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Title: Public value of the e-Sick Leave system in Emirate of Abu Dhabi
Author: Almansoori, Mouza
ISNI:       0000 0005 0290 1782
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2019
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The e-Sick Leave system is a new information system in the Health Sector in the Emirate of Abu Dhabi. Until now, no other country has implemented a programme focused on digitalisation, controlling, and regulating the issuance and attestation of sick leave certificates. This thesis takes a unique approach in describing the implementation and evaluation of this medico-legal system. In 2012, the Department of Health (DOH) in Abu Dhabi commissioned a medico-legal system, called the e-Sick Leave system, to control abuses and protect the rights of employees, employers, and doctors. This study sought to develop a framework for understanding the influence of the e-Sick Leave system on sick leave service performance, using the public value approach. No previous research has investigated the public value of such a system, and this study addressed the question of how the e-Sick Leave system can create such public value. The five research objectives were to define and describe a modern, digital healthcare initiative by analysing the characteristics of an e-Sick Leave system; to develop a benefits map to connect the enablers of e-Sick Leave benefits with its public value; to assess the influence of e-Sick Leave system on transaction costs; to assess the influence of e-Sick Leave on controlling different actors and agencies; and to develop recommendations that would improve the framework for understanding this healthcare initiative as well as to improve its public value. To this end, the research used a phased, mixed-research approach. First, to extend and verify the public value of e-Sick Leave from the users' perspective, 16 policy-makers in the DOH were interviewed to define e-Sick Leave, to understand its mechanisms for controlling and orchestrating its users, and to define its public value from the perspective of its sponsor and owner. Fifty doctors from different hospitals, 18 policy-makers, 15 patients and ten employers were interviewed. To verify and generalise the perceptions, two surveys were conducted, which collected 223 and 230 questionnaires, respectively, from doctors and patients. E-Sick Leave system is (my own definition) 'digital cybernetic platform that integrates different systems in different institutions to understand, and so to enable, regulation of the behaviour of different sub-systems and their players'. To understand the public value of this system, a benefits map was developed to connect enablers with the outcomes and benefits. The enablers here were both digital and cybernetic. The outcomes and benefits are the control of the fabrication of sick leave certificates, less paperwork, the removal of unnecessary and duplicated activities, a simplified sick leave process, standardised processes and sickness leave criteria, governing the medical decision-making process, reducing doctors' undesired behaviours (i.e. prescribing long periods off work to patients, and unnecessary examinations and medications), reducing undesirable patient behaviour (e.g. fabrication of data, visiting different doctors to obtain the longest period of sick leave, and exploiting informal relationships with doctors), and controlling disease behaviour. E-Sick Leave's public value dimensions are its economic and welfare benefits. The economic benefits take the form of reduced total controlling costs (i.e. the cost of controlling abusers, and the cost of abusers), reduced transaction costs (i.e. search costs, negotiation costs, and enforcement costs), and operational costs (e.g. process costs). The welfare benefits are in improving morale (i.e. accountability and the giving of false/misleading information), improving public health, total system satisfaction (i.e. satisfaction of employees, employers, doctors, and the DOH as a win-win scenario), improved services (i.e. greater speed, accessibility, and accuracy), protecting rights (i.e. transparency, fairness and trust), and improving relationships between different actors. To consolidate the two functionalities of the e-Sick Leave system effectively, and to be more decentralised while reducing transaction costs, a blockchain system is proposed. Because of other operational and governance issues, to achieve the full potential of benefits as a cybernetic system and a digital platform, a new, independent board was proposed to manage these benefits. This research filled several knowledge gaps. It was the first to define the e-Sick Leave system from a cybernetic perspective, and hence is considered to be a contribution that introduced cybernetics into the healthcare sector. It was also the first to use the benefits maps methodology in mapping the relations between the enablers (i.e. the functionalities of the system) and the benefits. Finally, this research was the first to apply a public value framework to a medico-legal system in the Emirate.
Supervisor: Brookes, Stephen Sponsor: Not available
Qualification Name: Thesis (D.B.A.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available