Deviations of Governance In IT Multi-Sourcing: A Case Study

IT outsourcing (ITO) refers to the shift of IT/IS activities from internal to external of an organization. In prior research, the governance of ITO is recognized with persistent strategic importance for practice, because it is tightly related to ITO success. Under the rapid transformation of global market, the evolving practice of ITO requires updated knowledge on effective governance. However, research on ITO governance is still under developed due to the lack of integrated theoretical frameworks and the variety of empirical settings besides dyadic client-vendor relationships. Especially, as multi-sourcing has become an increasingly common practice in ITO, its new governance challenges must be attended by both ITO researchers and practitioners. To address this research gap, this study aims to understand multi-sourcing governance with an integrated theoretical framework incorporating both governance structure and governance mechanisms. The focus is on the emerging deviations among formal, perceived and practiced governance. With an interpretive perspective, a single case study is conducted with mixed methods of Social Network Analysis (SNA) and qualitative inquiries. The empirical setting embraces one client firm and its two IT suppliers for IT infrastructure services. The empirical material is analyzed at three levels: within one supplier firm, between the client and one supplier, and among all three firms. Empirical evidences, at all levels, illustrate various deviations in governance mechanisms, with which emerging governance structures are shaped. This dissertation contributes to the understanding of ITO governance in three domains: the governance of ITO in general, the governance of multi-sourcing in particular, and research methodology. For ITO governance in general, this study has identified two research strands of governance structure and governance mechanisms, and integrated both concepts under a unified framework. The composition of four research papers contributes to multi-sourcing research by illustrating the benefits of zooming in and out across the multilateral relationships with different aspects and scopes. Methodologically, the viability and benefit of mixed-method is illustrated and confirmed for both researchers and practitioners.

Improvement of Energy Efficiency in a Gold Mining Industry: Case Study of a Russian Gold Mining Company

The issue of energy efficiency is attracting more and more attention of academia, business and policy makers worldwide due to increasing environmental concerns, depletion of non-renewable energy resources and unstable energy prices. The significant importance of energy efficiency within gold mining industry is justified by considerable energy intensity of this industry as well as by the high share of energy costs in the total operational costs. In the context of increasing industrial energy consumption energy efficiency improvement may provide significant energy savings and reduction of CO2 emission that is highly important in order to contribute to the global goal of sustainability. The purpose of this research is to identify the ways of energy efficiency improvement relevant for a gold mining company. The study implements single holistic case study research strategy focused on a Russian gold mining company. The research involves comprehensive analysis of company’s energy performance including analysis of energy efficiency and energy management practices. This study provides following theoretical and managerial contributions. Firstly, it proposes a methodology for comparative analysis of energy performance of Russian and foreign gold mining companies. Secondly, this study provides comprehensive analysis of main energy efficiency challenges relevant for a Russian gold mining company. Finally, in order to overcome identified challenges this research conceives a guidance for a gold mining company for implementation of energy management system based on the ISO standard.

Structuring of internal control – a case study

The aim of this Master’s thesis is to find out how should internal control be structured in a Finnish retail company in order to fulfil the requirements set out in the Finnish Corporate Governance Code and to be value adding for the company as well as to analyse the added value that a structured and centrally led internal control can provide for the case company. The underlying fundamental theoretical framework of the study essentially stems from the theory of the firm; the agent-principal problem is the primary motivator for internal control. Regulatory requirements determine the thresholds that the internal control of a company must reach. The research was carried out as a case study and methodically the study is qualitative and the empirical data gathering was conducted by interviews and by participant observation. The data gathered (processes, controls etc.) is used to understand the control environment of the company and to assess the current state of internal control. Deficiencies and other points of development identified are then discussed.

Internal communication during an organizational change: An ethnographic case study

This study discusses the importance of internal communication during organizational change of a case study company X. The purpose of this study is to find out how to use internal communication effectively during organizational change. This study is an ethnographic cade study where a unique case of an organizational change was chosen as the research object. The theoretical background of this study consists of literature relating to the concepts of communication, organizational communication, organizational change, change management and communication of change. The empirical research conducted for this study is based on an ethnographic research method where data was collected through participant observation, informal interviews and field records in the form of a research diary. The research data was collected between September and December 2015. During this period the researcher was working within the case study organization while observing the internal communication during the organizational change process. Triangulation was used to analyze the research data in order to build a united and theoretical picture of the topic. The study finds that without clear internal communication strategy the effectiveness of communication is ought to be poor, which may lead to resistance of change, lack of trust and lower level of overall job satisfaction. Moreover the study findings highlight the importance of managerial presence during an organizational change process and consistency in using formal and informal communication and utilizing multiple communication channels. Based on the findings of this research the study suggests that during an organizational change process a clear internal communication strategy should be carefully planned and executed. The goals of internal communication should be clearly stated and communicated to the company’s employees. The findings of this study enhance importance of managers promoting sense of belonging, developing awareness of the overall change process and contributing to the manager employee relationships and trust. In addition this study points out the key factors that should be included in the internal change communication strategy which are how to ensure that the communications, both vertical and horizontal, are constant. Future research is however necessary in order to gain a more comprehensive view of the research and wider perspective of the case study. Nevertheless, this study deepens the understanding of how to use internal communication effectively during organizational change.

Variational Monte Carlo study of core-valence separation schemes for first-row atoms and positive ions /

All-electron partitioning of wave functions into products ^core^vai of core and valence parts in orbital space results in the loss of core-valence antisymmetry, uncorrelation of motion of core and valence electrons, and core-valence overlap. These effects are studied with the variational Monte Carlo method using appropriately designed wave functions for the first-row atoms and positive ions. It is shown that the loss of antisymmetry with respect to interchange of core and valence electrons is a dominant effect which increases rapidly through the row, while the effect of core-valence uncorrelation is generally smaller. Orthogonality of the core and valence parts partially substitutes the exclusion principle and is absolutely necessary for meaningful calculations with partitioned wave functions. Core-valence overlap may lead to nonsensical values of the total energy. It has been found that even relatively crude core-valence partitioned wave functions generally can estimate ionization potentials with better accuracy than that of the traditional, non-partitioned ones, provided that they achieve maximum separation (independence) of core and valence shells accompanied by high internal flexibility of ^core and Wvai- Our best core-valence partitioned wave function of that kind estimates the IP's with an accuracy comparable to the most accurate theoretical determinations in the literature.

Gaining a better understanding of how Outward Bound Western Canada course outcomes are achieved : a research study /

This study examined how Outward Bound Western Canada (OBWC) course outcomes are achieved by exploring the relationships among course components, students' characteristics, and course outcomes. OBWC is a wilderness-based adventure education organization that helps students achieve outcomes such as increased self-awareness, self-confidence, motivation, interpersonal skills, concern for others, and concern for the environment. This study explored the ways in which the various components of courses and the characteristics of students contribute to determining the outcomes students experience as a result of their courses. The purpose of the study was to gain a better understanding of how OBWC course outcomes are achieved in order to strengthen adventure education theory, enhance practice at OBWC and other adventure education organizations, and provide a foundation for further research on this topic. As an interpretive case study, this study sought to describe how OBWC course outcomes are achieved and to provide interpretations of the research findings. Data was gathered from OBWC students and instructors using the quantitative and qualitative data collection techniques of questionnaire, interview, and observation. Data collected from 98 participants ensured a considerable breadth to the study, while interviews with a number of participants also enabled the collection of in-depth data. Analysis and triangulation of the data from the various sources allowed discernment of the research findings. A comprehensive and detailed picture of how course outcomes are achieved emerged from the findings. Twenty-nine course components were found to influence course outcomes, including various aspects of course activities, the physical environment, instructors, and the group. The findings indicated that certain course components were most influential in determining increases to students' self-awareness, self-confidence, self-reliance, self-esteem, self-concept, motivation, self-responsibility, interpersonal skills, concern for others, and concern for the environment. A number of course components were found to indirectly contribute to positive course outcomes by helping maximize the effectiveness of other components, by increasing students' motivation while on course, or by facilitating the processing and transference of new information. The findings also suggested that several course components either directly or indirectly affected course outcomes in negative ways. In addition, the gender, age, population, and expectations of students were found to play a role in determining the course outcomes they experienced and in determining which course components caused those outcomes. Interpretation of the findings resulted in the generation of research-based theory. The main theoretical argument derived from the results of the study was that course outcomes are influenced by a combination of course components and characteristics of students. More specifically, the theory generated by the study indicated that five groupings of factors contribute to course outcomes, including course activities, the physical environment, instructors, the group, and students' characteristics. The study was considered in relation to existing adventure education literature and larger theoretical issues. The generated theory and research findings were then used to develop suggestions for improving practice at OBWC and other adventure education organizations, as well as for enhancing future research studies.

