Primary care in Switzerland: evolution of physicians' profile and activities in twenty years (1993-2012).

BACKGROUND: According to the Organization for Economic Cooperation and Development, the Swiss healthcare system is one of the most effective in the world. Yet, as other occidental countries, it has to face the increase of chronic diseases frequency and its resulting cost, particularly for primary care (PC). However very few consistent data are available to describe PC features and its evolution over time. The aim of this study is to describe the evolution of the Swiss PC physicians' (PCPs) profile and activities between 1993 and 2012. METHODS: The date come from two independent European surveys carried out in Switzerland respectively in 1993 and 2012. Both surveys were cross-sectional ones and based on representative samples of 200 PCPs, interviewed by questionnaire. RESULTS: In 20 years, PCPs became older (median age 46 vs 56, p < 0.001) and more feminized (7 % vs 22 %, p < 0.001). Nowadays, they more often work in group practices (28 % vs 52 % in 2012, p < 0.001) and are more involved in other paid activities (28 % vs 66 % in 2012, p < 0.001). All the PCPs have a computer in 2012 (78 % in 1993, p < 0.001) and it is mostly used for keeping records of consultations (47 %). The number of daily face-to-face contacts with patients decreased from 31 to 24 but the average length rose from 15 to 20 min (p < 0.001). PCPs provide fewer pediatric and gynecological services but their activity remains globally unchanged in other domains. The frequency of meetings with other disciplines decreased significantly (e.g. once/month face-to-face meets with ambulatory specialists: 78 % vs 23 % in 2012, p < 0.001). The involvement of PCPs in follow-up and treatment of chronic disease globally little differed. In 2012, 8.5 % of the PCPs never performed any chirurgical acts (vs 0 % in 1993, p < 0.001). CONCLUSION: This study showed a substantial evolution of Swiss PC over the last twenty years in terms of socio-demographic, organizational and service provided. The main changes include: feminization and ageing, lower diversity in services provided, fewer but longer consultations. These changes may have important implications for patients' management and will need to be considered for health planning purposes.

Mixed and Hybrid Models of Public Service Delivery

This symposium presents research from different contexts to improve our collective understanding of a variety of aspects of mixed forms of service delivery, be they mixed contracting at the level of the market (which is more common in the U.S.), or mixed management and ownership at the level of the firm (which is more common in Europe). The articles included in this special symposium examine the factors that give rise to mixed forms of service delivery (e.g., economic and fiscal stress, regulatory flexibility, geography, management) and how these factors impact their design and operation. Articles also explore the performance of mixed forms of service delivery relative to more conventional arrangements like contracted or direct service delivery. The articles contribute to a better theoretical and conceptual understanding of mixed/hybrid forms of services delivery.

Geography of talent and regional differences in Spain

Tentative empirical evidence suggests that the agglomeration of talent contributes to regional development. However, given that talented people are not evenly distributed across regions, this paper seeks to determine how the concentration of talent affects patterns of regional development. Here, we empirically evaluate the effects of the distribution of talent on regional differences by means of a detailed analysis of the 17 Autonomous Communities of Spain between 1996 and 2004. We hypothesise that regions specialising in strategic sectors that are creative and which can be assumed to enjoy rapid growth in productivity will experience faster rates of development and, in turn, that this concentration of talent will have a positive impact on the region’s economic performance. Thus, we believe that this mechanism can explain the marked regional imbalances in Spain. Our findings confirm that regional differences, measured in terms of GDP per capita and by, - industrial and service- oriented production, are influenced by the Communities’ talent bases as determined by, educational attainment and employment in assumed to be strategic for regional development, inasmuch as these sectors provide economic specialization.

Service Quality of ASPs (Application Service Providers): Case of an E-accounting Service

Service quality has been a hot topic in services marketing research since the ‘80s. Although it has been widely researched in the B2C context, as well as there is some research in the B2B side, it has received very little attention specifically in the context of the ASP (Application Service Provider) business model. The thesis uses streams of service quality literature in B2C and B2B as well as research of the ASP model to form a comprehensive understanding of service quality in the context of the ASPs. The empirical part consists of a case study of Netvisor, a fast-growing Finnish ASP providing e-accounting services. The key findings are that some traditional service quality dimensions seem to apply also in the ASP context and the relative importance of some dimensions differs with regard to different customer levels. Suggestions are made to improve the service quality of the case company.

Developing the service offering of an industrial company

The purpose of this thesis was to determine, what kind of service offering the case company should provide to its customers in the Australian market. For this, a model for analysing the competitive environment was developed. In the model, three players were considered: customers, competitors and the case company. Benchmarking was used in identifying competitors’ offerings currently available in the market. Experts inside the case company were consulted for determining the customer need. The competitors’ offerings were analysed on the basis of Pekkarinen et al.’s (2009) framework, dividing the offerings to services supporting the supplier’s product (SSP), supporting the client (SSC), supporting the client’s network (SSN), supporting mutual actions (SSM) and benefit and risk sharing elements. After this, they were compared to the competitive environment in order to identify areas where the case company can differentiate itself from its competitors in the Australian market. On the basis of the company’s key success factors, and the Finnish service concept currently in use, some additional offerings were suggested for the case company in order to further outperform its competitors in the market. Finally, on the basis of the suggested offerings and competitors’ offerings, a service concept was suggested for the case company to introduce in the Australian market.

The value of digitalization of services in the new service development

The purpose of this thesis is to study factors that have an impact on the company’s capabilities to identify and analyze the value of digitalization of services during the early stages of service development process and evaluate them from the perspective of a case company. The research problem was defined: “How digitalization of services affects delivering the services of the future?” The research method of this thesis was based on the qualitative case study which aimed to study both company’s and customer’s set of values. The study included a literature review and a development study. The empirical research part consisted of analyzing three existing services, specifying a new digital service concept and its feasibility analysis as part of a business requirement phase. To understand the set of values, 10 stakeholder interviews were conducted and earlier customer surveys were utilized, and additionally, a number of meetings were conducted with the case company representatives to develop service concept, and evaluate the findings. The impact of the early stages of service development process discovered to reflect directly in the capabilities of the case company to identify and create customer value were related to the themes presented in the literature review. In order to specify the value achieved from the digitalization the following areas of strategic background elements were deepened during the study: Innovations, customer understanding and business service. Based on the findings, the study aims to enhance the case company’s capability to identify and evaluate the impact of the digitalization in delivering services of the future. Recognizing the value of digital service before the beginning of the development project is important to the businesses of both customer and provider. By exploring the various levels of digitalization one can get the overall picture of the value gained from utilizing digital opportunities. From the development perspective, the process of reviewing and discovering the most promising opportunities and solutions is the key step in order to deliver superior services. Ultimately, a company should understand the value outcome determination of the individual services as well as their digital counterparts.

Measuring the performance of corporate events : an empirical study of measuring practices in Finnish companies

Corporate events as an effective part of marketing communications strategy seem to be underestimated in Finnish companies. In the rest of the Europe and the USA, investments in events are increasing, and their share of the marketing budget is significant. The growth of the industry may be explained by the numerous advantages and opportunities that events provide for attendees, such as face-to-face marketing, enhancing corporate image, building relationships, increasing sales, and gathering information. In order to maximize these benefits and return on investment, specific measurement strategies are required, yet there seems to exist a lack of understanding of how event performance should be perceived or evaluated. To address this research gap, this research attempts to describe the perceptions of and strategies for evaluating corporate event performance in the Finnish events industry. First, corporate events are discussed in terms of definitions and characteristics, typologies, and their role in marketing communications. Second, different theories on evaluating corporate event performance are presented and analyzed. Third, a conceptual model is presented based on the literature review, which serves as a basis for the empirical research conducted as an online questionnaire. The empirical findings are to a great extent in line with the existing literature, suggesting that there remains a lack of understanding corporate event performance evaluation, and challenges arise in determining appropriate measurement procedures for it. Setting clear objectives for events is a significant aspect of the evaluation process, since the outcomes of events are usually evaluated against the preset objectives. The respondent companies utilize many of the individual techniques that were recognized in theory, such as calculating the number of sales leads and delegates. However, some of the measurement tools may require further investments and resources, thus restricting their application especially in smaller companies. In addition, there seems to be a lack of knowledge of the most appropriate methods in different contexts, which take into account the characteristics of the organizing party as well as the size and nature of the event. The lack of inhouse expertise enhances the need for third-party service-providers in solving problems of corporate event measurement.

