Adoption of an E-service Innovation and its Effects on Customer Service Processes in Forest Industry

Tämän tutkielman tavoitteena oli selvittää miten asiakkaille suunnattu Internet –pohjainen palvelu muuttaa asiakaspalvelua metsäteollisuudessa, ja mitkä tekijät vaikuttavat tällaisen palvelun omaksumiseen. Tutkimuksesta ilmenee että muutokset asiakaspalvelussa ovat olleet asiakkaiden mielestä pääasiassa positiivisia. Selvisi, että uuden sovelluksen laatuun ollaan tyytyväisiä, mutta että kaikki asiakkaat eivät pidä sen etuja huomattavina verrattuna vanhoihin toimintatapoihin. Esimerkkiyrityksen oma henkilöstö ei keskimäärin koe sovellusta kovin hyödylliseksi oman työnsä kannalta. Jotta sovelluksen käyttöä ja mahdollisia hyötyjä esimerkkiyritykselle saataisiin lisättyä, on sovellukseen tehtävien parannusten lisäksi panostettava tehokkaampaan kommunikointiin ja lisäkoulutukseen asiakkaille. Lisäksi on löydettävä keinoja, joiden avulla asiakkaat kokisivat sovelluksen käytön itselleen edullisemmaksi kuin pitäytymisen vanhoissa toimintatavoissa. Edellä mainitun saavuttaminen edellyttää esimerkkiyrityksen asiakaspalvelu-henkilöstön ja operatiivisen johdon sitoutumista sovelluksen aktiiviseen markkinointiin asiakkaiden suuntaan. Tutkimuksen aineisto kerättiin haastatteluilla ja asiakkaille suunnatulla kyselylomakkeella käyttäen pääasiassa kvalitatiivisia menetelmiä. Haastatteluja tehtiin kahdessa esimerkkiyrityksen yksikössä, kolmessa myyntikonttorissa sekä kahden asiakasyrityksen yhteensä neljässä eri yksikössä. Kyselylomake lähetettiin 215 asiakaskäyttäjälle, joista 30 palautti lomakkeen. Palautusprosentiksi tuli 14.

Impact of Sleep and Circadian Disruption on Energy Balance and Diabetes: A Summary of Workshop Discussions.

ABSTRACT: A workshop was held at the National Institute for Diabetes and Digestive and Kidney Diseases with a focus on the impact of sleep and circadian disruption on energy balance and diabetes. The workshop identified a number of key principles for research in this area and a number of specific opportunities. Studies in this area would be facilitated by active collaboration between investigators in sleep/circadian research and investigators in metabolism/diabetes. There is a need to translate the elegant findings from basic research into improving the metabolic health of the American public. There is also a need for investigators studying the impact of sleep/circadian disruption in humans to move beyond measurements of insulin and glucose and conduct more in-depth phenotyping. There is also a need for the assessments of sleep and circadian rhythms as well as assessments for sleep-disordered breathing to be incorporated into all ongoing cohort studies related to diabetes risk. Studies in humans need to complement the elegant short-term laboratory-based human studies of simulated short sleep and shift work etc. with studies in subjects in the general population with these disorders. It is conceivable that chronic adaptations occur, and if so, the mechanisms by which they occur needs to be identified and understood. Particular areas of opportunity that are ready for translation are studies to address whether CPAP treatment of patients with pre-diabetes and obstructive sleep apnea (OSA) prevents or delays the onset of diabetes and whether temporal restricted feeding has the same impact on obesity rates in humans as it does in mice.

Health Migration Policies and Ethical Controversies: the Case of African Nurses in the UK

The United Kingdom (UK) for last few decades has been faced with a growing need for health personnel and has therefore attracted professionals, particularly overseas nurses. The country has been characterised by a historical migration policy favourable to the recruitment of foreign health staff. However, in the context of deep shortage and high level of diseases and health system weakness, the international health professional recruitment from Sub Saharan Africa has created unprecedented ethical controversies which have pushed the UK to the centre of discussions because of its liberal policies towards international recruitment that have been considered as aggressive. While the 'brain drain' controversy is well known, less attention has been devoted to the specific international health migration controversy and the pivotal role of the UK in the diffusion of ethical code of practice. Using mainly the perspective of the policy analysis of controversy (Roe 1994) and the analysis of discourses (de Haas 2008), our paper comes back respectively to the nature of the controversy and the pivotal role of the UK. It also analyses how the implementation of UK ethical policies - Code of Practice, banned countries list of recruitment, restrictive immigration policies - have been considered as inefficient and unethical in their contents and their targets.

Packet backbone design differences between commercial network and Container Trial System of LTE/SAE

The mobile networks of earlier and current generations, or 2G and 3G networks, provide users voice and packet services with higher transmission rates and good quality over the same core network. When developing the next generation of mobile networks the current quality of services needs to be maintained. This thesis concentrates on the next generation mobile network, especially on the evolution of the packet network part. The new mobile network has requirements for the common packet backbone network, Mobile Packet Backbone Network, which is additionally discussed in this study. The next generation mobile network, called LTE/SAE, is currently under testing. The test system is called Container Trial System. It is a mini sized LTE/SAE site. The LTE/SAE is studied in this thesis concentrating on the evolved packet core, the SAE part of the composition. The empirical part of the study compares the LTE/SAE Container Trial System and commercial network designs and additionally produces documentation for internal personnel and customers. The research is performed by comparing the documentations and specifications of both the Container Trial System and commercial network. Since the LTE commercial network is not yet constructed, the comparison is done theoretically. The purpose is furthermore to find out if there are any design issues that could be done differently in the next version of the Container Trial System.

Solving Challenging Real-World Scheduling Problems

This work contains a series of studies on the optimization of three real-world scheduling problems, school timetabling, sports scheduling and staff scheduling. These challenging problems are solved to customer satisfaction using the proposed PEAST algorithm. The customer satisfaction refers to the fact that implementations of the algorithm are in industry use. The PEAST algorithm is a product of long-term research and development. The first version of it was introduced in 1998. This thesis is a result of a five-year development of the algorithm. One of the most valuable characteristics of the algorithm has proven to be the ability to solve a wide range of scheduling problems. It is likely that it can be tuned to tackle also a range of other combinatorial problems. The algorithm uses features from numerous different metaheuristics which is the main reason for its success. In addition, the implementation of the algorithm is fast enough for real-world use.

Free Prostate-specific Antigen Forms and Kallikrein-related Peptidase 2: Tools for Prostate Cancer Diagnostics

Prostate-specific antigen (PSA) is a marker that is commonly used in estimating prostate cancer risk. Prostate cancer is usually a slowly progressing disease, which might not cause any symptoms whatsoever. Nevertheless, some cases of cancer are aggressive and need to be treated before they become life-threatening. However, the blood PSA concentration may rise also in benign prostate diseases and using a single total PSA (tPSA) measurement to guide the decision on further examinations leads to many unnecessary biopsies, over-detection, and overtreatment of indolent cancers which would not require treatment. Therefore, there is a need for markers that would better separate cancer from benign disorders, and would also predict cancer aggressiveness. The aim of this study was to evaluate whether intact and nicked forms of free PSA (fPSA-I and fPSA-N) or human kallikrein-related peptidase 2 (hK2) could serve as new tools in estimating prostate cancer risk. First, the immunoassays for fPSA-I and free and total hK2 were optimized so that they would be less prone to assay interference caused by interfering factors present in some blood samples. The optimized assays were shown to work well and were used to study the marker concentrations in the clinical sample panels. The marker levels were measured from preoperative blood samples of prostate cancer patients scheduled for radical prostatectomy. The association of the markers with the cancer stage and grade was studied. It was found that among all tested markers and their combinations especially the ratio of fPSA-N to tPSA and ratio of free PSA (fPSA) to tPSA were associated with both cancer stage and grade. They might be useful in predicting the cancer aggressiveness, but further follow-up studies are necessary to fully evaluate the significance of the markers in this clinical setting. The markers tPSA, fPSA, fPSA-I and hK2 were combined in a statistical model which was previously shown to be able to reduce unnecessary biopsies when applied to large screening cohorts of men with elevated tPSA. The discriminative accuracy of this model was compared to models based on established clinical predictors in reference to biopsy outcome. The kallikrein model and the calculated fPSA-N concentrations (fPSA minus fPSA-I) correlated with the prostate volume and the model, when compared to the clinical models, predicted prostate cancer in biopsy equally well. Hence, the measurement of kallikreins in a blood sample could be used to replace the volume measurement which is time-consuming, needs instrumentation and skilled personnel and is an uncomfortable procedure. Overall, the model could simplify the estimation of prostate cancer risk. Finally, as the fPSA-N seems to be an interesting new marker, a direct immunoassay for measuring fPSA-N concentrations was developed. The analytical performance was acceptable, but the rather complicated assay protocol needs to be improved until it can be used for measuring large sample panels.

Enhancing human security through crisis management : opportunities and challenges for learning

Inhimilliseen turvallisuuteen kriisinhallinnan kautta – oppimisen mahdollisuuksia ja haasteita Kylmän sodan jälkeen aseelliset konfliktit ovat yleensä alkaneet niin sanotuissa hauraissa valtioissa ja köyhissä maissa, ne ovat olleet valtioiden sisäisiä ja niihin on osallistunut ei-valtiollisia aseellisia ryhmittymiä. Usein ne johtavat konfliktikierteeseen, jossa sota ja vakaammat olot vaihtelevat. Koska kuolleisuus konflikteissa voi jäädä alle kansainvälisen määritelmän (1000 kuollutta vuodessa), kutsun tällaisia konflikteja ”uusiksi konflikteiksi”. Kansainvälinen yhteisö on pyrkinyt kehittämään kriisinhallinnan ja rauhanrakentamisen malleja, jotta pysyvä rauhantila saataisiin aikaiseksi. Inhimillinen turvallisuus perustuu näkemykseen, jossa kunnioitetaan jokaisen yksilön ihmisoikeuksia ja jolla on vaikutusta myös kriisinhallinnan ja rauhanrakentamisen toteuttamiseen. Tutkimukseen kuuluu kaksi empiiristä osaa: Delfoi tulevaisuuspaneeliprosessin sekä kriisinhallintahenkilöstön haastattelut. Viisitoista eri alojen kriisinhallinta-asiantuntijaa osallistui paneeliin, joka toteutettiin vuonna 2008. Paneelin tulosten mukaan tulevat konfliktit usein ovat uusien konfliktien kaltaisia. Lisäksi kriisinhallintahenkilöstöltä edellytetään vuorovaikutus- ja kommunikaatiokykyä ja luonnollisesti myös varsinaisia ammatillisia valmiuksia. Tulevaisuuspaneeli korosti vuorovaikutus- ja kommunikaatiotaitoja erityisesti siviilikriisinhallintahenkilöstön kompetensseissa, mutta samat taidot painottuivat sotilaallisen kriisinhallinnan henkilöstön kompetensseissakin. Kriisinhallinnassa tarvitaan myös selvää työnjakoa eri toimijoiden kesken. Kosovossa työskennelleen henkilöstön haastatteluaineisto koostui yhteensä 27 teemahaastattelusta. Haastateltavista 9 oli ammattiupseeria, 10 reservistä rekrytoitua rauhanturvaajaa ja 8 siviilikriisinhallinnassa työskennellyttä henkilöä. Haastattelut toteutettiin helmi- ja kesäkuun välisenä aikana vuonna 2008. Haastattelutuloksissa korostui vuorovaikutus- ja kommunikaatiotaitojen merkitys, sillä monissa käytännön tilanteissa haastateltavat olivat ratkoneet ongelmia yhteistyössä muun kriisinhallintahenkilöstön tai paikallisten asukkaiden kanssa. Kriisinhallinnassa toteutui oppimisprosesseja, jotka usein olivat luonteeltaan myönteisiä ja informaalisia. Tällaisten onnistumisten vaikutus yksilön minäkuvaan oli myönteinen. Tällaisia prosesseja voidaan kuvata ”itseä koskeviksi oivalluksiksi”. Kriisinhallintatehtävissä oppimisella on erityinen merkitys, jos halutaan kehittää toimintoja inhimillisen turvallisuuden edistämiseksi. Siksi on tärkeää, että kriisinhallintakoulutusta ja kriisinhallintatyössä oppimista kehitetään ottamaan huomioon oppimisen eri tasot ja ulottuvuudet sekä niiden merkitys. Informaaliset oppimisen muodot olisi otettava paremmin huomioon kriisinhallintakoulutusta ja kriisinhallintatehtävissä oppimista kehitettäessä. Palautejärjestelmää olisi kehitettävä eri tavoin. Koko kriisinhallintaoperaation on saatava tarvittaessa myös kriittistä palautetta onnistumisista ja epäonnistumisista. Monet kriisinhallinnassa työskennelleet kaipaavat kunnollista palautetta työrupeamastaan. Liian rutiininomaiseksi koettu palaute ei edistä yksilön oppimista. Spontaanisti monet haastatellut pitivät tärkeänä, että kriisinhallinnassa työskennelleillä olisi mahdollisuus debriefing- tyyppiseen kotiinpaluukeskusteluun. Pelkkä tällainen mahdollisuus ilmeisesti voisi olla monelle myönteinen uutinen, vaikka tilaisuutta ei hyödynnettäisikään. Paluu kriisinhallintatehtävistä Suomeen on monelle haasteellisempaa kuin näissä tehtävissä työskentelyn aloittaminen ulkomailla. Tutkimuksen tulokset kannustavat tutkimaan kriisinhallintaa oppimisen näkökulmasta. On myös olennaista, että kriisinhallinnan palautejärjestelmiä kehitetään mahdollisimman hyvin edistämään sekä yksilöllistä että organisatorista oppimista kriisinhallinnassa. Kriisinhallintaoperaatio on oppimisympäristö. Kriisinhallintahenkilöstön kommunikaatio- ja vuorovaikutustaitojen kehittäminen on olennaista tavoiteltaessa kestävää rauhanprosessia, jossa konfliktialueen asukkaatkin ovat mukana.

