Yrityksen jäykän organisaatiorakenteen keventäminen ulkoistamisen keinoin: Case MTV3

Tutkimuksen tavoitteena on ollut selvittää, kuinka yrityksen jäykkää organisaatiorakennetta on kevennetty ulkoistamisten avulla vastaamaan nykyaikaisia vaatimuksia. Tarkoituksena ei ole ollut neuvoa yritystä sen liiketoimissa, vaan tarkastella objektiivisesti, mitä on tehty ja kuinka tehdyt toimenpiteet vastaavat teorioissa esiteltyjä toimintamalleja. Tutkimuksen empiirinen osuus on tehty keräämällä teemahaastattelun keinoin tietoa kyseisessä organisaatiossa työskenteleviltä henkilöiltä ja analysoimalla kerättyä materiaalia. Kaikki haastateltavat kuuluvat tai ovat kuuluneet yrityksen johtotasolle, joten kyseessä on heidän näkemyksensä tehdyistä toimenpiteistä ja niiden vaikutuksista. Ulkoistaminen on todettu hyväksi keinoksi keventää yrityksen jäykkää organisaatiorakennetta. Yrityksen ydinosaamisen tulee olla erittäin tarkkaan selvillä ennen kuin ulkoistamisista päätetään. Oman ydinosaamisen määrittely ohjaa ulkoistettavien toimintojen valinta. Liiketoimintaympäristössä tapahtuvat muutokset vaikuttavat ulkoistamispäätöksiin huomattavasti. Ajan vaikutus ydinosaamiseen ja ulkoistettaviin toimintoihin on kanssa tarpeellista selvittää ennen toimiin ryhtymistä.

Päivittäistavarakaupan rahahuollon tehostaminen asiakaslähtöisesti

Tutkielman tavoitteena oli tutkia, miten päivittäistavarakaupan rahahuoltoa voidaan tehostaa ja samalla ottaa huomioon yritysasiakkaiden tarpeet. Tutkielman teoriaosan lähdeaineistona käytettiin lähinnä asiakkaiden tarpeita, palvelun laatua, asiakastyytyväisyyttä, asiakassuhteita, prosesseja sekä palveluiden tuottavuutta käsitteleviä tieteellisiä tutkimuksia, kirjallisuutta ja artikkeleita. Tutkimuksen lähestymistapa on kuvaileva eli deskriptiivinen ja tutkimusmenetelmä kvalitatiivinen ja kvantitatiivinen. Empiirisessä osassa tavoitetta lähestyttiin tutkimalla alustavien teemahaastattelujen avulla Nordean päivittäistavarakaupan toimialaan kuuluvien yritysasiakkaiden rahahuoltotarpeita ja yrityksille tärkeitä tyytyväisyystekijöitä. Päätutkimusmenetelmänä käytettiin kvantitatiivista kysely-tutkimusta kyseiselle kohderyhmälle. Kysymyslomake laadittiin tutkielman teorian ja esihaastattelujen pohjalta. Tutkimusaineistoa analysoitiin SPSS for Windows –tilasto-ohjelmalla. Empiirisessä tutkimuksessa havaittiin, että vastaajien kokonaistyytyväisyys Nordean rahahuoltopalveluihin oli melko hyvä. Sen sijaan palvelun laatua ei koettu hyvänä, sillä yritysten odotukset palvelujen laatu-ulottuvuuksista ja palveluun liittyvistä tekijöistä olivat korkeammat kuin heidän kokemuksensa niistä. Tämä synnytti laatukuiluja (esim. palvelujen hyvä hinta-laatu-suhde, niiden selkeä hinnoittelu ja sopimusten selkeys). Rahahuoltopalvelut vastaavat parhaiten niiden yritysten tarpeita, jotka käyttävät palveluita. Tärkeimpänä tilityksiin kohdistuvana tekijänä pidettiin rahojen hyvittämistä nopeasti tilille. Rahahuollosta vastaavan pankin valintaan vaikuttaa eniten rahahuoltopalvelujen keskittäminen muiden raha-asioiden kanssa samaan pankkiin. Pankin rahahuoltopalvelujen tehostamiseksi suunnittelemat toimenpiteet ja yritysten mielipiteet niistä eroavat toisistaan. Pankin tuleekin ottaa yritysten rahahuoltotarpeet huomioon parantaessaan sisäistä kustannustehokkuutta ja tehostaessaan rahahuoltoprosessia. Asiakkaiden tyytyväisyys täytyy säilyttää ja ohjeistaa asiakkaat toimimaan rahahuollon osalta tehokkaasti ja järkevästi.

Discovery of a High-Energy Gamma-Ray-Emitting Persistent Microquasar

Microquasars are stellar x-ray binaries that behave as a scaled down version of extragalactic quasars. The star LS 5039 is a new microquasar system with apparent persistent ejection of relativistic plasma at a 3 kiloparsec distance from the sun. It may also be associated with a gamma-ray source discovered by the Energetic Gamma Ray Experiment Telescope (EGRET) on board the COMPTON-Gamma Ray Observatory satellite. Before the discovery of LS 5039, merely a handful of microquasars had been identified in the Galaxy, and none of them was detected in high-energy gamma-rays.

Evolutionary dynamics of collective action in spatially structured populations.

Many models proposed to study the evolution of collective action rely on a formalism that represents social interactions as n-player games between individuals adopting discrete actions such as cooperate and defect. Despite the importance of spatial structure in biological collective action, the analysis of n-player games games in spatially structured populations has so far proved elusive. We address this problem by considering mixed strategies and by integrating discrete-action n-player games into the direct fitness approach of social evolution theory. This allows to conveniently identify convergence stable strategies and to capture the effect of population structure by a single structure coefficient, namely, the pairwise (scaled) relatedness among interacting individuals. As an application, we use our mathematical framework to investigate collective action problems associated with the provision of three different kinds of collective goods, paradigmatic of a vast array of helping traits in nature: "public goods" (both providers and shirkers can use the good, e.g., alarm calls), "club goods" (only providers can use the good, e.g., participation in collective hunting), and "charity goods" (only shirkers can use the good, e.g., altruistic sacrifice). We show that relatedness promotes the evolution of collective action in different ways depending on the kind of collective good and its economies of scale. Our findings highlight the importance of explicitly accounting for relatedness, the kind of collective good, and the economies of scale in theoretical and empirical studies of the evolution of collective action.

Analysis of the antibiotic prophylaxis prescribed by Spanish oral surgeons

Aim: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedication to Oral Surgery in different types of tooth extraction surgeries. Method: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 different tooth extraction modalities scaled according to their surgical invasiveness. Results: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyed surgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventional tooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, the percentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap was elevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis. Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participants would prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days. Conclusions: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infection is not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drug reactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibiotics in the prevention of postsurgical wound infection

Yhteistoiminnan ja tiedon jakamisen kehittäminen

Tässä tutkimustyössä on tavoitteena tutkia UPM-Kymmene Wood Oy:n vaneriliiketoimintaorganisaation lähtölogistiikka- ja myyntiosaston tiedon jakamisen ja yhteistoiminnan nykytilaa ja kartoittaa osastojen tiedontarpeita yhteistoimintaan liittyen. Työn tavoitteena on tämän jälkeen antaa kohdeosastoille ehdotuksia toimenpiteistä ja teknologisista ratkaisuista toiminnan parantamiseen. Työssä esitetään aluksi tietoon ja sen jakamiseen liittyviä käsitteitä. Tämän jälkeen tekstissä luodaan katsaus liiketoimintatietoon ja sen hallintaan. Lisäksi tutkimuksessa tarkastellaan tutkimuksen kohteena olevaa organisaatiota ja kohdeosastoja. Haastatteluiden ja havainnoinnin avulla kerätyn tutkimusaineiston perusteella kohdeosastojen välillä vaihdetaan nykytilassa paljon erilaista asiakkaisiin ja markkinoihin liittyvää tietoa. Tiedon jakaminen ja vaihto perustuu kuitenkin nykytilassa hyvin vahvasti säännöllisen yhteistoiminnan sijaan erillisesti ilmaistuihin tietotarpeisiin. Haastatteluiden perusteella kohdeosastoissa on havaittavissa myös parannustarpeita nykyiseen tiedonkulkuun ja tiedon jakamiseen verrattuna. Annetut kehitysehdotukset koskevat yhteistoiminnan muuntamista säännölliseksi ja keskustelevaksi, olemassa olevien tietojen tehokkaammasta jakamisesta ja nykyisten tietohallintajärjestelmien hyödyntämisestä yhteistoiminnassa uusien järjestelmien luomisen sijaan.