Drumming toward communitas : a case study of facilitated recreational music making and the Arthurian method

The phenomenon of communitas has been described as a moment 'in and out of time' in which a collective of individuals may be experienced by one as equal and individuated in an environment stripped of structural attributes (Turner, 1 969). In these moments, emotional bonds form and an experience of perceived 'oneness' and synergy may be described. As a result of the perceived value of these experiences, it has been suggested by Sharpe (2005) that more clearly understanding how this phenomenon may be purposefully facilitated would be beneficial for leisure service providers. Consequently, the purpose of this research endeavor was to examine the ways in which a particular leisure service provider systematically employs specific methods and sets specific parameters with the intention of guiding participants toward experiences associated with communitas or "shared spirit" as described by the organization. A qualitative case study taking a phenomenological approach was employed in order to capture the depth and complexity of both the phenomenon and the purposefiil negotiation of experiences in guiding participants toward this phenomenon. The means through which these experiences were intentionally facilitated was recreational music making in a group drumming context. As such, an organization which employs specific methods of rhythm circle facilitation as well as trains other facilitators all over the world was chosen purposely for their recognition as the most respectable and credible in this field. The specific facilitator was chosen based on high recommendation by the organization due to her level of experience and expertise. Two rhythm circles were held, and participants were chosen randomly by the facilitator. Data was collected through observation in the first circle and participant- observation in the second, as well as through focus groups with circle participants. Interviews with the facilitator were held both initially to gain broad understanding of concepts and phenomenon as well as after each circle to reflect on each circle specifically. Data was read repeatedly to drawn out patterns which emerged and were coded and organized accordingly. It was found that this specific process or system of implementation lead to experiences associated with communitas by participants. In order to more clearly understand this process and the ways in which experiences associated with communitas manifest as a result of deliberate facilitator actions, these objective facilitator actions were plotted along a continuum relating to subjective participant experiences. These findings were then linked to the literature with regards to specific characteristics of communitas. In so doing, the intentional manifestation of these experiences may be more clearly understood for ftiture facilitators in many contexts. Beyond this, findings summarized important considerations with regards to specific technical and communication competencies which were found to be essential to fostering these experiences for participants within each group. Findings surrounding the maintenance of a fluid negotiation of certain transition points within a group rhythm event overall were also highlighted, and this fluidity was found to be essential to the experience of absorption and engagement in the activity and experience. Emergent themes of structure, control, and consciousness have been presented as they manifested and were found to affect experiences within this study. Discussions surrounding the ethics and authenticity of these particular methods and their implementation has also been generated throughout. In conclusion, there was a breadth as well as depth of knowledge found in unpacking this complex process of guiding individuals toward experiences associated with communitas. The implications of these findings contribute in broadening the current theoretical as well as practical understanding as to how certain intentional parameters may be set and methods employed which may lead to experiences of communitas, and as well contribute a greater knowledge to conceptualizing the manifestation of these experiences when broken down.

Forsaking all others: towards a new model of nationalism utilizing the case study of former Yugoslavia

Many people would like to believe that nationalism is a thing of the past, a dinosaur belonging to some bygone, uncivilized era. Such a belief is not borne out by recent history, however. Nationalism occupies the political forum with as much force as ever. Yet, in many ways, it remains a mystery to us. The purpose of this study is to explore individual motivations involved in the rise of nationalism, in addition to the role of structural factors. The linkage employed in this exploration is the psychosocial phenomenon of self-identity, including emotions and self-esteem. We demonstrate how individual, socially-constructed self-identity accounts for why some people embrace nationalism while others eschew it. The methodology employed was theoretical and historical analyses of secondary sources and indepth interviews with subjects who had some connection with former Yugoslavia, the country utilized to test the new model. Our analyses yielded the result that current conceptualizations of nationalism from an exclusively macro or micro perspective are unsatisfactory; we require a more comprehensive approach wherein the two perspectives are integrated. Such an integration necessitates a bridge: hence, our new model, which rests on the psychosocial premise, offers a more useful conceptual tool for the understanding of nationalism. We conclude that nationalism is first and foremost a matter relating to individual social self-identity which takes place within a particular context where oppositional forces emerge from structural factors and our membership in a particular group becomes paramount.