Reframing the relationship between service design and operations: a service engineering approach

The significance of services as business and human activities has increased dramatically throughout the world in the last three decades. Becoming a more and more competitive and efficient service provider while still being able to provide unique value opportunities for customers requires new knowledge and ideas. Part of this knowledge is created and utilized in daily activities in every service organization, but not all of it, and therefore an emerging phenomenon in the service context is information awareness. Terms like big data and Internet of things are not only modern buzz-words but they are also describing urgent requirements for a new type of competences and solutions. When the amount of information increases and the systems processing information become more efficient and intelligent, it is the human understanding and objectives that may get separated from the automated processes and technological innovations. This is an important challenge and the core driver for this dissertation: What kind of information is created, possessed and utilized in the service context, and even more importantly, what information exists but is not acknowledged or used? In this dissertation the focus is on the relationship between service design and service operations. Reframing this relationship refers to viewing the service system from the architectural perspective. The selected perspective allows analysing the relationship between design activities and operational activities as an information system while maintaining the tight connection to existing service research contributions and approaches. This type of an innovative approach is supported by research methodology that relies on design science theory. The methodological process supports the construction of a new design artifact based on existing theoretical knowledge, creation of new innovations and testing the design artifact components in real service contexts. The relationship between design and operations is analysed in the health care and social care service systems. The existing contributions in service research tend to abstract services and service systems as value creation, working or interactive systems. This dissertation adds an important information processing system perspective to the research. The main contribution focuses on the following argument: Only part of the service information system is automated and computerized, whereas a significant part of information processing is embedded in human activities, communication and ad-hoc reactions. The results indicate that the relationship between service design and service operations is more complex and dynamic than the existing scientific and managerial models tend to view it. Both activities create, utilize, mix and share information, making service information management a necessary but relatively unknown managerial task. On the architectural level, service system -specific elements seem to disappear, but access to more general information elements and processes can be found. While this dissertation focuses on conceptual-level design artifact construction, the results provide also very practical implications for service providers. Personal, visual and hidden activities of service, and more importantly all changes that take place in any service system have also an information dimension. Making this information dimension visual and prioritizing the processed information based on service dimensions is likely to provide new opportunities to increase activities and provide a new type of service potential for customers.

Hacking User Experience in a Repository Service: ScholarSphere as a Case Study

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

A simple HPLC-fluorescence method for the measurement of R,S-sotalol in the plasma of patients with life-threatening cardiac arrhythmias

R,S-sotalol, a ß-blocker drug with class III antiarrhythmic properties, is prescribed to patients with ventricular, atrial and supraventricular arrhythmias. A simple and sensitive method based on HPLC-fluorescence is described for the quantification of R,S-sotalol racemate in 500 µl of plasma. R,S-sotalol and its internal standard (atenolol) were eluted after 5.9 and 8.5 min, respectively, from a 4-micron C18 reverse-phase column using a mobile phase consisting of 80 mM KH2PO4, pH 4.6, and acetonitrile (95:5, v/v) at a flow rate of 0.5 ml/min with detection at lex = 235 nm and lem = 310 nm, respectively. This method, validated on the basis of R,S-sotalol measurements in spiked blank plasma, presented 20 ng/ml sensitivity, 20-10,000 ng/ml linearity, and 2.9 and 4.8% intra- and interassay precision, respectively. Plasma sotalol concentrations were determined by applying this method to investigate five high-risk patients with atrial fibrillation admitted to the Emergency Service of the Medical School Hospital, who received sotalol, 160 mg po, as loading dose. Blood samples were collected from a peripheral vein at zero, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 6.0, 8.0, 12.0 and 24.0 h after drug administration. A two-compartment open model was applied. Data obtained, expressed as mean, were: CMAX = 1230 ng/ml, TMAX = 1.8 h, AUCT = 10645 ng h-1 ml-1, Kab = 1.23 h-1, a = 0.95 h-1, ß = 0.09 h-1, t(1/2)ß = 7.8 h, ClT/F = 3.94 ml min-1 kg-1, and Vd/F = 2.53 l/kg. A good systemic availability and a fast absorption were obtained. Drug distribution was reduced to the same extent in terms of total body clearance when patients and healthy volunteers were compared, and consequently elimination half-life remained unchanged. Thus, the method described in the present study is useful for therapeutic drug monitoring purposes, pharmacokinetic investigation and pharmacokinetic-pharmacodynamic sotalol studies in patients with tachyarrhythmias.

