Screening of mental health and substance users in frequent users of a general Swiss emergency department.

BACKGROUND: The objectives of this study were to determine the proportions of psychiatric and substance use disorders suffered by emergency departments' (EDs') frequent users compared to the mainstream ED population, to evaluate how effectively these disorders were diagnosed in both groups of patients by ED physicians, and to determine if these disorders were predictive of a frequent use of ED services. METHODS: This study is a cross-sectional study with concurrent and retrospective data collection. Between November 2009 and June 2010, patients' mental health and substance use disorders were identified prospectively in face-to-face research interviews using a screening questionnaire (i.e. researcher screening). These data were compared to the data obtained from a retrospective medical chart review performed in August 2011, searching for mental health and substance use disorders diagnosed by ED physicians and recorded in the patients' ED medical files (i.e. ED physician diagnosis). The sample consisted of 399 eligible adult patients (≥18 years old) admitted to the urban, general ED of a University Hospital. Among them, 389 patients completed the researcher screening. Two hundred and twenty frequent users defined by >4 ED visits in the previous twelve months were included and compared to 169 patients with ≤4 ED visits in the same period (control group). RESULTS: Researcher screening showed that ED frequent users were more likely than members of the control group to have an anxiety, depressive disorder, post-traumatic stress disorder (PTSD), or suffer from alcohol, illicit drug abuse/addiction. Reviewing the ED physician diagnosis, we found that the proportions of mental health and substance use disorders diagnosed by ED physicians were low both among ED frequent users and in the control group. Using multiple logistic regression analyses to predict frequent ED use, we found that ED patients who screened positive for psychiatric disorders only and those who screened positive for both psychiatric and substance use disorders were more likely to be ED frequent users compared to ED patients with no disorder. CONCLUSIONS: This study found high proportions of screened mental health and/or substance use disorders in ED frequent users, but it showed low rates of detection of such disorders in day-to-day ED activities which can be a cause for concern. Active screening for these disorders in this population, followed by an intervention and/or a referral for treatment by a case-management team may constitute a relevant intervention for integration into a general ED setting.

Lifelong learning teachers' needs in virtual learning environments

Peer-reviewed

Transforming Maritime Safety Culture. Evaluation of the impacts of the ISM Code on maritime safety culture in Finland

The purpose of the METKU Project (Development of Maritime Safety Culture) is to study how the ISM Code has influenced the safety culture in the maritime industry. This literature review is written as a part of the Work Package 2 which is conducted by the University of Turku, Centre for Maritime Studies. The maritime traffic is rapidly growing in the Baltic Sea which leads to a growing risk of maritime accidents. Particularly in the Gulf of Finland, the high volume of traffic causes a high risk of maritime accidents. The growing risks give us good reasons for implementing the research project concerning maritime safety and the effectiveness of the safety measures, such as the safety management systems. In order to reduce maritime safety risks, the safety management systems should be further developed. The METKU Project has been launched to examine the improvements which can be done to the safety management systems. Human errors are considered as the most important reason for maritime accidents. The international safety management code (the ISM Code) has been established to cut down the occurrence of human errors by creating a safety-oriented organizational culture for the maritime industry. The ISM Code requires that a company should provide safe practices in ship operation and a safe working environment and establish safeguards against all identified risk. The fundamental idea of the ISM Code is that companies should continuously improve safety. The commitment of the top management is essential for implementing a safety-oriented culture in a company. The ISM Code has brought a significant contribution to the progress of maritime safety in recent years. Shipping companies and ships’ crews are more environmentally friendly and more safety-oriented than 12 years ago. This has been showed by several studies which have been analysed for this literature research. Nevertheless, the direct effect and influence of the ISM Code on maritime safety could not be isolated very well. No quantitative measurement (statistics/hard data) could be found in order to present the impacts of the ISM Code on maritime safety. In this study it has been discovered that safety culture has emerged and it is developing in the maritime industry. Even though the roots of the safety culture have been established there are still serious barriers to the breakthrough of the safety management. These barriers could be envisaged as cultural factors preventing the safety process. Even though the ISM Code has been effective over a decade, the old-established behaviour which is based on the old day’s maritime culture still occurs. In the next phase of this research project, these cultural factors shall be analysed in regard to the present safety culture of the maritime industry in Finland.

The Innovation Process – Aiming towards Innovativeness in a Construction Company

The bachelor’s thesis concentrates on the innovativeness in the construction industry. The purpose of the thesis is to define the innovation as a concept reflected on a context of the construction industry. The second objective is to examine how the construction companies could foster and increase the innovativeness. The third objective was to find out tools, methods and phases of the front-end of the innovation process. The construction industry is often considered as a traditional and an old-fashioned manufacturing industry. The innovation or the innovativeness rarely linked to the construction industry. Productivity is a common problem in the construction industry. The construction industry needs to increase the productivity to compete in a globalized world. The productivity can be increased by the innovation. The thesis based on a literature review. The findings from the literature include a description of the innovation as a concept, the innovative culture and the innovation process as a context of the construction industry. The phases of the front-end of the innovation process were explained. Customers centered approach was taken into account in the innovation process. The required tools and methods for managing the front-end of the innovation process were illustrated. The thesis ensures the importance of the innovation facing challenges of the construction industry. Managing the front-end of the innovation is the most important aspect to stand out from the less innovative companies. To take a full advantage of the innovation companies cannot fear of changes. The innovation process requires a full support of the top management of the company. Taking into consideration a theoretical aspect of the thesis a further research is required to respond practical needs of the company. Tools and methods should be considered according the company’s needs and activities. Company’s existing state and culture should be examined before implementing the front-end of the innovation process to ensure the functionality.

Toimintolaskenta tuotehallinnan tukena

Tämän tapaustutkimuksen päätavoitteina on luoda toimintolaskentamalli kohdeyritykselle ja testata toimintolaskennan soveltuvuutta pilottiprojektilla, joka toteutetaan vain pienelle osalle tuotteista. Toimintolaskentaprojektin tavoitteena on tarkentaa tuotteiden kustannuslaskentaa ja näin tukea yrityksen päätöksentekoa tuotehallinnan päätöksissä. Tutkimuksen tuloksena pilottiprojekti on vahvistanut ennakkokäsityksiä laskentakohteina olleiden tuotteiden osalta. Implementointiprosesseilla on sekä inhimillisiä että teknisiä ongelmia. Resurssikustannusten kohdistaminen asetettiin projektin tärkeimmäksi tekniseksi ongelmaksi. Pilottiprojekti keskittyy lähinnä laskennan tekniseen toteutukseen, mutta kattavampi muutosprojekti vaatii muutosjohtajuutta ja keskittymistä inhimillisiin tekijöihin. Pilottivaiheessa tärkein inhimillinen ongelma on saavuttaa johdon tuki ja osallistuminen projektiin. Toimintolaskentaprojekti onnistui kohdeyrityksessä hyvin ja johdon tuki onnistuttiin saavuttamaan. Tutkimuksen tuloksena nähdään toimintolas-kennan hyödyttävän tuotehallintaa ja tutkimuksen seurauksena toimintolaskentaprojektia jatketaan kattamaan koko tuotevalikoima. Yrityksessä havaittiin laskentaprojektin aikana myös toiminnan kehityskohteita, jotka vaativat tarkempaa tarkastelua toimintoanalyysin avulla.

Safety Culture and Maritime Personnel’s Safety Attitudes: Interview Report

”METKU –projektissa” (Merenkulun turvallisuuskulttuurin kehittäminen) tutkitaan kansainvälisen turvallisuusjohtamiskoodin (ISM-koodin) vaikutuksia merenkulun turvallisuuteen ja etsitään kehittämiskohteita merenkulun turvallisuusjohtamisen parantamiseksi. Tämä haastatteluraportti on laadittu METKU –projektin yhteistyössä työpakettien 1 ja 2 kesken. Tähän raporttiin haastateltiin yhteensä 94 merenkulun ammattilaista. Suurimman osan haastateltavista muodostivat aktiiviset merenkulkijat: miehistön jäsenet, päällystö ja alusten päälliköt. Haastattelukohteena oli seitsemän suomalaista varustamoa. Haastatteluissa kerättiin merenkulkijoiden kokemuksia ja mielipiteitä ISM-koodin vaikutuksesta heidän käytännön työhönsä. Suomalaiset merenkulkijat uskovat, että tänä päivänä varustamoiden johtajat ovat hyvin sitoutuneita turvallisuuteen. Myös miehistön asenteet turvallisuuteen ovat ISM-koodin käytön myötä parantuneet. Haasteltavien yhteinen huoli kohdistui jatkuvan parantamisen toimivuuteen. Kaikki haastatellut ryhmät olivat samaa mieltä siitä, että poikkeamien raportointi ei ISMkoodin vaatimuksesta huolimatta toimi kunnolla. ISM-koodin käyttöön otosta on ollut merenkululle selkeää hyötyä. Haastateltavat esittivät hyötyinä parantuneen yhteistyön ja tiedonkulun alusten ja varustamon välillä sekä sen, että merenkulun toiminnan laatu on parantunut. Monet haastateltavat korostivat, että ISM-koodin selkeät turvallisuusvastuut yhtiölle on ollut merkittävä hyöty. Itse ISM-koodiin merenkulkijoilla ei ollut juurikaan huomauttamista. Sen sijaan turvallisuusjohtamisen käytännön toteutuksessa nähtiin parantamisen varaa. ISMkoodin aiheuttamina ongelmina mainittiin mm. lisääntynyt byrokratia ja liian monimutkaiset ja yksityiskohtaiset turvallisuuskäsikirjat. Monet haastateltavat toivovat, että ISM-koodin käytännön soveltamiseen laadittaisiin ohjeita.

Pienen perheyrityksen johtoryhmä yrittäjänä

Tämän tutkimuksen tavoitteena on selvittää miten yrittäjyys näkyy pienen perheyrityksen johtoryhmän toiminnassa. Pyrkimyksenä on ymmärtää millaisia nämä johtoryhmät ovat. Tutkimuksessa pyritään myös selvittämään, miten nämä tiimit toimivat. Lopuksi tutkimuksen kiinnostuksen kohteena on, mitä suoritteita tiimit saavat aikaan. Tutkimuksessa on käytetty kvalitatiivista tutkimusmenetelmää. Tutkimus on toteutettu teemahaastatteluina valituissa pienissä perheyrityksissä. Tutkimustulokset osoittavat, että pienissä perheyrityksissä toimivat johtoryhmät ovat hyvin erilaisia koostumukseltaan. Usein niissä on samoja henkilöitä kuin hallituksessa. Heterogeeniset tiimit osoittautuivat kuitenkin toimivimmiksi. Pienissä perheyrityksissä todettiin olevan sekä johtoryhmiä että yrittäjämäisiä tiimejä. Johtoryhmä voi tuoda yritykseen uusia johtamiskäytäntöjä ja siten järkevöittää yrityksen johtamista ja kehittymistä.

Improving Intraorganizational Knowledge Sharing

The objective of this research was to find how the critical factors enabling intraorganizational knowledge sharing could be implemented to be part of case organization’s actions. The theoretical framework of the research was constituted based on previous scientific discussions concerning knowledge and its dimensions, knowledge sharing and its linkage to organizational learning. The intraorganizational knowledge sharing critical factors form an essential part of the theoretical framework. The study was a qualitative case study. The data was collected using focus group interviews and analyzed using theme analysis. In the empirical part of the study case organizations characteristics to the intraorganizational knowledge sharing were researched, intraorganizational knowledge sharing goals were mapped and finally improvement actions were suggested. The most significant suggestions were creating an organization wide knowledge sharing strategy, facilitating the development of social networks and communicating the top management support for knowledge sharing activities.

Innovative Culture – Searching for Innovativeness in a Construction Company

The purpose of the thesis is to study innovativeness in a context of the construction industry especially the front-end of the innovation process. The construction industry is often considered an old-fashioned manufacturing industry. Innovations and innovativeness are rarely linked to the industry. The construction industry, as well as other industries in Finland, is facing challenges such as productivity, the climate change and internationalization. The meaning of innovations is greater than ever in continuously changing markets, for standing out from competitors or increasing the competitiveness. Traditional production methods, tight building regulations, unique buildings, one-of-a-kind project organizations and highlighting the cheapest price in building contracts are particular challenges in the construction industry. The research questions of the thesis were: - What kind of factors shift the existing company culture towards innovativeness? - What are the phases of the front-end of the innovation process? - What kind of tools and methods enable managing the front-end of the innovation process? The theoretical part of the thesis bases on the literature review. The research methodology of the empirical part was the action research and qualitative approach. Empirical data was collected by the theme interviews from three companies. The results were practical methods and experiences from innovation activities of the companies. The results of the thesis can be clarified as follows: enhancement of the innovation activities requires support and commitment of the top management, innovative culture and innovation strategy. Innovativeness can be promoted by systematical methods for example collecting ideas from employees. Controlling and managing the front-end phase is essential to succeeding. Despite that managing the front-end is the most challenging part of the innovation process, development and management of that save companies’ money, resources and prevents useless investments. Further clarification and studies are needed to find out furthermore functional tools and methods to manage innovations and implementing them to the culture of the companies.

Skenaariotyöskentely organisaation oppimisen välineenä

Skenaarioita käytetään usein ylimmän johdon strategiasuunnitteluvälineinä. Tämän tutkimuksen tavoitteena oli selvittää vaikuttavatko skenaariot ja skenaariotyöskentely organisaation oppimiseen laajemminkin kuin yksilötasolla ja minkälaista oppimista tapahtuu sekä minkälaisia ominaisuuksia skenaariotyötä johtavalla olisi hyvä olla. Tutkimusaineisto on kerätty haastattelemalla skenaariotöitä johtanutta henkilöä sekä niihin osallistuneita henkilöitä. Tutkittavana oli kaksi skenaariotyötä, joista toisen tavoittena oli kuvata tulevaisuuden mobiileja liiketoimintamalleja ja toisen mallintaa verkko-operaattoriliiketoiminnan tulevaisuutta. Tutkimuksen aikana selvisi, että skenaarioilla ja skenaariotyöskentelyllä voi tukea organisaation oppimista niin yksilön, ryhmän/organisaation kuin organisaatioiden väliselläkin tasolla. Skenaariotyötä tekevällä ryhmällä ja sitä johtavalla henkilöllä on vaikutusta organisaation oppimiseen. Erityisen tärkeää organisaation oppimisen kannalta on, kuinka skenaariotyöskentely aloitetaan ja lopetetaan.

Efficiency of the ISM Code in Finnish Shipping Companies

Due to increasing waterborne transportation in the Gulf of Finland, the risk of a hazardous accident increases and therefore manifold preventive actions are needed. As a main legislative authority in the maritime community, The International Maritime Organization (IMO) has set down plenary laws and recommendations which are e.g., utilised in the safe operations in ships and pollution prevention. One of these compulsory requirements, the ISM Code, requires proactive attitude both from the top management and operational workers in the shipping companies. In this study, a crosssectional approach was taken to analyse whether the ISM Code has actively enhanced maritime safety in the Gulf of Finland. The analysis included; 1) performance of the ISM Code in Finnish shipping companies, 2) statistical measurements of maritime safety, 3) influence of corporate top management to the safety culture and 4) comparing safety management practices in shipping companies and port operations of Finnish maritime and port authorities. The main results found were that maritime safety culture has developed in the right direction after the launch of the ISM Code in the 1990´s. However, this study does not exclusively prove that the improvements are the consequence of the ISM Code. Accident prone ships can be recognized due to their behaviour and there is a lesson to learn from the safety culture of some high standard safety disciplines such as, air traffic. In addition, the reporting of accidents and nearmisses should be more widely used in shipping industry. In conclusion, there is still much to be improved in the maritime safety culture of the Finnish Shipping industry, e.g., a “no blame culture” needs to be adopted.

