Sponge Mass Mortalities in a Warming Mediterranean Sea: Are Cyanobacteria-Harboring Species Worse Off?

Mass mortality events are increasing dramatically in all coastal marine environments. Determining the underlying causes of mass mortality events has proven difficult in the past because of the lack of prior quantitative data on populations and environmental variables. Four-year surveys of two shallow-water sponge species, Ircinia fasciculata and Sarcotragus spinosulum, were carried out in the western Mediterranean Sea. These surveys provided evidence of two severe sponge die-offs (total mortality ranging from 80 to 95% of specimens) occurring in the summers of 2008 and 2009. These events primarily affected I. fasciculata, which hosts both phototrophic and heterotrophic microsymbionts, while they did not affect S. spinosulum, which harbors only heterotrophic bacteria. We observed a significant positive correlation between the percentage of injured I. fasciculata specimens and exposure time to elevated temperature conditions in all populations, suggesting a key role of temperature in triggering mortality events. A comparative ultrastructural study of injured and healthy I. fasciculata specimens showed that cyanobacteria disappeared from injured specimens, which suggests that cyanobacterial decay could be involved in I. fasciculata mortality. A laboratory experiment confirmed that the cyanobacteria harbored by I. fasciculata displayed a significant reduction in photosynthetic efficiency in the highest temperature treatment. The sponge disease reported here led to a severe decrease in the abundance of the surveyed populations. It represents one of the most dramatic mass mortality events to date in the Mediterranean Sea

La representació de la figura humana com a eina d'estudi dels dibuixos infantils

Aquest treball pretén apropar-nos al dibuix infantil a través d’una investigació que s’ha dut a terme amb infants d’edats compreses entre els 3 i 5 anys. Podrem observar si actualment, en el nostre context social, els infants segueixen unes etapes evolutives del dibuix i si l’estimulació de l’entorn influeix per accelerar-ne el procés. El tipus de recerca que s’ha dut a terme és principalment de caire qualitatiu. També hi ha, però, una part de dades quantitatives. Els resultat obtinguts s’han posat en relació amb el marc teòric presentat en la investigació i se n’han pogut extreure unes conclusions.

Impact of the Femoral Head Position on Moment Arms in Total Hip Arthroplasty: A Parametric Finite Element Study.

BACKGROUND: Although the importance of accurate femoral reconstruction to achieve a good functional outcome is well documented, quantitative data on the effects of a displacement of the femoral center of rotation on moment arms are scarce. The purpose of this study was to calculate moment arms after nonanatomical femoral reconstruction. METHODS: Finite element models of 15 patients including the pelvis, the femur, and the gluteal muscles were developed. Moment arms were calculated within the native anatomy and compared to distinct displacement of the femoral center of rotation (leg lengthening of 10 mm, loss of femoral offset of 20%, anteversion ±10°, and fixed anteversion at 15°). Calculations were performed within the range of motion observed during a normal gait cycle. RESULTS: Although with all evaluated displacements of the femoral center of rotation, the abductor moment arm remained positive, some fibers initially contributing to extension became antagonists (flexors) and vice versa. A loss of 20% of femoral offset led to an average decrease of 15% of abductor moment. Femoral lengthening and changes in femoral anteversion (±10°, fixed at 15°) led to minimal changes in abductor moment arms (maximum change of 5%). Native femoral anteversion correlated with the changes in moment arms induced by the 5 variations of reconstruction. CONCLUSION: Accurate reconstruction of offset is important to maintaining abductor moment arms, while changes of femoral rotation had minimal effects. Patients with larger native femoral anteversion appear to be more susceptible to femoral head displacements.

