Thesis (Ph.D.)--University of Delaware, 2006. / Principal faculty advisor: Jeffrey A. Raffel, Urban Affairs & Public Policy. Includes bibliographical references.

The balanced scorecard, BSC is an idea submitted to Harvard Business Review by Prof. Robert S. Kaplan of Harvard University, from the medical academy, and Mr. David P. Norton, from the practical business field, in 1990. The present idea consists of the concepts and systems aiming at measurement of the continuous efficacy of business so that many profit and non-profit organizthations have equally introduced the present concepts and systems to attain the expectations and strategies of the organizations. Through the developmnts over the past decade, now the balanced scorecard has shown not only a great efficacy in attaining and executing the strategies of the organizations but also some efficacy in investigating the strategies of the organizations and even in guiding and promoting the strategies. After the general health insurance system has been established, the medical industry has been developed rather in the direction of "becoming bigger size" and "becoming collective." Public hospitals were not the exception either. For example, Taipei Hospital and KaohsiungHospital were "combined" as a united hospital; the "area connection" of the DOH hospitals is an area union of the Northern areas of which the center is Taipei; another area connection as such is the area union of the Central and Southern areas of which the center is "Taichung Hospital;" further, many of poorly-managed hospitals have ceaselessly become "publically administrated and privately-managed." For example, Kangsan Hospital in KaohsiungCounty has delegated Shouchwan Hospital to manage it. No matter whether such developments are combinations,connections or delegation managements, all they are for the purposes of getting better continuous efficacys of the hospitals. Thus, in facing the daily competition of the medical circumstances, hospitals are required to revise the location and clarification of the expectations of their organizations. Furthermore, hospitals are required to adoptaccurate strategies to attain their expectations that would lead them to be survived for good. The structure of the present study is a qualitative analysis that adopts a historical case study method and an in-depth interviewing study method. Taking the Jianan Mental Hospital as an example, discussions are made on the adjustment, which is done in responding to the severe changes in the outside administrative circumstances that the DOH hospital is faced, as follows: (1) Analyzing with SWOT the intensity of the aforementioned adjustment prior to once again introducing the balanced scorecard model. (2) Establishing the measurement indices in the 4 aspects. (3) Also, establishing the causal relation between the measurement indices and the strategical goals. (4) Finally, connecting the causal relation with the rewards to construct the effective driving factors. Then, there would be "a mutural growing of a psychiatric center of the first class of high quality and high efficiency, emphasizing humanity and rich in education and research climate, and that would provide the psychiatric patients in the Jianan area with psychatric services with completeness, continuity and comprehensiveness." These are the expectations of the Jianan Mental Hospital.

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 212-227). Available also in a digital version from Dissertation Abstracts.

Thesis (MPA)--University of Stellenbosch, 2005. / Bibliography. Also available via the Internet.

Purpose – The main aim of this study is to investigate the relationship between risk management practices and service quality in outpatient departments of Gauteng public hospitals. The study also evaluates the quality of the service provided at these outpatient departments. Methodology – The research design firstly included the review of literature on risk management and service quality. The study applied a quantitative research methodology where structured self-administered questionnaires were used as the data collection tools which were distributed to hospital staff to assess the relationship between risk management practices, and different set of questionnaires distributed to patients visiting the outpatient department. Judgement and convenience sampling was used to select the hospital staff and the patients, whereas stratified sampling was used to select the hospitals that were visited. Findings - The study reveals that outpatient departments of Gauteng public hospitals seem to be performing well with high patient perception scores. The positive aspects of service quality include neat and knowledgeable staff and informative patient files. The results show that only some of the risk management practises had a significant effect on service quality, such as management support and commitment, training and education and continuous improvement. / Dissertation (MBA)--University of Pretoria, 2010. / Gordon Institute of Business Science (GIBS) / unrestricted

Thesis (Ph. D.)--University of New South Wales, 2004. / Also available online.

This research examines the impact, if any, of the introduction of casemix funding on public hospitals in Victoria. The results reported here show that in Victoria, during the period under observation, rural hospitals showed a significantly greater preponderance, relative to metropolitan hospitals, to either amalgamate or close down. Since 1 July 1993 public hospitals in Victoria have been compared for efficiency in the delivery of their services. The casemix funding arrangements were installed, among other reasons, to improve efficiency in the delivery of hospital services. Duckett, 1999, p 107 states that under casemix funding 'The hospital therefore becomes more clearly accountable for variation in the efficiency of the services it provides'. Also, 'Generally, case-mix funding is seen as being able to yield efficiency improvements more rapidly than negotiated funding'. Hospital comparisons provide State bodies with information on how to allocate funding between hospitals by means of annual capped budgets. Budgets are capped because funding is restricted to a given number of patients that can be treated in any given year. Thus, casemix funding relies heavily on cost comparisons between hospitals, and the way that hospital output is measured relies on the use of diagnosis related groups (DRGs).

