Sopimusohjaus ohjausmenettelynä sairaanhoitopiirin ja terveyskeskusten yksiköissä ja niiden lääkärien työssä

This study concerns the implementation of steering by contracting in health care units and in the work of the doctors employed by them. The study analyses how contracting as a process is being implemented in hospital district units, health centres and in the work of their doctors, as well as how these units carry out their operations and patient care within the restrictions set by the contracts. Based on interviews with doctors, the study analyses the realisation of operations within the units from the doctors perspective and through their work. The key result of the study is that the steering impact of contracting was not felt at the level of practical work. The contracting was implemented by assigning the related tasks to management only. The management implemented the contract by managing their resources rather than by intervening in doctors activities or the content of their tasks. The steering did not extend to improving practical care processes. This allowed the unchanged continuation of core operations in an autonomous manner and in part, protected from the impacts of contracting. In health centres, the contract concluded was viewed as merely steering the operations of the hospital district and its implementation did not receive the support of the centres. The fact that primary health care and specialised health care constitute separate contracting parties had adverse effects on the contract s implementation and the integration of care. A theoretical review unveiled several reasons for the failure of steering by contracting to alter operations within units. These included the perception steering by contracting as a weak change incentive. The doctors shunned the introduction of an economic logic and ideology into health care and viewed steering by contracting as a hindrance to delivering care to patients and a disturbance to their work and patient relationships. Contracting caused tensions between representatives of the financial administration and health care professionals. It also caused internal tensions, while it had varying impacts on different specialities, including the introduction of varying potential to influence contracts. Most factors preventing the realisation of the steering objective could have been ameliorated through positive leadership. There is a need to bridge the gap between financial steering and patient work. Key measures include encouraging the commitment of middle management, supporting leadership expertise and identifying the right methods of contributing to a mutual understanding between the cultures of financing, administration and health care. Criticism of the purchasers expertise and the view that undersized orders are due to the purchaser s financial difficulties underlines the importance of the purchaser s size. Overly detailed, product-based contracts seemed to place the focus on the quantities and costs of services rather than health impacts and efficiency of operations. Bundling contracts into larger service packages would encourage the enhancement of operations. Steering by contracting represents unexploited potential: it could function as a forum for integrated regional planning of services, and the prioritisation and integration of care, and offer an opportunity and an incentive for developing core operations.

Kasvatus- ja valmennustyylien yhteys juniorijääkiekkoilijoiden suoriutumisstrategioihin, tyytyväisyyteen ja joukkueen koheesioon

This thesis focused on the roles of parenting styles (including parental norm-breaking attitudes and parents perceptions of players coach-athlete relationship), players achievement strategies, perceptions of coaching behaviours, coaches own perceptions, and perceptions of team leaders, in explaining player satisfaction and team cohesion. Five studies based on the same data provided by the Finnish Ice Hockey Association (FIHA) were carried out. The sample sizes were as follows: players, 1,018; parents, 979; coaches, 35; and team leaders, 57. Questionnaires and self-report questionnaires were used to collect data. The results revealed that: (1) family-parenting styles provided a basis for adolescents achievement strategies and influenced whether the sons played fairly or engaged in rule breaking. Democratic parenting was associated with the adolescents high level of mastery-oriented behaviour, low level of task-irrelevant behaviour, and low level of norm-breaking behaviour. The adaptive achievement strategies enhanced player satisfaction. (2) Democratic parenting styles influenced parents perception of the coach-athlete relationship, which was further associated with a coaching style that also influenced how the child experienced his own cohesion within the team. (3) The adolescents tended to reflect the similarity in leadership behaviours between home and sport from both democratic and autocratic backgrounds. In particular, the compensating combination of non-demanding styles at home and a high level of support by a positive coach was associated with high team cohesion. (4) The stress factor changed the dynamics of the parenting behaviour. (5) Players ratings, coaches ratings, and the ratings of team leaders all differed upon coaching behaviours and team cohesion. Only the players ratings were associated with cohesion high with positive coaching and low with autocratic coaching. The developmental age and the long-lasting membership on an ice hockey team made positive coaching acceptable for all players. Sixteen year-olds from all families rated high team cohesion with positive coaching. Parenting styles were associated with adolescent ice hockey players achievement strategies, norm breaking, and satisfaction. The combination of parenting and coaching was associated with cohesion rated by players. The staff s experiences of coaching and its effects on cohesion differed from the players experiences. These results contribute to understanding links between parenting styles, achievement strategies, norm breaking, and satisfaction, as well as parenting styles, coaching behaviour and cohesion. This work has importance for parents, coaches, sport organizations, and teachers.

