A comparative assessment of performance and productivity of health centres in Seychelles

Purpose - The purpose of this paper is to measure the technical and scale efficiency of health centres; to evaluate changes in productivity; and to highlight possible policy implications of the results for policy makers. Design/methodology/approach - Data envelopment analysis (DEA) is employed to assess the technical and scale efficiency, and productivity change over a four-year period among 17 public health centres. Findings - During the period of study, the results suggest that the public health centres in Seychelles have exhibited mean overall or technical efficiency of above 93 per cent. It was also found that the overall productivity increased by 2.4 per cent over 2001-2004. Research limitations/implications - Further research can be undertaken to gather data on the prices of the various inputs to facilitate an estimation of the allocative efficiency of clinics. If such an exercise were to be undertaken, researchers may also consider collecting data on quantities and prices of paramedical, administrative and support staff to ensure that the analysis is more comprehensive than the study reported in this paper. Institutionalization of efficiency monitoring would help to enhance further the already good health sector stewardship and governance. Originality/value - This paper provides new empirical evidence on a four-year trend in the efficiency and productivity of health centres in Seychelles. © Emerald Group Publishing Limited.

Revolution or evolution:the challenges of conceptualizing patient and public involvement in a consumerist world

Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice. Objective This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly. Conclusions A framework for conceptualizing PPI is presented that differentiates between the different types and aims of involvement and their potential impact. Approaches to involvement are different in those countries that adopt a rights-based rather than a regulatory approach. I conclude with a discussion of the tension and interaction apparent in the globalization of both involvement and patient choice in both policy and practice. © 2009 Blackwell Publishing Ltd.

The Rover Task Force:a case study in proactive and reactive policy intervention?

The paper examines the policy responses in the UK West Midlands to the successive crises at the car maker MG-Rover. Whilst the firm’s eventual collapse in 2005 was a substantial shock to the West Midlands economy, the impact was much less than was anticipated when the firm was first threatened with closure in 2000 at the time of its break-up and sale by the German car firm BMW. Although the firm struggled as an independent producer, the five years of continued production until 2005 and the work of the initial Rover Task Force (RTF1), enabled many suppliers to adjust and diversify away from their hitherto dependence on MG-Rover resulting in as many as 10,000–12,000 jobs being ‘saved’. This first intervention was later followed by a programme to help ex-workers to find new jobs or re-train and assist supply firms to continue trading in the short term. Examination of the effectiveness of these emergency initiatives enables a wider discussion about the nature of industrial policy in the region and the work of the local regional development agency’s cluster-based approach to economic development and business support. Whilst the actions taken were successful in a number of aspects, there were a number of significant ‘failures’ at both national and local level. The MG-Rover case also illustrates a number of critical issues pertaining to regionally based cluster policies and the organization of cluster management groups where the ‘cluster’ in question not only crosses both administrative and ‘sector’ boundaries but is also subject to the imperatives of the global market car market.

An investigation of the relationships between selected characteristics and leadership outcomes of Athletic Training Education Program directors

There is currently no evidence describing what characteristics make an Athletic Training Program Director (PD) an effective leader. An influx of accredited programs resulted in a rapid increase in the demand for PDs, yet training and preparation for these positions has failed to evolve. Although Certified Athletic Trainers (ATs) are trained in specific content areas, they may not always be prepared for the administrative and leadership responsibilities associated with the role of PD (Leone, 2008). This dissertation examined the relationships between selected characteristics and leadership outcomes of Athletic Training Program Directors. Each PD participants (n=27) completed a demographic questionnaire to obtain the leader's academic preparation, accreditation experience and leadership training history. Each participant also completed the Multifactor Leadership Questionnaire (MLQ) to obtain leadership styles, behaviors, and outcomes. Overall, the PDs reported utilizing transformational leadership most often and passive avoidant leadership least often. There was no significant difference between PDs with master's and doctorate degrees on overall leadership outcome. However, participants with a doctorate degree scored significantly different on the effectiveness component of the leadership outcome compared with participants with a master's degree. Those participants who have completed academic coursework on leadership scored significantly different on the leadership outcome compared to those who have not completed academic coursework on leadership. Findings from this study indicate that changes to the current requirements for the role of PD may be warranted. Consideration should be given to increasing the minimum degree requirement and requiring academic coursework on leadership. Future research may be useful in determining specific degree guidelines and types and amounts of leadership training that would be beneficial to Athletic Training PDs.