The effects of ICT on school: teachers’ and students’ perspectives

The purpose of this study was to investigate the effects of information and communication technology (ICT) on school from teachers’ and students’ perspectives. The focus was on three main subject matters: on ICT use and competence, on teacher and school community, and on learning environment and teaching practices. The study is closely connected to the national educational policy which has aimed strongly at supporting the implementation of ICT in pedagogical practices at all institutional levels. The phenomena were investigated using a mixed methods approach. The qualitative data from three cases studies and the quantitative data from three statistical studies were combined. In this study, mixed methods were used to investigate the complex phenomena from various stakeholders’ points of view, and to support validation by combining different perspectives in order to give a fuller and more complete picture of the phenomena. The data were used in a complementary manner. The results indicate that the technical resources for using ICT both at school and at homes are very good. In general, students are capable and motivated users of new technology; these skills and attitudes are mainly based on home resources and leisuretime use. Students have the skills to use new kinds of applications and new forms of technology, and their ICT skills are wide, although not necessarily adequate; the working habits might be ineffective and even wrong. Some students have a special kind of ICT-related adaptive expertise which develops in a beneficial interaction between school guidance and challenges, and individual interest and activity. Teachers’ skills are more heterogeneous. The large majority of teachers have sufficient skills for everyday and routine working practices, but many of them still have difficulties in finding a meaningful pedagogical use for technology. The intensive case study indicated that for the majority of teachers the intensive ICT projects offer a possibility for learning new skills and competences intertwined in the work, often also supported by external experts and a collaborative teacher community; a possibility that “ordinary” teachers usually do not have. Further, teachers’ good ICT competence help them to adopt new pedagogical practices and integrate ICT in a meaningful way. The genders differ in their use of and skills in ICT: males show better skills especially in purely technical issues also in schools and classrooms, whereas female students and younger female teachers use ICT in their ordinary practices quite naturally. With time, the technology has become less technical and its communication and creation affordances have become stronger, easier to use, more popular and motivating, all of which has increased female interest in the technology. There is a generation gap in ICT use and competence between teachers and students. This is apparent especially in the ICT-related pedagogical practices in the majority of schools. The new digital affordances not only replace some previous practices; the new functionalities change many of our existing conceptions, values, attitudes and practices. The very different conceptions that generations have about technology leads, in the worst case, to a digital gap in education; the technology used in school is boring and ineffective compared to the ICT use outside school, and it does not provide the competence needed for using advanced technology in learning. The results indicate that in schools which have special ICT projects (“ICT pilot schools”) for improving pedagogy, these have led to true changes in teaching practices. Many teachers adopted student-centred and collaborative, inquiry-oriented teaching practices as well as practices that supported students' authentic activities, independent work, knowledge building, and students' responsibility. This is, indeed, strongly dependent on the ICT-related pedagogical competence of the teacher. However, the daily practices of some teachers still reflected a rather traditional teacher-centred approach. As a matter of fact, very few teachers ever represented solely, e.g. the knowledge building approach; teachers used various approaches or mixed them, based on the situation, teaching and learning goals, and on their pedagogical and technical competence. In general, changes towards pedagogical improvements even in wellorganised developmental projects are slow. As a result, there are two kinds of ICT stories: successful “ICT pilot schools” with pedagogical innovations related to ICT and with school community level agreement about the visions and aims, and “ordinary schools”, which have no particular interest in or external support for using ICT for improvement, and in which ICT is used in a more routine way, and as a tool for individual teachers, not for the school community.

PK-YRITYKSET INNOVAATTOREINA : Satunnaisista parannuksista kohti innovaatioiden virtaa. Yhteenveto tutkimusraportista, 3/2009

