Study of management decision making by ward sisters in a hospital and the effects on decision making after the implementation of a decision support sytem

This thesis considers management decision making at the ward level in hospitals especially by ward sisters, and the effectiveness of the intervention of a decision support system. Nursing practice theories were related to organisation and management theories in order to conceptualise a decision making framework for nurse manpower planning and deployment at the ward level. Decision and systems theories were explored to understand the concepts of decision making and the realities of power in an organisation. In essence, the hypothesis was concerned with changes in patterns of decision making that could occur with the intervention of a decision support system and that the degree of change would be governed by a set of `difficulty' factors within wards in a hospital. During the course of the study, a classification of ward management decision making was created, together with the development and validation of measuring instruments to test the research hypothesis. The decision support system used was rigorously evaluated to test whether benefits did accrue from its implementation. Quantitative results from sample wards together with qualitative information collected, were used to test this hypothesis and the outcomes postulated were supported by these findings. The main conclusion from this research is that a more rational approach to management decision making is feasible, using information from a decision support system. However, wards and ward sisters that need the most assistance, where the `difficulty' factors in the organisation are highest, benefit the least from this type of system. Organisational reviews are needed on these identified wards, involving managers and doctors, to reduce the levels of un-coordinated activities and disruption.

An institutional perspective on management accounting change in the public sector : a case study from Canada

This thesis reports on a four-year field study conducted at the Saskatchewan regional office of the Department of Indian Affairs and Northern Development, a large department of the Government of Canada. Over the course of the study, a sweeping government-wide accounting reform took place entitled the Financial Information Strategy. An ethnographic study was conducted that documented the management accounting processes in place at the regional office prior to the Financial Information Strategy reform, the organization’s adoption of the new accounting system associated with this initiative, and the state of the organization’s management accounting system once the implementation was complete. This research, therefore, captures in detail a management accounting change process in a public sector organization. This study employs an interpretive perspective and draws on institution theory as a theoretical framework. The concept of loose coupling and insights from the literature on professions were also employed in the explanation-building process for the case. This research contributes to institution theory and the study of management accounting change by recognizing conflicting institutional forces at the organizational level. An existing Old Institutional Economics-based conceptual framework for management accounting change is advanced and improved upon through the development of a new conceptual framework that incorporates the influence of wider institutional forces, the concepts of open and closed organizational systems and loose coupling, and the recognition of varying rates of change and institutionalization of organizational activity sets. Our understanding of loose coupling is enhanced by the interpretation of institutional influences developed in this study as is the role of professionalization as a normative influence in public sector organizations.

Enhancing delivery of health behaviour change interventions in primary care: a meta-synthesis of views and experiences of primary care nurses

Objective To systematically find and synthesise qualitative studies that elicited views and experiences of nurses involved in the delivery of health behaviour change (HBC) interventions in primary care, with a focus on how this can inform enhanced delivery and adherence to a structured approach for HBC interventions. Methods Systematic search of five electronic databases and additional strategies to maximise identification of studies, appraisal of studies and use of meta-synthesis to develop an inductive and interpretative form of knowledge synthesis. Results Nine studies met the inclusion criteria. Synthesis resulted in the development of four inter-linking themes; (a) actively engaging nurses in the process of delivering HBC interventions, (b) clarifying roles and responsibilities of those involved, (c) engaging practice colleagues, (d) communication of aims and potential outcomes of the intervention. Conclusion The synthesis of qualitative evidence resulted in the development of a conceptual framework that remained true to the findings of primary studies. This framework describes factors that should be actively promoted to enhance delivery of and adherence to HBC interventions by nurses working in primary care. Practice implications The findings can be used to inform strategies for researchers, policymakers and healthcare providers to enhance fidelity and support delivery of HBC interventions.

The design and implementation of a portable operating system for microcomputers

Communication and portability are the two main problems facing the user. An operating system, called PORTOS, was developed to solve these problems for users on dedicated microcomputer systems. Firstly, an interface language was defined, according to the anticipated requirements and behaviour of its potential users. Secondly, the PORTOS operating system was developed as a processor for this language. The system is currently running on two minicomputers of highly different architectures. PORTOS achieves its portability through its high-level design, and implementation in CORAL66. The interface language consists of a set of user cotnmands and system responses. Although only a subset has been implemented, owing to time and manpower constraints, promising results were achieved regarding the usability of the language, and its portability.