Government decentralization and disaster impact, an exploratory study

The purpose of this study is to explore the link between decentralization and the impact of natural disasters through empirical analysis. It addresses the issue of the importance of the role of local government in disaster response through different means of decentralization. By studying data available for 50 countries, it allows to develop the knowledge on the role of national government in setting policy that allows flexibility and decision making at a local level and how this devolution of power influences the outcome of disasters. The study uses Aaron Schneider’s definition and rankings of decentralization, the EM-DAT database to identify the amount of people affected by disasters on average per year as well as World Bank Indicators and the Human Development Index (HDI) to model the role of local decentralization in mitigating disasters. With a multivariate regression it looks at the amount of affected people as explained by fiscal, administrative and political decentralization, government expenses, percentage of urbanization, total population, population density, the HDI and the overall Logistics Performance Indicator (LPI). The main results are that total population, the overall LPI and fiscal decentralization are all significant in relation to the amount of people affected by disasters for the countries and period studied. These findings have implication for government’s policies by indicating that fiscal decentralization by allowing local governments to control a bigger proportion of the countries revenues and expenditures plays a role in reducing the amount of affected people in disasters. This can be explained by the fact that local government understand their own needs better in both disaster prevention and response which helps in taking the proper decisions to mitigate the amount of people affected in a disaster. The reduction in the implication of national government might also play a role in reducing the time of reaction to face a disaster. The main conclusion of this study is that fiscal control by local governments can help reduce the amount of people affected by disasters.

The gender wage gap in the public and private sectors in Bangladesh

The gender wage gap is well studied in developed countries; however, recently it has generated much interest in developing countries. This thesis addresses three issues regarding the gender wage gap in Bangladesh. Firstly, it explores the wage determinants for formal public and private sector employees in Bangladesh and examines the gender pay gap. This is the first time different decomposition methods have been used to compare the sources of the gender wage gap as well as any potential discrimination effect in the formal sector of the Bangladeshi labour market. These decomposition methods are: the original Oaxaca (1973) and Blinder (1973) decomposition methods, the Neumark (1988), Cotton (1988), and Reimers (1983) methods, and the extended Oaxaca method including both the employment selection and the double selection correction in the wage equation. In addition to mentioned methods, to quantify the gender wage gap in monetary terms, a recently developed ‘simulated change’ approach by Olsen and Walby (2004) is also applied for the first time to the Bangladeshi data. By using the Labour Force Survey 2005-06, BBS (LFS 2005-06) data results show formal sector female employees earn about 32.1 per cent less than their male counterparts. Without considering the selection correction, a large range of human capital, demographic and labour market related variables are explained less than half of the total gender wage gap (21 to 46 per cent of the total wage gap) and the major part of the wage gap is unexplained (54 to 79 per cent of the total wage gap). This could partly be attributed to discrimination. Using the double selection correction method, the decomposition results changed where a small part of the wage gap was explained by the measured characteristics (only nine per cent of the total wage gap) and a major part is attributed to the discrimination and selection effect. The selection effect also reveals that exclusion of the double selection correction might lead to an overestimation of the gender wage gap in the formal sector of Bangladesh. In addition, results based on the Olsen and Walby (2004) simulation method show that, if the other characteristics of male and female employees were similar, ‘being female’ is sufficient, to generate significantly lower wages than males in the formal sector. If females in the workplace are treated as males, without considering any other endowment increases, females could increase their earnings by 4095.3 Taka1 per year. Results also indicate that not only endowment differences in human capital and work experience related variables were important, but discrimination appears to play a significant role in the total wage gap throughout the formal sector of the Bangladeshi labour market. Secondly, the study investigates whether public sector employees enjoyed a wage premium or not, compared to the private sector and whether the gender wage gap is greater in the public sector. In addition, the research considered whether there was an impact from the inclusion of the different selection correction terms in the wage equation. In Bangladesh, public sector employees have, on average, a 60 per cent wage premium over the private sector. Using both the original Oaxaca and the extended Oaxaca methods, where selection effect is partly captured by both explained and unexplained components, and using the public sector wage structure as the basis of the non-discriminatory wage structure, these methods revealed a considerably larger portion of explained (72 - 93 per cent of the total wage gap) and a smaller portion of unexplained part of the wage gap. However, if the selection correction is considered as another component of the decomposition outcome then the major portion of the total public and private sectors wage gap is justified (explained) by the effect of the selection correction and unexplained factors. Furthermore, a large part of the wage premium exists in favour of public sector female employees compared to males and the gender wage gap is lower in the public sector than the private sector. Finally, this study compares the gender wage gap of five different occupations. The gender wage gap is associated with labour market rigidities where one of the important factors is occupational segregation where females are disproportionately distributed in occupations resulting in lower earnings. The largest gender wage gap was found in agriculture, forestry, fisheries, production and transport labour jobs (56.4 per cent) and the lowest in the professional, technical administrative and managerial jobs (22.1 per cent). Substantial differences are found in the size of the endowment gap across occupations and larger variations occurred in the adjusted wage gap which varied from 21.4 per cent in sales and service occupations, to 100 per cent in professional and technical jobs (the highest). This too can be partly explained by discrimination. A reduction in the gender wage gap is expected not only to increase national income, but also to reduce poverty and lead to better outcomes for future generations. National policy should aim to reduce the gender wage gap and achieve gender wage equality in the formal sector; for example through a targeted program to remove the gender differences in education and to reduce the skill difference, with a better child care policy to encourage labour force retention and increased labour market experience for female employees, with anti-discriminatory policies and the enforcement of existing antidiscrimination policies, and a more equal distribution of males and females across occupations.

