Local politico-administrative perspectives on quality improvement based on national registry data in Sweden : a qualitative study using the Consolidated Framework for Implementation Research.

Background. Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results. The politicians and administrators perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions. The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

Production and Delivery (Optimization of production system and reliability)

This thesis is done to solve two issues for Sayid Paper Mill Ltd Pakistan. Section one deals with a practical problem arise in SPM that is cutting a given set of raw paper rolls of known length and width, and a set of product paper rolls of known length (equal to the length of raw paper rolls) and width, practical cutting constraints on a single cutting machine, according to demand orders for all customers. To solve this problem requires to determine an optimal cutting schedule to maximize the overall cutting process profitability while satisfying all demands and cutting constraints. The aim of this part of thesis is to develop a mathematical model which solves this problem.Second section deals with a problem of delivering final product from warehouse to different destinations by finding shortest paths. It is an operational routing problem to decide the daily routes for sending trucks to different destination to deliver their final product. This industrial problem is difficult and includes aspect such as delivery to a single destination and multiple destinations with limited resources. The aim of this part of thesis is to develop a process which helps finding shortest path.

An analysis of the aspects attracting medical tourists : a case study in Seoul, South Korea

Many countries recognized the potential of medicaltourism as an alternative source of economic growth. Especially after theeconomic crisis many Asian countries joined medical tourism in hopes to escapethe severe financial difficulty. However, yet only few countries have managedto become a famous medical tourism destination. With growing number ofcompetitors, newly joined countries of medical tourism, face the difficulty inintroducing them self as attractive medical tourism destination. South Koreaas a new medical tourism destination, should consider what to offer to themedical tourists to attract them. The aim of the thesis was to investigate aspects influencing the participationof medical tourists to discover how South Korea could develop anattractive medical tourism destination. After examining the casestudy and results from the text analysis, researcher reached to the conclusionthat quality, cost and accessibility to treatment are the major reasons toparticipate in medical tourism. Also in the fierce competition, it is importantto develop differentiated offers from other destinations. Therefore, Koreashould concentrate on specialized treatments and ICT system to become anattractive medical tourism destination.

A Psychoanalytical Reading of Emily Brontë's Wuthering Heights : An Analysis of the Defense Mechanisms of Some Characters

This essay presents a portrayal of Heathcliff, Catherine and Isabella from a psychoanalytical perspective with regard to four defense mechanisms; namely, repression, denial, sublimation and projection in order to see how these defense mechanisms have affected the characters’ decisions and behaviour, and led them to their destinations in life. It will include three major sections: repression in characters, denial in characters, and sublimation and projection in characters. These terms will be more clearly defined and explained in the subsequent sections.

Baking Dalarna's biking cake : Collaboration as a means for destination competitiveness, a case study of “Biking Dalarna"

In the contemporary tourism industry, the competitive game is between destinations. Tourism operations struggle to remain competitive on the international market and their success depends to a large extent on other complementary and competing tourism organizations at the destination. It is the sum of the total tourism offerings at the destination which determines its attractiveness. This research explores tourism collaboration process as a means of generating destination competitiveness. The focus of the research is on the enhancing factors which contribute to the success of the collaboration and to the development of quality tourism products. The research studies the case of Biking Dalarna, a collaboration of different organizations at five biking destinations in Dalarna, Sweden. Its purpose is to develop biking tourism in the region and to make Dalarna into Sweden’s leading biking destination. It is a qualitative research; the empirical data was collected through in depth interviews with representatives of six Biking Dalarna member organizations. The qualitative data collected from the participants provides inside look into the members reflections and experience of collaborating. The findings of this research demonstrate how collaboration has improved the biking product in Dalarna and promoted solutions to development problems. The research finds the good relationship between the collaborating actors and the involvement and leadership of the regional tourism management organization as the most contributing factors to the success of Biking Dalarna. The research also suggests that a third desired outcome of collaboration, improved marketing attributes was yet to be achieved in the case of Biking Dalarna.

International conference site selection criteria : And a case study of Stockholm as an international conference city

The purpose of this thesis is to identify the destination site selection criteria for internationalconferences from the perspectives of the three main players of the conference industry,conference buyers (organizers and delegates) and suppliers. Additionally, the researchidentifies the strengths and weaknesses of the congress cities of Stockholm and Vienna.Through a comparison with Vienna, the top city for hosting international conferences, a roadmap for Stockholm has been designed, to strengthen its congress tourism opportunities, thus,obtaining a higher status as an international congress city. This qualitative research hascombined both primary and secondary data methods, through semi-standardized expertinterviews and secondary studies respectively, to fulfil the study’s aim. The data have beenanalysed by applying the techniques of qualitative content analysis; the secondary dataadopting an inductive approach according to Mayring (2003) while the expert interviewsusing a deductive approach according to Meuser & Nagel (2009). The conclusions of thesecondary data have been further compared and contrasted with the outcomes of the primarydata, to propose fresh discoveries, clarifications, and concepts related to the site selectioncriteria for international conferences, and for the congress tourism industry of Stockholm. Theresearch discusses the discoveries of the site selection criteria, the implications of thestrengths and weaknesses of Stockholm in comparison to Vienna, recommendations forStockholm via a road map, and future research areas in detail. The findings andrecommendation, not only provide specific steps and inceptions that Stockholm as aninternational conference city can apply, but also propose findings, which can aid conferencebuyers and suppliers to cooperate, to strengthen their marketing strategies and developsuccessful international conferences and destinations to help achieve a greater competitiveadvantage.