The interaction between the implementation of an occupational health and safety management system and safety culture:a case study in the rubber industry

A prominent theme emerging in Occupational Health and Safety (OSH) is the development of management systems. A range of interventions, according to a prescribed route detailed by one of the management systems, can be introduced into an organisation with some expectation of improved OSH performance. This thesis attempts to identify the key influencing factors that may impact upon the process of introducing interventions, (according to B88800: 1996, Guide to Implementing Occupational Health and Safety Management Systems) into an organisation. To help identify these influencing factors a review of possible models from the sphere of Total Quality Management (TQM) was undertaken and the most suitable TQM model selected for development and use in aSH. By anchoring the aSH model's development in the reviewed literature a range ofeare, medium and low level influencing factors were identified. This model was developed in conjunction with the research data generated within the case study organisation (rubber manufacturer) and applied to the organisation. The key finding was that the implementation of an OSH intervention was dependant upon three broad vectors of influence. These are the Incentive to introduce change within an organisation which refers to the drivers or motivators for OSH. Secondly the Ability within the management team to actually implement the changes refers to aspects, amongst others, such as leadership, commitment and perceptions of OSH. Ability is in turn itself influenced by the environment within which change is being introduced. TItis aspect of Receptivity refers to the history of the plant and characteristics of the workforce. Aspects within Receptivity include workforce profile and organisational policies amongst others. It was found that the TQM model selected and developed for an OSH management system intervention did explain the core influencing factors and their impact upon OSH performance. It was found that within the organisation the results that may have been expected from implementation of BS8800:1996 were not realised. The OSH model highlighted that given the organisation's starting point, a poor appreciation of the human factors of OSH, gave little reward for implementation of an OSH management system. In addition it was found that general organisational culture can effectively suffocate any attempts to generate a proactive safety culture.

Maintenance of communication in primary classrooms : some evidence for the role of elicitation and code-switching in English medium schools in Kenya, with implications for teaching

This is a study of specific aspects of classroom interaction primary school level in Kenya. The study entailed the identification of the sources of particular communication problems during the change-over period from Kiswahili to English medium teaching in two primary schools. There was subsequently an examination of the language resources which were employed by teachers to maintain pupil participation in communication in the light of the occurrence of possibility of occurrence of specific communication problems. The language resources which were found to be significant in this regard concerned firstly the use of different elicitation types by teachers to stimulate pupils into giving responses and secondly teachers' recourse to code-switching from English to Kiswahili and vice-versa. It was also found in this study that although the use of English as the medium of instruction in the classrooms which were observed resulted in certain communication problems, some of these problems need not have arisen if teachers had been more careful in their use of language. The consideration of this finding, after taking into account the role of different elicitation types and code-switching as interpretable from data samples had certain implications which are specified in the study for teaching in Kenyan primary schools. The corpus for the study consisted of audio-recordings of English, Science and Number-Work lessons which were later transcribed. Relevant data samples were subsequently extracted from transcripts for analysis. Many of the samples have examples of cases of communication breakdowns, but they also illustrate how teachers maintained interaction with pupils who had yet to acquire an operational mastery of English. This study thus differs from most studies on classroom interaction because of its basic concern with the examination of the resources available to teachers for overcoming the problem areas of classroom communication.

West German bank advertising and the East German public:a study in intercultural advertising communication

In the wake of German unification, initial advertising by many West German companies in the new federal states (the former German Democratic Republic - GDR) proved largely ineffective and many advertisers were forced to change their approach to this new market. The advertising task proved even more complicated for banks, because banking existed only at the most basic level in the former GDR. Furthermore, under the old regime, "capitalist" banks represented the very antithesis of the GDR's founding ideology. This analysis of advertising by West German banks - in particular Dresdner Bank - in the new federal states brings together elements of discourse and communication theory, particularly Relevance Theory [Sperber and Wilson 1986], with the overall objective of designing a model of intercultural advertising communication. A series of simple association tasks based on texts from pre-Wende advertisements was completed by a sample of advertisees (as they are called in the study) in Leipzig. The research shows the lack of relevance between the advertiser's understanding of concepts such as "credit", "bank" etc. and the associations which these concepts have for the sample of advertisees. Further analysis reveals that this lack of relevance occurs because advertisers and advertisees assign differing contexts to these concepts when they communicate through advertising. The study concludes that these different contexts, governed by the contrasting ideological, economic and linguistic environments of the advertisers and advertisees, interfere with the effective communication of the advertising message.