A microanalysis of EMG and EEG changes during the sleep onset period (SOP) : a theoretical investigation with practical applications /

The present study has both theoretical and practical aspects. The theoretical intent of the study was to closely examine the relationship between muscle activity (EMG) and EEG state during the process of falling asleep. Sleep stages during sleep onset (SO) have been generally defined with regards to brain wave activity (Recht schaff en & Kales (1968); and more precisely by Hori, Hayashi, & Morikawa (1994)). However, no previous study has attempted to quantify the changes in muscle activity during this same process. The practical aspect of the study examined the reliability ofa commercially developed wrist-worn alerting device (NovAlert™) that utilizes changes in muscle activity/tension in order to alert its user in the event that he/she experiences reduced wakefulness that may result in dangerous consequences. Twelve female participants (aged 18-42) sp-ent three consecutive nights in the sleep lab ("Adaptation", "EMG", and "NOVA" nights). Each night participants were given 5, twenty-minute nap opportunities. On the EMG night, participants were allowed to fall asleep freely. On the NOV A night, participants wore the Nov Alert™ wrist device that administered a Psychomotor Vigilance Test (PVT) when it detected that muscle activity levels had dropped below baseline. Nap sessions were scored using Hori's 9-stage scoring system (Hori et aI, 1994). Power spectral analyses (FFT) were also performed. Effects ofthe PVT administration on EMG and EEG frequencies were also examined. Both chin and wrist EMG activity showed reliable and significant decline during the early stages ofHori staging (stages HO to H3 characterized by decreases in alpha activity). All frequency bands studied went through significant changes as the participants progressed through each ofHori's 9 SO stages. Delta, theta, and sigma activity increased later in the SO continuum while a clear alpha dominance shift was noted as alpha activity shifted from the posterior regions of the brain (during Hori stages HO to H3) to the anterior portions (during Hori stages H7 to H9). Administration of the PVT produced significant increases in EMG activity and was effective in reversing subjective drowsiness experienced during the later stages of sleep onset. Limitations of the alerting effects of the PVTs were evident following 60 to 75 minutes of use in that PVTs delivered afterwards were no longer able to significantly increase EMG levels. The present study provides a clearer picture of the changes in EMG and EEG during the sleep onset period while testing the efficacy of a commercially developed alerting device. EMG decreases were found to begin during Hori stage 0 when EEG was - dominated by alpha wave activity and were maximal as Hori stages 2 to 5 were traversed (coincident with alpha and beta activity). This signifies that EMG decrements and the loss of resting alpha activity are closely related. Since decreased alpha has long been associated with drowsiness and impending sleep, this investigation links drops in muscle tone with sleepiness more directly than in previous investigations. The EMG changes were reliably demonstrated across participants and the NovAlert™ detected the EMG decrements when Hori stage 3 was entered. The alerting vibrations produced by the NovAlert™ occurred early enough in the SO process to be of practical importance as a sleepiness monitoring and alerting device.

Exploratory study : exploring the effectiveness of a literacy-based intervention with children with language impairments

Research points clearly to the need for all concerned stakeholders to adopt a preventative approach while intervening with children who are at-risk for future reading disabilities. Research has indicated also that a particular sub-group of children at-risk for reading impairments include preschool children with language impairments (Catts, 1993). Preschool children with language impairments may have difficulties with emergent literacy skills - important prerequisite skills necessary for successful formal reading. Only in the past decade have researchers begun to study the effects of emergent literacy intervention on preschool children with language impairments. As such, the current study continues this investigation of how to effectively implement an emergent literacy therapy aimed at supporting preschool children with language impairments. In addition to this, the current study explores emergent literacy intervention within an applied clinical setting. The setting, presents a host of methodological and theoretical challenges - challenges that will advance the field of understanding children within naturalistic settings. This exploratory study included thirty-eight participants who were recruited from Speech Services Niagara, a local preschool speech and language program. Using a between-group pre- and posttest design, this study compared two intervention approaches - an experimental emergent literacy intervention and a traditional language intervention. The experimental intervention was adopted from Read It Again! (Justice, McGinty, Beckman, & Kilday, 2006) and the traditional language intervention was based on the traditional models of language therapy typically used in preschool speech and language models across Ontario. 5 Results indicated that the emergent literacy intervention was superior to the ,t..3>~, ~\., ;./h traditional language therapy in improving the children's alphabet knowledge, print and word awareness and phonological awareness. Moreover, results revealed that children with more severe language impairments require greater support and more explicit instruction than children with moderate language impairments. Another important finding indicated that the effects of the preschool emergent literacy intervention used in this study may not be sustainable as children enter grade one. The implications of this study point to the need to support preschool children with language impairments with intensive emergent literacy intervention that extends beyond preschool into formal educational settings.

