This study’s aim is to examine how companies integrate their multiple CRM channels to enhance the relationships with the customers. A qualitative method was used and the collection of data was conducted from eleven interviews. The interviews were semi-structured with open-ended questions. The theory is written in three main themes; customer relationship management, channels of communication and multichannel integration. Empirical findings and the analysis also follows these themes. The study is ending with conclusions. What is affecting companies channel selection depends on what message companies want to send, but also whether if it is existing or new potential customers’ that are targeted. The geographical factor also influences the channel selection. Channel decision further depends on the size of the companies, if it is business to business or business to consumer and what kind of product the company is selling. More complex products require more personal interactions. How to successfully implement a multichannel integration strongly depends on the quality of data, an organizational common interpretation of customer relationship management, integration of information from all departments and that the company has an easy, yet powerful system for the accessible data. This study helps to give an understanding of how the multichannel integration is done in a business to business company with complex products. The study can be applied on other companies using a multichannel integration. It can help managers to understand the importance of the multichannel integration, how to succeed and other important factors for a successful multichannel integration. It also contributes to an understanding of the critical factors of the multichannel integration.  A framework with an alternative model of multichannel integration is presented. The study also presented that the process of multichannel integration is of great importance and emphasized by a leading company in the field of customer relationship management. This study therefore has succeeded in giving an easy, more powerful and greater picture of the multichannel integration, which is an important determined factor for building customer relationships. A figure (figure 10) is provided for other companies to use that are business to business with complex products. This study is a case study with a qualitative research approach, the studied company is a business to business company with complex products. The study is made from the company’s perspective. Future research can be conducted by studying multichannel integration from the customers’ perspective instead of the company’s perspective. The study could have been conducted on more than one company to compare the results, or on a business to consumer company instead of a business to business company. Studies on multichannel integration can also be interesting regarding companies that are selling less complicated products. Finally, studies can be conducted regarding the “information overflow” from social media.

Stress and mental health issues are now the most common cause of workplace absence. Increasing evidence points to the need for organisations to take steps to enhance well-being at work for employees. Social support has been identified as one key factor affecting employee psychological well-being, however, the definition and conceptualisation of the term continues to be debated. To date, research examining the relationship between social support and well-being at work tends to be predominantly quantitative and to prioritise work-based sources of support above other sources of support. Few workplace interventions aimed at improving employee well-being appear to have a specific focus on enhancing social support. This thesis presents findings from a mixed-methods case study of a large, public sector organisation in Scotland. The study had four phases: an online survey (n=158), semi-structured interviews (n=31), a diary phase (n=11) and a final interview (n=11). Higher levels of social support were associated with a higher level of psychological well-being. Findings highlighted the importance of various work and non-work based sources of social support, such as peer support and support from friends, and various dimensions of support too, such as ‘distant vs. proximal’ support. Potential negative effects of social support were also identified, for example, when perceived as interfering. Women reported higher levels of support and of positive mental well-being than did men. Interview and diary data revealed a range of contextual, organisational and individual factors that affected both access to and availability of social support, and the relationship between social support and employee well-being. Recent organisational changes appeared to be particularly influential. Employee opinion regarding existing organisational well-being initiatives varied on the basis of whether the support was formal or informal and in terms of perceived versus received support. Social support was valued highly by respondents with regard to improving employee well-being. Open and honest communication, physical presence of support and familiarity with context-specific knowledge were of particular pertinence. This thesis contributes to knowledge in three ways. Substantively, the importance of examining social support more holistically is highlighted in order to better understand the relationship between social support and employee well-being. Methodologically, this mixed methods approach proved fruitful in generating a richness and depth of data largely untapped by previous, predominantly quantitative, studies. Finally, the findings have practical implications for HR personnel and policy makers as they offer an insight into the contribution of various sources and dimensions of social support to employee well-being, as understood by employees.

