Työhyvinvointi, koulutus ja toiminnan kehittäminen terveyskeskuksissa lääkäritilanteen näkökulmasta

Finnish health centres have suffered from a shortage of physicians in recent years. This is why more physicians are being educated, the tutelage of the young physicians has been improved and many tasks which were previously reserved for physicians have been transferred to nurses and other personnel of the health centres. Only a little research has been done about the effects of the shortage of physicians and education to the work atmosphere in the health centres The objectives of the study was to describe the situation of the physicians in the counties Satakunta and South-Western Finland at the time when the University of Turku started to decentralise its education to Satakunta and describe the health centres attitudes towards training and research co-operation with the University of Turku; to gain information about the training programmes for physicians in specific training in general medical practice (STPG); study how the shortage of physicians affects the job atmosphere, the job satisfaction and the operation of the health centres; study health centre employees opinions about their professional skills, their needs and interets in continuing education; study medical and nurse students professional indentity and their readiness to multiprofessional teamwork. The material of the study was gathered during 2003-2006 with three mail questionnaires and a questionnaire given to medical and nurse students who practised in the training health centre in Pori. The first questionnaire was sent to the chief physicians of the health centres in counties Satakunta and South-Western Finland to clarify the number of unfilled positions of physicians and the reasons for physician shortage as well as the readiness for practical training of medical students and research at the health centres. The second questionnaire was posted to doctors in specific training in general medical practice and their trainers at the health centres and it gained information about training programmes of young physicians at health centres. The third questionnaire was sent to personnel at health centres in Satakunta and South-Western Finland and included questions about job satisfaction and education. The survey for medical and nurse students gained information about their professional indentity and their readiness to multiprofessional teamwork. In spring 2003 the shortage of physicians was more severe in Satakunta than in South-Western Finland. Attitudes towards training of medical students and research co-operation with the universities were generally positive. The guidance of STGP doctors in health centres improved during 2003-2005. A shortage of physicians had only a slightly negative impact on employee job satisfaction. The shortage of physicians had also positive impact on the operation of the health centres because it led to reorganization of the operations. The personnel at Finnish health centres were willing to take more challenging tasks and also to acquire appropriate further education or training. The medical and nurse students had strong professional identity and they understood the significance of teamwork for the health care service system.

Evaluating End-User Training Effectiveness in ERP System Implementation

Today’s business world demands more and more internal and external integration and transparency among companies at all fields. Integrated ERP (enterprise resource planning) systems offer a possibility to improve business practices and procedures by providing a unified view on the business including all functions and departments. Due to the obvious benefits, the popularity of integrated ERP systems keeps growing. The implementation of ERP systems has however proven risky. The implementation projects tend to be long, extensive, and costly – and often they end up in a failure. Due to the significant task and role changes ERP implementation brings to almost everybody in the company, training has been identified as one of the most critical success factors of an ERP implementation. To ensure that the training is conducted in the most effective and successful manner, the training outcomes should be evaluated. So far, training evaluation has however gained only limited attention at most companies investing in different training programs. Uponor corporation has initiated a large ERP implementation and process harmonization program in 2004. Thousands of end-users have been trained during this project so far, and the work still continues until the project is completed in 2010. In this thesis, the evaluation of end-user training in Uponor’s ERP program is brought further from the current state of performing the basic participant satisfaction survey in the end of each class. The results show that in order to reach reliable training effectiveness evaluation results, not only the reaction towards training but also transfer of skills and attitudes and the final results of the training program should be evaluated.

