Modularity in Health and Social Services: Perspectives on Organization and Management

Organizations that provide health and social services operate in a complex and constantly changing environment. Changes occur, for example, in ageing, technology and biotechnology, and customers’ expectations, as well as the global economic situation. Organizations typically aim to adapt the changes by introducing new organizational structures and managerial practices, such as process and lean management. Only recently has there been an interest in evaluating whether organizations providing health and social services could apply modularity in order to respond to some of the changes. The concept of modularity originates from manufacturing, but is applied in many other disciplines, such as information technology and logistics. However, thus far, the literature concerning modularity in health and social services is scarce. Therefore the purpose of this thesis is to increase understanding concerning modularity and the possibilities to apply modularity in the health and social services context. In addition, the purpose is to shed light on the viewpoints that are worth taking into account when considering the application of modularity in the health and social services context. The aim of the thesis is to analyze the way in which the modular structures are applied in the health and social services context and to analyze what advantages and possible barriers, as well as managerial concerns, might occur if modularity is applied in the health and social services context. The thesis is conducted by using multiple methods in order to provide a broad aspect to the topic. A systematic literature review provided solid ground for pre-understanding the topic and supported the formulation of the research questions. Theoretical reasoning provided a general overview of the special characteristics of the health and social services context and their effect on application of modularity. Empirical studies concentrated on managerial concerns of modularity particularly from the perspective of health and social services for the elderly. Results of the thesis reveal that structures in products, services, processes, and organizations are rather modular in health and social services. They can be decomposed in small independent units, while the challenges seem to occur especially in the compatibility of the services. It seems that health and social services managers have recognized this problem and they are increasingly paying attention to this challenge in order to enhance the flexible compatibility of services. Advantages and possible barriers of modularity are explored in this thesis, and from the theoretical perspective it could be argued that modularity seems to be beneficial in the context of health and social services. In fact, it has the potential to alleviate several of the challenges that the health and social services context is confronting. For example, modular structures could support organizations in their challenging task to respond to customers’ increasing demand for heterogeneous services. However, special characteristics of the health and social services context create barriers and provide significant challenges in application of modularity. For example, asymmetry of information, negative externalities, uncertainty of demand, and rigid regulation prevent managers from extensively drawing benefits from modularity. Results also reveal that modularity has managerial implications in health and social service. Modularity has the potential to promote and support new service development and outsourcing. Results also provide insights into network management and increases managerial understanding of different network management strategies. Standardization in health and social services is extensive due to legislation and recommendations. Modularity provides alternative paths to take an advantage of standardization while still ensuring the quality of the services. Based on this thesis, it can be concluded, both from a theoretical perspective and from empirical results concerning modularity in health and social services, that modularity might fit well and be beneficial. However, the special characteristics of the health and social services context prevent some of the benefits of modularity and complicate its application. This thesis contributes to the academic literature on the organization and management of health and social services by describing modularity as an alternative way for organizing and managing health and social services. In addition, it contributes to the literature of modularity by exploring the applicability of modularity in the context of health and social services. It also provides practical contribution to health and social services managers by evaluating the pros and cons of modularity when applied to health and social services.

Offshoring and outsourcing under demand uncertainty -a supply chain management analysis

Outsourcing and offshoring or any combinations of these have not just become a popular phenomenon, but are viewed as one of the most important management strategies due to the new possibilities from globalization. They have been seen as a possibility to save costs and improve customer service. Executing offshoring and offshore outsourcing successfully can be more complex than initially expected. Potential cost savings resulting from of offshoring and offshore outsourcing are often based on lower manufacturing costs. However, these benefits might be conflicted by a more complex supply chain with service level challenges that can respectively increase costs. Therefore analyzing the total cost effects of offshoring and outsourcing is necessary. The aim of this Master´s Thesis was to to construct a total cost model using academic literature to calculate the total costs and analyze the reasonability of offshoring and offshore outsourcing production of a case company compared to insourcing production. The research data was mainly quantitative and collected mainly from the case company past sales and production records. In addition management level interviews from the case company were conducted. The information from these interviews was used for the qualification of the necessary quantitative data and adding supportive information that could not be gathered from the quantitative data. Both data collection and analysis were guided by a theoretical frame of reference that was based on academic literature concerning offshoring and outsourcing, statistical calculation of demand and total costs. The results confirm the theories that offshoring and offshore outsourcing would reduce total costs as both offshoring and offshore outsourcing options result in lower total annual costs than insourcing mainly due to lower manufacturing costs. However, increased demand uncertainty would make the alternative of offshore outsourcing more risky and difficult to manage. Therefore when assessing the overall impact of the alternatives, offshoring is the most preferable option. As the main cost savings in offshore outsourcing came from lower manufacturing costs, more specifically labour costs, the logistics costs in this case company did not have an essential effect in total costs. The management should therefore pay attention initially to manufacturing costs and then logistics costs when choosing the best production sourcing option for the company.