Success of service-intensive manufacturing firms - resource-based view

The main objective of this study is to examine the relationships between resources, competitive advantage and firm success. The study focuses, on one hand, on the financial performance of service-intensive manufac-turing firms against competitors with a lower service intensity and, on the other hand, on the resources as drivers for competitive advantage and success. The purpose of the theoretical part is to link the study in the field of the strategy research. The empirical part of the study is based on the quantitative analyses of the survey data collected from 50 major suppliers of industrial machinery and transportation equipment in Europe and North America. Results indicate that service-intensive manufacturing firms have performed better and their performance has been more stable vis-à-vis their peers. The main resources that differentiate service-intensive manufacturing firms from their non-service intensive competitors are service strategy and service-oriented top management. The analyses on the VRIO resources produced only a limited amount of information and solely service-centred culture appeared to be a rent generating resource.

External knowledge transfer mechanisms in service business acquisition

In knowledge-intensive economy an effective knowledge transfer is a part of the firm’s strategy to achieve a competitive advantage in the market. Knowledge transfer related to a variety of mechanisms depends on the nature of knowledge and context. The topic is, however, very little empirical studied and there is a research gap in scientific literature. This study examined and analyzed external knowledge transfer mechanisms in service business and especially in the context of acquisitions. The aim was to find out what kind of mechanisms was used when the buyer began to transfer data e.g. their own agendas and practices to the purchased units. Another major research goal was to identify the critical factors which contributed to knowledge transfer through different mechanisms. The study was conducted as a multiple-case study in a consultative service business company, in its four business units acquired by acquisition, in various parts of the country. The empirical part of the study was carried out as focus group interviews in each unit, and the data were analyzed using qualitative methods. The main findings of this study were firstly the nine different knowledge transfer mechanisms in service business acquisition: acquisition management team as an initiator, unit manager as a translator, formal training, self-directed learning, rooming-in, IT systems implementation, customer relationship management, codified database and ecommunication. The used mechanisms brought up several aspects as giving the face to changing, security of receiving right knowledge and correctly interpreted we-ness atmosphere, and orientation to use more consultative touch with customers. The study pointed out seven critical factors contributed to different mechanisms: absorption, motivation, organizational learning, social interaction, trust, interpretation and time resource. The two last mentioned were new findings compared to previous studies. Each of the mechanisms and the related critical factors contributed in different ways to the activity in different units after the acquisition. The role of knowledge management strategy was the most significant managerial contribution of the study. Phenomenon is not recognized enough although it is strongly linked in knowledge based companies. The recognition would help to develop a better understanding of the business through acquisitions, especially in situations such as where two different knowledge strategies combines in new common company.

Marketing culture of Finnish research libraries : an analysis of marketing attitude, knowledge and behaviour