Productivity and Services – Safety Telephone Services for the Elderly

Previous research on productivity is often associated with manufacturing or uses manufacturing definitions of productivity. Marketing research on services has not been satisfied with the manufacturing definitions. No universal definition for service productivity exists. The lack of a universal definition highlights the complexity entailed in the concept of productivity. The objective of this study was to investigate service productivity in situations, where traditional ways are in some cases even not possible or are not enough. In one definition of the productivity of service organisations there is the efficiency of the organisation on the input side and on the output side the customers’ perceived quality or value-in-use. To learn about value-in-use, many methods have been developed. A common practice is to make customer opinion surveys in the form of customer questionnaires and interviews. However, customers cannot always be asked directly, for example, because of impaired cognitive abilities. Such cases include the elderly and children. Furthermore, customer opinion surveys are time consuming. In addition, customers do not always know what kind of services they would benefit from. For the empirical part of the study, a business area was identified where traditional ways of measuring value-in-use are difficult or in some cases even not possible. This business area is safety telephone services. These services are most often used by the elderly. The way to define value-in-use here was to assess how well the services offered met customer expectations. Comparing the services customers asked for and the services provided to them indicated whether customer expectations were met. This study showed that customers had their ideas concerning the contents of the services but many times the services provided did not meet these expectations. Organisational efficiency aspirations can decrease customers’ value-in-use. This study found a solution, in which increasing organisational efficiency would go hand-in-hand with increasing customers’ value-in-use; the result being that the organisations’ needs and the service users’ expectations were in line. Value creation for customers produced organisational efficiency and thus increased productivity. In this study, customer expectations were observed by means of wellness technology. With the help of modern technology, customer expectations can be followed quickly and easily and customers can co-create with the organisation. This type of an approach could be useful even in the development of other services for other ages and in different contexts. If a service organisation decreases the number of personnel and, at the same time, tries to offer services to the same or a larger clientele, customers easily notice the change, which is often negative. To avoid harmful decrease in value-in-use, limitations to the aspiration of efficiency should be implemented – one of such is that the organisation is required to meet certain quality standards defined by experts. The aim is to secure that, as a result of efficiency aspirations in the organisation, the quality of the service offerings does not diminish below mutually agreed standards. Traditionally, when productivity in services has been estimated, organisational efficiency has not been combined with both customer expectations and an expert assessment of quality. This study contributes with novel thinking entitled ‘Relationship Management of the Elderly’. This study handles productivity, expert defined quality and value-in-use in an organisational context, which is practically untouched in previous research studies.