Deregulation of Railroads and Future Development Scenarios in Europe - Literature Analysis of Privatization Process Taken Place in US, UK and Sweden

Euroopan unionissa päätettiin jo yli vuosikymmen sitten, että rautatieliiketoiminta vapautetaan kilpailulle. Iso-Britanniasta olimäärä tulla esimerkkivaltio tämän prosessin käyttöönotossa. Pääideana oli säännöstelyn keventäminen, jolloin omistuspohja toimialalla laajenee ja rautateiden infrastruktuuri sekä toiminta parantuvat. Infrastruktuuri on määrä olla yhden organisaation hallinnassa ja raiteiden käyttöoikeus on kaikilla lupaehdot täyttävillä operaattoreilla, jotka kilpailevat keskenään matkustajista ja tavararahdeista. Kuitenkin Yhdysvalloissa ja eräissä Latinalaisen Amerikan maissa kilpailu on vapautettu siten, että rautatieyritys omistaa raideinfrastruktuurin, junat, tavarankuljetus- sekä matkustajavaunut. Iso-Britannian yksityistämistä pidettiin aluksi isonaepäonnistumisena: nopealla aikataululla sovellettiin jäykkiä transaktioperusteisia ulkoistamisstrategioita infrastruktuurin kunnossapitoon, jotka lopulta johtivat junien jatkuviin myöhästymisiin ja muutamaan tuhoisaan onnettomuuteen. Liiketoiminnallisessa mielessäkään ei oikein onnistuttu: infrastruktuurista vastaava yritys jouduttiin listaamaan pois Lontoon pörssistä, ja hallituksen oli pakko luoda tukipaketti pahasti velkaantuneen, vain marginaalisien investointien kohteena olleen yrityksen toimintaa varten (vaikka kapasiteettitarvetta oli markkinoilla). Myös rautatieoperaattorit olivat taloudellisessa ahdingossa ja vain määrätietoisten hallituksen laatimien pelastuspakettien avulla ala nousi syvimmästä kriisistään. Tästä huolimatta näiden negatiivisten sivuvaikutusten ohella koko ala pystyi kasvattamaan kysyntää, niin matkustaja- kuin rahtiliikenteenkin osalta. Vähenevän kysynnän trendi, joka alkoi 1970-luvulla, otti käännöksen parempaan. Toinen eurooppalaismaa, jolla on pitkät kokemukset yksityistämisestä, on Ruotsi. Tämä maatapaus on melko konservatiivinen verrattuna tilanteeseen edellisessä; vain rajattu määrä reittejä on avattu kilpailulle ja sopimukset tehdään kerralla pitkäksi aikaa eteenpäin. Ruotsin säännöstelyn purku osoittautui menestykseksi, koska tuottavuus onollut vakaassa kasvussa ja rautateiden markkinaosuus erityisesti matkustajapuolella on noussut merkittävästi, verrattuna muihin kuljetusmuotoihin. Kuitenkin kilpailua on käytännössä vähän tässä maassa ja parempiatuloksia on lupa odottaa, kun vain säännöstelyn purkaminen jatkuu. Viimeinen tutkimuksemme kohteena oleva maa on Yhdysvallat, joka alistutti rautatiet kilpailulle jo 1980-luvun alussa, käyttäen jo edellä mainittua vertikaalista integraatiota; tämä valinta on taas johtanut hyvin erilaisiin tuloksiin. Vaihtoehtoinen rakenteellinen uudistustapa on suosinut rahtivirtoja matkustajiin nähden, ja lopputuloksena tämä tapaus synnytti yrityksiä huolehtimaan toista näistä kahdesta pääasiakasryhmästä. Viimeaikaiset tulokset tästä yksityistämisprosessista ovat olleet hyviä: jäljellejääneiden yritysten voitot ovat kasvaneet, osinkoja ollaan kyetty jakamaan ja osakkeiden arvostus on noussut. Tässä tutkimusraportissa yritämme kolmen maatapauksen kautta esittää, miten yksityistämisprosessi tulee vaikuttamaan Euroopassa, kun kilpailu rautateillä vapautuu. Me käymmeläpi, mikä näistä kolmesta maaesimerkistä on kaikkein todennäköisin jaesitämme ehdotuksia siihen, miten valtiot voisivat välttää ei-haluttuja sivuvaikutuksia. Kolme maaesimerkkiä, ja lopuksi esitetty lyhyt tilastollinen analyysi osoittavat, että rautateillä on tulevaisuuden potentiaalia Euroopassa, ja kilpailun vapauttaminen on avain tämän potentiaalin realisointiin.