Tämän tutkimuksen tarkoituksena oli selvittää, minkälaisia innovaatioita eri toimialojen pienissä yrityksissä on kehitetty ja minkälaisia kyvykkyyksiä se on edellyttänyt. Lisäksi tavoitteena oli selvittää, kuinka suotuisana ympäristönä yritykset kokivat oman alueensa ja miten alueiden kehittämistyö on vaikuttanut yritysten kykyyn kilpailla. Teoreettiset oletukset perustuvat aikaisempiin tutkimuksiin innovaatiojohtamisen, yrittäjyyden ja pk-yritysten liiketoiminnan kehittämisen alueilta. Empiirinen aineisto on kerätty sähköpostikyselyllä tuottaen 733 kriteerit täyttävää vastausta. Kyselytutkimusta edelsi neljän alueen tapaustutkimus, jonka aikana luotiin teoreettinen rakennelma pienten yritysten innovaatiokyvykkyyden arvioimiseksi. Tämän tutkimuksen aineisto ei tue yleistä väitettä, jonka mukaan innovaatiotoiminta olisi harvinaisempaa tai vähäisempää kooltaan pienemmissä yrityksissä. Kokoa enemmän näyttäisi vaikuttavan innovaatiotoiminnan luonne ja siihen kytkeytyvä kyvykkyys. Yritysten innovaatio-toiminnan luonteen ja laajuuden perusteella tuloksista nousee neljä erilaista innovaattoriprofiilia: satunnainen parantaja, jatkuva parantaja, radikaali uudistaja ja monipuolinen kehittäjä. Innovaatiokyvykkyyttä tutkittiin seitsemän eri osatekijän suhteen. Eri profiilit omaavien yritysten kyvykkyyden tasot erosivat toisistaan merkittävästi. Tulokset vahvistavat käsityksiä siitä, että yksittäisen kyvykkyystekijän sijaan kyvykkyyskombinaatio vaikuttaa enemmän innovatiotoiminnan monipuolisuuteen. Innovaatiotoiminnan lisääntyessä ja monipuolistuessa, yritysten kyvykkyys-vaatimukset kasvavat kaikkien osatekijöiden suhteen. Yritykset ovat tiedostaneet innovaatio-kyvykkyyden kehittämisen tarpeet. Kyvykkyys on ajuri, jonka kyydissä pienet ja suuret innovaatiot syntyvät. Tämä tutkimus suosittelee, että innovaatiokyvykkyyden kehittäminen nostetaan näkyväm-mäksi tavoitteeksi. Pienissä yrityksissä luontevin tapa vahvistaa kyvykkyyksiä on integroida se yrityksen kehittämistoimintaan johtaen itse itseään ruokkivaksi prosessiksi. Haasteelliset kehittämis-tavoitteet edellyttävät monipuolista kyvykkyyksien vahvistamista ja vahvistuneet kyvykkyydet mahdollistavat entistä haastavampien kehittämistavoitteiden asettamisen. Parhaimmillaan tämä prosessi johtaa pienelle yritykselle soveltuvaan onnistumisen spiraaliin, joka samanaikaisesti kiihdyttää sekä kyvykkyyksien että innovaatioiden kehittämistä - tuotoksena jatkuva ja monipuolinen innovaatioiden virta. Tulokset vahvistavat ensimmäisessa vaiheessa toteutetun tapaustutkimuksen havaintoja siitä, että alueiden kehittämistyöstä hyötyvät yritykset, joiden kyvykkyystekijät ovat entuudestaan korkeaa tasoa. Pitkälle tuotteistetut julkiset palvelut soveltuvat parhaiten suuremmille yrityksille, joissa kehittämistoiminta on projektoitu ja kehittämistyö tehdään erillisten resurssien turvin. Sitä vastoin, valtaosassa pieniä yrityksiä kehittämistyö tapahtuu tavanomaisen liiketoiminnan ohessa ja samoilla resursseilla. Alueet tarjoavat varsin runsaasti luonteeltaan epäjatkuvia palveluja kohdistuen yksittäisten kyvykkyystekijöiden parantamiseen tai prosessin yksittäiseen vaiheeseen, usein innovaatioprosessin alkupäähän radikaalin innovaation kehittämiseksi. Tämän kyselyn tulokset suosittelevat myös toista reittiä: vahvistetaan ensin yritysten innovaatiokyvykkyyttä jatkuvaan pieniä askelia ottavaan innovaatiotoimintaan, josta matka jatkuu radikaalien uudistusten kautta moni-puoliseksi kehittämiseksi.

PhD Students’ Research Group Networks: a Qualitative Approach

This article examines the networks within the research groups where Spanish PhD students are pursuing their doctorate. Capó et al. (2007) used quantitative data to predict PhD students’ publishing performance from their background, attitudes, supervisors’ performance and research group networks. Variables related to the research group network had a negligible explanatory power on student performance once the remaining variables had been accounted for. In this article, a qualitative follow up of the same students is carried out using extreme case sampling and indepth interviews. The qualitative research shows networking as important for students. Out of the 115 aspects that students mention in the interviews as relevant to publishing in the qualitative research, 92 have to do with their supervisors, their research group or their network as a whole. Similarly, out of the 50 hindrances mentioned, 20 have to do with the networks or relations. The most commonly mentioned network-related topics are research group members pushing PhD students to publish, meeting researchers outside the research group, existence of other PhD students in the group, help with the PhD from group members, supervisor’s interest in the thesis, the possibility of discussing with experts on the PhD’s topic and frequent contact with the supervisor and research group members. Some of these characteristics were not, however, measured in the conventional quantitative social network survey

