Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods.

Keyboard warriors in cyberfights:conflict in online communities of consumption

Nowadays, with the use of social media generalizing, increasingly more people gather online to share their passion for specific consumption activities. Despite this shared passion, conflicts frequently erupt in online communities of consumption (OCC). A systematic review of the literature revealed that a lot of knowledge has developed on OCC conflict. Different types of conflicts unfolding in an OCC context have been distinguished, various drivers of conflict identified and various consequences outlined at the individual level (experiential value) and the community level (collective engagement and community culture). However the specificity of conflicts unfolding in an OCC context has not been conceptualized. Past research is also inconclusive as to where and when does OCC conflict create or destroy value in communities. This research provides a theory of OCC conflict and its impact on value formation by conceptualizing OCC conflict as performances. The theory was developed by conducting a netnography of a clubbing forum. Close to 20,000 forum posts and 250 pages of interview transcript and field notes were collected over 27 months and analysed following the principles of grounded theory. Four different types of conflict performances are distinguished (personal, played, reality show and trolling conflict) based on the clarity of the performance. Each type of conflict performance is positioned with regard to its roots and consequences for value formation. This research develops knowledge on disharmonious interactions in OCCs contributing to the development of a less utopian perspective of OCCs. It indicates how conflict is not only a byproduct of consumption but it is also a phenomenon consumed. It also introduces the concept of performance clarity to the literature on performance consumption. This research provides guidelines to community managers on how to manage conflict and raises ethical issues regarding the management of conflict on social media.

Knowledge management in support of enterprise risk management

Risk management and knowledge management have so far been studied almost independently. The evolution of risk management to the holistic view of Enterprise Risk Management requires the destruction of barriers between organizational silos and the exchange and application of knowledge from different risk management areas. However, knowledge management has received little or no attention in risk management. This paper examines possible relationships between knowledge management constructs related to knowledge sharing, and two risk management concepts: perceived quality of risk control and perceived value of enterprise risk management. From a literature review, relationships with eight knowledge management variables covering people, process and technology aspects were hypothesised. A survey was administered to risk management employees in financial institutions. The results showed that the perceived quality of risk control is significantly associated with four knowledge management variables: perceived quality of risk knowledge sharing, perceived quality of communication among people, web channel functionality, and risk management information system functionality. However, the relationships of the knowledge management variables to the perceived value of enterprise risk management are not significant. We conclude that better knowledge management is associated with better risk control, but that more effort needs to be made to break down organizational silos in order to support true Enterprise Risk Management.

Az abduktív menedzsmenttől a tudáskormányzásig = From abductive management to knowledge governance

Hogyan juthat az ember helyes döntésekig egy adott területre (mikroverzumra) vonatkozó mély, belsővé tett tudás birtokában anélkül, hogy következtetne? Az abduktivitás fogalmának körüljárása után öt hüvelykujjszabályt fogalmaz meg a szerző az abdukció működéséről, majd összekapcsolja azt a vezetői munkával, tudáskormányzási kontextusban. Ebből kiindulva a globális munkatérelmélet (Global Workspace Theory) alkalmazásával a vezetők vagy az organizmusként felfogott szervezetek abduktív kapacitásának fejlesztési lehetőségeit vizsgálja. Befejezésül egy hatlépéses, a szervezeti szintű abduktivitásra rákérdező speciális tudásaudit-módszertan rövid kifejtésére vállalkozik, két esettanulmány vázlatos bemutatásával. _____ How to make right decisions without any inferences, thanks to interiorized, deep knowledge on the given field (micro verse)? After defining the concept of abductivity, the author presents five thumbnail-like rules about the nature of abductivity, combining it with leadership aspects and knowledge governance approach. He introduces a method supporting the development of abductive capability of a leader or an organization as a whole, using the Global Works pace Theory. Finally, the author tries to briefly formulate six steps of an organization-level knowledge governance audit framework, illustrating its relevance with two short case studies.