A systematic literature review on agile project

In the 21st century, agile project management (APM) has emerged as a major evolutionary step in the area of software project management. APM is defined as a conceptual framework, consisting of various methods such as Scrum, quick respond to change, better customer collaboration, minimum coverage of documentation and extreme programming (XP) that facilitates to produce working software in multiple iterations with team work. Because agile project management has become more popular in the software industry in recent years, it constitutes an interesting and comprehensive research topic. This thesis presents a systematic literature review (SLR) of published research articles concerning agile project management. Based on a predefined search strategy, 273 such articles were identified, of which 44 were included in the review. The selected 44 articles were published between years 2005 and 2012. The thesis defines a review process by developing a review protocol and presenting the results of the review. The results are expected to provide researchers, software man

Helsingin ammattikorkeakoulu Stadian kulttuurituottamisen suuntautumisvaihtoehto : ensimmäisen opintonsa aloittaneen vuosikurssin seuranta

This thesis is based on a questionnaire presented to pilot students on the Degree Programme in Media, at Helsinki Polytechnic Stadia, of 1999. The initial aim was to discover whether the school was of use in the transition process into a field of work. Based on this, the questions for a questionnaire were formulated. The research thus aimed at answering questions concerning a) whether the education answered the need of working life b) the work situation of respondents and c) how respondents saw the future of Arts Management as well as themselves. The questionnaire was prepared using Stadia's Elomake software on the Internet. There was also a project specific contract for this final project, allowing information gathered during the project to be used in regional curriculum work. The thesis deals with Arts Management curriculum work within the framework provided by polytechnic law as well as Stadia's curriculum work processes. Research and education in Arts Management in Finland generally is also studied, and specifically in Stadia itself. The essence of this final project is derived from the analysis of the answers to the questionnaire. All responses were analysed, with the answers being divided into three subheadings according to the research questions. Questions and answers were also examined through a correlation matrix in an attempt to discover the dependency between things and conclusions were made in the light of relevant source literature. The questionnaire is meant to be used for the follow-up of every graduating Arts Management group. Information obtained through this questionnaire will of benefit in preliminary curriculum work.

Confronting a victim of intimate partner violence in nursing care : a literature review

Intimate partner violence is a growing problem in health care. The purpose of this thesis was to find ways of confronting a victim of intimate partner violence in nursing care and methods how nurses can encourage the victim to disclose the abuse. The aim of this thesis was to help the health care professionals to understand the issue and the need of the victims better, and that way provide a better care. This thesis is a literature review of previously made research articles about intimate partner violence. The research material consisted of 10 published articles, which were collected from different databases. The articles were published within 10 years. A content analysis method was used to examine the articles by making descriptive summary tables according to each questions. The results of this study showed multiple factors which the health care providers should take into consideration when caring the patients. Asking with a non-judgemental attitude, in a safe, confidential setting without the partner present and prioritizing the abuse was mentioned to be important for the victims. Routinely screening and different kind of brochures was considered as good methods to encourage the victims to disclose the abuse. The need for better training and counselling of the health care providers was also discovered. The results of this thesis, did answer to the chosen study questions and that way the purpose of the thesis was filled. Hopefully, in the future this problem can be minimized and prevented in advanced. Further studies are needed to examine whether these caring methods are actually being used in clinical settings and do they have any effect.