Commitment to military service among Finnish conscripts

This research establishes the primary components, predictors, and consequences of organizational commitment in the military context. Specifically, the research examines commitment to the military service among Finnish conscripts and whether initial affective commitment prior to service predicts later commitment, attitudes, behavior, and performance, and, furthermore, analyzes the changes in commitment and its possible outcomes. The data were collected from records as well as by surveys from 1,387 rank and file soldiers, immediately after they reported for duty, near the end of basic training, and near the end of 6 to 12 months of service. The data covered a wide array of predictor variables, including background items, attitudes toward conscription, mental and physical health, sociability, training quality, and leadership. Moreover, the archival data included such items as rank, criminal record, performance ratings, and the number of medical examines and exemptions. The measures were further refined based on the results of factor analysis and reliability tests. The results indicated that initial commitment significantly corresponded with expected adjustment, intentions to stay in the military, and acceptance of authority. Moreover, initial commitment moderately related to personal growth, perceived performance, and the number of effective service days at the end of service. During basic training, affective commitment was mostly influenced by challenging training, adjustment experiences, regimentation, and unit climate. At the end of service, committed soldiers demonstrated more personal growth and development in service, had higher-level expected performance, and less malingering during their service. Additionally, they had significantly more positive attitudes toward national defense. The results suggest that affective commitment requires adequate personal adjustment, experiences of personal growth and development, and satisfaction with unit dynamics and training. This research contributes to the theoretical discussion on organizational commitment and the will to defend the nation and advances developing models to support and manage conscript training, education, leadership, and personnel policy. This is achieved by determining the main factors and variables, including their relative strength, that affect commitment to the military service. These findings may also facilitate in designing programs aimed at reducing unwanted discharges and inadequate performance. In particular, these results provide tools for improving conscripts’ overall attachment to and identification with the military service.

Foot Health In Older People - Development of a preventive, evaluative instrument for nurses

Foot health is a part of overall health in every age group and its importance increases during ageing. Health care professionals are in a vital position for preventing foot health problems, and identifying and caring them in older people. Despite the rather high number of studies conducted in the field of foot health in older people, reliable and valid nurse-administered foot health assessment instruments seem to be lacking. By identifying foot health in older people, it is possible to develop nursing interventions to enhance safe, independent living at home. The purpose of this three-phase study was to develop an instrument to assess the level of foot health in older people and evaluate foot care practices from the perspective of older people themselves and nurses in home care. The ultimate goal is to prevent foot health problems by increasing the attention paid to older people’s feet and recognizing those foot health problems which need further care; thus not focus on different foot health problems. The study was conducted in different phases and contexts. In phase 1, a descriptive design with a literature review from the Medline (R) and CINAHL databases to explore foot health in older people and nurses’ role in foot health care and pre-post design intervention study in nursing home with nursing staff (n=16) and older residents (n=43) were conducted. In phase 2, a descriptive and explorative study design was employed to develop an instrument for assessing foot health in older people (N=651, n=309, response rate 47%) and explore the psychometrics of the instrument. The data were collected from sheltered housing and home care settings. Finally, in phase 3, descriptive and explorative as well as cross-sectional correlational survey designs were used to assess foot health and evaluate the foot self-care activities of older people (N=651, n=309, response rate 47%) and to describe foot care knowledge and caring activities of nurses (N=651, n=322, response rate 50%) in home care in Finland. To achieve this, the Foot Health Assessment Instrument (FHAI) developed in phase 2 was used; at the same time, this large sample also was used for the psychometric evaluation of the FHAI. The data analysis methods used in this study were content analysis, descriptive and inferential statistics including factor and multivariate analysis. Many long-term diseases can manifest in feet. Therefore, the FHAI, developed in this study consisted of items relating to skin and nail health, foot structure and foot pain. The FHAI demonstrated acceptable preliminary psychometric properties. A great deal of different foot health problems in older people were found of which edema, dry skin, thickened and discoloured toenails and hallux valgus were the most prevalent foot health problems. Moreover, many older people had difficulties in performing foot self-care. Nurses’ knowledge of foot care was insufficient and revealed a need for more information and continuing education in matters relating to foot care in older people. Instead, nurses’ foot care activities were mainly adequate, though the findings indicate the need for updating foot care activities to correspond with the evidence found in the field of foot care. Practical implications are presented for nursing practice, education and administration. In future, research should focus on developing interventions for older people and nurses to promote foot health in older people and to prevent foot health problems, as well as for further development of the FHAI.

Developing the Product Return Process of a Service Center With Lean Methods

Today lean-philosophy has gathered a lot of popularity and interest in many industries. This customer-oriented philosophy helps to understand customer’s value creation which can be used to improve efficiency. A comprehensive study of lean and lean-methods in service industry were created in this research. In theoretical part lean-philosophy is studied in different levels which will help to understand its diversity. To support lean, this research also presents basic concepts of process management. Lastly theoretical part presents a development model to support process development in systematical way. The empirical part of the study was performed by performing experimental measurements during the service center’s product return process and by analyzing this data. Measurements were used to map out factors that have a negative influence on the process flow. Several development propositions were discussed to remove these factors. Problems mainly occur due to challenges in controlling customers and due to the lack of responsibility and continuous improvement on operational level. Development propositions concern such factors as change in service center’s physical environment, standardization of work tasks and training. These factors will remove waste in the product return process and support the idea of continuous improvement.