Manufacturing 'authenticity' : a case study of the Niagara wine cluster

In this thesis, I use "Fabricating Authenticity," a model developed in the Production of Culture Perspective, to explore the evolving criteria for judging what constitute "real" and authentic Niagara wines, along with the naturalization of these criteria, as the Canadian Niagara wine cluster has come under increasing stress from globalization. Authenticity has been identified as a hallmark of contemporary marketing and important to cultural industries, which can use it for creating meaningful differentiation; making it a renewable resource for securing consumers, increasing market value; and for relationships with key brokers. This is important as free trade and international treaties are making traditional protective barriers, like trade tariffs and markups, obsolete and as governments increasingly allocate industry support via promotion and marketing policies that are directly linked to objectives of city and regional development, which in turn carry real implications for what gets to be judged authentic and inauthentic local culture. This research uses a mixed methods research strategy, drawing upon ethnographic observation, marketing materials, newspaper reports, and secondary data to provide insight into the processes and conflicts over efforts to fabricate authenticity, comparing the periods before and after the passage of NAFT A to the present period. The Niagara wine cluster is a good case in point because it has little natural advantage nor was there a tradition of quality table wine making to facilitate the naturalization of authenticity. Geographic industrial clusters have been found particularly competitive in the global economy and the exploratory case study contributes to our understanding of the dynamic of '1abricating authenticity," building on various theoretical propositions to attempt to derive explanations of how global processes affect strategies to create "authenticity," how these strategies affect cultural homogeneity and heterogeneity at the local level, and how the concept of "cluster" contributes to the process of managing authenticity.

The von Neumann Minimax Theorem and its relatives and a study of externality in on-line auctions

This work consists of a theoretical part and an experimental one. The first part provides a simple treatment of the celebrated von Neumann minimax theorem as formulated by Nikaid6 and Sion. It also discusses its relationships with fundamental theorems of convex analysis. The second part is about externality in sponsored search auctions. It shows that in these auctions, advertisers have externality effects on each other which influence their bidding behavior. It proposes Hal R.Varian model and shows how adding externality to this model will affect its properties. In order to have a better understanding of the interaction among advertisers in on-line auctions, it studies the structure of the Google advertisements networ.k and shows that it is a small-world scale-free network.

The Effects of Body Posture on Emotion Perception: A Developmental and Theoretical Analysis

Previously, studies investigating emotional face perception - regardless of whether they involved adults or children - presented participants with static photos of faces in isolation. In the natural world, faces are rarely encountered in isolation. In the few studies that have presented faces in context, the perception of emotional facial expressions is altered when paired with an incongruent context. For both adults and 8- year-old children, reaction times increase and accuracy decreases when facial expressions are presented in an incongruent context depicting a similar emotion (e.g., sad face on a fear body) compared to when presented in a congruent context (e.g., sad face on a sad body; Meeren, van Heijnsbergen, & de Gelder, 2005; Mondloch, 2012). This effect is called a congruency effect and does not exist for dissimilar emotions (e.g., happy and sad; Mondloch, 2012). Two models characterize similarity between emotional expressions differently; the emotional seed model bases similarity on physical features, whereas the dimensional model bases similarity on underlying dimensions of valence an . arousal. Study 1 investigated the emergence of an adult-like pattern of congruency effects in pre-school aged children. Using a child-friendly sorting task, we identified the youngest age at which children could accurately sort isolated facial expressions and body postures and then measured whether an incongruent context disrupted the perception of emotional facial expressions. Six-year-old children showed congruency effects for sad/fear but 4-year-old children did not for sad/happy. This pattern of congruency effects is consistent with both models and indicates that an adult-like pattern exists at the youngest age children can reliably sort emotional expressions in isolation. In Study 2, we compared the two models to determine their predictive abilities. The two models make different predictions about the size of congruency effects for three emotions: sad, anger, and fear. The emotional seed model predicts larger congruency effects when sad is paired with either anger or fear compared to when anger and fear are paired with each other. The dimensional model predicts larger congruency effects when anger and fear are paired together compared to when either is paired with sad. In both a speeded and unspeeded task the results failed to support either model, but the pattern of results indicated fearful bodies have a special effect. Fearful bodies reduced accuracy, increased reaction times more than any other posture, and shifted the pattern of errors. To determine whether the results were specific to bodies, we ran the reverse task to determine if faces could disrupt the perception of body postures. This experiment did not produce congruency effects, meaning faces do not influence the perception of body postures. In the final experiment, participants performed a flanker task to determine whether the effect of fearful bodies was specific to faces or whether fearful bodies would also produce a larger effect in an unrelated task in which faces were absent. Reaction times did not differ across trials, meaning fearful bodies' large effect is specific to situations with faces. Collectively, these studies provide novel insights, both developmentally and theoretically, into how emotional faces are perceived in context.