Oops! Another medication error : a literature review of contributing factors and methods to prevent medication errors

The purpose of this bachelor's thesis was to chart scientific research articles to present contributing factors to medication errors done by nurses in a hospital setting, and introduce methods to prevent medication errors. Additionally, international and Finnish research was combined and findings were reflected in relation to the Finnish health care system. Literature review was conducted out of 23 scientific articles. Data was searched systematically from CINAHL, MEDIC and MEDLINE databases, and also manually. Literature was analysed and the findings combined using inductive content analysis. Findings revealed that both organisational and individual factors contributed to medication errors. High workload, communication breakdowns, unsuitable working environment, distractions and interruptions, and similar medication products were identified as organisational factors. Individual factors included nurses' inability to follow protocol, inadequate knowledge of medications and personal qualities of the nurse. Developing and improving the physical environment, error reporting, and medication management protocols were emphasised as methods to prevent medication errors. Investing to the staff's competence and well-being was also identified as a prevention method. The number of Finnish articles was small, and therefore the applicability of the findings to Finland is difficult to assess. However, the findings seem to fit to the Finnish health care system relatively well. Further research is needed to identify those factors that contribute to medication errors in Finland. This is a necessity for the development of methods to prevent medication errors that fit in to the Finnish health care system.

Business Development Efforts and Performance Improvements in SMEs Case Study of Business Development Projects Implemented in SME

Under the circumstances of the increasing market pressure, enterprises try to improve their competitive position by development efforts, and a business development project is one tool for that. There are not many answers to the question of how the development projects launched to improve the business performance in SMEs have succeeded. Theacademic interest in the business development project success has mainly focused on projects implemented in larger organisations rather than in SMEs. The previous studies on the business success of SMEs have mainly focused on new business ventures rather than on existing SMEs. However, nowadays a large number of business development projects are undertaken in existing SMEs, where they can pose a great challenge. This study focuses on business development success in SMEs thathave already established their business. The objective of the present study is to gain a deep understanding on business development project success in the SME-context and to identify the dimensions and factors affecting the project success. Further, the aim is to clarify how the business development projects implemented in SMEs have affected their performance. The empirical evidence is based on multiple case study. This study builds a framework for a generic theory of business development success in the SME-context, based on literature from the areas ofproject and change management, entrepreneurship and small business management, as well as performance measurement, and on empirical evidence from SMES. The framework consists of five success dimensions: entrepreneurial, project preparation, change management, project management and project success. The framework provides a systematic way for analysing the business development project and its impact on the performance and on the performing company. This case evidence indicates that successful business development projects have a balanced, high performance concerning all the dimensions. Good performance in one dimension is not enoughfor the project success, but it gives a good ground for the other dimensions. The other way round, poor performance in one success dimension affects the others, leading to poor performance of the project. In the SME-context the business development project success seems to be dependent on several interrelated dimensions and factors. Success in one area leads to success in other areas, and so creates an upward success spiral. Failure in one area seems to lead to failure in other areas, creating a downward failure spiral. The study indicates that the internal business development projects have affected the SMEs' performance widely also on areas and functions not initially targeted. The implications cover all thesuccess categories: the project efficiency, the impact on the customer, the business success and the future potentiality. With successful cases, the success tends to spread out to areas and functions not mentioned as the project goals, andwith unsuccessful cases the failure seems to spread out widely to the SMEs' other functions. This study also indicates that the most important key factors for successful business development project implementation are the strength of intention, business ability, knowledge, motivation and participation of the employees, as well as adequate and well-timed training provided to the employees.

Information and Communication Society's Impact on Global Paper Consumption

Tämän tutkielman tavoitteena on selvittää informaatio- ja kommunikaatioyhteiskunnan vaikutusta paperin kulutukseen maailmanlaajuisesti. Tarkoituksena on löytää informaatio- ja kommunikaatioyhteiskuntaa kuvaavia mittareita, joiden avulla voidaan vertailla kehittyneitä ja kehittyviä markkina-alueita keskenään. Tutkimusongelmaan haetaan ratkaisua tutkimalla sekä kirjallisuutta että tilastoja, ja vertaamalla niitä esitettyihin teorioihin informaatio- ja kommunikaatioyhteiskunnan kehityksestä. Tutkielman avulla pyritään arvioimaan ja kuvaamaantoimintaympäristön muutoksia paperin kulutuksen suhteen pitkällä aikavälillä informaatio- ja kommunikaatioyhteiskunnan näkökulmasta.