Managing through measurement : A framework for successful operative level performance measurement

The research around performance measurement and management has focused mainly on the design, implementation and use of performance measurement systems. However, there is little evidence about the actual impacts of performance measurement on the different levels of business and operations of organisations, as well as the underlying factors that lead to a positive impact of performance measurement. The study thus focuses on this research gap, which can be considered both important and challenging to cover. The first objective of the study was to examine the impacts of performance measurement on different aspects of management, leadership and the quality of working life, after which the factors that facilitate and improve performance and performance measurement at the operative level of an organisation were examined. The second objective was to study how these factors operate in practice. The third objective focused on the construction of a framework for successful operative level performance measurement and the utilisation of the factors in the organisations. The research objectives have been studied through six research papers utilising empirical data from three separate studies, including two sets of interview data and one of quantitative data. The study applies mainly the hermeneutical research approach. As a contribution of the study, a framework for successful operative level performance measurement was formed by matching the findings of the current study and performance measurement theory. The study extents the prior research regarding the impacts of performance measurement and the factors that have a positive effect on operative level performance and performance measurement. The results indicate that under suitable circumstances, performance measurement has positive impacts on different aspects of management, leadership, and the quality of working life. The results reveal that for example the perception of the employees and the management of the impacts of performance measurement on leadership style differ considerably. Furthermore, the fragmented literature has been reorganised into six factors that facilitate and improve the performance of the operations and employees, and the use of performance measurement at the operative level of an organisation. Regarding the managerial implications of the study, managers who operate around performance measurement can utilise the framework for example by putting the different phases of the framework into practice.

Expectations and Experiences of International Students in Information Technology Department

Education in Finland plays a significant role. International students are becoming an essential part of Finnish Educational system. The study was meant to examine their expectations and experiences in a Finnish University. As a case, Lappeenranta University of Technology (LUT) was chosen and, in particular, Information Technology (IT) Department. The main objectives of the study were to examine students’ satisfaction of their study experiences, their evaluation of the teaching quality of courses and last but not least the cultural impact on those. Data for the study were mainly collected with the help of three Internet surveys from a sample of 50 students – currently studying at LUT or already graduated. Response rate from questionnaire to questionnaire varied, however, still close to average and was considered as good and relevant enough. The study was initially meant as qualitative, however, a number of quantitative data analysis methods were used as well. Most of students’ expectations appear to become true, majority of students are satisfied with their experiences. Results show that teaching quality in LUT is evaluated as ‘good’. Nevertheless, students prefer particular courses to the other ones. In conclusion, it can be said that culture does affect students’ expectations, experiences, perception of the world, however, cultural differences do not cause any serious problems.

Clinical reasoning of medical students in a public university in Brazil

The aim of this research was to understand the reasoning developed by medical students in a public university in Brazil. This research on education included semi-structured interviews and film recordings of interns discussing 10 clinical cases. A sample of 16 interns analyzed cases presented on a notebook computer with a webcam. They were instructed to verbalize all their thoughts on the procedures they would use. The film recordings and transcripts of the interviews were analyzed. Quantitative data was evaluated using Yates' chi-squared test and speech analysis was used to evaluate the transcripts. The theme worked on in the practice of reasoning was: the student's perceptions of their clinical practice. Of the 160 diagnoses, 57% were done with analytical reasoning and 43% with non-analytical reasoning. The hypothetical deductive method was employed by 31% of the interns and the inductive method was employed by 69%. The diagnostic accuracy was 81% correct for easy cases and 85% correct for difficult cases. We observed two empirical categories: the cognitive universe of the student and the patient's context.

Kuinka tutkia eläinten käyttäytymistä luonnossa?

