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.

La délégation d'activités étatiques au secteur privé

L'État s'appuie aujourd'hui sur le secteur privé pour déployer les nombreuses activités qui sont les siennes et cela suivant de multiples formules : en tant que client ou partenaire, dans le cadre de collaborations ou au sein de structures communes (sociétés d'économie mixte), voire dans le modèle de la privatisation. La 18e Journée de droit administratif, organisée à Lausanne le 10 février 2015, a ainsi choisi pour thème une modalité particulière de cette collaboration, fréquente aujourd'hui, celle de la délégation d'activités étatiques au secteur privé. Elle implique un transfert - partiel - de responsabilité de l'État au bénéficiaire de la délégation, pour un ensemble d'activités déterminées ; tel est le cas par exemple de celles accomplies par une caisse maladie dans le domaine de l'assurance-maladie sociale, une association interprofessionnelle investie de tâches de formation professionnelle ou encore le concessionnaire d'une ligne de transport public. Dans un premier temps, l'ouvrage revisite brièvement le phénomène dans une approche non juridique. Il s'agit en particulier d'en repérer les justifications (managériales ou, plus largement, économiques) et de prendre la mesure des objections qu'on lui oppose, notamment sur le plan démocratique. Le coeur de l'analyse porte sur le régime juridique applicable à ce mécanisme. Après une introduction générale, les principaux thèmes liés à la délégation de tâches publiques sont abordés. Comment, tout d'abord, prend naissance la relation entre l'administration et le délégataire, par quel type d'acte (décision, contrat) et selon quelle procédure intervient le choix du délégataire ? Sont traitées ensuite des relations de ce dernier avec les particuliers, plus spécialement sous l'angle des droits fondamentaux. L'ouvrage présente en outre le cadre juridique pertinent lorsque la délégation porte respectivement sur une activité étatique classique (ministérielle ; non économique) ou, au contraire, sur une activité à caractère économique ; les divergences, on le verra, sont nombreuses entre ces deux grandes catégories de délégations. Une étude sectorielle, consacrée au cas spécifique de la délégation aux hôpitaux (qui porte plus précisément sur les prestations de soins aigus en milieu stationnaire, à charge de l'assurance-maladie de base), complète la perspective. Le présent ouvrage dresse en définitive un « état de la question » du droit suisse sur le thème très actuel de la délégation ; une synthèse finale permet encore de nouer la gerbe dans une approche comparative.

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.

Preoperative education and its influence on perception of recovery for clients awaiting total hip and total knee replacement surgery /

The puqjose of this study was to examine the manner in which an inviting approach to a preoperative teaching and learning educational experience influenced the perception and subsequent recovery of clients who were awaiting total hip and total knee replacement surgery. An in-depth review of the internal and external factors that shape client perceptions was undertaken in this study. In addition, this study also explored whether or not the Prehab Program was preparing clients physically, socially, and psychologically for surgery. Data for this qualitative case study research were collected through preoperative interviews with 4 participants awaiting total hip replacement surgery and 1 participant awaiting total knee replacement surgery. Four postoperative interviews were conducted with the participants who had received total hip replacement surgery. The occupational therapist and physical therapist who were the coleaders of the Prehab Program at the time of this study were also interviewed. The results of this study suggest that while individuals may receive similar educational experiences, their perceptions of the manner in which they benefited from these experiences varied. This is illustrated in the research findings, which concluded that while clients benefited physically from the inviting approach used during the practical teaching session, not all clients perceived the psychological benefits of this practice session, especially clients with preexisting high levels of anxiety. In addition to increasing the understanding of the internal as well as external factors that influence the perceptions of clients, this study has also served as an opportunity for reflection on practice for the Prehab therapists and other healthcare educators.