Achievement and Social Strategies and the Cumulation of Positive and Negative Experiences During Young Adulthood

These longitudinal studies focused on investigating young adults during transition into a new educational environment. The aims were to examine: (1) what kinds of achievement and social strategies young adults deploy, (2) whether the deployment of these strategies predicts people's success in their studies, their life events, their peer relationships, and their well-being, (3) whether young adults' success in dealing with educational transition (e.g. success in studies, life events, peer relationships and well-being) predict changes in their strategies and well-being, and (4) the associations between young adults' social strategies, interpersonal behaviour, person perception, and their peer relationships and satisfaction with them. The participants were students from Helsinki university and from two vocational institutes (the numbers ranging between 92 and 303). The results revealed that achievement and social strategies contributed to individuals' success in dealing with both the academic and interpersonal challenges of a new environment. Social strategies were also associated with online interpersonal behaviour and person perception, which mediated their impact on peer relationships. Achievement and social strategies changed as a result of environmental feedback. However, they also showed high stability, forming reciprocal and cumulative associations with the feedback the individuals received about their success in dealing with educational transition: the use of functional strategies, such as optimistic, defensive-pessimistic and planning-oriented strategies, increased their success, which in turn enhanced their well-being and further deployment of functional strategies. The opposite was true in the case of dysfunctional strategies, such as self-handicapping and avoidance. Key words : Achievement strategies, social strategies, transition, young adults, life events, sociometric status, social behaviour, person perception, well-being.

Stress responses of Gram-positive bacteria to cationic antimicrobial peptides

As the resistance of bacteria to conventional antibiotics has become an increasing problem, new antimicrobial drugs are urgently needed. One possible source of new antibacterial agents is a group of cationic antimicrobial peptides (CAMPs) produced by practically all living organisms. These peptides are typically small, amphipathic and positively charged and contain well defined a-helical or b-sheet secondary structures. The main antibacterial action mechanism of CAMPs is considered to be disruption of the cell membrane, but other targets of CAMPs also exist. Some bacterial species have evolved defence mechanisms against the harmful effects of CAMPs. One of the most effective defence mechanisms is reduction of the net negative charge of bacterial cell surfaces. Global analysis of gene expression of two Gram-positive bacteria, Bacillus subtilis and Staphylococcus aureus, was used to further study the stress responses induced by different types of CAMPs. B. subtilis cells were treated with sublethal concentrations of a-helical peptide LL-37, b-sheet peptide protegrin 1 or synthetic analogue poly-L-lysine, and the changes in gene expression were studied using DNA macroarrays. In the case of S. aureus, three different a-helical peptides were selected for the transcriptome analyses: temporin L, ovispirin-1 and dermaseptin K4-S4(1-16). Transcriptional changes caused by peptide stress were examined using oligo DNA microarrays. The transcriptome analysis revealed two main cell signalling mechanisms mediating CAMP stress responses in Gram-positive bacteria: extracytoplasmic function (ECF)sigma factors and two-component systems (TCSs). In B. subtilis, ECF sigma factors sigW and sigM as well as TCS LiaRS responded to the cell membrane disruption caused by CAMPs. In S. aureus, CAMPs caused a similar stress response to antibiotics interfering in cell wall synthesis, and TCS VraSR was strongly activated. All of these transcriptional regulators are known to respond to several compounds other than CAMPs interfering with cell envelope integrity, suggesting that they sense cell envelope stress in general. Among the most strongly induced genes were yxdLM (in B. subtilis) and vraDE (in S. aureus) encoding homologous ABC transporters. Transcription of yxdLM and vraDE operons is controlled by TCSs YxdJK and ApsRS, respectively. These TCSs seemed to be responsible for the direct recognition of CAMPs. The yxdLM operon was specifically induced by LL-37, but its role in CAMP resistance remained unclear. VraDE was proven to be a bacitracin transporter. We also showed that the net positive charge of the cell wall affects the signalrecognition of different TCSs responding to cell envelope stress. Inactivation of the Dlt system responsible for the D-alanylation of teichoic acids had a strong and differential effect on the activity of the studied TCSs, depending on their functional role in cells and the stimuli they sense.