Evaluation of Teacher Education Programs by Students and Graduates

The purpose of this research was to do a repeated cross-sectional research on class teachers who study in the 4th year and also graduated at the Faculty of Education, University of Turku between the years of 2000 through 2004. Specifically, seven research questions were addressed to target the main purpose of the study: How do class teacher education masters’ degree senior students and graduates rate “importance; effectiveness; and quality” of training they have received at the Faculty of Education? Are there significant differences between overall ratings of importance; effectiveness and quality of training by year of graduation, sex, and age (for graduates) and sex and age (for senior students)? Is there significant relationship between respondents’ overall ratings of importance; effectiveness and their overall ratings of the quality of training and preparation they have received? Are there significant differences between graduates and senior students about importance, effectiveness, and quality of teacher education programs? And what do teachers’ [Graduates] believe about how increasing work experience has changed their opinions of their preservice training? Moreover the following concepts related to the instructional activities were studied: critical thinking skills, communication skills, attention to ethics, curriculum and instruction (planning), role of teacher and teaching knowledge, assessment skills, attention to continuous professional development, subject matters knowledge, knowledge of learning environment, and using educational technology. Researcher also tried to find influence of some moderator variables e.g. year of graduation, sex, and age on the dependent and independent variables. This study consisted of two questionnaires (a structured likert-scale and an open ended questionnaire). The population in study 1 was all senior students and 2000-2004 class teacher education masters’ degree from the departments of Teacher Education Faculty of Education at University of Turku. Of the 1020 students and graduates the researcher was able to find current addresses of 675 of the subjects and of the 675 graduates contacted, 439 or 66.2 percent responded to the survey. The population in study 2 was all class teachers who graduated from Turku University and now work in the few basic schools (59 Schools) in South- West Finland. 257 teachers answered to the open ended web-based questions. SPSS was used to produce standard deviations; Analysis of Variance; Pearson Product Moment Correlation (r); T-test; ANOVA, Bonferroni post-hoc test; and Polynomial Contrast tests meant to analyze linear trend. An alpha level of .05 was used to determine statistical significance. The results of the study showed that: A majority of the respondents (graduates and students) rated the overall importance, effectiveness and quality of the teacher education programs as important, effective and good. Generally speaking there were only a few significant differences between the cohorts and groups related to the background variables (gender, age). The different cohorts were rating the quality of the programs very similarly but some differences between the cohorts were found in the importance and effectiveness ratings. Graduates of 2001 and 2002 rated the importance of the program significantly higher than 2000 graduates. The effectiveness of the programs was rated significantly higher by 2001 and 2003 graduates than other groups. In spite of these individual differences between cohorts there were no linear trends among the year cohorts in any measure. In respondents’ ratings of the effectiveness of teacher education programs there was significant difference between males and females; females rated it higher than males. There were no significant differences between males’ and females’ ratings of the importance and quality of programs. In the ratings there was only one difference between age groups. Older graduates (35 years or older) rated the importance of the teacher training significantly higher that 25-35 years old graduates. In graduates’ ratings there were positive but relatively low correlations between all variables related to importance, effectiveness and quality of Teacher Education Programs. Generally speaking students’ ratings about importance, effectiveness and quality of teacher education program were very positive. There was only one significant difference related to the background variables. Females rated higher the effectiveness of the program. The comparison of students’ and graduates’ perception about importance, effectiveness, and quality of teacher education programs showed that there were no significant differences between graduates and students in the overall ratings. However there were differences in some individual variables. Students rated higher in importance of “Continuous Professional Development”, effectiveness of “Critical Thinking Skills” and “Using Educational Technology” and quality of “Advice received from the advisor”. Graduates rated higher in importance of “Knowledge of Learning Environment” and effectiveness of “Continuous Professional Development”. According to the qualitative data of study 2 some graduates expressed that their perceptions have not changed about the importance, effectiveness, and quality of training that they received during their study time. They pointed out that teacher education programs have provided them the basic theoretical/formal knowledge and some training of practical routines. However, a majority of the teachers seems to have somewhat critical opinions about the teacher education. These teachers were not satisfied with teacher education programs because they argued that the programs failed to meet their practical demands in different everyday situations of the classroom e.g. in coping with students’ learning difficulties, multiprofessional communication with parents and other professional groups (psychologists and social workers), and classroom management problems. Participants also emphasized more practice oriented knowledge of subject matter, evaluation methods and teachers’ rights and responsibilities. Therefore, they (54.1% of participants) suggested that teacher education departments should provide more practice-based courses and programs as well as closer collaboration between regular schools and teacher education departments in order to fill gap between theory and practice.

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.

"Tu seras Psychologue, ma fille". La transmission intergénérationnelle du choix professionnel : Une co-construction entre parents et enfants.

The aim of the study is to understand how the family influences the choice of becoming a psychologist and how an occupational choice is repeated in the family, via intergenerational transmission. We interviewed seven female students in a Master of Science in Psychology : first, they filled in a genosociogramm including data about occupations of their ancestors on about four generations ; then, they took part into a semi-structured qualitative enquiry. Our results have shown that a little bit less than half of the subjects have a parent who have social or care jobs, but more than half if we add the grand-parents. In a conscious level, subjects tend to deny any kind of family influence, in the majority ; afterwards, they discover influences they didn't notice. Secondly, the content analysis reveals five categories of family influence : the educational path (doubts, choices), the choice of psychology via the development of self-efficacy (interest, personality and soft skills), the exploration of occupations and activities during childhood and adulthood (leisure activities, professional world, suggestions, advice, education), the transmission of values (immaterial and material) and the family relationships during childhood and teenage years (relationship issues and difficulties, confidences and secrets, relationships and role in the brotherhood and/or sisterhood). The importance for the career counselor to investigate the relational context of his/her consultant is discussed, as much as the need for him to think about his own motivations to help others, linked with his family background.

Consultation pluridisciplinaire "Souffrance au travail": une expérience romande [Multidisciplinary consultation "Suffering at work": an experience in western Switzerland].

Les problèmes de santé mentale au travail constituent un défi à la fois clinique, professionnel, économique et de santé publique. Les coûts totaux qu'ils génèrent en Suisse équivalent à 3,2 % du produit intérieur brut (PIB) suisse et ils aboutissent très souvent à un licenciement. La grande majorité des personnes sont soignées par un médecin de premier recours. L'Institut de Santé au Travail propose une consultation spécialisée dans les questions de souffrance au travail, offrant aux soignants de première ligne un avis ou un soutien pluridisciplinaire, dans une perspective collaborative des soins. Son action, adaptée aux besoins de chaque situation, va d'un avis à une orientation vers des spécialistes pouvant étoffer durablement le réseau (suivi psychiatrique, programme de soutien à l'emploi, avis juridique ou social). Mental health problems at work constitute a challenge in the clinical feld, as well in the professional, the economic and the public health perspective. The total costs they generate in Switzerland are equivalent to 3.2% of the Swiss gross domestic product and they very often lead to dismissal. The vast majority of people are treated by their primary care physician. The Institute for Work and Health features a specialized consultation on the topic of suffering at work, offering the primary care physicians a pluridisciplinary advice or support, in a collaborative care prospect. Its action, adapted to each situation's needs, goes from an advice to a referral to specialists that can strengthen the network on a long-term basis (mental health follow-up, supported employment program, legal or social advice).

Travellers' profile, travel patterns and vaccine practices-a 10-year prospective study in a Swiss Travel Clinic.

