Fase 1 is ‘n vraelys terug ontvang van 39 spraak-taalterapeute en twee oudioloë in ses provinsies. Die data het aangedui dat deelnemers verskillende rolle in hierdie konteks vervul, wat beïnvloed was deur die omgewing, die instrumentasie en materiaal wat tot hulle beskikking was. Die meerderheid van die deelnemers was onervare, maar was vindingryk in hulle pogings om terapiemateriaal aan te pas en te ontwikkel. Deelnemers het ‘n behoefte vir kultureel toepaslike- en gebruikersvriendelike instrumente en materiaal uitgedruk met die oog op ouerleiding en personeel/span opleiding oor die onderwerp van ontwikkelingstoepaslike sorg. Gedurende Fase 2 is ‘n terapie instrument naamlik “Neonatale kommunikasie intervensie program vir ouers” saamgestel vir die gebruik in die neonatale sorgeenhede deur spraak-taalterapeute. Die samestelling van hierdie program is verantwoord deur die deelnemers se rolbeskrywing en behoeftebepaling van Fase 1, sowel as deur huidige vroeë kommunikasie intervensie (VKI) literatuur. Die program is deur drie deelnemers in ‘n loodsstudie geëvalueer. Voorstelle vir die verbetering van die program is verskaf, naamlik die byvoeging van ‘n terminologielys, aanpassing van die program se taalgebruik en terminologie en verskaffing van meer illustrasies. Die program het ooreengestem met die beginsels vir beste praktyk in VKI (ASHA, 2008) en kan daarom tot neonatale sorg van hoërisikobabas in Suid-Afrika bydra. Spraak-taalterapeute en oudioloë moet bydra tot neonatale sorg van hoërisiko neonate om sodoende optimale gesondheidsorg en ontwikkeling te fasiliteer en gesinne te ondersteun. Copyright / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted