Toiminnan laadun parantaminen organisaation itsearvioinnilla – tutkimus Suomen puolustusvoimien tulosyksiköissä

Laajoilla kyselylomaketutkimuksilla on tutkittu organisaation itsearvioinnin käyttöönoton motiiveja, käyttöä ja käytön hyötyjä 1990-luvulla ja 2000-luvun alussa. Organisaation itsearviointia on myös tutkittu laatupalkintomallien soveltamisen yhteydessä. Kolmas tutkimussuuntaus, johon myös tämä tutkimus sisältyy, on organisaation itsearvioinnin tutkiminen erilaisissa asiayhteyksissä. Tämän tutkimuksen tarkoituksena on lisätä tietoa ja ymmärrystä organisaation itsearvioinnista ja sen vaikuttavuudesta tutkimalla, miten organisaatiota itsearvioidaan maavoimien valmiusyhtymissä ja Maasotakoulussa. Näissä neljässä paikallistutkimuksessa käytin tutkimusotteena tapaustutkimuksen mukaista tutkimusstrategiaa. Aiempien tutkimuksien tulosten perusteella tärkein yhdistävä tekijä toiminnan parantamisessa on pyrkimys kokonaisvaltaisuuteen toiminnan laadun parantamisessa ja erinomaisuuden tavoittelussa. Osin kokonaisvaltaisuuteen sisältyviä ja sitä tukevia tekijöitä ovat jatkuvan parantamisen periaatteen käyttäminen ja oppivan organisaation edellyttämien toimintaedellytyksien luominen ja niiden huomioon ottaminen toiminnassa. Edelleen yhteisenä tekijänä ovat johdon sitoutumisen ja osallistumisen vaikutukset työntekijöiden osallistumiseen ja sitoutumiseen. Teorian perusteella olen arvioinut muodostuvan kolme organisaation itsearvioinnin strategisen tason johtamiskäytäntöä, jotka ovat ”Laatupalkinnon hakeminen”, ”Toiminnan ja tulosten arviointi” sekä ”Toiminnan kypsyyden arviointi”. Tutkimuksen tulosten perusteella organisaation itsearvioinnin vaikuttavuuden merkityskokonaisuus on selitettävissä viiden teeman avulla. Koko tutkimusaineiston yhdistäväksi vaikuttavuuden teemaksi, josta myös organisaation itsearvioinnin vaiheistus saa tukea, muodostuu teema ”organisaation itsearviointi ja tulosjohtaminen”. Tämän teeman perusteella organisaation itsearvioinnin vaikuttavuus perustuu itsearvioinnin käyttämiseen sekä tulosyksikön sisäisenä että johdon strategisen tason itsearviointina osana tulosjohtamista. Samoin teema ”ollaanko samaa perhettä” löytyy jokaisesta tutkimuskohteena olleesta tulosyksiköstä. Teeman perusteella vaikuttavuus perustuu siihen, että organisaation itsearvioinnin tilaisuus koetaan sosiaalisena tapahtumana ja organisaation itsearviointi vahvistaa työntekijöiden osallistumista ja sitoutumista toiminnan laadun parantamiseen. Vaikuttavuuden teemoissa ”poistetaan kivi kengästä, ja hiertäminen loppuu siihen”, ”strateginen valinta” ja ”henkilöstön työhyvinvoinnin edistäminen” organisaation itsearvioinnin vaikuttavuus on tulosyksikkökohtainen. Organisaation itsearvioinnista haetaan vaikuttavuutta organisaation itsearvioinnista saatavien tulosten nopealla toimeenpanolla. Vaikuttavuuteen pyritään systemaattisella eri organisaation tasoilla tehtävillä toiminnan kuvauksilla, mihin liittyy laatupalkinnon hakeminen. Vaikuttavuuteen voidaan myös päästä työpistelähtöisesti henkilöstön johtamisen ja hallinnon kautta. Vaiheistettua organisaation itsearviointia voidaan käyttää osana tulosjohtamista. Muita keskeisiä tutkimustuloksia ovat organisaation itsearvioinnin välittömät ja välilliset vaikutukset. Tutkimuksen tulosten perusteella teen suositukset organisaation itsearvioinnin johtamiskäytännöistä ja organisaation itsearvioinnin vaiheistuksesta osana tulosyksikön tulosjohtamista. Kolmas suositus käsittää organisaation itsearvioinnin käytön palautejärjestelmänä.

Evaluation of markets for irrigation water in the internal river basins of Catalonia, Spain

Irrigated agriculture has come under close scrutiny in Europe recently because of its high share of total water consumption and its apparent inefficiency. Several water policies have been advocated, in particular the use of economic instruments such as water markets. This paper simulates the impact of a policy based upon water markets on agricultural production in the internal river basins of Catalonia (Spain). This zone presents certain particularities that make it very interesting to study: competition between sectors for the resource (agriculture-urban consumption-recreational uses), recent periods of resource insufficiency and conflicts between irrigators as a result of the measures taken by the hydraulic administration in drought situations. The results show that these markets would guarantee an optimal reassignment of the resource in situations of supply restrictions, and although compared to the situation without markets they would not mean higher economic profits for the irrigators, they could prevent conflicts between them. Nevertheless, doubts exist about their acceptance by irrigators

A study of electromagnetic shielding properties of Ni79Fe16Mo5/copper films

The plane wave electromagnetic interference (EMI) shielding properties of DC sputtered Ni79Fe16Mo5 and copper layers were studied according to ASTM D 4935-89 on frequency range of 50 MHz – 2.5 GHz and RF magnetic shielding effectiveness by shielded magnetic loop probes. Results show that Ni79Fe16Mo5 provides better RF magnetic shielding above the layer thickness of approximately 120 nm. Copper provides better plane wave shielding effectiveness. The effect of shield internal interfaces was studied by depositing thin multilayer structures with and without a dielectric spacer layer.

Improvement of Operational Efficiency effectiveness (OEE) using Six Sigma DMAIC Methodology — Case Bottomer line AD2378

Overall Equipment Effectiveness (OEE) is the key metric of operational excellence. OEE monitors the actual performance of equipment relative to its performance capabilities under optimal manufacturing conditions. It looks at the entire manufacturing environment measuring, in addition to the equipment availability, the production efficiency while the equipment is available to run products, as well as the efficiency loss that results from scrap, rework, and yield losses. The analysis of the OEE provides improvement opportunities for the operation. One of the tools used for OEE improvement is Six Sigma DMAIC methodology which is a set of practices originally developed to improve processes by eliminating defects. It asserts the continuous efforts to reduce variation in process outputs as key to business success, as well as the possibility of measurement, analysis, improvement and control of manufacturing and business processes. In the case of the Bottomer line AD2378 in Papsac Maghreb Casablanca plant, the OEE figures reached 48.65 %, which is below the accepted OEE group performance. This required immediate actions to achieve OEE improvement. This Master thesis focuses on the application of Six Sigma DMAIC methodology in the OEE improvement on the Bottomer Line AD2378 in Papsac Maghreb Casablanca plant. First, the Six Sigma DMAIC and OEE usage in operation measurement will be discussed. Afterwards, the different DMAIC phases will allow the identification of improvement focus, the identification of OEE low performance causes and the design of improvement solutions. These will be implemented to allow further tracking of improvement impact on the plant operations.

Extended Endoscopic Endonasal Approaches for Cerebral Aneurysms: Anatomical, Virtual Reality and Morphometric Study

Introduction. The purpose of the present contribution is to perform a detailed anatomic and virtual reality three-dimensional stereoscopic study in order to test the effectiveness of the extended endoscopic endonasal approaches for selected anterior and posterior circulation aneurysms. Methods. The study was divided in two main steps: (1) simulation step, using a dedicated Virtual Reality System (Dextroscope, Volume Interactions); (2) dissection step, in which the feasibility to reach specific vascular territory via the nose was verified in the anatomical laboratory. Results. Good visualization and proximal and distal vascular control of the main midline anterior and posterior circulation territory were achieved during the simulation step as well as in the dissection step (anterior communicating complex, internal carotid, ophthalmic, superior hypophyseal, posterior cerebral and posterior communicating, basilar, superior cerebellar, anterior inferior cerebellar, vertebral, and posterior inferior cerebellar arteries). Conclusion. The present contribution is intended as strictly anatomic study in which we highlighted some specific anterior and posterior circulation aneurysms that can be reached via the nose. For clinical applications of these approaches, some relevant complications, mainly related to the endonasal route, such as proximal and distal vascular control, major arterial bleeding, postoperative cerebrospinal fluid leak, and olfactory disturbances must be considered

Les vaccins contre le zona : efficacité, sécurité, et rapport coût/bénéfices [Vaccines against Herpes zoster: Effectiveness, safety, and cost/benefit ratio].