BACKGROUND: The travel clinic in Lausanne serves a catchment area of 700 000 of inhabitants and provides pre- and post-travel consultations. This study describes the profile of attendees before departure, their travel patterns and the travel clinic practices in terms of vaccination over time. METHODS: We included all pre-travel first consultation data recorded between November 2002 and December 2012 by a custom-made program DIAMM/G. We analysed client profiles, travel characteristics and vaccinations prescribed over time. RESULTS: Sixty-five thousand and forty-six client-trips were recorded. Fifty-one percent clients were female. Mean age was 32 years. In total, 0.1% were aged <1 year and 0.2% ≥80 years. Forty-six percent of travellers had pre-existing medical conditions. Forty-six percent were travelling to Africa, 35% to Asia, 20% to Latin America and 1% (each) to Oceania and Europe; 19% visited more than one country. India was the most common destination (9.6% of travellers) followed by Thailand (8.6%) and Kenya (6.4%). Seventy-three percent of travellers were planning to travel for ≤ 4 weeks. The main reasons for travel were tourism (75%) and visiting friends and relatives (18%). Sixteen percent were backpackers. Pre-travel advice were sought a median of 29 days before departure. Ninety-nine percent received vaccine(s). The most frequently administered vaccines were hepatitis A (53%), tetanus-diphtheria (46%), yellow fever (39%), poliomyelitis (38%) and typhoid fever (30%). CONCLUSIONS: The profile of travel clinic attendees was younger than the general Swiss population. A significant proportion of travellers received vaccinations that are recommended in the routine national programme. These findings highlight the important role of travel clinics to (i) take care of an age group that has little contact with general practitioners and (ii) update vaccination status. The most commonly prescribed travel-related vaccines were for hepatitis A and yellow fever. The question remains to know whether clients do attend travel clinics because of compulsory vaccinations or because of real travel health concern or both.

A Co-Processor Approach for Efficient Java Execution in Embedded Systems

This thesis deals with a hardware accelerated Java virtual machine, named REALJava. The REALJava virtual machine is targeted for resource constrained embedded systems. The goal is to attain increased computational performance with reduced power consumption. While these objectives are often seen as trade-offs, in this context both of them can be attained simultaneously by using dedicated hardware. The target level of the computational performance of the REALJava virtual machine is initially set to be as fast as the currently available full custom ASIC Java processors. As a secondary goal all of the components of the virtual machine are designed so that the resulting system can be scaled to support multiple co-processor cores. The virtual machine is designed using the hardware/software co-design paradigm. The partitioning between the two domains is flexible, allowing customizations to the resulting system, for instance the floating point support can be omitted from the hardware in order to decrease the size of the co-processor core. The communication between the hardware and the software domains is encapsulated into modules. This allows the REALJava virtual machine to be easily integrated into any system, simply by redesigning the communication modules. Besides the virtual machine and the related co-processor architecture, several performance enhancing techniques are presented. These include techniques related to instruction folding, stack handling, method invocation, constant loading and control in time domain. The REALJava virtual machine is prototyped using three different FPGA platforms. The original pipeline structure is modified to suit the FPGA environment. The performance of the resulting Java virtual machine is evaluated against existing Java solutions in the embedded systems field. The results show that the goals are attained, both in terms of computational performance and power consumption. Especially the computational performance is evaluated thoroughly, and the results show that the REALJava is more than twice as fast as the fastest full custom ASIC Java processor. In addition to standard Java virtual machine benchmarks, several new Java applications are designed to both verify the results and broaden the spectrum of the tests.