Developing construction site operations for EPC power plant projects

The purpose of this thesis is to find development areas for site operations in power plant construction projects delivered by Wärtsilä. The inspected operations are subcontractor management, site material management and work scheduling. The contractor's role in EPC project is to respond for engineering, procurement, and construction supervision. Geographical and cultural differences brings challenges for finding development areas as Wärtsilä delivers projects world-wide. Searching for development area is mainly made with survey, which answers were collected from the target company's site personnel. Based on the results, with good planning and preparation various problems would be avoided. An external view for the thesis was collected by an expert interview, which was held to three expe-rienced construction operating executives. Interviewees believed that with the se-lection of right site personnel and clearly defined areas of responsibility will great-ly affect the outcome of the project. Some of the theory has been collected from areas, which have helped to under-stand the inspected operations on site. Improving competence knowledge has been important due to the broad scope of work and the author’s inexperience of the topic. Also generally effective practices from construction projects has been col-lected to the theory part. Functionality of general practices have been reflected together with the results of empirically collected data for Wärtsilä's projects. As a result, a model was generated where development proposals and the benefits from new procedures were presented.

Perceptions of corporate social responsibility: A case study of the perceived contents and outcomes

CSR has been subject of broad debate and research over the decades and has gained attention recently. The purpose of this thesis is to find out how companies perceive CSR. In addition this thesis is researching what is CSR in Finnish companies, how do companies measure CSR, what are the effects of CSR and how companies perceive those effects and what actors and factors support CSR. This research is a case study where altogether nine informants from seven companies were interviewed. This research is qualitative case study implemented with theme interviews. The analysis method is content analysis. Several interesting issues emerged from the empirical findings. CSR is playing pivotal role in companies values, vision and mission. CSR was perceived differently in companies but also mutual points emerged. The role of stakeholders is essential in CSR. In addition the communication with stakeholders was seen very important. Companies perceived that they can gain many benefits when acting responsibly for instance in issues related to cost reduction, reputation and personnel. However measuring these effects from CSR point of view was seen challenging. Other CSR related challenges are for example change and lack of resources. When considering empirical findings from a theoretical point of view, three interesting issues emerged. CSR reports play an important role in measuring and developing of CSR. However, this is not the case with all companies and some of them argued that reporting has too much attention nowadays when talking about CSR. The benefits of CSR are mostly related to responsive CSR. However maybe in a long-term follow-up strategic CSR related competitive advantage benefits could be more easily noticed. Many different issues supported CSR. Some issues are driven by outside of companies like NGO`s and media and some inside like the motivation of personnel and management. Vastuullista liiketoimintaa on tutkittu vuosien saatossa laajalti ja se on saanut viime vuosina erityisen paljon huomiota. Tämän pro gradu –tutkielman tavoitteena on selvittää, miten yritykset kokevat vastuullisen liiketoiminnan. Tämän lisäksi tutkimuksessa selvitetään, mitä vastuullinen liiketoiminta suomalaisissa yrityksissä tarkoittaa, miten yritykset mittaavat omaa vastuullisuuttaan, mitkä ovat vastuullisuuden vaikutukset, miten yritykset kokevat vastuullisuuden vaikutukset ja mitkä tekijät tukevat vastuullisen liiketoiminnan syntyä. Tutkimus toteutettiin haastattelemalla yhdeksää suomalaisen yrityksen yritysvastuusta vastaavaa tai sen kanssa työskentelevää henkilöä seitsemästä eri organisaatiosta loppuvuodesta 2014 ja alkuvuodesta 2015. Tutkimus on laadullinen, teemahaastatteluilla toteutettu haastattelututkimus. Aineisto on analysoitu teemoittain. Tutkimusaineiston perusteella vaikuttaa siltä, että vastuullinen liiketoiminta on tärkeässä roolissa yritysten arvoissa, visiossa ja missiossa. Yritysvastuu koettiin yrityksissä erilailla, mutta myös yhtäläisyyksiä on nähtävissä. Sidosryhmien rooli on erittäin tärkeä yritysvastuusta puhuttaessa ja myös kommunikointi sidosryhmien kanssa nousi tärkeäksi aiheeksi. Yritykset kokivat saavuttavansa monia hyötyjä vastuullisesta toiminnasta kuten kustannussäästöihin, maineeseen ja työntekijöihin liittyvissä asioissa. Näiden hyötyjen mittaaminen yritysvastuun näkökulmasta koettiin kuitenkin haasteelliseksi. Muita vastuullisuuteen liittyviä haasteita olivat esimerkiksi siihen liittyvä muutos sekä niukat resurssit. Tutkimuksen johtopäätöksistä nousi esille kolme merkittävää seikkaa. Vastuullisuusraportoinnin koettiin olevan hyödyllinen yritysvastuun mittaamisessa ja kehittämisessä. Kaikki yritykset eivät kuitenkaan olleet tätä mieltä ja osa koki raportoinnin saavan liian paljon huomiota nykypäivänä. Yritysten kokemat hyödyt vastuullisuuteen liittyen syntyivät pääosin reaktiivisesta vastuullisuudesta. Tässä kohdin on kuitenkin huomionarvoista mainita, että strategisen vastuullisuuden hyödyt olisivat saattaneet nousta paremmin esille pidemmän aikavälin tutkimuksessa. Yritysvastuun syntyä tukevia tekijöitä löytyi monia. Osa tekijöistä oli yrityksen ulkopuolisia kuten kansalaisjärjestöt ja media ja jotkut taas kumpusivat yrityksen sisältä esimerkiksi työntekijöiden ja johdon motivaatio.

