The purpose of this study was to examine the relationships between perceived organizational support, perceived coworker support, and debriefing on the one hand, and compassion satisfaction, burnout, and secondary traumatic stress on the other hand in Florida law enforcement, fire, emergency medical services, and dispatch public safety workers. In order to explore the relationships between these constructs, the research questions examined the relationships of the work environment of Florida public safety by administering surveys gauging perceived organizational support, perceived coworker support, psychological resilience, and debriefing activities that the personnel participate in. The Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue Version 5 was also sent out to establish the self-reported levels of compassion satisfaction, burnout, and secondary traumatic stress. The study found that there were differences in the levels of compassion satisfaction, burnout, and secondary traumatic stress between the public safety fields. It also found that there was a positive relationship between the presence of perceived organizational support, perceived coworker support, psychological resilience, and debriefing activities on at least one of the constructs of compassion satisfaction, burnout, or secondary traumatic stress within the different public safety fields. This study furthers the literature by being the first study to compare the four different public safety fields in the state of Florida and with regards to those constructs.

The implications of rising healthcare expenditures are of great concern nationally and internationally. Performing procedures in the outpatient setting can be one solution to this crisis. However, there is a lack of research on systematic approaches for transitioning procedures to the outpatient setting. Unicondylar knee arthroplasty (UKA) presents an opportunity, as it is already in the early stages of transitioning to the outpatient setting. The key step in facilitating an effective transition to the outpatient setting is comparing outpatient UKAs with inpatient UKAs with a focus on process time, quality outcomes, and patient satisfaction. This study retrospectively compares 400 UKA patients in the outpatient setting with 675 UKA patients in the inpatient setting. The primary analytical tools for this study are Ordinary Least Squares Regression, Logistic Regression, and Ordinal Regression adjusting for comorbidity, social history, demographics, and surgery related characteristics. Outpatient UKAs outperformed inpatient UKAs across 11 of 18 variables analyzed. Process Time will be less for outpatient UKAs in all phases with the exception of Surgery Breakdown Time. The risk-adjusted quality outcomes of UKAs in the outpatient setting were better across Non-Surgery Related Complications, Follow-Up Pain, and Follow-Up Functional Range of Motion Limitation. Patient Satisfaction was higher for outpatient UKAs. There was a lack of consistent and appropriate information to conduct a substantial statistical analysis of the costs. These findings point towards outpatient UKAs being a viable option in the future. This research serves as a platform to launch a system-wide effort of transitioning procedures to the outpatient setting across different specialties.

American hospitals have made serious efforts to implement and expand their health information technology capabilities and to integrate different specialized care or high-tech services in order to maximize the efficiency and quality of care. In providing a variety of HIT-related services, these hospitals expanded their national reputation in line with integrated care goals. As a result, hospitals are encouraged to establish effective communication channels to facilitate patient-physician sharing of the patient care experience, to enhance effective pain management, and to transform patient-centered care modalities to solidify the adequacy of patient care processes. By analyzing national data sets publicly available, this investigation explored the relationship of acute-care hospitals' performance to the contextual, organizational and patient characteristics, using a cross-sectional study design. This study developed and evaluated the quality and efficiency of hospitals with respects to the structural complexity, process adequacy, efficiency, and quality of care. The structure-process-outcome theory in quality of care developed by Donabedian (1980), is adopted for this investigation. Statistical methods such as confirmatory factor analysis (CFA) and covariance structure model are employed. The population surveyed by the American Hospital Association (AHA) are acute care hospitals throughout the United States, including more than 3000 acute care hospitals of all types of ownership. The data provided by HIMSS Analytics and AHA are available for 2015 and the data provided CMS quality indicators are available for 2016. The key finding of this research is that process adequacy mediates the relationship between hospital structure and performance variables. The efficiency variable played an important role in shaping quality. The location and hospital teaching status have a moderate impact in determining hospital performance by affecting the structure and process of hospitals.