Strategies for agricultural change and the UK balance of payments

The world food crisis, Britain's reliance on imported food and feedstuffs and balance of payments difficulties were some of the factors which lent weight to the call for increased self-sufficiency in Britain's agriculture in the 1970s. This project considers two main areas: an investigation of the impact of radical agricultural change, designed to increase self-sufficiency, on the balance of payments; and, an appraisal of the potential role of the food industry within a radically different food system. The study proceeded by: an examination of the principles of agricultural policy and its development in Britain; an overview of the mechanism and meaning of the balance of payments; a consideration of the debate on agricultural import saving; the construction of radical agricultural strategies; the estimation of effects of the strategies, particularly to the balance of. payments; the role of the food industry and possible innovations within the strategies; a case study of textured vegetable proteins; and, the wider implications of implementation of radical agricultural alternatives. Two strategies were considered: a vegan system, involving no livestock; and, an intermediate system, including some livestock and dairy cattle. The study concludes that although agricultural change could in principle make a contribution to the balance of payments, implementation of agricultural change cannot be justified for this purpose alone. First, balance of payments problems can be solved by more appropriate methods. Second, the UK' s balance of payments problem has disappeared for the time being owing to North Sea oil and economic recession. Third, the political and social consequences of the changes investigated would be unacceptable. Progress in UK food policy is likely to be in the form of an integrated food and health policy.

Semantics of query-driven communication of exact values

We address the question of how to communicate among distributed processes valuessuch as real numbers, continuous functions and geometrical solids with arbitrary precision, yet efficiently. We extend the established concept of lazy communication using streams of approximants by introducing explicit queries. We formalise this approach using protocols of a query-answer nature. Such protocols enable processes to provide valid approximations with certain accuracy and focusing on certain locality as demanded by the receiving processes through queries. A lattice-theoretic denotational semantics of channel and process behaviour is developed. Thequery space is modelled as a continuous lattice in which the top element denotes the query demanding all the information, whereas other elements denote queries demanding partial and/or local information. Answers are interpreted as elements of lattices constructed over suitable domains of approximations to the exact objects. An unanswered query is treated as an error anddenoted using the top element. The major novel characteristic of our semantic model is that it reflects the dependency of answerson queries. This enables the definition and analysis of an appropriate concept of convergence rate, by assigning an effort indicator to each query and a measure of information content to eachanswer. Thus we capture not only what function a process computes, but also how a process transforms the convergence rates from its inputs to its outputs. In future work these indicatorscan be used to capture further computational complexity measures. A robust prototype implementation of our model is available.

Compositional semantics of dataflow networks with query-driven communication of exact values

We develop and study the concept of dataflow process networks as used for exampleby Kahn to suit exact computation over data types related to real numbers, such as continuous functions and geometrical solids. Furthermore, we consider communicating these exact objectsamong processes using protocols of a query-answer nature as introduced in our earlier work. This enables processes to provide valid approximations with certain accuracy and focusing on certainlocality as demanded by the receiving processes through queries. We define domain-theoretical denotational semantics of our networks in two ways: (1) directly, i. e. by viewing the whole network as a composite process and applying the process semantics introduced in our earlier work; and (2) compositionally, i. e. by a fixed-point construction similarto that used by Kahn from the denotational semantics of individual processes in the network. The direct semantics closely corresponds to the operational semantics of the network (i. e. it iscorrect) but very difficult to study for concrete networks. The compositional semantics enablescompositional analysis of concrete networks, assuming it is correct. We prove that the compositional semantics is a safe approximation of the direct semantics. Wealso provide a method that can be used in many cases to establish that the two semantics fully coincide, i. e. safety is not achieved through inactivity or meaningless answers. The results are extended to cover recursively-defined infinite networks as well as nested finitenetworks. A robust prototype implementation of our model is available.

Paediatric 'care closer to home':stake-holder views and barriers to implementation

In this study we explore the views of NHS stakeholders on providing paediatric ‘care closer to home’ (CCTH), in community-based outpatient clinics delivered by consultants. Design: Semi-structured interviews and thematic framework analysis. Setting: UK specialist children's hospital and surrounding primary care trusts. Participants: 37 NHS stakeholders including healthcare professionals, managers, commissioners and executive team members. Results: Participants acknowledged that outreach clinics would involve a change in traditional ways of working and that the physical setting of the clinic would influence aspects of professional practice. Different models of CCTH were discussed, as were alternatives for improving access to specialist care. Participants supported CCTH as a good principle for paediatric outpatient services; however the challenges of setting up and maintaining community clinics meant they questioned how far it could be achieved in practice. Conclusions: The place of service delivery is both an issue of physical location and professional identity. Policy initiatives which ignore assumptions about place, power and identity are likely to meet with limited success.