ISO 9000 AND CONTROL OF DOCUMENTS

ISO 9000 is a family of international standards for quality management, applicable to all sizes of company, whether public or private.Management Systems ISO 9000 quality make up the human side, administrative and operating companies. By integrating these three aspects, the organization takes full advantage of all its resources, making results more efficiently, reducing administrative and operating expenses.With globalization and opening markets this has become a competitive advantage by providing further confidence and evidence to all customers, subcontractors, personnel and other stakeholders that the organization is committed to establishing, maintaining and improving levels acceptable quality products and services.Another advantage of quality systems is the clear definition of policies and functions, the staff is utilized according to their ability and focus on real customer needs.It should be mentioned that to achieve these benefits, it is necessary that management of the organization, is committed to the development of its quality system and to allocate financial and human resources to do so. These resources are minimal compared with the benefits you can achieve.

New Jersey; county subdivisions, townships and places. 1970.

Scale ca. 1:250,000.

Quem estabelece prioridades? Um estudo sobre a natureza do trabalho de investigação na polícia federal

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Sociais, Departamento de Sociologia, 2015.

The library of the Institute of Alajuela address the information and communication technologies: User training and information literacy

The Library of the Institute of Alajuela made an induction experience and training of users and ventured into the information literacy and engaged in the work of the teaching-learning as an integral part of the curriculum. The actions of the library in developing search strategies, location, selection and use of information brought inthe health service, changes to the role of the library, the librarian, the book and the information in the educational environment.By sharing this experience is intended to provide information that can motivate staff of educational institutions that wish toenter the field of information literacy as a strategy to support the development oflifelong independent learning skills and meaningful learning. Currently, the library should be a proactive part in the education of students but also teachers, administrative and family.This will result in a benefit to Costa Rica: the development of youth and their proper integration into the workplace.

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.