Violations of children's rights in armed conflicts : international treaties, observations by peacekeepers and crisis management training in Finland

Ninety-nine Finnish peacekeepers, who had been serving in 15 different operations around the world, participated in the study (8 women, 27-52 years old, m = 37.4, SD = 8.9; and 91 men, 21-69 years old, m = 41.4, SD = 10.2). Three military crisis management trainers from the Finnish Defence Forces International Centre also participated in the study. The data was collected with two webbased questionnaires. In addition two interviews were made with specialists of civilian crisis management in Finland. The study also provides an overview of international treaties concerning children’s rights in armed conflict. The results show that 48.7 % of dangers for children in conflicts reported by the peacekeepers were related to physical injury (e.g. landmines and traffic), and 27.4 % were related to social problems (e.g. poverty, child soldiers, and trafficking). 24.1 % of the peacekeepers had made observations of children’s rights violations either often or very often during peacekeeping operations. 49.6 % of the observations were related to social problems (e.g. child labour or being forced to beg), and 33.0 % were related to physical injury (e.g. assault). Frequency of observation of children’s rights violations was not associated with either sex or military degree of the peacekeepers; instead it was significantly correlated with the peacekeepers’ degree of knowledge of EU’s child protection guidelines. On the basis of the results, it is recommended that knowledge about children’s rights and protection should be included in the training of Finnish crisis management personnel to a much higher degree than at the present.

Service paradox in a product oriented company: A service business development case

The master´s thesis had three aims; to develop a service portfolio, to support the management of services through the developed portfolio, and evaluate effects of service differentiation strategy on the future selection of services. The product oriented case company in service paradox is Hilti (Suomi) Oy, which is entering systematic service management era, supported by the late strategic change. Low return on service business investments is referred as service paradox. The project was carried out as a case study, where the primary information source was twenty-one conducted interviews. The theory part focuses on marketing logics, service strategies, and categorization of services. The empirical part contributes in solving the aim related research questions. As a result of the case study a service portfolio was created, next further steps in service management were suggested, and the effect on selection of services by service differentiation strategy was evaluated. The main goal of creating service portfolio contributes to systematic management of services, which required revising at the case company.

Työn fyysinen ja psyykkinen kuormittavuus vanhustenhoidossa - seurantatutkimus ergonomisen kehittämistyön tuloksista