Part Time University Teaching in Ontario: A Self-Study

This qualitative self-study explored the disappointment I felt as a part-time university teacher in a mid-sized, primarily undergraduate Ontario university, where I experienced difficulty integrating my beliefs about teaching into my practice of teaching. The purpose of this qualitative study was to inquire into why it was difficult for me, representative of a part-time university teacher in a mid-sized, primarily undergraduate university, to enact the critical pedagogical practices I espoused in my teaching philosophy. The secondary purpose was to apply the findings of the study to reframe my university teaching practice in a way that met my need to enact my beliefs about university teaching while complying with the broader geo-political conditions of part-time university teaching in Ontario (Loughran, 2006; Russell & Loughran, 2007). This study is grounded in the sociological theoretical framework of critical pedagogy (Freire, 1970; Giroux, 1988, 2010; McLaren, 2003) and the methodological framework of The Self-Study of Teacher Education Practices (S-STEP). This study combined the methods of Brookfield’s (1995; 2002) critically reflective practice and Cole and Knowles (2000) practice of reflexive inquiry with Creswell’s (2005) methods of thematic analysis to answer the research question: Why is it difficult for me to enact my beliefs about university teaching as a part-time teacher in an Ontario university? Findings suggest the geo-political contexts of part-time university teaching work can impact a teacher’s ability to enact his/her beliefs about teaching within his/her practice of teaching.

A Narrative Study of Patient Encounter Accounts of Physicians, Nurses, and Medical Receptionists after Two Decades of a Paradigm of Patient-Centered Care

Despite recent well-known advancements in patient care in the medical fields, such as patient-centeredness and evidence-based medicine and practice, there is rather less known about their effects on the particulars of clinician-patient encounters. The emphasis in clinical encounters remains mostly on treatment and diagnosis and less on communicative competency or engagement for medical professionals. The purpose of this narrative study was to explore interactive competencies in diagnostic and therapeutic encounters and intake protocols within the context of the physicians’, nurses’, and medical receptionists’ perspectives and experiences. Literature on narrative medicine, phenomenology and medicine, therapeutic relationships, cultural and communication competency, and non-Western perspectives on human communication provided the guiding theoretical frameworks for the study. Three data sets including 13 participant interviews (5 physicians, 4 nurses, and 4 medical receptionists), policy documents (physicians, nurses, and medical receptionists) and a website (Communication and Cultural Competency) were used. The researcher then engaged in triangulated analyses, including N-Vivo, manifest and latent, Mishler’s (1984, 1995) narrative elements and Charon’s (2005, 2006a, 2006b, 2013) narrative themes, in recursive, overlapping, comparative and intersected analysis strategies. A common factor affecting physicians’ relationships with their clients was limitation of time, including limited time (a) to listen, (b) to come up with a proper diagnosis, and (c) to engage in decision making in critical conditions and limited time for patients’ visits. For almost all nurse participants in the study establishing therapeutic relationships meant being compassionate and empathetic. The goals of intake protocols for the medical receptionists were about being empathetic to patients, being an attentive listener, developing rapport, and being conventionally polite to patients. Participants with the least iv amount of training and preparation (medical receptionists) appeared to be more committed to working narratively in connecting with patients and establishing human relationships as well as in listening to patients’ stories and providing support to narrow down the reason for their visit. The diagnostic and intake “success stories” regarding patient clinical encounters for other study participants were focused on a timely securing of patient information, with some acknowledgement of rapport and emapathy. Patient-centeredness emerged as a discourse practice, with ambiguous or nebulous enactment of its premises in most clinical settings.