Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2016-10-13T19:05:26Z No. of bitstreams: 1 Michele Darque Pinheiro.pdf: 857091 bytes, checksum: 01e95bf27dd554cb95173cac3a261cff (MD5) / Made available in DSpace on 2016-10-13T19:05:26Z (GMT). No. of bitstreams: 1 Michele Darque Pinheiro.pdf: 857091 bytes, checksum: 01e95bf27dd554cb95173cac3a261cff (MD5) Previous issue date: 2016-08-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This study's main objective is to understand the challenges of structuring of the health care regionalized networks in Santos: Rede de Cuidados da Pessoa com Deficiência (RCPD) [care network for people with disabilities], from the example of the Centro Especializado de Reabilitação (CER) [rehabilitation specialized center], facility originally designed as a component of federal influence into the conformation of networks for regionalized health care policies. According to literature, one of the greatest obstacles to achieving these regional policies in the country refers to the structure of municipal SUS [health unic system] base. Semi-structured interviews with key informants from the municipal administrations were carried out: directing municipal group; Comissão Intergestores Regional (CIR) [regional managers committee]; and Departamento Regional de Saúde (DRS) [regional health department]. The analysis revealed structural and planning problems, and low technical capacity. Among the most basic challenges, highlights the prevalence of municipalist management culture in the region. / Este estudo tem por objetivo principal compreender os desafios da estruturação de uma das redes regionalizadas de assistência à saúde na Baixada Santista: Rede de Cuidados da Pessoa com Deficiência (RCPD), a partir do exemplo do Centro Especializado de Reabilitação (CER), equipamento originalmente idealizado como componente das políticas federais de indução da conformação de redes regionalizadas de assistência à saúde. Segundo a literatura, um dos maiores entraves à consecução dessas políticas regionais no país refere-se à estruturação de base municipal do SUS. Foram realizadas entrevistas semiestruturadas com informantes-chave das gestões municipais: grupo condutor municipal, Comissão Intergestores Regional (CIR) e Departamento Regional de Saúde (DRS). As análises revelaram dificuldades estruturais, de planejamento e baixa capacidade técnica. Entre os desafios mais elementares, destaca-se a prevalência de uma cultura de gestão municipalista na região.

The health industry in Canada, as well as in other industrial countries, has been in the process of reform for many years. While such reform has been attributed to fiscal necessity due to increased health costs, the underlying causes are far more complex. Demographic changes, new technologies, expanded health care procedures and medications, increased demand and the globalization of health services have all contributed to the change and complexity of the industry. Health reform varies from country to country. In Canada, with a publicly funded health industry, the main reform method has been regionalization. This decentralized reform method arranges health services under a regional corporate management structure. The primary objective of this study was to assess the effects of health reform on the educational development of health-care managers in British Columbia, a western province of Canada. The study had a two-fold approach; to ascertain how health reform had changed the skill needs of health-care managers, and whether e-learning could benefit health management education. The key research questions that guided the study were: How might recent changes in the health industry have affected the learning needs and priorities of health-care managers? What factors might hinder attempts to meet any learning needs and priorities of health-care managers? and What benefits might e-learning provide in overcoming hindrances to effective health management education? / A combination of quantitative (survey closed questions) and qualitative (survey open-ended questions, interviews and stakeholder feedback) methods was employed in this study. Overall, this study is described as productive social theory research, in that it addressed a recognized change in learning needs for health-care managers following a period of health reform, a socially significant phenomenon in the health industry. Relying on such tools as a survey, interviews, and stakeholder discussions, data was collected from over five hundred health-care managers. The data collected in this study provided valuable insight into the paradigm shift occurring in the educational needs of these managers. The study found that health reform had expanded the management responsibilities of healthcare managers and increased the complexity of service delivery. Restructuring of the health industry decreased the number of managers, support systems, and career opportunities for managers and increased the manager’s workload, communication problems and the need for new knowledge and skills. In addressing the learning needs of health-care managers, the study found there were limitations in health management educational opportunities available to health-care managers. The findings also show that current health management education was focused on senior managers leaving the majority of industry leaders with limited learning opportunities to upgrade their knowledge and skills at a time of great organizational change. / In addition, a classroom format dominated the learning delivery options for many managers. A list of fourteen management skills was used in the survey instrument to ascertain what new skills were needed by health-care managers following thirteen years of health reform. The findings show that of the fourteen skills, twenty-nine percent of health-care managers had no training and fifty-seven percent received their training through in-service, workshops and seminars. Irrespective of gender, age, working location and education the data showed that healthcare managers were mainly receiving training in change and complexity and people skills with less training occurring in planning and finances. Using the same fourteen skills, health-care managers priorized their immediate learning needs, listing the top three, as: evidence-based management, change and complexity and financial analysis. While evidence-based management and financial analysis could be attributed to the introduction of a corporate management structure in the health industry, change and complexity was an anomaly as managers were already receiving training in this skill. Health industry stakeholders believed this anomaly was due to continued uncertainties with ongoing health reform and/or a need for increased social interaction during a time of organizational change. In addressing the many learning needs of health-care managers a new health management education strategy was proposed for the province which included the need for an e-learning strategy. / The e-learning approach being proposed in this study is an integration of skill training and knowledge sharing directly blended into the workflow of the managers, using a variety of learning technologies. To support this idea, the study found that the majority of health-care managers were not only familiar with e-learning, they also felt they had the computer and Internet skills for more learning delivered in this manner. While a strong need for face-to-face learning still remained, a blended e-learning strategy was proposed for skill training, one that would accommodate the learning needs of managers in rural and remote areas of the province. Knowledge sharing technologies were also proposed to improve the flow of information and learning in small units to both newcomers and experts in the industry. Since this would be a new strategy for the province, attention to quality and costs were identified as essential in the planning. The study found that after years of health reform a new health management educational strategy was needed for the health industry of British Columbia, one that would incorporate a number of learning technologies. Such a change in educational direction is needed if the health industry wishes to provide their leaders with a responsive learning environment to adapt to ongoing organizational change.