International volunteers at a Costa Rican organic farm : sheepish volunteers, proud tourists and unwitting developers

This thesis analyzes the practices and experiences of two groups of Canadian volunteers who visited the organic fanning and "alternative development" project ofFinca la Flor (FLF) in central Costa Rica. Using both participant observation and in-depth interviews with volunteers and other people involved with FLF, I examine volunteers' understandings of their involvement with the fann. I argue that three discursive fonnations are instrumental in shaping this particular volunteering encounter. Specifically, interpretation of these Canadian volunteers' experiences inspires the argument that the emerging practice of international volunteering (or voluntourism) exists at the intersection of discourses of development, volunteering and tourism, all of which both reflect and maintain problematic North-South relationships. The analysis shows that in spite ofFLF's construction as an (alternative / sustainable) international-development project, and in spite of volunteers' initial conceptualization of their trip as "volunteering," volunteers tend to act and describe their time at FLF in ways that look more like tourism than like volunteer labor or international development. Likewise, although FLF claims to principally be focused on alternative development, and merely to open up this authentic development space to volunteers for their participation, the organization in both practice and discourse seems primarily to construct a tourist experience and cater to the needs of foreigners as tourists. Discourses of development and volunteering do infonn the practices offann personnel and volunteers at FLF, but they become subordinated to the more dominant discourse of tourism as the volunteers' and fann management's ideals of development and volunteering capitulate to become focused on satisfying volunteers' (perceived or "real") touristic desires. The FLF participants I studied may have entered the encounter as volunteers, but they departed the site having been tourists.

Some Incidents and Circumstances Written by William F. Haile in the Course of his Life, 1859

William Frederick Haile was born in Putney, Windham County, Vermont on November 4th, 1791. He was raised in Fairfield, Herkimer County, New York. At the age of 21 he entered the United States Army. He served in the War of 1812 as a lieutenant in the 11th United States Infantry. He was severely wounded in the Battle of Lundy’s Lane [not mentioned in this memoir]. After the war he settled in Plattsburgh, New York and became a lawyer. He was a judge from April 1837 to March of 1843. He was also the fifth collector of customs for the District of Champlain. He died on October 1861 at the age of 69. This document was written for the children of William Frederick Haile in January of 1859 [as noted on p.23]. The memoir ends in July of 1814 before the Battle of Lundy’s Lane. Haile’s memoir is laced with names of military personnel and he expresses his opinions freely.