Retusch av landskapsfoto i annonser för turistmål : En kvantitativ undersökningkring den accepterade nivån av retusch

Etik kring bilder i annonser har diskuterats mycket, speciellt modell-, ochproduktbilder har kritiserats. Det tycks dock saknas forskning om acceptanskring efterbehandling av landskapsfotografier som ofta används vidmarknadsföring av turistmål. En webbenkätundersökning genomfördes medbildexempel för att undersöka vilken nivå av efterbehandling som ansågsverklighetstrogen, tilltalande och accepterbar i sådana annonser. Slutsatsenblev att fotografier där exponeringen korrigerats för att skapa en tydligare bildvar det mest accepterade. Skillnader i åsikter mellan åldrar, kön, de som haroch inte har tidigare erfarenhet av fotografi och retuschering diskuterades ochdet visade sig att kvinnor och de utan tidigare erfarenhet var lite mer kritiskatill efterbehandling. Det framkom att en del betraktare kan accepteraytterligare efterbehandling om den genomförs för att sälja en specifik känslaoch så länge inte betraktaren kan känna sig vilseledd.

IAS 40 ur ett Nordenperspektiv : Jämförelse av regelverkets efterlevnad 2014 jämfört med 2009

Börsnoterade bolag ska i sin koncernredovisning redovisa enligt IFRS och förvaltningsfastigheter skall redovisas enligt IAS 40 Förvaltningsfastigheter. Detta examensarbete undersöker hur Nordiska börsnoterade bolag tillämpar vissa punkter inom IAS 40 i 2014 års redovisning jämfört med 2009 års redovisning. Syftet med undersökningen är att undersöka skillnader mellan de granskade företagens redovisning 2014 och 2009, med utgångspunkten i en tidigare publicerad undersökning (Hedlund & Ersson, 2011). Det som undersöks är om företagen använder samma värderingsmetod, om de informerar om hur värdering av förvaltningsfastigheter skett, om var i resultatrapporten de rapporterar justeringar av verkligt värde samt hur väl de lämnar upplysningar enligt IAS 40 punkt 75. Undersökningen har skett med en kvantitativ metod då det är årsredovisningar som granskats. Undersökt data är årsredovisningar från 2014 och 2009 för samma företag som granskats i den tidigare undersökningen. Några företag har utgått då de inte ingår i urvalsramen Nordiskt börsnoterat fastighetsbolag. Totalt granskades 14 stycken företag. Resultatet visar att efterlevnaden totalt sett är något bättre 2014 jämfört med den tidigare undersökningen. Till stor del beror det på urvalet där de företag som utgått var dåliga på att lämna upplysningar enligt IAS 40 i 2009 års redovisning. Sett till de företag som är med i båda undersökningarna är efterlevnaden likartad de jämförda åren. Det är få företag som lämnar upplysningar om begränsningar i rätten att sälja förvaltningsfastigheter, avtalsenliga förpliktelser att köpa eller hur de skiljer på rörelsefastigheter och förvaltningsfastigheter. Tolkningen kan då göras att det inte finns någon restriktion eller förpliktelse om det inte lämnas några sådana upplysningar. Om det är ett fastighetsbolag så kan det tolkas som att de inte har några rörelsefastigheter. Med dessa tolkningar blir efterlevnaden bland de undersökta företagen god.

Tourism and Arctic Observation Systems : exploring the relationships

The Arctic is affected by global environmental change and also by diverse interests from many economic sectors and industries. Over the last decade, various actors have attempted to explore the options for setting up integrated and comprehensive trans-boundary systems for monitoring and observing these impacts. These Arctic Observation Systems (AOS) contribute to the planning, implementation, monitoring and evaluation of environmental change and responsible social and economic development in the Arctic. The aim of this article is to identify the two-way relationship between AOS and tourism. On the one hand, tourism activities account for diverse changes across a broad spectrum of impact fields. On the other hand, due to its multiple and diverse agents and far-reaching activities, tourism is also well-positioned to collect observational data and participate as an actor in monitoring activities. To accomplish our goals, we provide an inventory of tourism-embedded issues and concerns of interest to AOS from a range of destinations in the circumpolar Arctic region, including Alaska, Arctic Canada, Iceland, Svalbard, the mainland European Arctic and Russia. The article also draws comparisons with the situation in Antarctica. On the basis of a collective analysis provided by members of the International Polar Tourism Research Network from across the polar regions, we conclude that the potential role for tourism in the development and implementation of AOS is significant and has been overlooked.

Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden

BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.