<p>The purpose of this thesis is to describe a research strategy for evaluating the efficacy of a reduced dose maternal tetanus immunization schedule in reducing neonatal tetanus deaths in Sierra Leone.</p> <p>Neonatal tetanus has been demonstrated to be a major cause in infant death in areas where sanitary midwifery is unavailable. A review of the literature reveals evidence for reduction in neonatal tetanus deaths by maternal immunization using a conventional three dose adsorbed tetanus toxoid.</p> <p>In Sierra Leone, as in many developing countries, the resources are unavailable to maintain a three-dose schedule in the relatively inaccessible interior of the country. A two-dose schedule of a concentrated adsorbed toxoid has been recommended as an alternative by the World Health Organization. Research on simplified immunization schedules has been reviewed; the results are inconclusive.</p> <p>A double-blind randomized placebo-controlled design has been selected to address the research questions. Various aspects of this design are discussed with respect to methodologic and ethical issues.</p> <p>Procedures for carrying out the trial and for the assessment of neonatal tetanus death in a remote chiefdom in Sierra Leone are proposed. A procedure for the analysis of outcome data is presented.</p> / Master of Science (MS)

<p>The introduction of a new radiologic imaging technology requires an assessment of its proper place in the diagnosis and treatment of specified conditions. In terms of its use in diagnosis, computed tomography must be evaluated with reference to the existing diagnostic process to determine whether its contribution is likely to have any beneficial impact on the patient. In terms of its use in therapy, the special ability of computed tomography to make an image of soft tissue points to its potential use in the initial staging of malignant neoplastic disease.</p> <p>The objective of this thesis is to propose a methodology of evaluation of Computed Body Tomography that may be carried out in association with normal clinical practice, and to illustrate this with a diagnostic example and a therapeutic example. In both instances there are two steps to the evaluation. First, a comparison of the accuracy of the information of computed tomography against the conventional diagnostic tests. Second, the strategy for evaluating the benefit of the introduction of computed tomography in the diagnostic and therapeutic examples.</p> / Master of Science (MS)

<p>The objective of this thesis is to propose a methodology of the evaluation of the effectiveness of therapeutic ultrasound and exercise in physiotherapy outpatients with shoulder stiffness. The comparison group is to obtain exercise alone. The results of the study are to be analysed using an analysis of covariance with suspected confounding variables as the covariates.</p> / Master of Science (MS)

Problématique : À l'instar de beaucoup de pays en développement, la qualité des services offerts dans les hôpitaux de la RDP Lao, surtout périphériques, est souvent critiquée. Il est dès lors intéressant d'examiner les cas "à succès", ceux dont on considère qu'ils devraient être des modèles pour le pays. Tel est le cas de 2 hôpitaux de la province de Vientiane, dont le développement a été soutenu par la Coopération luxembourgeoise. Méthodologie: Cette étude est une étude de cas multiples portant sur deux hôpitaux (Maria Teresa et Vang Vieng). Elle visait à étudier les facteurs organisationnels associés à la perception par les travailleurs en santé et les femmes enceintes ou en post-partum, de la performance des soins obstétricaux offerts dans ces hôpitaux. Des entrevues individuelles, basées sur des thématiques découlant du cadre conceptuel de l'étude ont été réalisées. Résultats : L'analyse des résultats montrent une grande satisfaction tant de la part des travailleurs des hôpitaux que des utilisatrices de services, avec les services offerts, même si certains services attendus ne sont pas systématiquement offerts. Les principaux facteurs associés à la fonctionnalité perçue des deux hôpitaux sont liés à deux aspects : un investissement dans les ressources humaines et un investissement dans l'accessibilité de population-cible aux services obstétricaux. L'investissement en ressources humaines a porté sur des stratégies visant l'expertise de tous, cliniciens et non cliniciens, la valorisation du travail du personnel et la création d'une ambiance d'équipe plaisante. L'investissement dans l'accessibilité a porté sur les barrières géographiques et économiques, ainsi que sur la diffusion d'information dans la communauté sur l'importance des soins périnatals. Conclusion : Un investissement dans les ressources humaines et l'accessibilité aux services permet aux hôpitaux régionaux de la RDP Lao de devenir fonctionnels et performants. Mots clés : soins obstétricaux, coopération luxembourgeoise, qualité des services de santé, ressources humaines, RDP Lao. / Problematic: Like many developing countries, the quality of services provided in Lao hospitals, especially in remote regions, is often criticized. It is therefore interesting to examine "successful" cases hospitals that are considered by many as models for the rest country. Such is the case of two hospitals in the province of Vientiane, whose evolution was supported by Luxembourg Cooperation. Methodology: This study is a multiple case study took place in two hospitals (Maria Teresa and Vang Vieng). It aimed to study organizational factors associated with the perception by health workers and pregnant or postpartum, of the performance of obstetric care. Individual interviews, based on themes derived from the conceptual framework of the study were performed. Results: Analyses of the results show a great satisfaction with the services offered by both, hospital workers and users, even if some expected services are not routinely offered. The main factors associated with the perceived functionality of the two hospitals are related to two aspects: an investment in human resources and an investment in the accessibility of the target population to obstetric services. The investment in human resources focused on strategies aiming the improvement of the expertise detained by all, clinicians and non-clinicians, the recognition of the work done by the staff and the creation of a pleasant atmosphere for team work. Investment in accessibility focused on geographical and economic barriers, as well as on providing information on the importance of perinatal care to the community. Conclusion: An investment in human resources and in the accessibility to services allows regional hospitals of the Lao PDR to become functional and efficient. Key words: Obstetric care, Luxembourg cooperation, quality of care, human resources, RDP Lao.

