Managing ServerHotel

This graduate study was assigned by Unisys Oy Ab. The purpose of this study was to find tools to monitor and manage servers and objects in a hosting environment and to remotely connect to the managed objects. Better solutions for promised services were also researched. Unisys provides a ServerHotel service to other businesses which do not have time or resources to manage their own network, servers or applications. Contracts are based on a Service Level Agreement where service level is agreed upon according to the customer's needs. These needs have created a demand for management tools. Unisys wanted to find the most appropriate tools for its hosting environment to fulfill the agreed service level with reasonable costs. The theory consists of literary research focusing on general agreements used in the Finnish IT business, different types of monitoring and management tools and the common protocols used inthem. The theory focuses mainly on the central elements of the above mentioned topics and on their positive and negative features. The second part of the study focuses on general hosting agreements and what management tools Unisys has selected for hosting and why. It also gives a more detailed account of the hosting environment and its features in more detail. Because of the results of the study Unisys decided to use Servers Alive to monitor network and MS applications’ services. Cacti was chosen to monitor disk spaces, which gives us an idea of future disk growth. For remote connections the Microsoft’s Remote Desktop tool was the mostappropriate when the connection was tunneled through Secure Shell (SSH). Finding proper tools for the intended purposes with cost-conscious financial resources proved challenging. This study showed that if required, it is possible to build a professional hosting environment.

What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?

BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke. METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset. RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs. CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

Systematic work environment management : experiences from implementation in Swedish small-scale enterprises

Small-scale enterprises face difficulties in fulfilling the regulations for organising Systematic Work Environment Management. This study compared three groups of small-scale manufacturing enterprises with and without support for implementing the provision. Two implementation methods, supervised and network method, were used. The third group worked according to their own ideas. Twenty-three enterprises participated. The effects of the implementation were evaluated after one year by semi-structured dialogue with the manager and safety representative. Each enterprise was classified on compliance with ten demands concerning the provision. The work environment was estimated by the WEST-method. Impact of the implementation on daily work was also studied. At the follow-up, the enterprises in the supervised method reported slightly more improvements in the fulfilment of the demands in the provision than the enterprises in the network method and the enterprises working on their own did. The effect of the project reached the employees faster in the enterprises with the supervised method. In general, the work environment improved to some extent in all enterprises. Extensive support to small-scale enterprises in terms of advise and networking aimed to fulfil the regulations of Systematic Work Environment Management had limited effect especially considering the cost of applying these methods.

Kostnader och risker med internationell verksamhet i Mexiko

Detta examensarbetes syfte är att identifiera vilka faktorer som påverkar kostnader och risker som kan finnas vid internationellt företagande i Mexiko utifrån ett perspektiv där företagande samt företagsomgivningar vanligtvis är stöttande och välfungerande. En litteraturstudie utfördes på Internationella verksamheter (International Business), och skapade intervjuunderlaget som användes för att intervjua företagare i Mexiko med erfarenheter av både internationell verksamhet samt USA/EU, och enbart erfarenheter från företagande inom landet. Resultat visar att det finns sex stycken samlingsområden som påverkar kostnader och risker; Politiska faktorer som innebär att drastiska förändringar orsakas i ett lands affärsomgivning, och som negativt påverkar ett företags vinster eller andra mål; Ekonomiska faktorer som innebär att det kostar mer att ha verksamhet på grund av brister inom infrastruktur och stödjande verksamheter; Den ekonomiska utvecklingen; Det finns utbredd korruption hos Mexikanska myndigheter på både lokal- och statsnivå; Ledningsprocesser och metoder kan behöva anpassas enligt kulturellt bestämda arbetsrelaterade värderingar; och Internationella verksamheter bör anställa lokala individer till hjälp att utföra affärer inom en specifik kultur.

Developing leadership in managers to facilitate the implementation of national guideline recommendations : a process evaluation of feasibility and usefulness

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

Factors facilitating a national quality registry to aid clinical quality improvement : findings of a national survey

Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with ‘Colleagues’ call for local results’ (p=<0.001), ‘Management Request of Registry data’ (p=<0.001), and it was said to be ‘Simple to explain the results to colleagues’ (p=0.02). Using stepwise regression, ‘Colleagues’ call for local results’ was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.