Shared-decision making in designing new healthcare environments : ready to take off for improved quality

Background Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. Discussion This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. Summary We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

Konflikter, ogräs eller frön? : Arbetsplatskonflikter utifrån ett ledarskapsperspektiv

Det gemensamma intresset för konflikter grundade idén att studera väl ansedda ledares perspektiv på arbetsplatskonflikter och hur dessa ledare löser konflikter konstruktivt. I grunden finns en undran om väl ansedda ledare har förmågor som gör att de löser konflikter mer konstruktivt. Konflikter utgör en stor del av en ledares arbetstid. Konflikter kan förmodligen inte undvikas men hur konflikter hanteras är avgörande för att en organisation och dess anställda skall mogna och utvecklas. Det har utövats forskning inom konflikthantering utifrån ett ledarskapsperspektiv men de studierna har haft en kvantitativ ansats. Studiens syfte är att undersöka hur väl ansedda chefer ser på arbetsplatskonflikter och hur dessa chefer hanterar konflikter. Ett delsyfte är att erhålla kunskap om vilka metoder ansedda ledare använder i konflikthantering. För att besvara syftet har följande frågeställningar använts: Vilka typer av arbetsplatskonflikter uppstår i en organisation? Vad är avgörande om konflikter blir konstruktiva eller destruktiva? Vad har ledarskapet för inverkan på konflikthantering och hur ska ledaren ta sig an konflikter? Vilka förmågor och egenskaper har ledare som hanterar konflikter effektivt? Studien grundar sig på en kvalitativ ansats med semistrukturerade intervjuer som insamlingsmetod. Det införskaffade materialet kodades och tematiserades. Resultaten analyserades med hjälp av teoriramen. Slutligen användes Rahims (2002) teori om conflict management i diskussion då det i resultatet framkom stöd för modellen, dock med en utveckling vilket presenteras i slutsatsen. I studiens analys framkom att ledare som hanterar konflikter konstruktivt behärskar tre huvudområden. Dessa förmågor är människoorienterad, uppgiftsorienterad och lärande- och kulturorienterad. Väl ansedda ledare manövrerar emellan dessa förmågor beroende på situation. I studiens resultat framkom också att undvikande och dominant ledarskapsbeteende skapar barriärer i konflikthantering.

Immigration, security and the public debate on US language policy : a critical discourse analysis of language attitudes in the United States of America

The narrative of the United States is of a "nation of immigrants" in which the language shift patterns of earlier ethnolinguistic groups have tended towards linguistic assimilation through English. In recent years, however, changes in the demographic landscape and language maintenance by non-English speaking immigrants, particularly Hispanics, have been perceived as threats and have led to calls for an official English language policy.This thesis aims to contribute to the study of language policy making from a societal security perspective as expressed in attitudes regarding language and identity originating in the daily interaction between language groups. The focus is on the role of language and American identity in relation to immigration. The study takes an interdisciplinary approach combining language policy studies, security theory, and critical discourse analysis. The material consists of articles collected from four newspapers, namely USA Today, The New York Times, Los Angeles Times, and San Francisco Chronicle between April 2006 and December 2007.Two discourse types are evident from the analysis namely Loyalty and Efficiency. The former is mainly marked by concerns of national identity and contains speech acts of security related to language shift, choice and English for unity. Immigrants are represented as dehumanised, and harmful. Immigration is given as sovereignty-related, racial, and as war. The discourse type of Efficiency is mainly instrumental and contains speech acts of security related to cost, provision of services, health and safety, and social mobility. Immigrants are further represented as a labour resource. These discourse types reflect how the construction of the linguistic 'we' is expected to be maintained. Loyalty is triggered by arguments that the collective identity is threatened and is itself used in reproducing the collective 'we' through hegemonic expressions of monolingualism in the public space and semi-public space. The denigration of immigrants is used as a tool for enhancing societal security through solidarity and as a possible justification for the denial of minority rights. Also, although language acquisition patterns still follow the historical trend of language shift, factors indicating cultural separateness such as the appearance of speech communities or the use of minority languages in the public space and semi-public space have led to manifestations of intolerance. Examples of discrimination and prejudice towards minority groups indicate that the perception of worth of a shared language differs from the actual worth of dominant language acquisition for integration purposes. The study further indicates that the efficient working of the free market by using minority languages to sell services or buy labour is perceived as conflicting with nation-building notions since it may create separately functioning sub-communities with a new cultural capital recognised as legitimate competence. The discourse types mainly represent securitising moves constructing existential threats. The perception of threat and ideas of national belonging are primarily based on a zero-sum notion favouring monolingualism. Further, the identity of the immigrant individual is seen as dynamic and adaptable to assimilationist measures whereas the identity of the state and its members are perceived as static. Also, the study shows that debates concerning language status are linked to extra-linguistic matters. To conclude, policy makers in the US need to consider the relationship between four factors, namely societal security based on collective identity, individual/human security, human rights, and a changing linguistic demography, for proposed language intervention measures to be successful.