Analyse des nouvelles formes organisationnelles hospitalières en émergence au Mali

Au Mali, une loi hospitalière a été adoptée en 2002 pour définir le cadre institutionnel d’une réforme majeure. Cette loi a décrété des transformations substantielles de la structure interne, tant administrative que clinique des établissements publics hospitaliers notamment l’implication des populations locales dans la prise de décision de l’établissement, l’autonomie administrative et financière à travers la délégation budgétaire et l’implication des professionnels de santé à la gestion, l’intégration des services de spécialité et la participation du secteur privé au service public hospitalier. Cependant, la capacité des hôpitaux à réussir les transformations prévues a été remise en question par la majorité des acteurs internes et externes. L’objectif de cette thèse a été d’étudier de quelle manière l’hôpital malien se transforme sous la pression de la décentralisation des pouvoirs de l’État et d’étudier comment les groupes d’acteurs réagissent face à ces changements à partir de deux cadres d’analyse. Le premier cadre intègre les caractéristiques essentielles des transformations hospitalières en termes de différents types de décentralisation et le second cadre inspiré des travaux de Crozier et coll. (1977) analyse les jeux de pouvoir entre les groupes d’acteurs hospitaliers selon deux niveaux à savoir un niveau stratégique et systémique. Pour cela, nous avons conduit une étude multiple de deux cas et utilisé trois modes de collecte des données à savoir les entrevues semi-structurées auprès des informateurs clés, l’analyse documentaire, et l’observation lors de réunions. Dans un premier temps, les analyses ont révélé pour les changements intervenus dans la structure, selon l’importance des responsabilités attribuées à l’hôpital public, (1) plusieurs variantes de la décentralisation. Globalement, l’intention politique était focalisée sur une délégation puis une déconcentration et une dévolution; les mécanismes mis en place ont penché plus vers une déconcentration puis une délégation et une dévolution tandis que les transformations réellement effectuées dans les établissements publics hospitaliers ont plutôt confirmé une déconcentration en plus d’une délégation particulièrement dans le cas de l’implication des populations locales dans la gestion hospitalière. Tandis que l’hôpital public pouvait faire des recettes à partir du recouvrement partiel des coûts des soins auprès des usagers, l’État gardait une main forte sur la gestion financière et la gestion du personnel, et définissait les directives et les objectifs à poursuivre. (2) Les analyses apportent une compréhension des liens existant entre les différents éléments du processus de réforme, le type de mécanisme mis en place dans le cadre de la réforme semble déterminer le type de transformation effectué selon les fonctions que peut assurer l’hôpital public. La logique traduit le passage de la délégation vers une déconcentration qui est jugée comme étant la forme la moins poussée d’une décentralisation. Dans un deuxième temps, les résultats confirment la présence de conflit entre les normes professionnelles établies et reconnues par les professionnels de santé et les normes organisationnelles et institutionnelles mises en avant par la réforme. Elles sont défendues par la majorité des gestionnaires qui sont imputables face aux autorités alors que les normes professionnelles dominent dans les services cliniques. Les deux cas ont mis en évidence le soutien de leur direction générale, il existait une tension dans les réactions des médecins, qui a été variable selon le type de changement structurel visé, tandis que les infirmiers se sont montrés plutôt accessibles face aux nouvelles mesures introduites par la réforme. L’une des originalités de cette thèse tient au fait que très peu de travaux sur les pays en développement ont tenté d’opérationnaliser de façon multidimensionnelle les concepts de décentralisation avant d’analyser les variantes susceptibles d’exister entre eux et les stratégies développées par les groupes d’acteurs de l’hôpital. En outre, alors que la pertinence de la prise en compte des caractéristiques du contexte organisationnel dans la mise en place des réformes des systèmes de soins est au cœur des préoccupations, ce travail est l’un des premiers à analyser l’influence de l’interaction entre le processus de réforme hospitalière et les prises de position des acteurs. Les résultats de cette thèse fournissent des recommandations aux décideurs politiques et aux gestionnaires quant aux modes de changement structurel à privilégier ou en éviter dans la planification, l’exécution et la mise en œuvre du processus de réforme hospitalière en fonction des caractéristiques du contexte organisationnel sanitaire. La planification de la réforme est essentielle : Élaborer un projet d’établissement discuté et validé par l’ensemble des acteurs de l’hôpital. Ce projet doit être compatible avec les objectifs du schéma d’organisation sanitaire nationale et déterminer les moyens en personnel et en équipements, dont l’hôpital doit disposer pour réaliser ses objectifs. Concevoir un cadre budgétaire et financier hospitalier flexible (qui va alléger la chaine de prise de décision), sur lequel reposera le nouveau système de gestion des hôpitaux. La capacité de mobilisation et d’exécution des ressources hospitalières devrait renforcer l’autonomie de gestion. Enfin, promouvoir une culture de l’évaluation et faciliter les évaluations périodiques de la mise en œuvre de la réforme hospitalière par des organismes d’évaluation externes et indépendants.