The aim of the present dissertation is to investigate the marketing culture of research libraries in Finland and to understand the awareness of the knowledge base of library management concerning modern marketing theories and practices. The study was based onthe notion that a leader in an organisation can have large impact on its culture. Therefore, it was considered important to learn about the market orientation that initiates at the top management and flows throughout the whole organisationthus resulting in a particular kind of library culture. The study attempts to examine the marketing culture of libraries by analysing the marketing attitudes, knowledge (underlying beliefs, values and assumptions), behaviour (market orientation), operational policies and activities, and their service performance (customer satisfaction). The research was based on the assumption that if the top management of libraries has market oriented behaviour, then their marketing attitudes, knowledge, operational policies and activities and service performance should also be in accordance. The dissertation attempts to connect all these theoretical threads of marketing culture. It investigates thirty three academic and special libraries in the south of Finland. The library director and three to ten customers from each library participated as respondents in this study. An integrated methodological approach of qualitative as well as quantitative methods was used to gain knowledge on the pertinent issues lying behind the marketing culture of research libraries. The analysis of the whole dissertation reveals that the concept of marketing has very varied status in the Finnish research libraries. Based on the entire findings, three kinds of marketing cultures were emerged: the strong- the high fliers; the medium- the brisk runners; and the weak- the slow walkers. The high fliers appeared to be modern marketing believers as their marketing approach was customer oriented and found to be closer to the emerging notions of contemporary relational marketing. The brisk runners were found to be traditional marketing advocates as their marketing approach is more `library centred¿than customer defined and thus is in line of `product orientation¿ i.e. traditional marketing. `Let the interested customers come to the library¿ was appeared to be the hallmark of the slow walkers. Application of conscious market orientation is not reflected in the library activities of the slow walkers. Instead their values, ideology and approach to serving the library customers is more in tuneof `usual service oriented Finnish way¿. The implication of the research is that it pays to be market oriented which results in higher customer satisfaction oflibraries. Moreover, it is emphasised that the traditional user based service philosophy of Finnish research libraries should not be abandoned but it needs to be further developed by building a relational based marketing system which will help the libraries to become more efficient and effective from the customers¿ viewpoint. The contribution of the dissertation lies in the framework showing the linkages between the critical components of the marketing culture of a library: antecedents, market orientation, facilitators and consequences. The dissertationdelineates the significant underlying dimensions of market-oriented behaviour of libraries which are namely customer philosophy, inter-functional coordination,strategic orientation, responsiveness, pricing orientation and competition orientation. The dissertation also showed the extent to which marketing attitudes, behaviour, knowledge were related and impact of market orientation on the serviceperformance of libraries. A strong positive association was found to exist between market orientation and marketing attitudes and knowledge. Moreover, it also shows that a higher market orientation is positively connected with the service performance of libraries, the ultimate result being higher customer satisfaction. The analysis shows that a genuine marketing culture represents a synthesis of certain marketing attitudes, knowledge and of selective practices. This finding is particularly significant in the sense that it manifests that marketing culture consists of a certain sets of beliefs and knowledge (which form a specific attitude towards marketing) and implementation of a certain set of activities that actually materialize the attitude of marketing into practice (market orientation) leading to superior service performance of libraries.

Suorituskykymittariston kehittäminen sinisen meren strategiaa soveltavaan pk-yritykseen

Strategian toimivuutta voi tarkastella mittaamalla sitä. Suorituskyvyn mittaristolla pystytään parhaimmillaan näkemään, kuinka organisaatio toteuttaa valittua strategiaa ja reagoimaan siihen tarpeen mukaan. Tutkimuksen tavoitteena oli kehittää malli suorituskyvyn mittaristosta tutkimuksen kohdeyritykselle. Kehitetty mittaristo pohjautui balanced scorecardiin. Tutkimuksen kohdeyritys sovelsi sinisen meren strategian ideaa, jota analysoitiin balanced scorecardia vasten. Tutkimus tehtiin kvalitatiivisena. Kehitettyä balanced scorecardia ei implementoitu kohdeyritykseen tutkimuksen puitteissa. Balanced scorecard kehitettiin sinisen meren strategian kautta, mikä muutti merkittävästi sen rakennetta. Uudessa suorituskyvyn mittaristossa korostui sisäisen näkökulman sijaan asiakasnäkökulma. Tutkimus vahvistaa ylimmän johdon sitoutumisen tärkeyden suorituskyvyn mittaristoa kehitettäessä sekä strategiakartan käyttökelpoisuuden, kun strategiaa kehitetään mittareiksi.