A survey of attitudes of agricultural society leaders toward leadership development education

It was the purpose of this study to investigate attitudes toward leadership development education of one client group served by the ontario Ministry of Agriculture and Food. The survey, answered by 175 participants, attempted to answer the following questions: (a) What is a common definition of leadership?, (b) What leadership concepts are important to leadership development education? and, (c) What are client attitudes toward leadership development education? A descriptive research approach was used and the data were analyzed according to a model developed by Colaizzi. Concept maps were developed under the broad areas of: (a) Developing leader qualities; (b) Past experiences that developed leadership skills that worked on the jOb; (c) Leadership skills developed from present day positions; and (d) How leadership skills may be developed in future situations. A description of the dynamics of leadership development was written and the essential dynamics of leadership skill development in one volunteer organization was described. This study supports the linkages perspective of leadership within voluntary organizations developed by Vandenberg, Thullen and Fear (1987). The linkages perspective consists of three major components: perception, property and process. As a perception, leadership is the set of beliefs each group member holds regarding the behaviours and qualities characteristic of effective leaders. As a property, leadership represents the qualities attributed by group members to persons perceived as effectively (or potentially) influencing the goal achievement process. As a process, leadership involves the use of non-coercive influence to facilitate group accomplishment of valued goals. Leadership concepts important for development in a leadership development education program related to personal, organizational and societal development. The top five concepts in terms of rank order are communicating effectively, forming and working with groups, working creatively (tie), developing followers, managing meetings, directing projects or activities, understanding financial matters, managing negotiations (tie), developing resources and understanding and developing oneself (tie). Several recommendations are relevant for extension personnel as educators. Theoretical concepts on leadership need to be shared to extension practitioners involved in leadership development. currently used teaching materials for leadership development should be evaluated to see if they include concepts from preferrred theoretical leadership perceptions.

Athletic injury care training in high school coaches

The purpose of this qualitative study was to understand the client and occupational therapist experiences of a mental health group. A secondary aim was to explore the extent to which this group seemed to have reflected a client-centred approach. The topic emerged from personal and professional issues related to the therapist as teacher and to inconsistencies in practice with the profession's client-centred philosophy. This philosophy, the study's frame of reference, was established in terms of themes related to the client-therapist relationship and to client values. Typical practice was illustrated through an extensive literature review. Structured didacticexperiential methods aiming toward skill development were predominant. The interpretive sciences and, to a lesser extent, the critical sciences directed the methodology. An ongoing support group at a community mental health clinic was selected as the focus of the study; the occupational therapist leader and three members became the key participants. A series of conversational interviews, the . core method of data collection, was supplemented by observation, document review, further interviews, and fieldnotes. Transcriptions of conversations were returned to participants for verification and for further reflection Analysis primarily consisted of coding and organizing data according to emerging themes. The participants' experiences of group, presented as narrative stories within a group session vignette, were also returned to participants. There was a common understanding of the group's structure and the importance of having "air time" within the group; however, differences in perceptions of such things as the importance of the group in members' lives were noted. All members valued the therapeutic aspects of group, the role of group as weekly activity and, to a lesser extent, the learning that came from group. The researcher's perspective provided a critique of the group experience from a client-centred perspective. Some areas of consistency with client-centred practice were noted (e.g., therapist attitudes); however the group seemed to function far from a client-centred ideal. Members held little authority in a -relationship dominated by the leaders, and leader agendas rather than member values controlled the session. Possible reasons for this discrepancy ranging from past health care encounters through to co-leader discord emerged. The actual and potential significance of this study was discussed according to many areas of implications: to OT practice, especially client-centred group practice, to theory development, to further areas of research and methodology considerations, to people involved in the group and to my personal growth and development.

A sequential analysis of therapist scaffolding and child concept formation in narrative therapy

Narrative therapy is a postmodern therapy that takes the position that people create self-narratives to make sense of their experiences. To date, narrative therapy has compiled virtually no quantitative and very little qualitative research, leaving gaps in almost all areas of process and outcome. White (2006a), one of the therapy's founders, has recently utilized Vygotsky's (1934/1987) theories of the zone of proximal development (ZPD) and concept formation to describe the process of change in narrative therapy with children. In collaboration with the child client, the narrative therapist formalizes therapeutic concepts and submits them to increasing levels of generalization to create a ZPD. This study sought to determine whether the child's development proceeds through the stages of concept formation over the course of a session, and whether therapists' utterances scaffold this movement. A sequential analysis was used due to its unique ability to measure dynamic processes in social interactions. Stages of concept formation and scaffolding were coded over time. A hierarchical log-linear analysis was performed on the sequential data to develop a model of therapist scaffolding and child concept development. This was intended to determine what patterns occur and whether the stated intent of narrative therapy matches its actual process. In accordance with narrative therapy theory, the log-linear analysis produced a final model with interactions between therapist and child utterances, and between both therapist and child utterances and time. Specifically, the child and youth participants in therapy tended to respond to therapist scaffolding at the corresponding level of concept formation. Both children and youth and therapists also tended to move away from earlier and toward later stages of White's scaffolding conversations map as the therapy session advanced. These findings provide support for White's contention that narrative therapists promote child development by scaffolding child concept formation in therapy.