Adolescent readers' self-perceptions of affective factors related to performance on standardized tests

The purpose of this study was to investigate which affective factors of adolescent high school readers were related to high-level readers, middle-level readers and low-level readers. The research problem was to determine the relationship between adolescent high school students' self-perceived reading self-efficacy factors and the students' reading performance on a standardized reading assessment considering demographic factors of age, gender and socio-economic status as covariates. The research design was ex post facto making inferences without direct intervention. The sample was obtained from one large, diverse, urban high school, consisting of 9th and 10th grade adolescent students (N = 176). Students voluntarily completed a self-report, reading self-efficacy survey. School records were used to obtain standardized reading level scores, age, gender, and socio-economic status data. An exploratory factor analysis of the self-efficacy survey responses resulted in the identification of 7 underlying factors. The striving (low-level) readers had significantly lower self-perceptions on 5 of the 7 affective factors than the middle-level readers, and strong (high-level) readers, p < .05. The 5 affective factors on which the striving readers had significantly lower self-perceptions were: (a) Observational Comparison, (b) Progress, (c) Lack of Progress, (d) Lack of Anxiety, and (e) Positive Social Feedback. The 2 affective factors which were not significantly different for reader level were Anxiety and Negative Social Feedback. Girls had significantly less anxiety than boys for both of the factors in the Anxiety category. Statistical results showed that none of the demographic covariates tested; age, gender, or socio-economic status, moderated the relationship between affective reader self-efficacy factors and reader level. This study concluded that there were distinguishable differences for striving, middle, and strong readers' self-efficacy factors. Determining affective factors related to reading can be used to create better instructional environments and instruction for adolescent students.

Essays on corporate reputation: Antecedents and consequences

This dissertation studied the determinants and consequences of corporate reputation. It explored how firm-, industry-, and country-level factors influence the general public’s assessment of a firm’s reputation and how this reputation assessment impacted the firm’s strategic actions and organizational outcomes. The three empirical essays are grounded on separate theoretical paradigms in strategy, organizational theory, and corporate governance. The first essay used signaling theory to investigate firm-, industry-, and country-level determinants of individual-level corporate reputation assessments. Using a hierarchical linear model, it tested the theory based on individual evaluations of the largest companies across countries. Results indicated that variables at multiple analysis levels simultaneously impact individual level reputation assessments. Interactions were also found between industry- and country-level factors. Results confirmed the multi-level nature of signaling influences on reputation assessments. Building on a stakeholder-power approach to corporate governance, the second essay studied how differences in the power and preferences of three stakeholder groups—shareholders, creditors, and workers—across countries influence the general public’s reputation assessments of corporations. Examining the largest companies across countries, the study found that while the influence of stock market return is stronger in societies where shareholders have more power, social performance has a more significant role in shaping reputation evaluations in societies with stronger labor rights. Unexpectedly, when creditors have greater power, the influence of financial stability on reputation assessment becomes weaker. Exploring the consequences of reputation, the third essay investigated the specific effects of intangible assets on strategic actions and organizational outcomes. Particularly, it individually studied the impacts of acquirer acquisition experience, corporate reputation, and approach toward social responsibilities as well as their combined effect on market reactions to acquisition announcements. Using an event study of acquisition announcements, it confirmed the significant impacts of both action-specific (acquisition experience) and general (reputation and social performance) intangible assets on market expectations of acquisition outcomes. Moreover, the analysis demonstrated that reputation magnifies the impact of acquisition experience on market response to acquisition announcements. In conclusion, this dissertation tried to advance and extend the application of management and organizational theories by explaining the mechanisms underlying antecedents and consequences of corporate reputation.

The employee satisfaction -performance link: A unit -level analysis

In this dissertation, I present an integrated model of organizational performance. Most prior research has relied extensively on testing individual linkages, often with cross-sectional data. In this dissertation, longitudinal unit-level data from 559 restaurants, collected over a one-year period, were used to test the proposed model. The model was hypothesized to begin with employee satisfaction as a key antecedent that would ultimately lead to improved financial performance. Several variables including turnover, efficiency, and guest satisfaction are proposed as mediators of the satisfaction-performance relationship. The current findings replicate and extend past research using individual-level data. The overall model adequately explained the data, but was significantly improved with an additional link from employee satisfaction to efficiency, which was not originally hypothesized. Management turnover was a strong predictor of hourly level team turnover, and both were significant predictors of efficiency. Full findings for each hypothesis are presented and practical organizational implications are given. Limitations and recommendations for future research are provided. ^

Contrasting patterns of individual specialization and trophic coupling in two marine apex predators