Tutkimuksen tarkoituksena oli analysoida vanhusten ympärivuorokautisen hoidon yksiköissä työskentelevien työntekijöiden työn fyysistä ja psyykkistä kuormittavuutta ja työhön liittyviä fyysisiä riskejä. Lisäksi haluttiin selvittää, millaisia vaikutuksia fyysisen kuormittavuuden vähentämistä tavoitelleella ergonomisella kehittämisinterventiolla saadaan aikaan. Tutkimuksessa hyödynnettiin Turun kaupungin vanhuspalveluissa vuosina 2010–2012 toteutuneessa ergonomisessa kehittämisinterventiossa (47 työyksikköä) kertynyttä ja vuosien 2010 ja 2012 Kunta10-kyselyn (120 työyksikköä) tuottamaa tietoa. Intervention ydin oli Työterveyslaitoksen Fyysisten riskien hallintamalli hoitoalalla -mallin käyttööotto. Käytetyt mittarit olivat seuraavat: Työn kuormitus- ja työtyytyväisyyskysely työntekijöille, asiakkaiden toimintakykyä mittaava RAVATM -indeksi, fyysistä kuormitusta ja työn riskejä mittava Care ThermometerTM-menetelmä, potilassiirtojen turvallisuusjohtamisen (PHOQS) arviointi sekä esimies- ja ergonomiavastaavien kysely. Lisäksi käytössä olivat Kunta10-kyselyn tulokset valittujen muuttujien osalta kaikista tutkimukseen osallistuvista kaupungeista sekä ympärivuorokautisen hoidon asiakkaita ja hoitohenkilöstöä kuvaavia tilastoja. Työ vanhusten ympärivuorokautisessa hoidossa on fyysisesti ja psyykkisesti kuormittavaa. Interventiotoimenpiteistä huolimatta koettu fyysinen ja psyykkinen kuormittavuus kasvoivat, tosin fyysinen psyykkistä vähemmän. Kuormittavuus vaihteli toimintamuodoittain ja ammattiryhmittäin. Fyysisesti kuormittavimmaksi työ koettiin pitkäaikaissairaanhoidossa, psyykkinen kuormitus kasvoi eniten tehostetussa palveluasumisessa. Vanhainkodit sijoittuivat näiden väliin. Lähihoitajat kokivat työnsä fyysisesti kuormittavimmaksi, kun taas sairaanhoitajien työ oli psyykkisesti lähihoitajien työtä kuormittavampaa. Ergonomiakoulutus vähensi eniten koettua fyysistä kuormittavuutta. Kehityskeskustelut ja aiempaa paremmaksi arvioitu työkyky vähensivät mutta tyytymättömyys työhön lisäsi koettua fyysistä ja psyykkistä kuormittavuutta. Työntekijöiden ikä, RAVATM -indeksi, Care ThermometerTM -mittaukset ja PHOQS-pisteet eivät olleet tilastollisesti merkitsevästi yhteydessä kuormittavuuden muutoksiin. Työn kuormittavuuden vähentäminen ja turvallisen työskentelyn edistäminen vaativat pitkäkestoista toimintaa ja hyvää johtamista erityisesti lähiesimiehiltä. Fyysisten riskien hallintamallin käyttöönotto ja ergonomiavastaavien toiminnan vakiinnuttaminen tukevat tavoitteiden saavuttamista.

Role of service and data reuse in enterprises

Digitalization has been predicted to change the future as a growing range of non-routine tasks will be automated, offering new kinds of business models for enterprises. Serviceoriented architecture (SOA) provides a basis for designing and implementing welldefined problems as reusable services, allowing computers to execute them. Serviceoriented design has potential to act as a mediator between IT and human resources, but enterprises struggle with their SOA adoption and lack a linkage between the benefits and costs of services. This thesis studies the phenomenon of service reuse in enterprises, proposing an ontology to link different kinds of services with their role conceptually as a part of the business model. The proposed ontology has been created on the basis of qualitative research conducted in three large enterprises. Service reuse has two roles in enterprises: it enables automated data sharing among human and IT resources, and it may provide cost savings in service development and operations. From a technical viewpoint, the ability to define a business problem as a service is one of the key enablers for achieving service reuse. The research proposes two service identification methods, first to identify prospective services in the existing documentation of the enterprise and secondly to model the services from a functional viewpoint, supporting service identification sessions with business stakeholders.

Customer involvement in new service development

This case study aims at filling the research gap in the literature, by researching how customers experience customer involvement in new service development, in addition to giving insight on what are the organisational customers’ motivations to become involved in service development. These subjects are studied by conducting three interviews. The thesis gives a review of previous findings regarding customer-driven new service development, customer involvement, customer roles, modes of involvement, communication in the involvement process, what is the role of customer engagement and what are the motivational drivers for customers. The thesis also explains what new service development is and makes a distinction between new service development and new service design. The results revealed that organisational customers want to be involved throughout the development process, with active involvement in the beginning and end phases. Moreover, customers prefer face-to-face methods and active and bidirectional communication throughout the process. The findings propose seven motivational factors, a new framework for customer-driven new service development and communication process map. The managerial implications list five themes for service providers to take into consideration when involving customers to the service development process.

Scandinavian companies of banking, retailing and hotel sectors investing into the Baltic States-developing service sector