The Finnish Leadership Style in Transition - A Study of Leadership Criteria in the Insurance Business, 1997-2004 (summary section only)

The aim of the study was to explore the importance of evaluating leadership criteria in Finland at leader/subordinate levels of the insurance industry. The overall purpose of the thesis is tackled and analyzed from two different perspectives: - by examining the importance of the leadership criteria and style of Finnish insurance business leaders and their subordinates - by examining the opinions of insurance business leaders regarding leadership criteria in two culturally different countries: the US and Finland. This thesis consists of three published articles that scrutinise the focal phenomena both theoretically and empirically. The main results of the study do not lend support to the existence of a universal model of leadership criteria in the insurance business. As a matter of fact, the possible model seems to be based more on the special organizational and cultural circumstances of the country in question. The leadership criteria seem to be quite stable irrespective of the comparatively short research time period (3–5 years) and hierarchical level (subordinate/leader). Leaders have major difficulties in changing their leadership style. In fact, in order to bring about an efficient organizational change in the company you have to alternate the leader. The cultural dimensions (cooperation and monitoring) identified by Finnish subordinates were mostly in line with those of their managers, whilst emphasizing more the aspect of monitoring employees, which could be seen from their point of view as another element of managers’ optimizing/efficiency requirements. In Finnish surveys the strong emphasis on cooperation and mutual trust become apparent by both subordinates and managers. The basic problem is still how to emphasize and balance them in real life in such a way that both parties are happy to work together on a common basis. The American surveys suggests hypothetically that in a soft market period (buyer’s market) managers employ a more relationship-oriented leadership style and correspondingly adapt their leadership style to a more task-oriented approach in a hard market phase (seller’s market). In making business better Finnish insurance managers could probably concentrate more on task-oriented items such as reviewing, budgeting, monitoring and goal-orientation. The study also suggests that the social safety net of the European welfare state ideology has so far shielded the culture-specific sense of social responsibility of Finnish managers from the hazards of free competition and globalization.

Strategic Priorities, Company Performance and Attitudes Towards Management Accounting Techniques: an Empirical Study

The study investigates whether there is an association between different combinations of emphasis on generic strategies (product differentiation and cost efficiency) and perceived usefulness of management accounting techniques. Previous research has found that cost leadership is associated with traditional accounting techniques and product differentiation with a variety of modern management accounting approaches. The present study focuses on the possible existence of a strategy that mixes these generic strategies. The empirical results suggest that (a) there is no difference in the attitudes towards the usefulness of traditional management accounting techniques between companies that adhere either to a single strategy or a mixed strategy; (b) there is no difference in the attitudes towards modern and traditional techniques between companies that adhere to a single strategy, whether this is product differentiation or cost efficiency, and c) companies that favour a mixed strategy seem to have a more positive attitude towards modern techniques than companies adhering to a single strategy

Leadership through the Gender Lens: Women and Men in Organisations

Leadership and management remain highly gendered. Recent decades have seen a major international growth of studies on gender relations in leadership, organisations and management, in both empirical research and theoretical analysis. The differential relations of women and men to leadership and management are a key question for both theory and practice. Recent research and discussion on the gendering of leadership have been influenced by and have addressed: feminism; recognition of women and women’s situations, experiences and voices in leadership; organisational culture; communication; divisions of labour, hierarchy, power and authority; imagery and symbolism; information technology; sexuality, harassment, bullying and violence in organisations; home-work relations; men and masculinities in leadership; globalisation, transnationalism, intersectionality and post¬¬colonialism – amongst other issues. Having said that, the vast majority of mainstream work on leadership retains little or no gender analysis. In most business schools and other universities the position of gender-explicit work on leadership is still not well established. Leadership through the Gender Lens brings together critical analyses and debates on gender, leadership and management with contributions from 13 countries and five continents. How leadership and management are gendered can mean more gender equal or more gender unequal conditions for women and men. This includes how education and training can contribute to gendered leadership and management. The volume is organised in three main sections, on: careers and leadership; management, hierarchy and leadership: and interventions in leadership.