1. Apex predators are often assumed to be dietary generalists and, by feeding on prey from multiple basal nutrient sources, serve to couple discrete food webs. But there is increasing evidence that individual level dietary specialization may be common in many species, and this has not been investigated for many marine apex predators. 2. Because of their position at or near the top of many marine food webs, and the possibility that they can affect populations of their prey and induce trophic cascades, it is important to understand patterns of dietary specialization in shark populations. 3. Stable isotope values from body tissues with different turnover rates were used to quantify patterns of individual specialization in two species of ‘generalist’ sharks (bull sharks, Carcharhinus leucas, and tiger sharks, Galeocerdo cuvier). 4. Despite wide population-level isotopic niche breadths in both species, isotopic values of individual tiger sharks varied across tissues with different turnover rates. The population niche breadth was explained mostly by variation within individuals suggesting tiger sharks are true generalists. In contrast, isotope values of individual bull sharks were stable through time and their wide population level niche breadth was explained by variation among specialist individuals. 5. Relative resource abundance and spatial variation in food-predation risk tradeoffs may explain the differences in patterns of specialization between shark species. 6. The differences in individual dietary specialization between tiger sharks and bull sharks results in different functional roles in coupling or compartmentalizing distinct food webs. 7. Individual specialization may be an important feature of trophic dynamics of highly mobile marine top predators and should be explicitly considered in studies of marine food webs and the ecological role of top predators.

Social determinants of dental treatment needs in Brazilian adults

Background The chronic cumulative nature of caries makes treatment needs a severe problem in adults. Despite the fact that oral diseases occur in social contexts, there are few studies using multilevel analyses focusing on treatment needs. Thus, considering the importance of context in explaining oral health related inequalities, this study aims to evaluate the social determinants of dental treatment needs in 35–44 year old Brazilian adults, assessing whether inequalities in needs are expressed at individual and contextual levels. Methods The dependent variables were based on the prevalence of normative dental treatment needs in adults: (a) restorative treatment; (b) tooth extraction and (c) prosthetic treatment. The independent variables at first level were household income, formal education level, sex and race. At second level, income, sanitation, infrastructure and house conditions. The city-level variables were the Human Development Index (HDI) and indicators related to health services. Exploratory analysis was performed evaluating the effect of each level through calculating Prevalence Ratios (PR). In addition, a three-level multilevel modelling was constructed for all outcomes to verify the effect of individual characteristics and also the influence of context. Results In relation to the need for restorative treatment, the main factors implicated were related to individual socioeconomic position, however the city-level contextual effect should also be considered. Regarding need for tooth extraction, the contextual effect does not seem to be important and, in relation to the needs for prosthetic treatment, the final model showed effect of individual-level and city-level. Variables related to health services did not show significant effects. Conclusions Dental treatment needs related to primary care (restoration and tooth extraction) and secondary care (prosthesis) were strongly associated with individual socioeconomic position, mainly income and education, in Brazilian adults. In addition to this individual effect, a city-level contextual effect, represented by HDI, was also observed for need for restorations and prosthesis, but not for tooth extractions. These findings have important implications for the health policy especially for financing and planning, since the distribution of oral health resources must consider the inequalities in availability and affordability of dental care for all.

A importância da qualidade na avaliação em formato a distância

Relatório de estágio para obtenção do grau de mestre em Educação e Comunicação Multimédia

The Politics of Gender Socialization

This manuscript is comprised of three papers that examine the far-reaching and often invisible political outcomes of gender role socialization in the United States. These papers focus primarily on two areas: political confidence amongst girls and women, and the effects of gender on survey measurement and data quality.

Chapter one focuses on political confidence, and the likelihood that women will run for political office. Women continue to be underrepresented at all levels of political leadership, and their lack of political ambition, relative to men, has been identified as a primary cause. In this paper, I explore the relationship between an individual's masculinity and femininity and her development of political ambition. Using original survey data from the 2012 Cooperative Congressional Election Study (CCES), I first empirically demonstrate that gender (masculinity/femininity) and sex (male/female) are unique elements of identity and, moreover, are both independently related to political ambition. I then explore the relevance of gender for the study of candidate emergence, testing whether and how masculinity and femininity might be related to political ambition are supported empirically. While the results suggest that masculinity is positively associated with the development of political ambition, the relationship between femininity and candidate emergence seems to be more complicated and not what prevailing stereotypes might lead us to expect. Moreover, while the relationship between masculinity and political ambition is the same for men and women, the relationship between femininity and political ambition is very different for women than it is for men. This study suggests that gender role socialization is highly related with both men's and women's desire to seek positions of political leadership.