A cross-sectional survey of 5-year-old children with non-syndromic unilateral cleft lip and palate:the Cleft Care UK study. Part 1: background and methodology

OBJECTIVES: We describe the methodology for a major study investigating the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after an initial survey, detailed in the Clinical Standards Advisory Group (CSAG) report in 1998, had informed government recommendations on centralization. SETTING AND SAMPLE POPULATION: This is a UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Children born between 1 April 2005 and 31 March 2007 were seen in cleft centre audit clinics. MATERIALS AND METHODS: Consent was obtained for the collection of routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) and anthropometric measures (height, weight, head circumference). The methodology for each clinical measure followed those of the earlier survey as closely as possible. RESULTS: We identified 359 eligible children and recruited 268 (74.7%) to the study. Eleven separate records for each child were collected at the audit clinics. In total, 2666 (90.4%) were collected from a potential 2948 records. The response rates for the self-reported questionnaires, completed at home, were 52.6% for the Health and Lifestyle Questionnaire and 52.2% for the Satisfaction with Service Questionnaire. CONCLUSIONS: Response rates and measures were similar to those achieved in the previous survey. There are practical, administrative and methodological challenges in repeating cross-sectional surveys 15 years apart and producing comparable data.

Financial and Criminal Responsibility for Public Funds – Protection of the Constitutional Fundamental Social Law of Health

Abstract: The implementation of Fundamental Constitutional Health and Social Rights is necessary, appropriate and proportionate, following the demands of the population. Accountability and self-responsibility play a very important role. This requires the development of constitutional principles that protect public funds against corruption and offer a constitutional right to health protection. Financial and criminal liability might provide an incentive to improve the management of public funds and reinforce fundamental constitutional principles, particularly regarding the right to health. Constitutional, administrative and criminal issues, as well as public management and administration and the science of good governance, should be articulated in a single strategy also in the health sector. In Portugal and Brazil, as examples, the Federal Court / Constitutional Court, the Supreme Court / High Court of Justice or the Court of Auditors should be considered together.

Multi-victim sexual assault : a case study in rural Australia

Objective: There is a paucity of information regarding cases of multi-victim sexual assault of children. The reported incidence suggests that these cases are rare. The aim of this paper is to provide practitioners with information about effective intervention strategies arising out of the direct experience of managing a case of multi-victim sexual assault in an Australian rural community. --------- Method: A descriptive, case-report methodology summarizing the investigation and intervention in a case of multi-victim sexual assault is reported. A community based intervention arising out of the disclosures of 21 male children is described. The intervention occurred at an individual, group, and community level using a coordinated multi-disciplinary team and natural helping networks. ---------- Results: The coordination of police and welfare services increased the communication flow to victims, their families, and the community. The case also demonstrated the utility in regularly briefing political and bureaucratic authorities as well as local officials about emergent issues. Coordinating political and bureaucratic responses was essential in obtaining ongoing support and sufficient researching to enable the effective delivery of services. ---------- Conclusions: Interventions were focused at an individual, group, and community level using a coordinated multi-disciplinary team and natural helping networks. This provided a choice of services which were sensitive to the case setting. Recommendations are offered for practitioners who are confronted with similar events. While this paper describes an approach for intervening in a case of multi-victim sexual assault, further empirical research is needed to enable service deliverers to efficaciously target interventions which offer choice to victims and their families.

From the panopticon to the playground : disciplinary practices

It is easy to take many of the practices that constitute the contemporary school for granted. Timetables, academic records, rows of desks, playgrounds, guidance counsellors now all seem a natural and inevitable part of an optimal learning environment. However, the evidence suggests that they did not appear by chance. Instead, they were put in place, albeit often in a piecemeal and haphazard way, as part of the process by which a new type of institution was constructed. By understanding the school as a disciplinary society, constituted through a variety of diverse practices, it becomes possible to re-interpret the way we have come to educate ourselves. No longer is the modern school some kind of pedagogic inevitability—simply the best and most obvious way to educate, the end result of two thousand years of trying to finally get it right. Rather, mass schooling, as we know it, is an historical by-product of changes in the way society was organised. It is a contingent collection of particular forms of government, deployed at different historical moments, often for quite different administrative and educational reasons.