United We Stand - Divided We Fall : A Standard Model of Unit Cohesion

Research on unit cohesion has shown positive correlations between cohesion and valued outcomes such as strong performance, reduced stress, less indiscipline, and high re-enlistment intentions. However, the correlations have varied in strength and significance. The purpose of this study is to show that taking into consideration the multi-component nature of cohesion and relating the most applicable components to specific outcomes could resolve much of the inconsistency. Unit cohesion is understood as a process of social integration among members of a primary group with its leaders, and with the larger secondary groups of which they are a part. Correspondingly, included in the framework are four bonding components: horizontal (peer) and vertical (subordinate and leader) and organizational and institutional, respectively. The data were collected as part of a larger research project on cohesion, leadership, and personal adjustment to the military. In all, 1,534 conscripts responded to four questionnaires during their service in 2001-2002. In addition, sociometric questionnaires were given to 537 group members in 47 squads toward the end of their service. The results showed that platoons with strong primary-group cohesion differed from other platoons in terms of performance, training quality, secondary-group experiences, and attitudes toward refresher training. On the sociometric level it was found that soldiers who were chosen as friends by others were more likely to have higher expected performance, better performance ratings, more positive attitudes toward military service, higher levels of well-being during conscript service, and fewer exemptions from duty during it. On the group level, the selection of the respondents own group leader rather than naming a leader from outside (i.e., leader bonding) had a bearing not only on cohesion and performance, but also on the social, attitudinal, and behavioral criteria. Overall, the aim of the study was to contribute to the research on cohesion by introducing a model that takes into account the primary foci of bonding and their impact. The results imply that primary-group and secondary-group bonding processes are equally influential in explaining individual and group performance, whereas the secondary-group bonding components are far superior in explaining career intentions, personal growth, avoidance of duty, and attitudes toward refresher training and national defense. This should be considered in the planning and conducting of training. The main conclusion is that the different types of cohesion components have a unique, positive, significant, but varying impact on a wide range of criteria, confirming the need to match the components with the specific criteria.

"Musiikki merkitsee minulle paljon" : Asennetutkimus musiikin opiskelun merkityksellisyydestä peruskoulun 9. luokkalaisille

The main purpose of the Master Thesis was to find out what kind of attitudes the pupils in the 9th grade of Finnish comprehensive school have towards music as a school subject and compare it to the attitudes of the principals at a school level. The theoretical context of the research is based on the former studies of the significance of music education in the comprehensive school, the connection between learning and attitudes and the motivational factors towards the study motivation of music. In addition to this, I have analysed the role of the evaluation and the assessment from the point of view of developing the educational system and what is the role of management and leadership in relation to the pupils` behaviour and attitudes. The data of the research is the Finnish National Board of Education`s collected data of the assessment of the learning outcomes of arts education and it is nationally representative (N=5056 I phase and n=1570 II phase), both the Finnish-language and the Swedish-language pupil data. I have especially concentrated on the items of measuring the attitudes, the certain background variables and the questionnaire of the principals. The numerical data was analyzed using the multivariate statistical methods. The results of the research prove that in general the pupils and the principals think that music is quite significant as a school subject. The girls valued music on average more than the boys when comparing all the dimensions. The differences were systematic but the effect sizes were under 10 %. There were not statistically significant differences between the Finnish-language and the Swedish-language pupils. Comparing the grades of music in the 7th grade, the differences were growing linearly and the effect size was 15.7 %. There was a positive statistically significant correlation between the Significance of music and music as a hobby (Active interest in music, Informal interest in music, Taking part of music activities in the school) during free time. The strongest correlation were with the Active interest in music variable (r= 0.53, p= .000). Also the principals thought that music is important as a school subject considering the development of the pupil and the function of the school. The answers of the pupils were not clustering at a school level and there were no strong correlations between the attitudes of the pupils and the principals. A statistically nearly significant and a slight correlation (r= 0.21, p= .011) was found between the principals valuing the Significance of the music for school function and the pupils valuing the Benefits and hobbyism. The role of a well-motivated and active music teacher can be important from this point of view. The most important conclusion of the research was that the significance of music is a very personal individual level phenomenon. The results highlight also that in the pupils` opinion the most important thing about music lessons is to musical activity and learning as an experience.

A new method for modulating the activity of parvalbumin-positive neurons and cerebellar Purkinje cells in vivo

Neurons can be divided into various classes according to their location, morphology, neurochemical identity and electrical properties. They form complex interconnected networks with precise roles for each cell type. GABAergic neurons expressing the calcium-binding protein parvalbumin (Pv) are mainly interneurons, which serve a coordinating function. Pv-cells modulate the activity of principal cells with high temporal precision. Abnormalities of Pv-interneuron activity in cortical areas have been linked to neuropsychiatric illnesses such as schizophrenia. Cerebellar Purkinje cells are known to be central to motor learning. They are the sole output from the layered cerebellar cortex to deep cerebellar nuclei. There are still many open questions about the precise role of Pv-neurons and Purkinje cells, many of which could be answered if one could achieve rapid, reversible cell-type specific modulation of the activity of these neurons and observe the subsequent changes at the whole-animal level. The aim of these studies was to develop a novel method for the modulation of Pv-neurons and Purkinje cells in vivo and to use this method to investigate the significance of inhibition in these neuronal types with a variety of behavioral experiments in addition to tissue autoradiography, electrophysiology and immunohistochemistry. The GABA(A) receptor γ2 subunit was ablated from Pv-neurons and Purkinje cells in four separate mouse lines. Pv-Δγ2 mice had wide-ranging behavioral alterations and increased GABA-insensitive binding indicative of an altered GABA(A) receptor composition, particularly in midbrain areas. PC-Δγ2 mice experienced little or no motor impairment despite the lack of inhibition in Purkinje cells. In Pv-Δγ2-partial rescue mice, a reversal of motor and cognitive deficits was observed in addition to restoration of the wild-type γ2F77 subunit to the reticular nucleus of thalamus and the cerebellar molecular layer. In PC-Δγ2-swap mice, zolpidem sensitivity was restored to Purkinje cells and the administration of systemic zolpidem evoked a transient motor impairment. On the basis of these results, it is concluded that this new method of cell-type specific modulation is a feasible way to modulate the activity of selected neuronal types. The importance of Purkinje cells to motor control supports previous studies, and the crucial involvement of Pv-neurons in a range of behavioral modalities is confirmed.