Competitive advantage through proprietary erp implementation: analysis of the project Väinämö

In the market where companies similar in size and resources are competing, it is challenging to have any advantage over others. In order to stay afloat company needs to have capability to perform with fewer resources and yet provide better service. Hence development of efficient processes which can cut costs and improve performance is crucial. As business expands, processes become complicated and large amount of data needs to be managed and available on request. Different tools are used in companies to store and manage data, which facilitates better production and transactions. In the modern business world the most utilized tool for that purpose is ERP - Enterprise Resource Planning system. The focus of this research is to study how competitive advantage can be achieved by implementing proprietary ERP system in the company; ERP system that is in-house created, tailor made to match and align business needs and processes. Market is full of ERP software, but choosing the right one is a big challenge. Identifying the key features that need improvement in processes and data management, choosing the right ERP, implementing it and the follow-up is a long and expensive journey companies undergo. Some companies prefer to invest in a ready-made package bought from vendor and adjust it according to own business needs, while others focus on creating own system with in-house IT capabilities. In this research a case company is used and author tries to identify and analyze why organization in question decided to pursue the development of proprietary ERP system, how it has been implemented and whether it has been successful. Main conclusion and recommendation of this research is for companies to know core capabilities and constraints before choosing and implementing ERP system. Knowledge of factors that affect system change outcome is important, to make the right decisions on strategic level and implement on operational level. Duration of the project in the case company has lasted longer than anticipated. It has been reported that in cases of buying ready product from vendor, projects are delayed and completed over budget as well. In general, in case company implementation of proprietary ERP has been successful both from business performance figures and usability of system by employees. In terms of future research, conducting a study to calculate statistically ROI of both approaches; of buying ready product and creating own ERP will be beneficial.

A systematic mapping study of web services discovery mechanisms

Context: Web services have been gaining popularity due to the success of service oriented architecture and cloud computing. Web services offer tremendous opportunity for service developers to publish their services and applications over the boundaries of the organization or company. However, to fully exploit these opportunities it is necessary to find efficient discovery mechanism thus, Web services discovering mechanism has attracted a considerable attention in Semantic Web research, however, there have been no literature surveys that systematically map the present research result thus overall impact of these research efforts and level of maturity of their results are still unclear. This thesis aims at providing an overview of the current state of research into Web services discovering mechanism using systematic mapping. The work is based on the papers published 2004 to 2013, and attempts to elaborate various aspects of the analyzed literature including classifying them in terms of the architecture, frameworks and methods used for web services discovery mechanism. Objective: The objective if this work is to summarize the current knowledge that is available as regards to Web service discovery mechanisms as well as to systematically identify and analyze the current published research works in order to identify different approaches presented. Method: A systematic mapping study has been employed to assess the various Web Services discovery approaches presented in the literature. Systematic mapping studies are useful for categorizing and summarizing the level of maturity research area. Results: The result indicates that there are numerous approaches that are consistently being researched and published in this field. In terms of where these researches are published, conferences are major contributing publishing arena as 48% of the selected papers were conference published papers illustrating the level of maturity of the research topic. Additionally selected 52 papers are categorized into two broad segments namely functional and non-functional based approaches taking into consideration architectural aspects and information retrieval approaches, semantic matching, syntactic matching, behavior based matching as well as QOS and other constraints.

Customer orientation of sales personnel: Implications for service quality

Prior customer orientation research has concentrated mainly on studying the economical potential of customer orientation to companies. Service quality research instead has concentrated on emphasizing the evaluation of service quality from the customer’s perspective. This means that the service providers lack important information regarding customer orientation and service quality they would need for managerial purposes such as selecting and training employees. Therefore, there is an emerging need to study how customer orientation and service quality relate to company processes, policies and employees, and this study answers to those calls. The objective of this study was to examine what is the role of sales personnel’s’ customer orientation in quality of service delivery and what features support the development of customer orientation among sales personnel. Also the components customer orientation were studied extensively in order to understand how they relate to service quality. The empiric part of the study was conducted as a qualitative research by interviewing seven sales people from operative, tactical and strategic levels of the case corporation in order to get a broader view for customer orientation. The findings propose that both organizational factors and individual factors are affecting customer orientation construct inseparably. Organizational factors are bundled in this study under standards, support and systems, whereas individual factors are formed of employees’ personal attributes, motivation and self-perceived decision making authority. The findings suggest that in the service delivery process at an operative level, customer orientation appears largely in the employees’ individualistic characteristics. Their social and technical skills and motivation to serve customers are the most identifiable factors for customer orientation and consequently, quality service. However, organizational standards, support and systems are strongly dictating the frames the operative sales people operate in, having an influence on how the employees are experiencing their decision making authority and in the end, customer orientation. When looking at the service delivery process at tactical and strategic levels, customer orientation is affecting mainly in the organizational constructs through setting standards, support and systems. However, tactical and strategic level employees influence the operative level through individual customer orientation components as well. The findings indicate that their emotion and personal interaction skills are affecting the overall service delivery process mainly through supervisor support and motivation of the operative level employees. Based on this study it can be argued that an organization can operate as a facilitator and create certain frames for customer oriented sales behavior through standards, support and systems. However, as the impact of individual customer orientation factors on sales people’s service quality seems decisive, from an organizational perspective it puts pressures on the recruitment.