Kirjallisuusarvostelu

Network effects: Scale development and implications for new product performance

More and more innovations currently being commercialized exhibit network effects, in other words, the value of using the product increases as more and more people use the same or compatible products. Although this phenomenon has been the subject of much theoretical debate in economics, marketing researchers have been slow to respond to the growing importance of network effects in new product success. Despite an increase in interest in recent years, there is no comprehensive view on the phenomenon and, therefore, there is currently incomplete understanding of the dimensions it incorporates. Furthermore, there is wide dispersion in operationalization, in other words, the measurement of network effects, and currently available approaches have various shortcomings that limit their applicability, especially in marketing research. Consequently, little is known today about how these products fare on the marketplace and how they should be introduced in order to maximize their chances of success. Hence, the motivation for this study was driven by the need to increase our knowledge and understanding of the nature of network effects as a phenomenon, and of their role in the commercial success of new products. This thesis consists of two parts. The first part comprises a theoretical overview of the relevant literature, and presents the conclusions of the entire study. The second part comprises five complementary, empirical research publications. Quantitative research methods and two sets of quantitative data are utilized. The results of the study suggest that there is a need to update both the conceptualization and the operationalization of the phenomenon of network effects. Furthermore, there is a need for an augmented view on customers’ perceived value in the context of network effects, given that the nature of value composition has major implications for the viability of such products in the marketplace. The role of network effects in new product performance is not as straightforward as suggested in the existing theoretical literature. The overwhelming result of this study is that network effects do not directly influence product success, but rather enhance or suppress the influence of product introduction strategies. The major contribution of this study is in conceptualizing the phenomenon of network effects more comprehensively than has been attempted thus far. The study gives an augmented view of the nature of customer value in network markets, which helps in explaining why some products thrive on these markets whereas others never catch on. Second, the study discusses shortcomings in prior literature in the way it has operationalized network effects, suggesting that these limitations can be overcome in the research design. Third, the study provides some much-needed empirical evidence on how network effects, product introduction strategies, and new product performance are associated. In general terms, this thesis adds to our knowledge of how firms can successfully leverage network effects in product commercialization in order to improve market performance.

The Role of a firm’s mindset in international success - case study of Finnish marine industry firms

This thesis investigates the influence of a firm’s mindset on international success in the context of the Finnish marine industry. The study draws theoretical wisdom from organisational behaviour and strategic management literatures. The research aim set for this study was to identify and categorise existing strategic types based on mindsets found in the marine industry SMEs, and to link the influence of mindsets with success by examining the role of mindsets in a firm’s performance. Mindsets of firms were conceptualised as aggregate collections of perceptions that influence how the surrounding environment is discerned by the members of the firm. Mindsets are idiosyncratic to firms and therefore important firm-specific resources which influence decision-making and can be observed through the strategic behaviour of firms. Qualitative case study method was applied which was further supported by quantitative data on the financial performance of the ten case firms. Taxonomy based on the dimension of mindsets and prediction was developed to demonstrate four ideal types of firms identified within the marine industry. It was found that all of the case firms emphasised adaptation in their strategy while planning was emphasised to a varying degree. Moreover, two different methods of adapting were found; proactive and reactive. Firms which plan in the long-term and adapt proactively constantly investigate whether their plans are synchronous with the realities of the market; by having an open mindset, a firm’s perception of the reality of the market is enabling the firm to develop value creating strategies which are superiorly informed.This finding was supported by the financial data and led to the proposition that having an open mindset and placing a high level of emphasis on prediction may have a positive influence on international success. Also, it was proposed that concentrating only on exploiting business opportunities in the present time and not exploring any addition opportunities can have a negative influence on the firm’s performance, even if the mindset of the firm is open.

The Influence of Network Competence on Internationalization of SMEs

This study focuses on the relationship between organizational network competence and the internationalization process of small- and medium sized enterprises (SMEs). Over recent decades, the global business environment has become increasingly conducive to internationalization of small firms. A central facilitating factor in the process has been the emergence of networked business relationships between internationalizing firms. Research on SME internationalization has found that certain types of structures and dynamics of business networks allow SMEs access to the resources they need to enter foreign markets. This consequently means that their internationalization often becomes to depend on the networks they are embedded in. However, research so far has mostly ignored the possibility that the organizational ability to develop and manage business network relationships, network competence, may be a major underlying factor in determining how well SMEs can leverage their network relationships to enter foreign markets and consequently may determine in large part how successful their internationalization process turns out to be. This study aims to respond to those gaps, by empirically examining how the development of network competence in internationalizing SMEs influences the internationalization outcomes that they can expect, and how such network competence is conceptualized and developed. Using a mixed methods approach, survey data collected from 298 Finnish SMEs across five industry sectors is first used to examine how levels of network competence are related to internationalization propensity of SMEs and their subsequent international performance, growth and profitability as internationally operating firms. In order to illustrate in more detail the ways in which network competence is conceptualized and how it develops during the internationalization process of an SME, qualitative data from internationally operating Finnish SMEs are used. Longitudinal interview data of an internationalizing Finnish SME is accompanied by data gathered through a series of semistructured interviews of Finnish and Russian managers involved in mutual business relationship dyads. Structurally, this thesis examines the research issue as an article-based dissertation, consisting of five journal and conference publications. Three of these publications are based on the quantitative data, and the remaining two apply the qualitative interview data. The results find several aspects where network competence has a positive influence on the success of internationalizing SMEs, how it develops and what it entails conceptually in this context. Quantitatively, the level of network competence is found to have a positive relationship to various internationalization outcomes, including the propensity of SMEs to enter foreign markets and on their subsequent international performance, their growth and their profitability. Additionally, the positive relationship is divided between the relationship-specific and cross-relational dimension of network competence, in that the influence of the former is relevant for the propensity to internationalize, while the latter is for the growth and profitability of the already internationalized SMEs. Qualitatively, the results suggest, firstly, that the development process of network competence does not necessarily precede the start of the internationalization process, but may occur through a gradual learning process alongside it. And secondly, the results also imply that the conceptualization of network competence by Finnish managers of internationally operating Finnish SMEs is structurally distinct from that of their culturally distinct partner managers in Russia. This study contributes to the literature on SME internationalization in several ways. Firstly, it introduces operationalized organizational competencies to the literature on internationalization of SMEs, which has so far mainly examined the influence of business networking on the internationalization process without having such an organizational viewpoint. Furthermore, this study provides a multi-level analysis of the determinants of successful SME internationalization, by examining various strategic and performance outcomes across the process. These results also contribute to the literature on organizational strategy of internationalizing SMEs, by clarifying how different dimensions of business networking may be optimal in different phases of the internationalization process. Conceptually, the results of this study contribute to the literature on competence development and SME internationalization, by illustrating how the development process of network competence may occur during internationalization process. Thus, they also contribute to the discussion on how SMEs are able to influence the dynamics and structures of their business networks over time. Finally, this study contributes to the literature on the role of culture in the internationalization process, by implying that the cultural background of the manager of the SME may determine whether business networking and network competence is seen as an organizational-level or an individual level capability. The study also includes some additional contributions to the literature on dynamic capabilities in strategic management, and on that of strategic business networks. These include further clarifying the exact nature and tangibility of dynamic capabilities, and being one of the first studies to introduce constructs from both dynamic capabilities and business network literature to the field of international entrepreneurship. And finally, the study also has some contribution on the two streams of literature, in illustrating how both dyadic and network-level capabilities may be relevant, depending on the current strategic goals and market position of the firm. Keywords: network competence, internationalizatio

Liiketoiminnan strateginen suunnittelu: Konesali-liiketoiminta

Tässä diplomityössä selvitettiin tukkuliikkeen liiketoimintamahdollisuuksia konesali-liiketoiminnassa. Päätutkimuskysymys oli: Millainen liiketoimintamalli soveltuu kestävään arvontuotantoon tukkuliikkeelle konesali-liiketoiminnassa? Työn teoriaosassa paneudutaan strategiseen suunnitteluun, liiketoimintamalleihin ja liiketoimintamallien suunnitteluun. Teoriaosan pohjalta johdettiin vaatimukset ja luotiin viitekehys liiketoimintamallien suunnittelulle. Ongelmanratkaisu aloitettiin toimintaympäristön analyysillä, jonka pohjalta tunnistettiin liiketoimintamahdollisuuksia. Kerättyä dataa analysoitiin erilaisilla analysointimenetelmillä liikemahdollisuuksien tunnistamiseksi. Tämän jälkeen tunnistettuja liiketoimintamahdollisuuksia arvioitiin ja kaikkein potentiaalisimmat ideat kehitettiin liiketoimintamalleiksi. Työn varsinaiset tulokset jakautuvat kolmeen osaan: Toimintaympäristön analyysiin, kehitettyihin konsepteihin ja suunnitelmaan konseptien käyttöönotosta. Toimintaympäristön analyysi sisältää makro- ja mikroympäristön analysoinnin, joita voidaan hyödyntää, jos jokin liiketoimintamalleista päätetään ottaa käyttöön. Toimintaympäristön analyysin perusteella voidaan tehdä johtopäätös, etteivät tukkuliikkeen resurssit sovellu perinteiseen konesaliliiketoiminnan arvontuotantoon. Tutkimuksen tärkein tulos on kuitenkin kehitetyt liiketoimintamallit, jotka pystyvät hyödyntämään olemassa olevia resursseja ja silti olemaan kilpailukykyisiä konesali-liiketoiminnassa.

Yleislääkärin vastaanottotapahtuma - näkökulmia laatuun

Tutkimuksen tavoitteena oli tutkia yleislääkärin vastaanottotapahtuman laadun eri ulottuvuuksia, erityisesti lääkärin ja potilaan arvioita vastaanottotapahtuman laadusta, sekä verrata näitä arvioita keskenään. Lisäksi tarkoituksena oli tutkia palkkausjärjestelmän yhteyttä laatuun sekä löytää sopivia välineitä yleislääkärin vastaanottotapahtuman laadun arviointiin. Tutkimuksessa käytettiin triangulaatiota sekä materiaalien, tutkijoiden että menetelmien osalta. Materiaali koostui kyselylomakkeista (2191 vastaanottotapahtumaa, 2167 lääkärin lomaketta ja 1777 potilaan lomaketta), potilasasiakirjoista (n=175) ja vastaanottotapahtumien videoinneista (n=20). Analyysissä käytettiin sekä kvantitatiivisia että kvalitatiivisia menetelmiä. Laatu koostuu tässä tutkimuksessa tieteellisteknisestä/ammatillisesta osaamisesta, vuorovaikutustaidoista ja taloudellisesta laadusta. Kaikki osatekijät olivat kyselylomaketutkimuksen perusteella varsin hyviä, ja potilaat arvioivat laadun kaikki osatekijät paremmiksi kuin lääkärit. Potilaiden selviytyminen ja voimaantuminen vastaanottotapahtuman jälkeen oli parempaa, mikäli he pitivät vuorovaikutuksen laatua hyvänä ja lääkäriä omalääkärinään. Kyselylomaketutkimus antoi laadusta kuitenkin positiivisemman kuvan kuin tutkijoiden potilasasiakirjojen ja videointien avulla tekemät arviot. Potilasasiakirjat oli laadittu puutteellisesti ja potilasasiakirjajärjestelmät vaikuttivat postilaisasiakirjojen laatuun. Tutkijoiden arvioimana lääkäreiden vuorovaikutustaidot olivat keskimäärin tyydyttävät. Lääkärin virkaehtosopimus ei näyttänyt vaikuttavan potilaan kokemaan laatuun, mutta väestövastuulääkärit kokivat sekä oman työnsä ammatillisen laadun että vuorovaikutustaitonsa paremmaksi kuin muut lääkärit. Väestövastuuterveyskeskuksissa myös hoidon jatkuvuus ja potilaan valinnanvapaus näyttivät toteutuvan muita terveyskeskuksia paremmin. Yleislääkärin työn laadun arviointiin tarvitaan useita menetelmiä. Potilasasiakirjajärjestelmien tulisi olla helppokäyttöisiä, interaktiivisia ja tietoa automaattisesti kerääviä, jotta niistä saataisiin luotettavaa tietoa laadun arvioimiseksi. Lääkärin työn itsearviointia on edelleen tutkittava ja kehitettävä.