World Class Manufacturing (WCM) aineettoman pääoman johtamisen työkaluna

Tämän kvalitatiivisen tutkimuksen tavoitteena on tarkastella jatkuvan pa-rantamisen työkalun, WCM:n, roolia aineettoman pääoman johtajana. Tutkimuksen teoreettisessa osassa selvitetään aineettoman pääoman eri muotoja; inhimillistä, suhde- ja rakennepääomaa. Lisäksi tutkitaan WCM:n ideologiaa, sen käyttöönottoa ja eri osa-alueita. Teoriaosan lopussa selvite-tään WCM:n ja aineettoman pääoman yhteyttä toisiinsa ja niiden vaikutusta suorituskykyyn. Teoriaa tukemaan tehtiin empiirinen tutkimus case -organisaatiossa haastattelemalla organisaation toimihenkilöitä sekä työntekijöitä. Empiirisen tutkimuksen tavoitteena oli selvittää case –organisaation jatkuvan parantamisen mallin kehitystarpeita WCM:n ja inhimillisen pääoman näkö-kulmasta. Tutkimustulokset osoittivat, että WCM:llä voidaan johtaa aineettoman pää-oman eri muotoja – saaden siten myös suorituskykyä paremmaksi.

Quality of Qualitative Research in the Health Sciences : Analysis of the Common Criteria Present in 58 Assessment Guidelines by Expert Users

The number of qualitative research methods has grown substantially over the last twenty years, both in social sciences and, more recently, in the health sciences. This growth came with questions on the quality criteria needed to evaluate this work, and numerous guidelines were published. The latters include many discrepancies though, both in their vocabulary and construction. Many expert evaluators decry the absence of consensual and reliable evaluation tools. The authors present the results of an evaluation of 58 existing guidelines in 4 major health science fields (medicine and epidemiology; nursing and health education; social sciences and public health; psychology / psychiatry, research methods and organization) by expert users (article reviewers, experts allocating funds, editors, etc.). The results propose a toolbox containing 12 consensual criteria with the definitions given by expert users. They also indicate in which disciplinary field each type of criteria is known to be more or less essential. Nevertheless, the authors highlight the limitations of the criteria comparability, as soon as one focuses on their specific definitions. They conclude that each criterion in the toolbox must be explained to come to broader consensus and identify definitions that are consensual to all the fields examined and easily operational.

Complexity of the Paradigms Present in Quality Criteria of Qualitative Research Grids

With qualitative methods being increasingly used in health science fields, numerous grids proposing criteria to evaluate the quality of this type of research have been produced. Expert evaluators deem that there is a lack of consensual tools to evaluate qualitative research. Based on the review of 133 quality criteria grids for qualitative research in health sciences, the authors present the results of a computerized lexicometric analysis, which confirms the variety of intra- and inter-grid constructions, including within the same field. This variety is linked to the authors' paradigmatic references underlying the criteria proposed. These references seem to be built intuitively, reflecting internal representations of qualitative research, thus making the grids and their criteria hard to compare. Consequently, the consensus on the definitions and the number of criteria becomes problematic. The paradigmatic and theoretical references of the grids should be specified so that users could better assess their contributions and limitations.

Nutritional behaviour and beliefs of ski-mountaineers: a semi-quantitative and qualitative study.

BACKGROUND: Endurance athletes are advised to optimize nutrition prior to races. Little is known about actual athletes' beliefs, knowledge and nutritional behaviour. We monitored nutritional behaviour of amateur ski-mountaineering athletes during 4 days prior to a major competition to compare it with official recommendations and with the athletes' beliefs. METHODS: Participants to the two routes of the 'Patrouille des Glaciers' were recruited (A, 26 km, ascent 1881 m, descent 2341 m, max altitude 3160 m; Z, 53 km, ascent 3994 m, descent 4090 m, max altitude 3650 m). Dietary intake diaries of 40 athletes (21 A, 19 Z) were analysed for energy, carbohydrate, fat, protein and liquid; ten were interviewed about their pre-race nutritional beliefs and behaviour. RESULTS: Despite belief that pre-race carbohydrate, energy and fluid intake should be increased, energy consumption was 2416 ± 696 (mean ± SD) kcal · day(-1), 83 ± 17 % of recommended intake, carbohydrate intake was only 46 ± 13 % of minimal recommended (10 g · kg(-1) · day(-1)) and fluid intake only 2.7 ± 1.0 l · day(-1). CONCLUSIONS: Our sample of endurance athletes did not comply with pre-race nutritional recommendations despite elementary knowledge and belief to be compliant. In these athletes a clear and reflective nutritional strategy was lacking. This suggests a potential for improving knowledge and compliance with recommendations. Alternatively, some recommendations may be unrealistic.

