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A Comparative Case Study: Exploring Health System Governance in Canada and Saudi Arabia
(Western University, 2024) Almalki, Fawziah; Oudshoorn, Abe; Tryphonopoulos, Panagiota; Smith, Maxwell; Muntaner, Carles
Health systems and health system outcomes are incredibly complex. To understand how they function, researchers explore individual components of the system, in the study herein the component is ‘governance’. Research to date has demonstrated a positive relationship between governance and population health outcomes. Governance, therefore, may be a concept that assists in understanding differential health outcomes of seemingly comparable countries. This study aims to explore macro-level governance, particularly the two sub-concepts of ‘government effectiveness’ and ‘perceived corruption’, in two countries: Saudi Arabia and Canada. Government effectiveness reflects the quality of public health policy development and implementation, and how much the government adheres to these policies. These comparator countries are selected as they share similarities on three levels, economy, population size, and free basic healthcare; yet differ significantly in governance models. A case study methodology as described by Stake (1995), guided this study. This study is particularly a comparative case study design with a focus on qualitative data. The data will be used to understand in-depth nuances of governance in health systems. Two overarching questions guided this study, one for each of the sub-concepts: 1) How the government effectiveness process, in terms of health policy development and implementation, unfolds within the health system in Saudi Arabia and Canada. 2) How corruption, as an aspect of governance, is present within health systems. This work is framed within a critical theoretical perspective. Concerns about good governance and corruption that guide this work is to the purpose of seeking the best health outcomes for all people. Governance as a whole, and sub-concepts of government effectiveness and corruption, are all amenable to change and improvement. To engage with system complexity, multiple data sources were utilized within this case study. Primary data consisted of interviewing 32 participants (15 in Canada and 17 in Saudi Arabia) who work in the health system in service provision, research, policy, management, or education. Secondary data included government documents about health system structure and strategies at the macro level. Data collection was conducted through two phases. Phase one of data collection involved in-depth interviews with experts across the health systems. The interviews were conducted in both English and Arabic. Documents for analysis were collected and accessed through official websites of governments or Ministries of health, and healthcare organizations, and scientific databases. These documents were analyzed via Critical Discourse Analysis (CDA) as outlined by Van Dijk (1993) and Mullet (2018). The findings are divided into three foci as three chapters: 1) a methodological piece on conducting bilingual research; 2) the nature of government effectiveness; and 3) the nature of corruption in health systems. Conducting research in a language not spoken by all the research team members is relatively common, yet addressing the nuanced details of implementing bilingual work has limited guidance within extant literature. This includes consideration of promising practices for concept development, translation, data analysis, and presenting the findings. This chapter is an exploration of the strengths and limitations of doing bilingual research, and recommendations regarding these aforementioned issues from our own experiences. Ultimately, it is proposed that via bilingual research, the accumulation of knowledge pertaining to qualitative research concepts, translation, analysis, and dissemination of comprehensive frameworks can be enacted, ultimately enhancing the rigour of qualitative research and increasing confidence in applying knowledge created in the chosen language of participants. Findings on government effectiveness in health systems in both Canada and Saudi Arabia are presented in four themes. These four themes are: 1) Health is Political, 2) Health System Privatization, 3) An Outdated System vs. A System that is Catching Up, and 4) Social Determinants of Health (SDoH) and Cross-Sectoral Collaboration. Recommendations are provided on how to better identify elements of government effectiveness and integrate them with the SDoH in order to enhance system effectiveness and improve the health of populations. For the chapter on corruption, it is noted that Governance is a complex theoretical concept that includes the sub-concept of ‘corruption’. A very ‘loaded’ term, this study sought to understand how corruption is present in health systems, often in very subtle ways. Findings illustrate how corruption is still a relevant concept in advanced health systems and can include both subtle and even overt forms within Canadian and Saudi health systems. This is explained in three themes: 1) Corruption in Wealthy Nations: Subtle Opportunism; 2) Nepotism and Professional Courtesy; and 3) A Strict System vs A Relaxed System. This analysis uncovers nuanced forms of potential personal gain within Canadian and Saudi health systems that make the concept of corruption still a timely concern. Addressing these risks must be seen as a collective obligation, where healthcare providers identify and report cases of potential corruption, managers prevent and address opportunities for personal gain, and researchers study how to develop policies and processes that are most immune to corruption. Ultimately, this study continues to unpack the complex ways that health systems are actualized, looking particularly at the concept of governance, and selected sub-concepts of government effectiveness and corruption.