Consumer online communication of corporate social responsibility in the sin industry context: Cases in the global online gambling industry.

So-called sin industries are often related to harmfulness, unethical business, and unproductiveness. Nowadays, the alcohol, gambling, and tobacco industries are most often considered to be part of sin industries, which is also the context of this study. However, the definition of a sin industry is always related to time and culture. Despite the controversies of sin industries, there are studies that have shown that corporate social responsibility (CSR) engagement is even more important for sin industries than for normal industries and that CSR has a positive effect on firm value in sin industries. With CSR this study refers to an ideology where company takes mostly voluntary actions towards various groups of stakeholders and the environment. In other words, the company goes beyond the legal norms and regulations. In particular, the purpose of this thesis is to find out how companies, operating in the online gambling industry, communicate about their CSR actions to consumers at their web pages. The online environment is essential for this study as online gambling environment is a source of many controversies in comparison to the traditional gambling halls and casinos. These include, for example, greater accessibility, anonymity, and availability of the service. This study uses qualitative textual analysis as its approach, more precisely the discourse analysis. In addition, as this study focuses on large international companies and their actions, also case study approach will be presented. The cases studied are Mybet, Unibet, and Bwin.Party. In order to study the subject, elements from discourse analysis are combined with insights of essential CSR theories, and the specific characteristics of the online gambling industry. As a background for the framework, this study uses the framework of Du & Vieira (2012). After analyzing the discourses of CSR communication and CSR practices, it seems that all of the case companies still do not use all the potential that the online environment provides in terms of CSR or stakeholder communication. There are large differences between different communication tools used at different web pages (gambling pages vs. corporation pages) and between the firms’ CSR profiles. Moreover, there are large differences in the CSR practices used in the web pages of the case companies. The findings of this study are partially alarming as the case companies represent the largest companies in the industry. There are major varieties between the companies’ CSR communication and clear shortcomings in some parts of the online communication. Moreover, the trust of the consumer was broken in some places. If this is the standard that the biggest players in the industry have set with regards to CSR communication, it is probable that the smaller players are performing even worse. Moreover, the regulators are most likely concentrating on the larger companies, so the smaller companies might have fewer incentives and pressure to perform according to the regulations or exceeding the legislation. The conclusions of this thesis provide insights to managers, regulators, and scholars. Suggestions for future studies are provided as well.

Examining the side effects of sucrose for pain relief in preterm infants: a case-control study

Sucrose solution is recommended as relevant pain relief management in neonates during acute painful procedures; however, only a few studies have analyzed the potentially adverse effects of sucrose administration to preterm neonates. The goal of this study was to examine the potential side effects of sucrose for pain relief in preterm infants, assessing feeding and weight gain during hospitalization and their feeding patterns postdischarge. The study sample consisted of 43 preterm neonates divided into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which no sucrose was administered. The SG received 0.5 mL/kg 25% oral sucrose for 2 min prior to all acute painful procedures during three consecutive days. A prospective review of medical charts was performed for all samples. The study was done prior to implementation of the institutional sucrose guidelines as a routine service, and followed all ethical requirements. There were no statistically significant differences between groups in terms of weight gain, length of stay with orogastric tubes, and parenteral feeding. Postdischarge, infant nutritional intake included feeding human milk to 67% of the SG and 74% of the CG. There were no statistically significant differences between groups regarding human milk feeding patterns postdischarge. Neonate feeding patterns and weight gain were unaffected following the short-term use of sucrose for pain relief.