Chapter two continues this exploration of gendered differences in the development of political ambition, this time exploring how social attractiveness and gendered perceptions of political leadership impact the desire to hold political office.Women are persistently underrepresented as candidates for public office and remain underrepresented at all levels of government in the United States. Previous literature suggests that the gendered ambition gap, gender socialization, insufficient recruitment, media scrutiny, family responsibilities, modern campaign strategies, and political opportunity structures all contribute to the gender imbalance in pools of officeholders and candidates. To explain women's reticence to run, scholars have offered explanations addressing structural, institutional, and individual-level factors that deter women from becoming candidates, especially for high positions in the U.S. government. This paper examines a previously unexplored factor: how dating and socialized norms of sexual attraction affect political ambition. This study investigates whether young, single, and heterosexual women's desire for male attention and fear of being perceived as unattractive or "too ambitious" present obstacles to running for office. The results of these experiments suggest that social expectations about gender, attraction and sexuality, and political office-holding may contribute to women's reticence to pursue political leadership. Chapter two is a co-authored work and represents the joint efforts of Laura Lazarus Frankel, Shauna Shames, and Nadia Farjood.

Chapter 3 bridges survey methodology and gender socialization, focusing on how interviewer sex affects survey measurement and data quality. Specifically, this paper examines whether and how matching interviewer and respondent sex affects panel attrition--respondents dropping out of the study after participating in the first wave. While the majority of research on interviewer effects suggests that matching interviewer and respondent characteristics (homophily) yields higher quality data, little work has examined whether this pattern holds true in the area of panel attrition. Using paradata from the General Social Survey (GSS), I explore this question. My analysis reveals that, despite its broader positive effects on data quality, matching interviewer and respondent sex increases likelihood to attrit. Interestingly, this phenomenon only emerges amongst male respondents. However, while assigning female interviewers to male respondents decreases their propensity to attrit, it also increases the likelihood of biased responses on gender related items. These conflicting outcomes represent a tradeoff for scholars and survey researchers, requiring careful consideration of mode, content, and study goals when designing surveys and/or analyzing survey data. The implications of these patterns and areas for further research are discussed.

Together, these papers illustrate two ways that gender norms are related to political outcomes: they contribute to patterns of candidate emergence and affect the measurement of political attitudes and behaviors.

L’engagement au développement professionnel des infirmières œuvrant en centre hospitalier universitaire : une étude qualitative descriptive.

Le développement professionnel (DP) des infirmières est essentiel et déterminant dans l’obtention d’une meilleure qualité de soins. Pour se réaliser, le développement professionnel nécessite un engagement individuel des infirmières elles-mêmes. Or, une disparité est observée en centre hospitalier universitaire (CHU) entre la volonté exprimée par les infirmières de poursuivre leur DP et leur assiduité dans les activités de développement offertes par les organisations. L’objectif de cette étude qualitative est de décrire la perception des infirmières œuvrant en CHU (n=8) en regard des facteurs organisationnels susceptibles de favoriser leur engagement à poursuivre leur développement professionnel. Cette analyse a été effectuée à partir de huit entrevues individuelles semi-dirigées réalisées auprès d’infirmières œuvrant dans le secteur de chirurgie du CHU Sainte-Justine. Les résultats démontrent que de nombreux facteurs organisationnels et individuels. Les principaux facteurs influant sur l’engagement des infirmières sont : a) un environnement favorable au DP; b) l’accessibilité au DP et; c) des modalités de DP variées. Les modalités les plus favorables sont celles favorisant leur autonomie et incitant leur implication. En conclusion, pour obtenir un maximum d’engagement des infirmières, les organisations doivent présenter une offre de DP variée et structurée, répondant aux besoins professionnels des infirmières, tout en mitigeant l’impact des contraintes liées à leur fonction et à leur vie personnelle.

The adaptive response of humans to exercise: Impact of exercise intensity, fibre-type specific responses and molecular patterns of response

In an attempt to improve the current understanding of the adaptive response to exercise in humans, this dissertation performed a series of studies designed to examine the impact of training intensity and mode on aerobic capacity and performance, fibre-type specific adaptations to training, and individual patterns of response across molecular, morphological and genetic factors. Project #1 determined that training intensity, session dose, baseline VO2max and total training volume do not influence the magnitude of change in VO2max by performing a meta-regression, and meta-analysis of 28 different studies. The intensity of training had no effect on the magnitude of increase in maximal oxygen uptake in young healthy participants, but similar adaptations were achieved with lower training doses following high intensity training. Project # 2 determined the acute molecular response, and training-induced adaptations in aerobic performance, aerobic capacity and muscle phenotype following high-intensity interval training (HIT) or endurance exercise (END). The acute molecular response (fibre recruitment and signal activation) and training-induced adaptations in aerobic capacity, aerobic performance, and muscle phenotype were similar following HIT and END. Project # 3 examined the impact of baseline muscle morphology and molecular characteristics on the training response, and if muscle adaptations are coordinated. The muscle phenotype of individuals who experience the largest improvements (high responders) were lower before training for some muscle characteristics and molecular adaptations were coordinated within individual participants. Project # 4 examined the impact of 2 different intensities of HIT on the expression of nuclear and mitochondrial encoded genes targeted by PGC-1α. A systematic upregulation of nuclear and mitochondrial encoded genes was not present in the early recovery period following acute HIT, but the expression of mitochondrial genes were coordinated at an individual level. Collectively, results from the current dissertation contribute to our understanding of the molecular mechanisms influencing skeletal muscle and whole-body adaptive responses to acute exercise and training in humans.