The development, assessment, and implementation of an evaluation of the EMPOWER Program at shelters for abused women /

The development, assessment, and implementation of a program evaluation instrument was carried out to evaluate the impact and efficacy of the EMPOWER Program. This intervention was created to educate residents at a shelter for abused women with an anticipated outcome of prevention. Participants included the staff and residents at 2 shelters in Southern Ontario. Client pre, post and follow-up measures were obtained and analyzed statistically and using keyword content analysis. A single staff measure was obtained and summarized using keyword content analysis. Qualitative results were suggestive of important change in participants. All women in the post and follow-up measures believed their participation in the EMPOWER Program provided them with the knowledge, skills, and confidence to avoid abusive relationships in the fliture. This transformational impact was repeatedly expressed in both resident and staff feedback. Limitations of this research, as well as suggestions for future study were discussed.

A Foucaultian analysis of power relations in child protection case work with youth and families

This thesis takes some steps in examining the child protection system from a position that is rarely discussed. Specifically, I explore how Foucault's concept of disciplinary power can be used to demonstrate how power operates within the client/worker relationship. This relationship is shown to be quite complex with power flowing bidirectionally, rather than hierarchically. Instead of viewing power imbalances as a function of state control, I show how the client/worker relationship is constituted by the worker, the client, the organization and the social body. A postmodern auto ethnography is used to document my journey as I expose the disciplinary practices and instruments that I was subject to and used with my clients. 2 Given that the child protection system is constantly shifting and changing in order to improve its ability to safeguard children a greater emphasis is required to examine how workers operate within this complex, overwhelming and multi-dimensional world. This thesis has shown that by engaging in a reflexive examination of my position of power different approaches to making intervention beneficial to all involved become available. This is important if child protection work aims to work with clients rather than on clients.

Promoting parent-therapist collaboration in intensive behavioural intervention programs : exploring estrategies to improve teamwork

This qualitative study investigated senior level staff (Senior Therapists), front-line staff (Instructor Therapists), and parent perspectives on parent-therapist collaboration within Intensive Behavioural Intervention settings. Two senior staff interviews, two parent interviews, and a focus group with therapists were conducted to examine how parents and therapists currently interact within IBI settings, parent and therapist expectations of each other, factors that promote and barriers that impede parent-therapist collaboration, and how parent-therapist collaboration might be improved. A constant comparative analysis by question within and across cases revealed five prominent themes of 'Role Definition', 'Perspective-taking/Empathy', 'Trust', 'Open Communication', and 'Consistency'. Additional similarities and differences were discovered between parent and therapist perspectives such as the need for clear parentprofessional boundaries, the importance of maintaining client privacy, and respect. Implications of the findings and suggestions for future research are discussed.

Health-related quality of life among patients attending cardiovascular rehabilitation

Purpose: f i rst , an investigation of baseline differences in Health-Related Quality of l i fe (HRQOl) among adhere and non-adhere patients of Phase III cardiac rehabilitation (CR) was examined. Second, among patients who adhered to the program, effectiveness of t reatment based on HRQOl was evaluated. Methods: Data was collected by the Brock University Heart Institute. Participants completed a questionnaire battery at baseline and again at six months i f they were still a client. Results: The physical dimension of HRQOl differed at baseline between the adhere and non-adhere groups. for everyone point increase in physical HRQOl scores there was an associated 1.06 times greater likelihood that an individual would adhere to the program. Second, in those who adhered to the program for six months, physical HRQOl scores improved 3.18 points. Conclusions: Phase III CR significant improves HRQOl in patients suffering f rom cardiovascular disease.