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The Impact of Cloud Computing on the Skills, Autonomy, and Professional Identities of Junior External Auditors Case Studies of Three of the Big Four Audit Firms in Saudi Arabia
(The University of Sheffield, 2024-01) Alromaihi, Alaa; Lee, Bill; Matos De, Juliana; Ji, Jiao
This thesis critically applies the Marxist (1954) analysis of capitalism and labour process theory (LPT) to investigate the impact of technological advances – specifically the introduction of Cloud Computing – on the work and experiences of junior external auditors at three of the Big Four audit firms in Saudi Arabia. While previous research has predominantly focused on the organisational level, this study shifts the focus to concentrates on the individual level. The study undertakes three case studies, 29 in-depth semi-structured interviews with junior and senior external auditors, managers, and partners providing a comprehansive perspective of the transformative effects of Cloud technology on the career development of jounior auditors. Responding to calls for more qualitative studies in the field of accounting research and more research in developing countries, this thesis expands the scope of Cloud Computing research. The findings reveal aspects of deskilling in the reduced demand for physical and mental effort, while the enhancement of juniors’ technical skills represents a form of reskilling. Notably, the decrease in autonomy among junior auditors, attributed to the centralising effect of the Cloud, provides support for LPT, illustrating how technological and procedural changes can reshape power dynamics in the workplace. The findings emphasis the dynamic interplay between technology and labour processes; highlighting significant shifts in the roles, behaviours, and attitudes of junior auditors due to the adoption of Cloud technology.
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Achieving Global Recognition: Higher Education Rankings and the Commitment to Quality in Saudi Arabia’s 2030 Strategic Vision
(University of Glasgow, 2024) Alanazi, Abdulaziz Hamoud; Doherty, Robert
This study has as a primary focus the devising of strategic recommendations to help the government of Saudi Arabia achieve its goals, particularly the objective of having at least five Saudi institutions among the top 200 global universities by 2030. The research explored the challenges in realizing the educational targets set in The Saudi Vision 2030, aiming to position Saudi Arabia as a global education leader. In examining the background of education in the Kingdom of Saudi Arabia, the study delves into the historical evolution of the education system and its alignment with contemporary aspirations, notably the Saudi Vision 2030. This comprehensive overview provides context for understanding the current higher education landscape and the imperative for transformation. The conceptualization of the western form of the university, from its origins as a Church institution to its evolution into a globalized modern entity, forms a backdrop to an understanding of the university of today. The concept of excellence in higher education is explored, tracing its trajectory from ancient universities to the present era. This examination encompasses the historical development of formal quality systems and the contemporary imperative for achieving world-class status. The development of higher education quality and quality assurance frameworks are considered. The study explores ranking systems in higher education, addressing their development, impact, and significance to improving institutional status and global position. With reference to a wider framework of neoliberalism and its globalizing affects, attention is given to how Saudi universities confront the complexities of global ranking systems and their implications for institutional advancement. By considering critical perspectives and emerging trends in ranking methodologies, the research identifies pathways for enhancing the global competitiveness of Saudi institutions. The study underscores the interconnectedness of historical legacies, contemporary challenges, and future aspirations in advancing Saudi higher education. By synthesizing insights from diverse domains, strategic recommendations are formulated to support Saudi universities towards global prominence, aligning with the ambitious vision outlined in Saudi Vision 2030. In addition to a review of the relevant literature, ten interviews were conducted with senior leaders from universities, Vice Rectors for Planning, Development, and Quality. The participants, from both the United Kingdom and Saudi Arabia, possessed practical and operational expertise in higher education ranking focused activity. This research identified crucial factors pivotal for advancing the higher education system towards its strategic goal. The study highlights the significant roles of academic research, the cultivation of research identity, marketing, publicity, financial resource attraction, academic and administrative autonomy, and academic reputation. These elements are collectively decisive to any effort to elevate the global rankings of Saudi universities. The research indicates areas recommended for enhancement in Saudi universities, including bolstering academic reputation, promoting research, investing in research and development, fostering international collaborations, and attracting international students.
