Cutting from the Bottom: Reform and Hospital Work Under the Influence of New Public Management
Notice bibliographique
Résumé
Health care research predominantly analyzes the role of pharmaceuticals and physicians. Less focus is given to the majority of workers who are essential to the health care system. While often ignored, the non-physician work force has a large impact on health care financing and health care outcomes. Their work and the context they work in needs to be analyzed to provide a fuller understanding of health care systems. This dissertation is an attempt to fill this gap in health research. Hospital work exists in a complicated political context. Hospitals in Canada are privately operated, non-profit corporations that are publicly funded directly by provincial governments and indirectly by the federal government. Both levels of government have attempted to constrain health care spending in the last few decades, and much of this reduction was aimed at non-physician hospital workers and services. This dissertation utilized theories from public administration and sociology to contextualize hospital work within large political shifts and how they have impacted hospital work. These theories guided the literature review, the interview schedule, and the analysis and interpretation of the data. This dissertation examined the impact of health care reform on hospital work. Semi-structured interviews were utilized to ask hospital workers about their work, work-life balance, and how hospital work has changed over their careers. In total, 20 hospital workers were interviewed, including 10 nurses and 10 non-nurse workers. Interviews ranged from 30 to 65 minutes. Most respondents were from hospitals downtown Toronto, with the remaining working in hospitals within the Greater Toronto Area. This dissertation found that successive waves of health care reform have negatively impacted hospital work. Workers indicated various ways that the changing political and economic climate has impacted their lives and their ability to perform their work at a high level. In general, workers cited lowered autonomy, increased automation and documentation, and increased managerial control over their work. Workers also reported work intensification and high rates of injury. Workers pointed to budget cuts and a shift in accountability down to the workers to explain why these changes had occurred.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,012 | 0,028 |
| Communication savante | 0,013 | 0,005 |
| Science ouverte | 0,001 | 0,007 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».