Reading Instruction and Instructors’ Perceptions of Learners’ Needs in LINC Level 1-3 Classes

This study investigates instructors’ perceptions of reading instruction and difficulties among Language Instruction for Newcomers to Canada (LINC) Level 1-3 learners. Statistics Canada reports that 60% of immigrants possess inadequate literacy skills. Newcomers are placed in classes using the Canadian Language Benchmarks but large, mixed-level classes create little opportunity for individualized instruction, leading some clients to demonstrate little change in their reading benchmarks. Data were collected (via demographic questionnaires, semi-structured interviews, teaching plans, and field study notes) to create a case study of five LINC instructors’ perceptions of why some clients do not progress through the LINC reading levels as expected and how their previous experiences relate to those within the LINC program. Qualitative analyses of the data revealed three primary themes: client/instructor background and classroom needs, reading, strategies, methods and challenges, and assessment expectations and progress, each containing a number of subthemes. A comparison between the themes and literature demonstrated six areas for discussion: (a) some clients, specifically refugees, require more time to progress to higher benchmarks; (b) clients’ level of prior education can be indicative of their literacy skills; (c) clients with literacy needs should be separated and placed into literacy-specific classes; (d) evidence-based approaches to reading instruction were not always evident in participants’ responses, demonstrating a lack of knowledge about these approaches; (e) first language literacy influences second language reading acquisition through a transfer of skills; and (f) collaboration in the classroom supports learning by extending clients’ capabilities. These points form the basis of recommendations about how reading instruction might be improved for such clients.

The relationship between working alliance and treatment outcomes in remedial instruction for older dyslexic children

Research in psychotherapy has demonstrated that a positive working alliance between therapist and client leads to positive treatment outcomes. Though its focus is in the area of psychotherapy, the concept of working alliance holds significant value to the area of education. Current applications of the theory in educational settings have looked at relationships between teacher and students in the broad context of classroom interaction and found significant promise. The present study investigates the application of the theory of working alliance in a sample of older reading disabled children. The study examined the psychometric properties of the Reading Alliance Scale for Children (RASC) and for Teachers (RAST) in relation to student reading ability and motivation. A sample of 254 (66.1 % male, 33.9% female) grade 6-8 students (mean age 12.7 years) were enrolled in a remedial reading program for reading disabled children. The average standard score across multiple reading measures was more than 1 SD below age-level expectations. Students responded to measures of reading achievement and motivation at pretest, after 70 hours (post 70) of remediation and at the end of the program (post 125). All participants completed measures on the working alliance relationship at post 70 and post 125. Results showed that teacher reports were most predictive of outcome compared to student reports of the working alliance relationship. Working alliance was correlated with posttest reading ability and motivation. Male students and Black students obtained the weakest working alliance reports from their teacher. Overall, findings support the view that students' relationships with teachers provide an important component of success in the classroom.

Using Network Analysis to Understand and Advance Falls Prevention Services and Programs

The purpose of this study was to understand referral linkages that exist among falls prevention agencies in a southern Ontario region using network analysis theory. This was a single case study which included fifteen individual interviews. The data was analyzed through the constant comparative approach. Ten themes emerged and are classified into internal and external factors. Themes associated with internal factors are: 1) health professionals initiating services; 2) communication strategies; 3) formal partnerships; 4) trust; 5) program awareness; and 6) referral policies. Themes associated with external factors are: 1) client characteristics; 2) primary and community care collaboration; 3) networking; and 4) funding. Recommendations to improve the referral pathway are: 1) electronic database; 2) electronic referral forms; 3) educating office staff; and 4) education days. This study outlined the benefit of using network analysis to understand referral pathways and the importance of implementing strategies that will improve falls prevention referral pathways.

Improving Performance of Open Access Clinics

Open Access Scheduling has shown great promise in allowing health care practices to provide same-day access, and to match patients with their regular physicians. However, similarly to traditional clinics where appointments are pre-booked, open access clinics are also frustrated with long waits, long idle time and long overtime due to uncertainties such as patient no-shows, variable service time and variable daily demand. These aspects have not been studied previously in an open access setting. This study investigates different management options to improve clinical performance in terms of patient waiting time, doctor idle time and clinic overtime. Other factors studied with a simulation model include client load and placement of pre-booked slots. Results show that a proper panel size is critical to obtain good performance for open access clinics, and that good choices for management options depend on the client load.