Individual Variation in VO2peak Response Following Sprint Interval Training: The Role of Peripheral Adaptation

There is a large degree of heterogeneity in response to regular physical activity at the individual level, with some exhibiting no or very small improvements in VO2peak following highly controlled exercise training. The purpose of this thesis was to examine individual variation in VO2peak response to sprint interval training (SIT) in relation to individual responses to multiple measures of peripheral physiological adaptation. Specifically, VO2peak, capillary density, fibre-specific SDH content, and type I fibre % were measured in 23 young, healthy, recreationally active males before and after 4 weeks SIT (Tabata protocol 4 x per week). The key findings of this experiment included that, when separated into tertiles of VO2peak response, the high (HI) and low (LO) groups differed significantly in VO2peak change after training. Secondly, there was no difference between HI and LO groups for response in any of capillary density, fibre-specific SDH content, or fibre type %, with no correlation found between individual VO2peak response and changes in any measured peripheral variable. Together, these results confirm that individuals respond heterogeneously to SIT and suggest that this heterogeneity does not result from differences in individual changes in capillary density, fibre-specific SDH content or type I fibre %. It is speculated that some other combination of peripheral physiological adaptation must explain variability in VO2peak response to 4 weeks of SIT.

What's in it for us? A case study research about micro sense making processes through the eyes of front line employees, during culture change implementation

Abstract How employees make sense of change is a very complex process. Recently, academics have neglected to research sense making activities in a micro culture implementation context, through the eyes of front line employees. In contrast to a macro view, a micro perspective limits researchers to only look at an individual, departmental or group level. By doing so, we can zoom in on the details of sense making processes that employees use in their daily work life. A macro (organisational) view is based on the notion that there is a general integrated culture that can be found in all organisational units and departments. It is assumed that culture can be researched by using the entire organisation as one single research entity. This thesis challenges this assumption. In case of planned change it is usually the management community who are in charge of the change intervention. Because of their formal hierarchical position, they have the power to abort or initiate change programs. It is perhaps therefore that researchers tend to be focused on the management community rather than on lower level organisational members, such as front line employees. Apart from the micro view, scholars also neglected to research culture change implementation through the eyes of front line employees. This thesis is an attempt to fill these two gaps that currently exists in academic change management publications. The main research question is therefore: From a micro point of view how do front-line employees make sense of the impact of culture change, during the implementation phase? This thesis starts with a literature review which exposes the two main gaps. The most important outcome of this review is that only 2% of the research articles dealt with culture implementation, through the eyes of front line employees. A conceptual research model is built on the integrated sense making theory of Weber and Manning (2001) and the micro variables of Raelin and Cataldo (2011). These theories emphasize elements of sense making in a daily working context. It is likely that front line employees can identify themselves with research elements such as tasks, skills practices, involvement and behaviour. Front line employees were selected, because as lower level organisational members they are usually the change recipients. They are further away from the change initiating scene (usually the management of an organisation) and form a potential sense making ‘hotspot’ that could provide new academic insights. In order to carry out the primary research, two case organisations were selected in the leisure industry. A participative case study research method was chosen. This meant that the researcher worked in the concerning departments of the case organisations. The goal was to observe and interview front line employees, while they were performing their jobs. The most important advantage of this approach is that the researcher temporarily becomes one with the organisation and is therefore able to acquire both formal and informal narratives that front line employees use during sense making activities. It was found that front line employees make sense of organisational change by using a practical approach. They make sense of the change program by carrying out new tasks, developing new skills and sharing best practices. The most noticeable conclusion was that sense making activities predominantly take place at an individual level in relation to change acceptance. Organisational members tend to create a mental equation in order to weigh the advantages against the disadvantages. They evaluate whether the concerning change program is beneficial to them or not. For future research a sense making scheme model is suggested that is based on two methods: an introspection and an action method.