La recherche. Méthodes : quantitative, qualitative, mixte.

La simulation sous ses différentes formes est devenue un outil incontournable dans la formation des professionnels de la santé. Il n'en demeure pas moins que la simulation intervient dans un environnement complexe où le comportement humain est une variable essentielle. Dans ce contexte, la recherche en simulation est indispensable : elle doit produire des connaissances qui nous permettent de mieux comprendre l'apprentissage par la simulation. Pour atteindre cet objectif, la recherche en simulation doit être aussi rigoureuse que toute recherche clinique, afin qu'elle puisse produire des connaissances de qualité. De par la complexité de l'environnement simulé, la recherche dans ce domaine est riche et recourt à des méthodes variées issues des sciences du comportement, de l'éducation et plus largement des sciences sociales.

Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study.

BACKGROUND: Pediatric advance care planning differs from the adult setting in several aspects, including patients' diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals' perspective. AIM: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. DESIGN: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. SETTING/PARTICIPANTS: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. RESULTS: Perceived problems with pediatric advance care planning relate to professionals' discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor's advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. CONCLUSION: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers.

Care related pain in rehabilitation after orthopedic trauma: An exploratory study with qualitative data.

OBJECTIVE: Care related pain (CRP) is generally under-estimated and rarely studied in rehabilitation as well as in general medecine. Beliefs about pain influence psychological distress, adjustment to pain and physical disability. In this sense, perceptions of CRP could limit recovery. This exploratory study aims to understand patients' and caregivers' subjective perceptions and beliefs about CRP. PATIENTS AND METHODS: Questionnaires about CRP were submitted to members of the interdisciplinary team of a rehabilitation hospital and to patients with musculoskeletal complaints (cross-sectional design). Twenty patients were also individually interviewed (qualitative data). Four topics were addressed: frequency of CRP, situations and procedures causing CRP, beliefs about CRP and means used to deal with CRP. RESULTS: Seventy-five caregivers and 50 patients replied to the questionnaire. CRP is a very common experience in rehabilitation and it is recognized by both groups. Generally, the situations causing CRP reflect the specificity of rehabilitation (mobilization...) and are similarly perceived by patients and caregivers, with patients considering them as more painful. Beliefs about CRP are clearly different from those usually associated with pain. Both groups point out the utilitarian and the inevitable character of CRP. They differ on that, that patients had a more positive view about CRP. They associate it more often with progress and see it as acceptable at least until a certain limit. They are also able to perceive the richness of means used by physiotherapists to help them coping with CRP. CONCLUSION: Our data may suggest new keys to motivate patient to be active in rehabilitation for example in choosing carefully arguments or words which may fit theirs' beliefs about CRP, or in using various means to manage CRP. Promoting the use of relational competences with chronic pain patients and of a patient-centred approach may also be a concern in training caregivers.