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PERFORMANCE OPTIMIZATION OF A PROTON EXCHANGE MEMBRANE WATER ELECTROLYZER
(University of Delaware, 2024-07) Alkhaldi, Shabeeb; Ajay, Prasad
Green hydrogen can contribute significantly to combating climate change by helping to decarbonize the world's energy sector. Hydrogen can be produced in a carbon-free manner using renewable energy by electrolysis which is environmentally benign and produces hydrogen with high purity. Water is fed to the electrolytic cell as the reactant and it is dissociated into hydrogen and oxygen by the passage of electricity. Water electrolysis is typically accomplished today by one of three methods: (i) alkaline water electrolysis (AWE); (ii) solid oxide water electrolysis (SOWE); and (iii) proton exchange membrane water electrolysis (PEMWE). PEMWE offers certain advantages including high efficiency and high current density. Therefore, we focus on PEMWE in this study. First, we examine the effect of various operating parameters on PEMWE performance such as water flow rate, temperature, membrane thickness, flow field channel configuration, and porous transport layer properties. This work quantitatively compares the relative magnitude of anode water consumption against the concurrent water transport mechanisms of Fickian diffusion and electroosmotic drag as a function of the applied voltage. This study also gives insights on optimizing PEMWE performance by varying the operating parameters and provides a foundation for the design of a full-scale PEMWE system. Second, we evaluate multiple strategies for gas management in the PEMWE anode. In this study, we employ an electrolysis cell featuring a transparent anode to visualize oxygen bubble production and transport under a range of operating conditions. These strategies include changing the cell’s orientation with respect to gravity, increasing the water flowrate, and adding surfactant to the anode water supply. This study shows that optimally orientating the channels with respect to gravity can assist with oxygen bubble evacuation and improve performance. This study also captures the dynamic behavior of the two-phase flow phenomena in PEMWEs over a range of applied voltages. The results provide suggestions to enhance PEMWE performance by optimizing oxygen gas management within the PEMWE’s flooded anode. Third, we focus on the phenomenon of electroosmotic drag in an operating PEMWE with the goal of accurately measuring the electroosmotic drag coefficient. This study elucidates the effect of the cell temperature and membrane thickness on the relevant water transport phenomena. We also investigate the effect of supplying dry nitrogen to the cathode and provide an explanation for the improved current density based on the Nernst equation. Understanding these mechanisms is essential to improving PEMWE performance and efficiency. Finally, we compare the catalytic performance of nickel iron layered double hydroxide (NiFe LDH) against commercial iridium oxide (IrOx) in an anion exchange membrane water electrolyzer. In this study, we present the structural and performance analysis of NiFe LDH which was prepared in the form of nanosheets through a benzyl alcohol-mediated solvothermal process in one step. The NiFe LDH electrode demonstrated good stability over a 24-hour durability test. Although the electrochemical performance of NiFe LDH was somewhat lower compared to IrOx, it shows promise as a AEMWE catalyst due to its significantly lower cost and capacity for further activity enhancement.
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The Impact of Nurse-Led Clinics on Patient Satisfaction in Oncology Care: A Systematic Literature Review.
(Queen’s University Belfast, 2024-07) Alharbi, Shara; Cardwell , Pauline; Wilkie , Susie
Background: Due to the increasing complexity of cancer treatment in recent years, it has become crucial to establish a more patient-focused and efficient model of care delivery. Nurse-led clinics have emerged as a promising approach to meeting the demanding requirements of cancer care delivery, particularly within the emotionally and physically challenging field of oncology. This innovative approach aims to enhance patient satisfaction by providing personalised, holistic, and readily accessible services, and understanding the impact of nurse-led clinics on patient satisfaction is thus crucial in terms of optimising cancer care delivery and supporting practice development. Aim: This systematic literature review aims to examine the impact of nurse-led clinics on patient satisfaction in oncology care settings. Methodology: A comprehensive search was performed across three reputable databases: CINAHL, Medline, and EMBASE, utilising PRISMA guidelines. Strict inclusion and exclusion criteria were applied, along with specific keywords and combinations. Following a critical quality appraisal using the Joanna Briggs Institute (JBI) criteria, eight studies were found to meet the eligibility criteria for further review. Results: The eight studies identified for review were conducted across four different countries; they utilised a variety of study designs, including randomised controlled trials (RCTs), surveys, cross-sectional designs, and sequential multi-method designs. The focus was on oncology care settings, and studies were then categorised based on their findings around patient satisfaction with nurse-led follow-up, covering aspects such as patients' perceived satisfaction, the effectiveness of nurse-led follow-up, perceived convenience and accessibility, continuity of care, and cost-effectiveness of care. Conclusions: This literature review identified several key areas for improvement in patient satisfaction within nurse-led clinics: patients' perceived satisfaction, effectiveness of nurse-led follow-up, convenience and accessibility, continuity of care, and cost-effectiveness. The studies overall emphasised the positive impact of nurse-led clinics on patient satisfaction and outcomes in oncology care, however, highlighting the potential of such settings to enhance patient care by providing personalised and accessible supportive services. Future research should therefore focus on identifying and addressing various implementation barriers and evaluating long-term outcomes to further elucidate the benefits of nurse-led models in oncology care delivery.