Strategisk utveckling och ekonomistyrning : Ett livscykelperspektiv

This dissertation synthesizes previous research and develops a model for the study of strategic development, strategic congruence and management control. The model is used to analyze a longitudinal case study of the Swedish engineering company Atlas Copco. Employing contingency theory, the study confirms that long-term survival of a company requires adaption to contingencies. Three levels of strategy are examined: corporate, business and functional. Previous research suggests that consistency between these levels (strategic congruence) is necessary for a company to be competitive. The dissertation challenges this proposition by using a life-cycle perspective and analyzes strategic congruence in the different phases of a life cycle. It also studies management control from a life-cycle perspective. In this context, two types of management control are examined: formal and informal. From a longitudinal perspective, the study further discusses how these types interact during organizational life cycles. The dissertation shows that strategic development is more complex than previous studies have indicated. It is a long, complex and non-linear process, the results of which cannot always be predicted. Previous models for strategy and management control are based on simple relationships and rarely take into account the fact that companies often go through different phases of strategic development. The case study shows that strategic incongruence may occur at times during organizational life cycles. Furthermore, the use of management control varies over time. In the maturity phase, formal control is in focus, while the use of informal control has a bigger role in both the introduction and decline phases. Research on strategy and management control has intensified in recent years. Still there is a gap regarding the coordination of complex corporate structures. The present study contributes with further knowledge on how companies manage long-term strategic development. Few studies deal with more than two levels of strategy. Moreover, the present study addresses the need to understand strategic congruence from a life-cycle perspective. This is particularly relevant in practice, when management in large companies face difficult issues for which they expect business research to assist them in the decision-making process.

Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.