Optimisation des horaires des agents et du routage des appels dans les centres d’appels

Nous étudions la gestion de centres d'appels multi-compétences, ayant plusieurs types d'appels et groupes d'agents. Un centre d'appels est un système de files d'attente très complexe, où il faut généralement utiliser un simulateur pour évaluer ses performances. Tout d'abord, nous développons un simulateur de centres d'appels basé sur la simulation d'une chaîne de Markov en temps continu (CMTC), qui est plus rapide que la simulation conventionnelle par événements discrets. À l'aide d'une méthode d'uniformisation de la CMTC, le simulateur simule la chaîne de Markov en temps discret imbriquée de la CMTC. Nous proposons des stratégies pour utiliser efficacement ce simulateur dans l'optimisation de l'affectation des agents. En particulier, nous étudions l'utilisation des variables aléatoires communes. Deuxièmement, nous optimisons les horaires des agents sur plusieurs périodes en proposant un algorithme basé sur des coupes de sous-gradients et la simulation. Ce problème est généralement trop grand pour être optimisé par la programmation en nombres entiers. Alors, nous relaxons l'intégralité des variables et nous proposons des méthodes pour arrondir les solutions. Nous présentons une recherche locale pour améliorer la solution finale. Ensuite, nous étudions l'optimisation du routage des appels aux agents. Nous proposons une nouvelle politique de routage basé sur des poids, les temps d'attente des appels, et les temps d'inoccupation des agents ou le nombre d'agents libres. Nous développons un algorithme génétique modifié pour optimiser les paramètres de routage. Au lieu d'effectuer des mutations ou des croisements, cet algorithme optimise les paramètres des lois de probabilité qui génèrent la population de solutions. Par la suite, nous développons un algorithme d'affectation des agents basé sur l'agrégation, la théorie des files d'attente et la probabilité de délai. Cet algorithme heuristique est rapide, car il n'emploie pas la simulation. La contrainte sur le niveau de service est convertie en une contrainte sur la probabilité de délai. Par après, nous proposons une variante d'un modèle de CMTC basé sur le temps d'attente du client à la tête de la file. Et finalement, nous présentons une extension d'un algorithme de coupe pour l'optimisation stochastique avec recours de l'affectation des agents dans un centre d'appels multi-compétences.

Level Of Women Participation In Rural Development - A Comparative Study Of Governmental And Non-Governmental Organisations In Kerala

The study is intended to estimate the existing rate of participation of women beneficiaries in the development programmes of different organisations in Kerala. It would enable one to understand whether participation is at the satisfactory level or not. Given the rate of participation, the major thrust of the analysis is on the impact of governmental and non-governmental organisations on the rate of participation. This is undertaken under the assumption that NGOs, due to their proximity to people and their needs, ensure better participation rates. Besides the organisational differences, the other major determinants of women participation such as their socio-economic characteristics, psychological make up, the nature of the programme etc. are also highlighted. 0 Since the ascribed status of women in society is inferior, the role of organisers, development personnel and local leaders is also pointed out. Thus the basic objective of the study is women participation and its determinants in the development programmes