Coneixements, actituds i percepció versus la infecció per Virus del Papil·loma Humà en els professionals d'infermeria : tendències en salut pública

Actualment, s’evidencia una dificultat en el seguiment estricte de les infeccions de transmissió sexual (ITS). A nivell mundial, aquestes causen un problema de Salut Pública (SP) en termes de morbiditat i mortalitat per complicacions i seqüeles que es poden originar si no es diagnostiquen i no es tracten adequadament. Entre les ITS més comunes trobem la provocada pel Virus del Papil·loma Humà (VPH), la principal causant del càncer de cèrvix, entre altres complicacions La família de VPH compta amb més de 150 tipus virals. El coneixement de la situació epidemiològica de la infecció per VPH es veu dificultada per varis aspectes: el caràcter asimptomàtic; l’estigma social; les dificultats diagnòstiques; la falta de homogeneïtat dels sistemes de vigilància amb la infradeclaració de casos. Ens trobem en una inversemblança constant. Les intervencions des de SP, ja sigui a nivell nacional com regional, sónpròpiament enfocades a la prevenció de la malaltia. Paral·lelament, la incidència de les ITS continua amb una tendència ascendent, cosa que provoca una inquietant preocupació. Partint de la problemàtica exposada, el present estudi pretén identificar elsconeixements que tenen els professionals d’infermeria de l’atenció primària en relació a la infecció de transmissió sexual pel virus del papil·loma humà i quina és la seva percepció i actitud sobre l’atenció a l’usuari. Es tractarà d’un estudi multicèntric amb disseny descriptiu transversal. La instrumentació es farà mitjançant una enquesta totalment anònima sobre una mostra aproximada de 115 professionals d’infermeria que durant l’any 2013 que treballen a les àrees bàsiques de salut (ABS) de l’Institut Català de la Salut (ICS) del Gironès. Aquest estudi vol fer visible la necessitat d’incrementar la formació dels professionals d’infermeria en relació a la infecció VPH i el requeriment d’un consell addicional que promogui la salut encaminat a empoderar a la comunitat mitjançant educació per a la salut

Implementing an Evidence-based Hypertension Guideline into Finnish Primary Care Nursing

Kohonneen verenpaineen hoitosuosituksen käyttöönottosuomen perusterveydenhiollon hoitotyössä Tutkimuksen tavoitteena oli tuottaa suosituksia näyttöön perustuvien Käypä hoito -suositusten käytön edistämiseksi perusterveydenhuollon hoitotyössä. Tutkimuksen ensimmäisessä vaiheessa arvioitiin Kohonneen verenpaineen hoitosuosituksen käyttöönottoa terveyskeskuksissa. Toisessa vaiheessa selvitettiin hoitajien hoitosuositusasenteita ja kokemuksia hoitosuosituksen käyttöönotosta. Kolmannessa vaiheessa selvitettiin hoitohenkilöstön näkemyksiä hoitosuosituksen käyttöä edistävistä tekijöistä. Kohonneen verenpaineen hoitosuositus oli ylilääkäreiden ja ylihoitajien mukaan otettu käyttöön lähes kaikissa terveyskeskuksissa, mutta heidän näkemyksensä suositusten käyttöönottoa koskevista terveyskeskuksissa tehdyistä sopimuksista erosivat toisistaan monilta osin. Myös käyttöönoton toteutuksessa oli suurta vaihtelua terveyskeskusten välillä. Toteutustavan perusteella ääripäissä sijaitsevat terveyskeskukset luokiteltiin yksittäisin ja monin keinoin käyttöönottoa tukeneiksi. Hoitajien hoitosuositusasenteet olivat hyvin myönteisiä ja hoitosuosituksia pidettiin luotettavina tiedonlähteinä, ja niiden uskottiin parantavan hoidon laatua. Hoitosuositusten paikallinen soveltaminen sekä johdon ja lääkäreiden tuki olivat hoitajien mielestä keskeisiä käyttöönotossa, vaikkakin tulosten mukaan kaikki käytetyt keinot olivat yhteydessä positiivisempiin hoitosuositusasenteisiin sekä aktiivisempaan hoitajien itsensä ilmaisemaan hoitosuositusten käyttöön. Yhteenvetona voidaan todeta, että Käypä Hoito -suositukset on hyväksytty osaksi kliinistä hoitotyön käytäntöä. Niiden käytön tehostamiseksi tulisi kiinnittää huomiota suositusten paikalliseen soveltamiseen ja eri ammattiryhmien tehtäväkuvien määrittelyyn. Tähän tarvitaan terveyskeskusten johdon ja lääkäreiden selkeää tukea.