CONTEXT: A vaccination against herpes zoster and its complication is available in France since June 2015. Its exact benefit for public health is still controversial and its level of protection is not optimal. All those reasons seem to suggest a low acceptation rate from general practitioners. OBJECTIVE: To evaluate the effectiveness, the safety, and the cost/benefit ratio of the vaccination against herpes zoster in people aged 50 year or over. DOCUMENTARY SOURCE: Systematic review in Medline and PubMed with research by key words: "herpes zoster vaccine", "zoster vaccine" and "post herpetic neuralgia vaccine". SELECTION OF STUDIES: Randomized and observational studies published in English and French language have been selected by two readers. RESULTS: On 1886 articles identified, 62 studies were included in this systematic review of which 21 randomized trials, 21 observational studies, and 17 medico-economic studies concerned the unadjuvanted vaccine. Considered studies showed an effectiveness of 50% against herpes zoster and 60% on post-herpetic neuralgia incidence of the unadjuvanted vaccine. Five randomized controlled studies were identified for the adjuvanted vaccine. The overall effectiveness of this vaccine was > 90% whatever the age of subjects including those over age 70 and 80. The medico-economic studies conducted in many countries have shown that vaccine policies were beneficial in individuals aged 60 years or over. LIMITATION OF THE WORK: Most of data of effectiveness, and tolerance result from 2 large controlled studies only (SPS and ZEST) for the unadjuvanted vaccine and only one for the adjuvanted vaccine. CONCLUSION: Despite controversy and few uncertainties, the vaccine significantly reduces herpes zoster and its complication incidence. In terms of public health objectives, it reduces the burden of the disease and has a positive medico-economic impact. Preliminary data concerning the adjuvanted vaccine, whilst very promising, are still too limited. Up to now, no group of people with particularly high risk of herpes zoster-related complication who will beneficiate the most of the vaccination has been identified yet and only an age criteria has been considered for the recommendation.

Facilitating coordination improvement efforts in cross-functional process development programs

Business process improvement is a common approach in increasing the effectiveness of an organization. It can be seen as an effort to increase coordination between units. Process improvement has proved to be challenging, and most management consultation firms facilitate organizations in this kind of initiatives. Cross-functional improvement is one of the main areas for internal consultants as well. However, the needs, challenges and means of cross-functional help have been rarely discussed in the literature. The objective of this thesis is on one hand to present a conceptual and descriptive framework to help understand the challenges of facilitating coordination improvement efforts in cross-functional improvement programs, and on the other hand to develop and test feasible solutions for some facilitation situations. The research questions are: 1. Why and in what kind of situations do organizations need help in developing coordination in cross-functional processes? 2. How can a facilitator help organizations in improving coordination to develop cross-functional processes? The study consists of two parts. The first part is an overview of the dissertation, and the second part comprises six research publications. The theoretical background for the study are the differentiation causing challenges in cross-functional settings, the coordination needed to improve processes, change management principles, methods and tools, and consultation practises. Three of the publications introduce tools for helping in developing prerequisites, planning responsibilities and supporting learning during the cross-functional program. The three other papers present frameworks to help understand and analyse the improvement situation. The main methodological approaches used in this study are design science research, action research and case research. The research data has been collected from ten cases representing different kinds of organizations, processes and developing situations. The data has been collected mainly by observation, semi-structured interviews and questionnaires. The research contributes to the rare literature combining coordination theories and process improvement practises. It also provides additional understanding of a holistic point of view in process improvement situations. The most important contribution is the addition to the theories of facilitating change in process improvement situations. From the managerial point of view, this study gives advice to managers and consultants in planning and executing cross-functional programs. The main factors increasing the need for facilitation are the challenges for differentiation, challenges of organizational change in general, and the novelty of initiatives and improvement practices concerning process development. Organizations need help in creating the prerequisites to change, in planning initiatives, easing conflict management and collaboration between groups, as well as supporting the learning of cross-functional improvement. The main challenges of facilitation are combining the different roles as a consultant, maintaining the ownership for the improvement project with the client, and supporting learning in the client organization.

L'informatique: un outil remarquable pour l'enseignement de la médecine interne générale [The informatics: a remarkable tool for teaching general internal medicine].