Independent and mediating organizational commitment effects of trust in leadership on employees' job satisfaction and : a study within social and health care sector

The purpose of this study was to examine whether trust in supervisor and trust in senior management enhance employees' job satisfaction and organizational commitment, and whether trust mediates the relationship between perceived justice and these outcomes. Trust in supervisor was expected to mediate the effects of distributive justice and interactional justice, and trust in senior management was expected to mediate the effects of procedural justice. Theoretical background of the study is based on the framework for trust in leadership developed by Dirks and Ferrin (2002). According to the framework, perceived fairness of leaders' actions helps employees to draw inferences about the basis of the relationship and about leaders' characters. This allows trust formation. Reciprocation of care and concern in the relationship and confidence in leaders' characters are likely to enhance employees' job satisfaction and organizational commitment. This study was conducted with cross-sectional data (A/ = 960) of employees from social and health care sector. Hypotheses were studied using correlation analysis and several hierarchical regression analyses. Significances of the mediations were assessed using the Sobel test. Results partially supported the hypotheses. Trust in leadership was positively related to job satisfaction and organizational commitment. Trust in senior management mediated the relationship between procedural justice and the outcomes. Some support was also found for the mediating effect of trust in supervisor in the relationship between distributive justice and organizational commitment. Due to high correlation between trust in supervisor anil interactional justice, it wasn't possible to study the mediating e fleet of trust in supervisor in the relationship between interactional justice and the outcomes. Against expectations, results indicated that trust in senior management had a mediating effect in the relationship between distributive justice and organizational commitment, and in the relationship between interactional justice and organizational commitment. Results also indicated that trust in supervisor had a mediating effect in the relationship between procedural justice and organizational commitment.

Women, Management and Leadership - Naiset ja johtajuus : NASTA Women's Leadership Project Final Report

Leadership without the full participation of women not only excludes women individually and collectively, but is also a huge waste of talent, knowledge and expertise. And crucially, given the current state of society and the world, this aspect of gender inequality is likely to become even more important in the future. NASTA - Women’s Leadership: A Research and Education Development Project was established in 2005 as a national multi-university project mainly and generously funded by Finnish Ministry of Education. The project aims at producing new knowledge and increasing understanding about women’s leadership, as well as promoting women’s leadership through research, development of teaching, and public outreach. NASTA is a joint effort of three Finnish universities – Hanken School of Economics, University of Jyväskylä School of Business and Economics, and the Helsinki School of Economics (now part of Aalto University) – and has been coordinated by Hanken. This report presents research and activities conducted within and around the project. NASTA activities have been many and various. They have examined the position and experiences of women in relation to leadership, management, organisation and work more generally. They have sought new knowledge about gender and leadership, on women leaders’ values, attitudes and behaviour, as well as about values, attitudes and behaviour in relation to women’s leadership. NASTA activities have included teaching, student supervision, research theses, research projects, publishing, networking, seminars, meetings, an international conference, and knowledge transfer into other sectors of society. The first section of the book introduces NASTA joint projects, including web-based teaching material, a survey of gender staffing and teaching on gender in business schools, critical review of previous research literature, and new empirical research. The next section includes research articles on different aspects of gender, leadership and manage¬¬ment from more individual projects conducted by participating researchers and research groups linked to NASTA across the three universities. The final section includes short presentations of other research in progress. The appendix lists publications by NASTA members – journal articles, research reports, books, chapters, journal special issues, popular journal articles, magazine articles - and masters, licentiate and doctoral theses that have been produced. These matters of women, leadership and management are not simply academic concerns but urgent matters for practice, organisations, management, policy, and society more generally.