Diplomityö tehtiin Lappeenrannan yliopistossa päätavoitteenaan selvittää tärkeimmät motiivit, jotka ovat saaneet pohjoismaiset palvelualan yrityksetinvestoimaan Baltian maiden kehittyvillä markkinoilla. Pohjoismaiset yritykset ovat olleet aiemmin aktiivisia hyödyntämään Baltian maiden työvoimaa tuotantosektorilla. Suomalaiset yritykset ovat investoineet aiemmin telekommunikaatio- sekävaatetussektoreihin, mutta nykyisin investointien pääpaino on siirtynyt palvelualalle. Pankkisektori on erittäin kehittynyt pohjoismaissa ja ruotsalaiset yritykset ovat onnistuneet myös Baltiassa siirtyen markkinoille yksityistämisen tuomien mahdollisuuksien avulla. Nykyisin näillä yrityksillä on vahva jalansija Virossa sekä ovat etabloituneet myös Latviaan ja Liettuaan. Suomalaiset pankkialan yritykset ovat olleet vaatimattomampia tällä sektorilla. Vähittäiskauppiaat ovat vasta kansainvälistymisprosessinsa alkutaipaleella. Suomalaiset yritykset ovat laajentuneet Viroon ja tehneet yhteistyötä ruotsalaisten yritysten kanssa. Hotellisektorilla suomalaiset ja ruotsalaiset ovat edenneet rauhallisesti, mutta norjalainen ketju, Reval Hotel, on laajentunut kaikkiin Baltian maihin. Hotellisektorilla on luvassa kasvua lähivuosina. Kilpailutilanne on kiristynyt kaikilla palvelualan sektoreilla sekä paikallisten yritysten kasvun että ulkomaisten investoijien myötä. Elinolojen paraneminen vaikuttaa myös kilpailutilanteeseen kiristävästi, sillä se luo mahdollisuuksia yrityksille laajentua. Tämä diplomityö selvittäätilannetta valittujen yritysten kannalta niiden kansainvälistymisen alkutaipaleella.

On the innovation capacity of technologyrelated knowledge-intensive business services. A case study of the technology and engineering consulting (TEC) sector in Singapore

Even though the research on innovation in services has expanded remarkably especially during the past two decades, there is still a need to increase understanding on the special characteristics of service innovation. In addition to studying innovation in service companies and industries, research has also recently focused more on services in innovation, as especially the significance of so-called knowledge intensive business services (KIBS) for the competitive edge of their clients, othercompanies, regions and even nations has been proved in several previous studies. This study focuses on studying technology-based KIBS firms, and technology andengineering consulting (TEC) sector in particular. These firms have multiple roles in innovation systems, and thus, there is also a need for in-depth studies that increase knowledge about the types and dimensions of service innovations as well as underlying mechanisms and procedures which make the innovations successful. The main aim of this study is to generate new knowledge in the fragmented research field of service innovation management by recognizing the different typesof innovations in TEC services and some of the enablers of and barriers to innovation capacity in the field, especially from the knowledge management perspective. The study also aims to shed light on some of the existing routines and new constructions needed for enhancing service innovation and knowledge processing activities in KIBS companies of the TEC sector. The main samples of data in this research include literature reviews and public data sources, and a qualitative research approach with exploratory case studies conducted with the help of the interviews at technology consulting companies in Singapore in 2006. These complement the qualitative interview data gathered previously in Finland during a larger research project in the years 2004-2005. The data is also supplemented by a survey conducted in Singapore. The respondents for the survey by Tan (2007) were technology consulting companies who operate in the Singapore region. The purpose ofthe quantitative part of the study was to validate and further examine specificaspects such as the influence of knowledge management activities on innovativeness and different types of service innovations, in which the technology consultancies are involved. Singapore is known as a South-east Asian knowledge hub and is thus a significant research area where several multinational knowledge-intensive service firms operate. Typically, the service innovations identified in the studied TEC firms were formed by several dimensions of innovations. In addition to technological aspects, innovations were, for instance, related to new client interfaces and service delivery processes. The main enablers of and barriers to innovation seem to be partly similar in Singaporean firms as compared to the earlier study of Finnish TEC firms. Empirical studies also brought forth the significance of various sources of knowledge and knowledge processing activities as themain driving forces of service innovation in technology-related KIBS firms. A framework was also developed to study the effect of knowledge processing capabilities as well as some moderators on the innovativeness of TEC firms. Especially efficient knowledge acquisition and environmental dynamism seem to influence the innovativeness of TEC firms positively. The results of the study also contributeto the present service innovation literature by focusing more on 'innovation within KIBs' rather than 'innovation through KIBS', which has been the typical viewpoint stressed in the previous literature. Additionally, the study provides several possibilities for further research.