De nos jours, la collaboration interprofessionnelle (CIP) est considérée par plusieurs comme une manière efficace, efficiente et satisfaisante d'offrir des soins et services de santé. Or, actuellement, les milieux cliniques ne sont pas bien outillés pour être en mesure de reconnaître les pratiques exemplaires de CIP des pratiques plus déficientes. Ce projet doctoral a donc pour but d'outiller les gestionnaires et les professionnels de la santé pour qu'ils puissent évaluer la qualité des pratiques de CIP. Les objectifs spécifiques sont: 1) Proposer un cadre de référence qui illustre la façon dont les facteurs interactionnels de CIP s'actualisent concrètement en santé et services sociaux; 2) décrire la façon dont les facteurs interactionnels de CIP s'actualisent lors de la rencontre d'équipe interdisciplinaire et en identifier les indicateurs observables; 3) développer une grille d'observation pour évaluer la qualité des facteurs interactionnels de CIP par l'observation des rencontres d'équipe interdisciplinaires et en faire une validation initiale dans un contexte de réadaptation. Lors de la première étude, un cadre de référence a été développé et validé auprès d'experts selon une procédure proposé par Jabareen (2009). Pour la seconde étude, un groupe de consensus auprès d'experts (n=6) a été organisé et suivi d'une enquête. Lors de la troisième étude, des items ont été développés et pré-testés de façon itérative en impliquant des experts du construit (n=7) et des observateurs non-experts (n=4). La fidélité inter-observateur a été déterminée entre deux observateurs, suite à l'analyse de 30 enregistrements vidéo de rencontres dans deux centres de réadaptation. Le kappa de Cohen a été utilisé comme test statistique (résultats entre 0,17 et 0,79). Ces trois études ont permis de développer un cadre théorique décrivant cinq types de pratiques de CIP, de mieux préciser le déroulement d'une rencontre d'équipe interdisciplinaire et de développer une grille d'observation de 20 items pouvant être répondus selon une échelle à trois niveaux. En conclusion, ce projet doctoral a contribué à l'avancement des connaissances en proposant une conceptualisation novatrice des facteurs interactionnels de CIP, ainsi qu'un outil unique permettant d'évaluer la qualité de ces facteurs par l'observation des comportements de groupe lors des rencontres d'équipe interdisciplinaires.

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The general objective of this study is to assess the internal service quality at Mascom Wireless. Both qualitative and quantitative research methods were used to establish the number of employees who are not happy with their internal service quality and to find out what they suggest could be done to solve the problems that exist. A total of 110 employees out of 280 were given the questionnaire and only 64 of the sampled people responded . A random sampling technique was used to include respondents from each division in the company. The study has revealed that about half of the respondents knew the correct meaning of internal customers. About 6 percent confirmed that they had excellent relationship among themselves, however almost 34 percent assessed the relationship to be better than satisfactory. About 44 percent assessed the rendered service to be satisfactory. The study finally draws conclusions from the implications and makes recommendations before recommending areas for further research. One of the effects of poor working relationships that was revealed by the study was poor service delivery and lack of team spirit. Some recommendations given in the study are sensitisation of employees about internal customers and the need for proper communication between staff. Keywords: internal customers, quality of service, internal service suppliers, quality dimensions, internal customer satisfaction, internal marketing. / Thesis (MBA) North-West University, Mafikeng Campus, 2012