INTERMED training implies a three week course, integrated in the "primary care module" for medical students in the first master year at the school of medicine in Lausanne. INTERMED uses an innovative teaching method based on repetitive sequences of e-learning-based individual learning followed by collaborative learning activities in teams, named Team-based learning (TBL). The e-learning takes place in a web-based virtual learning environment using a series of interactive multimedia virtual patients. By using INTERMED students go through a complete medical encounter applying clinical reasoning and choosing the diagnostic and therapeutic approach. INTERMED offers an authentic experience in an engaging and safe environment where errors are allowed and without consequences.

Dix ans de revue de la littérature en médecine interne générale--un premier bilan [Ten years of literature review in general internal medicine--a first assessment].

A group of family physicians in an outpatient clinic in Switzerland prospectively followed scientific literature for ten years. What to remember among the numerous articles retrieved and which paper really changed our practice? If many readings are quickly forgotten, some of them marked our minds and changed our habits. This article is a summary of our efforts to keep the essential tools in clinical practice.

Customer-Related Internal Communication in a Global Matrix Organization

The objective of the thesis was to explore the nature and characteristics of customer-related internal communication in a global industrial matrix organization during a specific customer relationship, and how it could be improved. The theoretical part of the study views the field of the concepts of intra-organizational information and knowledge sharing. The theoretical part also views the internal communications influences to customer relationships, its problematic, and the suggestions to improve internal communication in literature. The empirical part of the study was conducted with the Content Analysis and the Social Network Analysis as research methods. The data was collected by interviews and a questionnaire. Internal communication was observed first generally within the organization from the point of view of a certain business, and secondly, during a specific customer relationship at personal level and at departmental level. The results of the study describe the nature and characteristics of internal communication in the organization. The results give 13 suggestions for improving internal communication in the organization. Although the study has been done in one specific organization, it also offers insights for other organizations as well as managers to improve their internal communication.

Déclaration et traitement des événements indésirables en médecine interne [Incident-reporting electronic-based system in internal medicine].

How to recognize, announce and analyze incidents in internal medicine units is a daily challenge that is taught to all hospital staff. It allows suggesting useful improvements for patients, as well as for the medical department and the institution. Here is presented the assessment made in the CHUV internal medicine department one year after the beginning of the institutional procedure which promotes an open process regarding communication and risk management. The department of internal medicine underlines the importance of feedback to the reporters, ensures the staff of regular follow-up concerning the measures being taken and offers to external reporters such as general practioners the possibility of using this reporting system too.

L'année 2014 mise en perspective par les internistes hospitaliers [What is new in 2014 for the specialist in hospital internal medicine? The point of view of university hospital chief residents].

The year 2014 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice and on the way we manage one problem or another. From the use of the ultrasound for the diagnosis of pneumonia to the choice of the site of venous access and the type of line, and the increasing complexity of choosing an oral anticoagulant agent, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.

Predicting the future effectiveness of protected areas for bird conservation in Mediterranean ecosystems under climate change and novel fire regime scenarios

AimGlobal environmental changes challenge traditional conservation approaches based on the selection of static protected areas due to their limited ability to deal with the dynamic nature of driving forces relevant to biodiversity. The Natura 2000 network (N2000) constitutes a major milestone in biodiversity conservation in Europe, but the degree to which this static network will be able to reach its long-term conservation objectives raises concern. We assessed the changes in the effectiveness of N2000 in a Mediterranean ecosystem between 2000 and 2050 under different combinations of climate and land cover change scenarios. LocationCatalonia, Spain. MethodsPotential distribution changes of several terrestrial bird species of conservation interest included in the European Union's Birds Directive were predicted within an ensemble-forecasting framework that hierarchically integrated climate change and land cover change scenarios. Land cover changes were simulated using a spatially explicit fire-succession model that integrates fire management strategies and vegetation encroachment after the abandonment of cultivated areas as the main drivers of landscape dynamics in Mediterranean ecosystems. ResultsOur results suggest that the amount of suitable habitats for the target species will strongly decrease both inside and outside N2000. However, the effectiveness of N2000 is expected to increase in the next decades because the amount of suitable habitats is predicted to decrease less inside than outside this network. Main conclusionsSuch predictions shed light on the key role that the current N2000may play in the near future and emphasize the need for an integrative conservation perspective wherein agricultural, forest and fire management policies should be considered to effectively preserve key habitats for threatened birds in fire-prone, highly dynamic Mediterranean ecosystems. Results also show the importance of considering landscape dynamics and the synergies between different driving forces when assessing the long-term effectiveness of protected areas for biodiversity conservation.