Asthma management : implementation of short-acting beta agonist guidelines in Western Australia:a unique collaboration

Background: The Respiratory Health Network in Western Australia developed the Asthma Model of Care in 2010 which incorporates best practice guidelines. At the same time short-acting beta agonist guidelines (SABA) were developed by stakeholder consensus at University of Western Australia (UWA) and incorporated the use of an Asthma Action Plan Card. Objective: To report on the implementation of a key component of the WA Asthma Model of Care, the SABA guidelines that incorporate the Asthma Action Plan card. Methods: Implementation strategies included lectures, direct pharmacy detailing, media releases, and information packs (postal and electronic). Groups targeted included pharmacists, consumers and medical practitioners. Results: State-based (n=18) and national (n=6) professional organisations were informed about the launch of the guidelines into practice in WA. In the four-month implementation period more than 47,000 Asthma Action Plan Cards were distributed, primarily to community pharmacies. More than 500 pharmacies were provided with information packs or individual detailing. More than 10,000 consumers were provided with information about the guidelines. Conclusions and implications: The collaboration of stakeholders in this project allowed for widespread access to various portals which, in turn, resulted in a multifaceted approach in disseminating information. Ongoing maintenance programs are required to sustain and build on the momentum of the implementation program and to ultimately address patient outcomes and practice change, which would be the longer-term goals of such a project. Future research will seek to ascertain the impact of the card on patient outcomes in WA.

Deindustrialisation and structural change during the post-Communist transition

The aim of this paper is to model the evolution of employment structure in post-communist economies in the broader context of deindustrialisation. The paper builds on the model of structural change developed by Rowthorn and Wells (1987). We show that the starting point of high industry sector share in total employment and its direct fall when productivity of sectors changes in favour of services can be explained in terms of this framework. Moreover, the model can also describe the phenomenon of a further expansion of the agriculture, observed in countries classified as "less consistent" in the reforms implementation. Hence, we distinguish two development paths, the efficient one, called "horizontal", and the inefficient one called "vertical". We illustrate it with empirical data, using alternative measures of structural change and patterns of structural evolutions during transition. Finally, we discuss the link between the EBRD indicators of reforms and structural change. We show that the "quality" of reforms, not the initial GDP level determines a country's development path.

Transparent heterogeneous terrestrial optical communication networks with phase modulated signals

This thesis presents a large scale numerical investigation of heterogeneous terrestrial optical communications systems and the upgrade of fourth generation terrestrial core to metro legacy interconnects to fifth generation transmission system technologies. Retrofitting (without changing infrastructure) is considered for commercial applications. ROADM are crucial enabling components for future core network developments however their re-routing ability means signals can be switched mid-link onto sub-optimally configured paths which raises new challenges in network management. System performance is determined by a trade-off between nonlinear impairments and noise, where the nonlinear signal distortions depend critically on deployed dispersion maps. This thesis presents a comprehensive numerical investigation into the implementation of phase modulated signals in transparent reconfigurable wavelength division multiplexed fibre optic communication terrestrial heterogeneous networks. A key issue during system upgrades is whether differential phase encoded modulation formats are compatible with the cost optimised dispersion schemes employed in current 10 Gb/s systems. We explore how robust transmission is to inevitable variations in the dispersion mapping and how large the margins are when suboptimal dispersion management is applied. We show that a DPSK transmission system is not drastically affected by reconfiguration from periodic dispersion management to lumped dispersion mapping. A novel DPSK dispersion map optimisation methodology which reduces drastically the optimisation parameter space and the many ways to deploy dispersion maps is also presented. This alleviates strenuous computing requirements in optimisation calculations. This thesis provides a very efficient and robust way to identify high performing lumped dispersion compensating schemes for use in heterogeneous RZ-DPSK terrestrial meshed networks with ROADMs. A modified search algorithm which further reduces this number of configuration combinations is also presented. The results of an investigation of the feasibility of detouring signals locally in multi-path heterogeneous ring networks is also presented.

Clustering algorithm based on minimal path loss ratio for vehicular communication

Emerging vehicular comfort applications pose a host of completely new set of requirements such as maintaining end-to-end connectivity, packet routing, and reliable communication for internet access while on the move. One of the biggest challenges is to provide good quality of service (QoS) such as low packet delay while coping with the fast topological changes. In this paper, we propose a clustering algorithm based on minimal path loss ratio (MPLR) which should help in spectrum efficiency and reduce data congestion in the network. The vehicular nodes which experience minimal path loss are selected as the cluster heads. The performance of the MPLR clustering algorithm is calculated by rate of change of cluster heads, average number of clusters and average cluster size. Vehicular traffic models derived from the Traffic Wales data are fed as input to the motorway simulator. A mathematical analysis for the rate of change of cluster head is derived which validates the MPLR algorithm and is compared with the simulated results. The mathematical and simulated results are in good agreement indicating the stability of the algorithm and the accuracy of the simulator. The MPLR system is also compared with V2R system with MPLR system performing better. © 2013 IEEE.