Sähköyhtiöiden liiketoiminnan tulevaisuudennäkymiä muuttuvilla sähkömarkkinoilla

Diplomityö tehtiin taustatutkimukseksi Komartek Oyj:n Kolibri-projektiin, jonka tarkoituksena on tuottaa uuden sukupolven asiakastietojärjestelmä sähköyhtiöille. Työn tarkoituksena oli kartoittaa sähkömarkkinoiden liiketoiminnan nykytilaa ja lähitulevaisuutta, kun sähkömarkkinoiden täydellisestä vapautumisesta on kulunut viisi vuotta. Kirjallisuuden perusteella tutkittiin markkinoiden vapautumista ja sähkömarkkinoiden nykyistä tilannetta. Työssä pohdittiin myös nykyisten markkinoiden toimijoitaja heidän toimintakenttäänsä. Toimintakenttää kartoitettiin myös päästökaupan ja hajautetun energiantuotannon kannalta. Diplomityön yhteydessä tehtiin kaksi haastattelututkimusta. Asiantuntijahaastattelu tehtiin 30 alan asiantuntijalle sähköpostitse Delphoi-menetelmällä ja tutkimuksen tarkoitus oli kerätä tietoa sähköyhtiöiden toimintaympäristön luomista uhkista ja mahdollisuuksista. Sähköyhtiöihin tehdyssä haastattelututkimuksessa haastateltiin 13 sähköyhtiön edustajaa. Tutkimuksen tarkoitus oli kartoittaa yhtiöiden tekemiä toimenpiteitä ja strategioita muuttuvassa toimintaympäristössä. Sähkömarkkinoiden rakennemuutos ei ole liiketoiminnan kannalta vielä loppunut. Useat sähköyhtiöt harjoittavat toimintaansa sekä vanhan että uuden tilanteen mukaan. Lisäksi edelleen odotetaan suuria muutoksia toimintakentässä esimerkiksi päästökaupan ja Euroopan sähkömarkkinoiden avaamisen suhteen. Toisaalta sähkömarkkinoidenavaaminen on tuonut toimijoille myös uusia mahdollisuuksia laajentaa tai tehostaa toimintaansa. Sähkömarkkinoiden liiketoiminnasta olisi hyvä tehdä lisäselvityksiä markkinatilanteen vakiinnuttua.

Factors affecting the adoption of electronic invoicing

Tämän diplomityön tarkoituksena oli selvittää tekijät, jotka vaikuttavat verkkolaskutuksen leviämiseen yrityksissä sekä selvittää verkkolaskutuksen levinneisyys Etelä-Karjalassa. Erityisesti haluttiin selvittää tekijät, jotka hidastavat diffuusiota. Työn teoreettinen osuus esittelee lyhyesti diffuusionkäsitettä; pääpaino on kirjallisuudesta löytyvillä innovaatioiden omaksumiseen vaikuttavilla tekijöillä. Teorian pohjalta muodostettiin 16 hypoteesia, jotka testattiin empiirisessä osassa. Empiirinen aineisto kerättiin eteläkarjalaisilta pk-yrityksiltä postikyselyn avulla. Vastanneet yritykset jaettiin verkkolaskutuksen omaksuneisiin ja ei-omaksuneisiin yrityksiin. Vastanneista yrityksistä 7.5 % käytti verkkolaskutusta. 17.8 % vasta testasi verkkolaskujen lähetystä ja/tai vastaanottamista. Näin ollen 25.3 % yrityksistä oli verkkolaskuominaisuudet tietojärjestelmissään. Suurin osa vastaajista ei ollut tehnyt päätöstä verkkolaskutukseen siirtymisen suhteen. Seitsemän hypoteesia jäi voimaan ja yhdeksän hylättiin.Hypoteesien ulkopuolelta löydettiin lisäksi kaksi tärkeää tekijää, joilla on mahdollisesti vaikutusta verkkolaskutuksen omaksumiseen yrityksissä. Yritykset kokivat, että suurempi painostus yrityksen ulkopuolelta nopeuttaisi penetraatiota, ja toisaalta verkkolaskutusta koskevan informaation määrä on koettu liian alhaiseksi. Työn lopussa esitellään toimenpide-ehdotuksia verkkolaskutuksen leviämisennopeuttamiseksi.