Knowledge management is considered a necessary precursor to organizational success. This view is increasingly prevalent in the case of the health care sector. Two main knowledge management strategies are recognized: codification and personalization strategies. An organizations choice of knowledge management strategy depends on its objectives and the dominant form of knowledge informing its decision-making processes.<p>Health care decision-makers have access to a wealth of knowledge with which to inform their decisions. Little is known, however, about how the various types of knowledge are managed to optimize their use in decision-making. This study examines the knowledge management strategies of health care decision-makers working in the context of a regionalized health care system. The potential of communities of practice as a conceptual means for understanding health care knowledge management is also explored.<p>Members of Regional health authorities (RHAs) in the province of Saskatchewan constitute the unit of analysis for the study, which is guided by a qualitative research design. Interviews were used as the main data collection technique. For data analysis, open and axial coding methods based on the inductive and deductive approaches were adopted.<p>The study concludes that regional health authority (RHA) members utilize more fully explicit rather than tacit forms of knowledge. One of the main knowledge management practices adopted by the RHA members is the use of professional reports. This indicates that RHA members pursue a codification strategy more strongly than a personalization strategy. Moreover, it was found that the practices and strategies associated with managing knowledge were in place, despite the absence of a stated knowledge management policy. Finally, RHAs cannot be regarded as communities of practice, even though they exhibit many of their features.<p>Recommendations include the following: (1) the need for RHAs to institutionalize a knowledge management policy to guide their knowledge management processes and strategies, and (2) the cultivation of online communities of practice to marshal the tacit knowledge of RHA members, and that of the public, as an intervention to complement the use of explicit knowledge.

Retailers in rural Saskatchewan are having to contend with two predominant trendsrural and retail restructuring. Decreasing rural populations, increased consumer mobility, and the chronic instability of primary industries such as agriculture and forestry continue to impact rural communities in the province. The growing presence of multinational corporations, the drive for economies of scale, and the centralization of services into larger urban centers are all influencing the retail sector, particularly in rural areas. In response to these trends, retail co-operatives operating in Northern and Central Saskatchewan have joined a larger urban-based co-op in Prince Albert to form a regional co-operative. Co-operative theory suggests this regional structure may create internal obstacles for co-ops that differ from those of private firms, as co-operatives must consider the implications of reorganization on membership structures and member relations. While most of the empirical investigation has focused on large agricultural co-operatives, less attention has been afforded to consumer co-operatives.<p>Through interviews with the delegates and managers of the Prince Albert Co-operative Association (PACA), this study examines how a multi-branch consumer co-operative has adapted to the present rural and retail milieu. It investigates the new relationships that have emerged among the key stakeholders including members, delegates, and managers as well as the new relations between the major structures, namely the branches and the central body. The research is a starting point for understanding how member and enterprise interests are mediated, communicated, and coordinated within a regional co-operative. Delegates are the focal point of the study as they play an integral role in all of these relations. The findings of the study suggest that while new relationships do form within a multi-branch system, the primary relationship between members and their local co-op branch remains relatively unaffected. Further, the study on the PACA adds to Fairtloughs (2005) work on business structural forms called triarchies. It is argued that the integration of hierarchies, heterachies and responsible autonomy in the form of a federated network reinforces the staying power of the co-op in smaller communities.