A qualitative study of adolescents with medically unexplained symptoms and their parents

Il est fréquent en médecine de premier recours de rencontrer des adolescents exprimant des symptômes somatiques pour lesquels aucune des investigations entreprises n'a permis de rendre compte d'une pathologie organique. De tels symptômes sont retrouvés dans la littérature sous la terminologie de symptômes médicalement inexpliqués (MUS) ou des troubles fonctionnels. Bien que la prévalence des adolescents souffrant de MUS est fréquente, les médecins éprouvent encore beaucoup de difficultés à prendre en charge et communiquer avec ces patients, principalement en raison d'une incompréhension de leurs besoins et préoccupations tant dans leur vie quotidienne que lors d'une consultation au cabinet. Le but de notre étude est de comprendre les expériences et vécus des adolescents avec des MUS ainsi que de leurs parents afin d'aider le praticien dans la compréhension de son patient dans sa globalité et ainsi d'améliorer sa prise en charge. Dans le premier article présenté, nous nous sommes intéressés à la vie quotidienne de ces adolescents en étudiant leurs relations avec leur famille et leur entourage ainsi que les répercussions sur leurs parcours scolaire et leurs activités extrascolaires. Dans le second article nous nous sommes penchés sur les relations qu'entretiennent ces adolescents et leurs parents avec le système de santé. Nous avons collecté des données qualitatives en moyennant des groupes focus incluant 16 adolescents atteints de troubles fonctionnels et leurs parents. L'analyse a permis de faire émerger les difficultés que ces jeunes et leurs familles vivent au quotidien et comment ils sont confrontés à la solitude dû principalement à l'incompréhension sociale. Les résultats mettent aussi en évidence l'insatisfaction de ces jeunes et de leurs parents par rapport à la prise en charge médical, notamment en raison d'un manque de communication. -- Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.

Verkostot kuntien kehittämisessä

Tutkimuksen tarkoituksena on selvittää verkostojen merkitystä uusien ideoiden tuojana kuntajohtamisessa kuntajohtajan näkökulmasta katsottuna ja osallistua liiketaloudelliseen keskusteluun kuntajohtamisen kehittämiseksi. Tutkimuksen tavoitteena on kuvata ja ymmärtää kuntajohtajan verkostoja ja niiden merkitystä kuntien kehittämisessä. Tutkimus on luonteeltaan laadullinen tutkimus, jonka aineisto on kerätty haastattelemalla neljää kuntajohtajaa. Tutkimustulokset osoittavat, että kuntajohtajat toimivat aktiivisesti kunnan ulkopuolisissa verkostoissa pyrkien löytämään ideoita ja ratkaisuja kuntien uudistamiseen. Kuntien sisäisten verkostojen, henkilöstön ja poliittisten päättäjien, hyödyntämistä voidaan parantaa yhteisellä strategiatyöllä ja sosiaalista vuorovaikutusta sekä johtamisjärjestelmiä kehittämällä. Myös asiakkaiden osallistumista uusien sosiaalisten innovaatioiden kehittämiseen tulisi lisätä. Tutkimuksessa käytettiin viitekehyksenä Todorova ja Durisinin (2008) absorptiivisen kapasiteetin mallia, johon mallin soveltamisen pohjalta esitetään kehittämisajatuksia.

Henkilöstön motivoituminen muutoksessa. Case: Asumisen rahoitus ja kehittämiskeskus

Tämän tutkimuksen tarkoituksena on ymmärtää henkilöstön motivoitumiseen vaikuttavia tekijöitä muutostilanteessa ja tunnistaa muutosjohtamisen kehittämiskohteita. Tutkielma on laadullinen tutkimus, jonka sekundaariaineistona käytetään ARAn työtyytyväisyystutkimuksia vuosilta 2007 ja 2008. Primääriaineiston muodostavat tutkimuksen kohdeorganisaation kolmentoista henkilön teemahaastattelut. Tutkimuksen perusteella voidaan todeta, että henkilöstön motivoitumiseen vaikuttaa työtehtävien mielekkyys, työyhteisöltä ja asiakkailta saatava palaute, työn arvostus ja toimiva yhteistyö. Henkilöstöpoliittiset toimenpiteet tukevat yksilöä muutoksessa. Muutosjohtamisen kehittämiskohteena on viestittää henkilöstölle muutoksen tarpeellisuus ja sen vaikutukset, toteuttaa muutos hallitusti sekä luoda muutokselle positiivinen ilmapiiri.