Objective: In order to evaluate the current situation of health information technology (HIT) in Guangzhou, to assess the different status of HIT between different classifications of public hospitals, and find out the influencing factors, to identify the core barriers affecting the development of HIT, I conducted a comprehensive survey, to analyze the framework of HIT from various aspects. Through this study, we would accurately grasp the development level of HIT in Guangzhou, and provide basic information for guideline making in the future. Methods: This is a cross-sectional & descriptive study design. I was responsible for organizing the survey, and monitoring the project cycle and work on a regular basis. I designed the questionnaire based on “The questionnaire of the development situation of national health information technology in 2009 in China”. Cluster sampling method was used, 415 public hospitals (based on the health statistics in Guangzhou in 2009) were selected for the analysis. I sent the questionnaires to all these public hospitals, and collected and entered the data with my colleague Miss LIU. I analyzed the data and wrote up the report solely by myself. At the other side, in order to evaluate the acceptance of HIT among different stakeholders, an interview was conducted by two interviewers among 20 public hospitals (using systematic sampling method, every 10th public hospital was selected). What’s more, in order to explore the characteristics of the development status of HIT in Guangzhou, diverse approaches like descriptive statistics, linear regression, t-test, and chi-square were used for the analysis. Outcome measures: Basic information of public hospitals includes the classifications of the public hospitals; the usage status of basic infrastructure, including the utilization rates of a variety of hardware, system software, new technologies and standards; the application situation of information system, including the utilization rates of a variety of information systems, such as HIS, LIS, PACS, EHR and RHIS; the status of input of funding. In addition, the information includes the core barriers affecting the development of HIT and the acceptance of HIT. Results: 205 of the public hospitals participated in this study, and the total response rate was 49.4%. Data showed that 91% of the public hospitals adopted at least one standard; 36.3% of them had established the Main Patient Index (MPI); 34.8%, 29.4.0%, 31.5% and 37.8% of the public hospitals implemented the Inpatient Doctor Workstation System, Inpatient Nurse Workstation System, Electronic Medical Records (EMR) and Laboratory Information System (LIS), respectively. Only12.1% of the public hospitals had participated in the development of region health information system (RHIS). Besides, “high speed Ethernet”, “bar code technology” and “data safety technology” were the top three information technologies in public hospitals, and the utilization rates were 91.2%, 44.1% and 29.4% respectively. In addition, the top three main barriers were “lack of funding”, “human resources which is not enough” and “on the part of device makers or software developers their lack of abilities to provide products and services”, these three accounted for 84.8%, 56.9% and 47.1% respectively. Data showed that the total investments were 235 million RMB, 270 million RMB and 320 million RMB in 2008, 2009 and 2010, respectively. On average, the accumulative total investments had doubled digit growth in the past 3 years. [1, 2] Conclusion: In general, data displayed that public hospitals in Guangzhou had made significant progress in HIT development in the past few years, which has greatly contributed to hospital management and the delivery of healthcare services. In recent years, there were increasing investments, more and more public hospitals began to implement HIT, a large number of new technologies were used (such RFID, cloud computing), and certain core information systems, liking HIS, LIS, PACS, EMR and RHIS were implemented. At the other side, the development direction of HIT had shifted from hospital management stage to clinical information stage. Although the process of health information in Guangzhou was rapidly developing in the past few years, however, there still have many barriers and shortages in it, for instance, shortage of IT professional and lack of funding are still the main factors that affects the development of HIT; the overall utilization level of basic infrastructure is still not satisfied; the development of information systems is unbalanced, meanwhile the breadth and depth of the information systems are not well enough. / published_or_final_version / Public Health / Master / Master of Public Health

Developing a safety culture: The unintended consequence of a ‘one size fits all’ policy. Background Adverse events in maternity care are relatively common but often avoidable. Evidence suggests it is necessary to understand the safety culture of an organisation to make improvements to patient safety. The safety domains that are thought to influence safety culture in health care include: Safety Climate; Teamwork; Working Conditions; Perceptions of Management; Job Satisfaction; and Stress Recognition. Little is known about the safety culture in the Australian maternity setting, which was the impetus for this Study. This thesis reports an examination of the safety culture in a maternity service in New South Wales (NSW). Setting The Study took place in one maternity service located in two public hospitals in NSW, Australia. Concurrently, both hospitals were undergoing an organisational restructure. Design This mixed method research study used a concurrent triangulation design and included two Studies. The Policy Study explored the policy context in which the maternity service was situated; and, the Service Study examined the safety culture within the maternity service. Data collection included: • A policy audit and chronological mapping of the key policies influencing safety culture within the maternity service. • Safety culture surveys, the Safety Attitudes Questionnaire and Safety Climate Scale (59/210, 28% response rate) that measured the following six safety culture domains; Safety climate; Teamwork climate; Job Satisfaction; Perceptions of management; Stress recognition and Working conditions (Sexton et al., 2004). • Semi-structured interviews (15) with key maternity, clinical governance and policy stakeholders. Results The safety culture was found to be lacking across all six safety domains. The key finding was that the overarching policy context created unintended consequences for the maternity service and adversely influenced their capacity to have a positive safety culture. These unintended consequences reduced their available infrastructure and capacity to respond to adverse events; and created a lack of leadership at all levels to drive the safety and quality agenda. The safety culture was also influenced by inadequate communication during the escalation of care; inadequate supervision of junior medical staff; difficulty ensuring the right staffing and skill mix, and low staff morale. Conclusion The safety culture in this maternity setting was complex, context-specific but importantly, influenced by the broader policy context in which it was situated. This Study provides evidence that the policy context needs to be included as a seventh safety culture domain in health care. This Study has demonstrated the importance of policy on the capacity to ensure patient safety. Implications The policy context has not been previously identified as being important when addressing the safety culture in health care. Considering the influence of the policy context in relation to safety culture is an important step to develop strategies to improve patient safety in other settings. This is an area for future research.

Thesis (M. Med. Sc.)--University of Hong Kong, 2005. / Also available in print.