This thesis investigates higher education regionalization by studying the case of the Asia Pacific Quality Assurance Network (APQN). In this thesis, higher education regionalization is conceptualized in three ideal-types: 1) as a sub-set of higher education globalization, 2) as a regional form of higher education internationalization, and 3) as an alternative to higher education globalization. Theories of international relations and globalization are used to develop a conceptual framework of the norms, values, ideologies, and concepts of regional identity that underpin these constructs. The main research question asks what can be learned about higher education regionalization through a study of the APQN? A sequential mixed method approach is used to gather data from textual analysis, key informant interviews, participant observation, and an online survey to investigate how the APQN bridges national, regional, and international levels of quality assurance in higher education. A methodological triangulation design is implemented to pinpoint the ideal-type of higher education regionalization that most represents the APQN. An embedded case study of Việt Nam’s QA capacity building activities demonstrates the APQN’s role in one country. The findings suggest that the ideal-type of higher education regionalization as a sub-set of globalization best represents the APQN. The nature of the APQN as a network for QA professionals highlights the transformative role that globalization is playing within the nation state. Instead of globalization being a homogenizing force on higher education systems, this study shows that higher education regionalization as a sub-set of globalization is changing the role of the nation state into a regulator for the global market. Higher education regionalization as a sub-set of globalization does not remove the control of the nation state, but rather reinforces the state’s role as a monitor of higher education for market competition. The study concludes by suggesting opportunities for QA policymakers and practitioners to shape higher education regionalization.

This thesis investigates higher education regionalization by studying the case of the Asia Pacific Quality Assurance Network (APQN). In this thesis, higher education regionalization is conceptualized in three ideal-types: 1) as a sub-set of higher education globalization, 2) as a regional form of higher education internationalization, and 3) as an alternative to higher education globalization. Theories of international relations and globalization are used to develop a conceptual framework of the norms, values, ideologies, and concepts of regional identity that underpin these constructs. The main research question asks what can be learned about higher education regionalization through a study of the APQN? A sequential mixed method approach is used to gather data from textual analysis, key informant interviews, participant observation, and an online survey to investigate how the APQN bridges national, regional, and international levels of quality assurance in higher education. A methodological triangulation design is implemented to pinpoint the ideal-type of higher education regionalization that most represents the APQN. An embedded case study of Việt Nam’s QA capacity building activities demonstrates the APQN’s role in one country. The findings suggest that the ideal-type of higher education regionalization as a sub-set of globalization best represents the APQN. The nature of the APQN as a network for QA professionals highlights the transformative role that globalization is playing within the nation state. Instead of globalization being a homogenizing force on higher education systems, this study shows that higher education regionalization as a sub-set of globalization is changing the role of the nation state into a regulator for the global market. Higher education regionalization as a sub-set of globalization does not remove the control of the nation state, but rather reinforces the state’s role as a monitor of higher education for market competition. The study concludes by suggesting opportunities for QA policymakers and practitioners to shape higher education regionalization.

Knowledge management is considered a necessary precursor to organizational success. This view is increasingly prevalent in the case of the health care sector. Two main knowledge management strategies are recognized: codification and personalization strategies. An organizations choice of knowledge management strategy depends on its objectives and the dominant form of knowledge informing its decision-making processes.<p>Health care decision-makers have access to a wealth of knowledge with which to inform their decisions. Little is known, however, about how the various types of knowledge are managed to optimize their use in decision-making. This study examines the knowledge management strategies of health care decision-makers working in the context of a regionalized health care system. The potential of communities of practice as a conceptual means for understanding health care knowledge management is also explored.<p>Members of Regional health authorities (RHAs) in the province of Saskatchewan constitute the unit of analysis for the study, which is guided by a qualitative research design. Interviews were used as the main data collection technique. For data analysis, open and axial coding methods based on the inductive and deductive approaches were adopted.<p>The study concludes that regional health authority (RHA) members utilize more fully explicit rather than tacit forms of knowledge. One of the main knowledge management practices adopted by the RHA members is the use of professional reports. This indicates that RHA members pursue a codification strategy more strongly than a personalization strategy. Moreover, it was found that the practices and strategies associated with managing knowledge were in place, despite the absence of a stated knowledge management policy. Finally, RHAs cannot be regarded as communities of practice, even though they exhibit many of their features.<p>Recommendations include the following: (1) the need for RHAs to institutionalize a knowledge management policy to guide their knowledge management processes and strategies, and (2) the cultivation of online communities of practice to marshal the tacit knowledge of RHA members, and that of the public, as an intervention to complement the use of explicit knowledge.