User-driven community-based service development

This final thesis project was carried out in the Industrial Management department of University of Applied Sciences Stadia for Forum Virium Helsinki. The purpose of this study was to answer to the question of how companies can use online customer community of co-creation in service development and what is the value gained from it. The paper combines a range of recently published theoretical works and ongoing customer community case development. The study aims to provide new information and action approaches to new service developers that may increase the success of the community building process. The paper also outlines the benefits of the use of online customer community and offers practical suggestions for maximizing the value gained from the community in service development projects. The concepts and suggestions introduced in the study appear to have notable new possibilities to the service development process but they have to be further tested empirically. This paper describes the online consumer community of co-creation to an important organizational process of innovation management suggesting that it possesses a great value to business. Online customer communities offer a potential of improving the success of new services or products enabling early, penetrable market entry and creating sustainable competitive advantage.

The Changing Face of Psychiatric Nursing –Care or Control?

This report has been written as part of the project “Toward improved quality – developing nurse’s continuing vocational training in hospitals and inpatient units”. Its overall goal is to ensure high quality, ethically appropriate and therapeutically effective interventions to enable nurses to manage distressed and disturbed patients in European psychiatric hospitals and inpatient units. In this large-scale, multinational projects there are all together six European countries involved: Finland, Ireland, England, Portugal, Italy and Lithuania. The project work plan were during autumn 2006 and spring 2007. The content of this publication was produced in the first stage of the project aiming to collect the preliminary source material for the project. The literature review was carried out in the project stage, providing the groundwork for the next steps for the project. This project aims to develop an interactive multinational portal with training material. Therefore, it is important to share an understanding of basic information, psychiatric nurse’s continuing vocational education, laws and ethical codes and patient restriction used in mental health care. In this publication, the purpose of the material produced here is to understand nurses’ educational need related to vocational continuing education and to be used in further project stages as an empirical data collection. The data were collected as a preliminary source material for latter phases where nurse’s perceptions of the current practice, nurse’s attitudes to mental illness, prevalence of use of seclusion room and existing and desired vocational training provision will be collected in six different European countries. The following organisations are involved in this project: University of Turku, Dublin City University, St. Vincent Hospital, National Council for the Professional Development of Nursing and Midwifery, University of Padova, Klaipeda College - Health Faculty, Klaipeda Psychiatric Hospital, Escola Superior de Enfermagem de Lisboa, Centro Hospitalar Psiquiátrico de Lisboa, Omnia Vocational Institution the Espoo Region, Kellokoski psychiatric hospital, Hyvinkää hospital area, Pirkanmaa Hospital District, Kingston University & St. George’s Medical School and South West London & St. George’s Mental Health NHS Trust. A wide variety of different countries, organisations and individuals in this project give us a strong confidence that theoretical, practical, ethical and political issues around the topic of interest will be taken account during this project lifetime. We are aware the content of this book will be partially outdated almost as soon as it has been published. We still hope that this publication will encourage nurses and different professions working in mental health care field to have a basic understanding of similarities and differences between different European countries related in mental health care. We also hope that this publication will inspirate and motivate nurses in maintaining and developing the quality of psychiatric care in Europe.

Nursing Advocacy: A concept clarification in context of procedural pain care

The purpose of this study was to clarify the concept of advocacy in context of procedural pain care and to investigate the implementation of advocacy in that context. First, the concept of advocacy was described on the basis of a literature review (n = 89 empirical studies from 1990 to 2003). Then, the concept was described in the context of procedural pain care on the basis of interview data (n = 22 patients, 21 nurses) in a medical and surgical context. In the second phase, an instrument exploring the content of advocacy and the implementation of advocacy in context of procedural pain care was developed and validated. Then, the content of advocacy and implementation of it was explored in a sample of otolaryngeal patients (n = 405) and nurses (n = 118) in 12 hospitals. In the third phase, an update literature review (n = 35 empirical studies from 2003 to 2007) was conducted, and all data from phases one and two were reviewed in order to refine the elements the concept of advocacy, and the relationships between these elements. As a result of this study, advocacy in context of procedural pain care was defined as consisting of the dual aspects of patient advocacy and professional advocacy, and called nursing advocacy. It was divided into dimensions and subdimensions in which patient and nurse empowerment seems to play a vital role. All the data obtained lend support to this definition of nursing advocacy. Patients and nurses felt that nearly all of the activities that they considered as advocacy were implemented.