Retailers in rural Saskatchewan are having to contend with two predominant trendsrural and retail restructuring. Decreasing rural populations, increased consumer mobility, and the chronic instability of primary industries such as agriculture and forestry continue to impact rural communities in the province. The growing presence of multinational corporations, the drive for economies of scale, and the centralization of services into larger urban centers are all influencing the retail sector, particularly in rural areas. In response to these trends, retail co-operatives operating in Northern and Central Saskatchewan have joined a larger urban-based co-op in Prince Albert to form a regional co-operative. Co-operative theory suggests this regional structure may create internal obstacles for co-ops that differ from those of private firms, as co-operatives must consider the implications of reorganization on membership structures and member relations. While most of the empirical investigation has focused on large agricultural co-operatives, less attention has been afforded to consumer co-operatives.<p>Through interviews with the delegates and managers of the Prince Albert Co-operative Association (PACA), this study examines how a multi-branch consumer co-operative has adapted to the present rural and retail milieu. It investigates the new relationships that have emerged among the key stakeholders including members, delegates, and managers as well as the new relations between the major structures, namely the branches and the central body. The research is a starting point for understanding how member and enterprise interests are mediated, communicated, and coordinated within a regional co-operative. Delegates are the focal point of the study as they play an integral role in all of these relations. The findings of the study suggest that while new relationships do form within a multi-branch system, the primary relationship between members and their local co-op branch remains relatively unaffected. Further, the study on the PACA adds to Fairtloughs (2005) work on business structural forms called triarchies. It is argued that the integration of hierarchies, heterachies and responsible autonomy in the form of a federated network reinforces the staying power of the co-op in smaller communities.

While the concept of regional organization (regionalization) of perinatal care aimed at reducing perinatal mortality has remained at the agenda of developed countries since 1970&rsquo / s, Turkey is one of the countries that does not have such a system yet. In this study, a three-level hierarchical location-allocation model is developed for the regionalization of perinatal care in an attempt to have a better distribution of maternal and perinatal health care services in Turkey. Since the mathematical model developed is difficult to solve in a reasonable time, we propose three heuristic approaches: top-down, modified top-down and Lagrangean relaxation based heuristics. These heuristics are computationally tested on a set of problem instances for networks ranging from 10 to 737 vertices. A significant result is that Lagrangean relaxation based heuristic outperforms the other two heuristics in terms of solution quality. In most of the test problems, the modified top-down heuristic outperforms the top-down heuristic in terms of solution quality. Using the proposed approaches, we solve a real life problem corresponding to the Eastern and South Eastern Anatolian Regions (the East Region) of Turkey.

Management of groundwater as a common pool resource relies heavily on an institutional design that is fitted to the aquifers to be managed and is scaled to provide efficient and effective governance. Texas has committed to a decentralized system of groundwater management through Groundwater Conservation Districts (GCDs) that offers a high level of local control and area-specific adaptability. However, increasing pressures on the state’s groundwater resources coupled with a strong local aversion to outsider interference has resulted in a proliferation of small single-county GCDs that are neither well fitted to the aquifer systems nor sufficiently scaled to be efficient or effective. In recognition of these challenges, the persistent response has been a slow transition towards larger-scale management. Although a full transition to centralization via state control is not likely to be politically feasible, it would also be limited in its effectiveness, recognizing the wide diversity of climate conditions, water use patterns, growth projections, and aquifer characteristics that exist across the state. Regionalization is offered as a policy proposal for an institutional arrangement and scale of groundwater governance that provides a balance between centralization and decentralization, using institutions that are better fitted to the aquifer systems and appropriately scaled to provide sufficient funding and resources. The merits and logic of regionalized groundwater management have been recognized as demonstrated by the establishment of the joint regional-planning process within aquifer-based Groundwater Management Areas (GMAs), using GCD representatives as the de facto regional groundwater planners. However, the new unfunded mandates for which the already underfunded GCDs are now responsible and the extraordinary planning process complexity that has developed may prove to be unworkable. This realization compels consideration of management through regional authorities designed using the ready-made framework of the GMAs and principles gleaned from successful models of regionalization from other states and within Texas. Such regional authorities, if provided with sufficient resources and authority, would respect the logic of fit and scale and would be better equipped to address the current and future groundwater management challenges in Texas. / text