Aims: The aims of this thesis were focused on the social climate of inpatient forensic mental health settings. Firstly, the study reviewed the literature of qualitative studies of staff and patient experiences of social climate. Secondly, the utility of a case study methodology to examine innovations to practice in forensic mental health settings are discussed. Thirdly, a longitudinal case study aimed to examine the impact of a Mentalization based treatment (MBT) training and case consultation intervention on the functioning of a low secure ward. Method: A systematic review and qualitative synthesis of social climate in forensic mental health settings was completed using the ‘best-fit’ framework approach. Secondly, a critical analysis of case study methodology was presented based on key decision points. A longitudinal ward case study with staff (n=37) and patient (n=7) participants examined the impact of staff MBT training and MBT based case consultation sessions. MBT based case consultation sessions ran on the ward over an eight month period. Data was collected through a range of methods including questionnaires, semi-structured interviews, ward observations and routinely reported data. The case study data was tested through a pattern matching approach with reference to rival explanations. Results: The systematic review identified 20 papers that met the inclusion criteria. The framework synthesis identified 22 themes related to social climate, which were organised in a conceptual model. Ten themes were seen to represent the experience of social climate. Consideration of the applicability of the case study method to forensic settings found the method to be feasible and acceptable to staff though a limitation is that outcomes are tentative and open to rival explanations. Positive impacts of the training and case consultation intervention included an increase in enthusiasm for working with patients with a personality disorder diagnosis and evidence of some increased team cohesion. The main rival explanation identified was the impact of changes to the composition of the staff and patient group. Conclusions: The systematic review findings highlight that current quantitative measures of social climate may not fully represent the construct. The conceptual model developed allows for generation of potential interventions to improve social climate. In the case study, staff reported positive perspectives of both MBT training and the case consultation sessions. The intervention did not appear to impact on patient motivation, though patients reported positive changes in staff behaviour. The case study method was seen as applicable to forensic mental health settings and provided interpretable data useful for analytical generalisations, and clinically in considering innovations to practice.

This research examined which factors of influence contributed towards efficacious systemic leadership development, within case studies in the energy and military sectors, and identified and explained common underlying themes and factors which could help formulate future interventions, as well as enhance extant theoretical knowledge. The literature showed that key challenges exist in identifying what contribution leadership development makes to enhancing organisational leadership, and as such, social capital and systemic development. To focus the research, specific definitions were constructed, as to what sort of effective leadership positively impacts upon organisational leadership; which cardinal themes of leadership development traverse interventions, namely Delivery, Contextualisation, Performance, Impact and Values integration; and what constitutes systemic leadership development. A Social Constructivist position was adopted which explains the nature of the phenomena underlying systemic leadership development.

The use of tobacco has been a known contributing factor in the development of disease and death since the 1960s. Unfortunately, evidence-based tobacco cessation protocol is still not effectively being taught in healthcare curriculum as evidenced by the lack of clinical competencies in many institutions. The purpose of this study was to gain an in-depth understanding of the process dental hygiene program directors use to adopt and implement tobacco dependence information into their curricula. Gaining a clearer idea of how and why dental hygiene faculty diffuse tobacco curriculum may inform future dissemination efforts leading to improved adoption and implementation of evidence-based information in healthcare education. A total of ten, one hour interview data sets of US dental hygiene program directors were chosen for this study. They were selected from a possible 14 interviews collected from a larger research project consisting of 32 one hour interview data sets. A case study research methodology was used to guide the collection of interviews. The Diffusion of Innovation, Five Stages in the Innovation Process in Organizations (Rogers, 2003) was used as the theoretical framework to inform the extraction of themes and patterns. The analysis of interview data revealed that all ten program directors reported a similar process of: learning about tobacco cessation, discussing the topic in a faculty meeting, deciding what class the topic should be taught, and that cessation should be a part of the clinical experience. What was not evident from these interviews was how and why the evidence-based tobacco cessation guideline was reduced from five essential elements to minimal implementation by most of the ten schools. Though the process of how dental hygiene programs learn of and implement tobacco cessation into their curriculum, further research is needed to explore how faculty make decisions on content and level of clinical competencies when new innovations are introduced into their program.

INTRODUCTION: Adolescent Idiopathic Scoliosis (AIS) is one of the most common spinal abnormalities in children, affecting 2% to 3% of adolescents in the United States. Its cause remains unclear. Many previous studies conclude that AIS may be caused by a combination of genetic and environmental factors, with very few consistencies. Severe scoliosis is usually treated with corrective surgery, and the etiology of post-surgical pain is even more unclear and has the opportunity to affect the patient well into adulthood. STUDY AIMS: By following a monozygotic twin pair with identical DNA, our retrospective case study can control for genetic disposition, and can look toward other possible causes for the pain the patients experienced. This study attempts to shed light on the complexities of AIS and pain with a focus on environmental and psychosocial factors. CASE PRESENTATION: We present a single pair of monozygotic twins treated for AIS with comparable spinal fusion surgeries performed at a large northeast urban children's hospital. Twin A and Twin B were initially treated with a brace for their scoliosis. Despite bracing, their curves progressed and warranted spinal fusion, with Twin A having a Cobb angle of 53°, and Twin B with 50°. The surgery was conducted simultaneously at the age of 13 by two different orthopedic surgeons. At age 7.5, Twin B was treated for Ebstein's anomaly of the tricuspid valve and significant dysrhythmias. METHODS: After the patients were discharged, a comprehensive retrospective chart review of the patients' pre-op, inpatient, and post-op pain and drug regiment was conducted. The patients were also asked to note their pain as they recovered after discharge. The patients and their mother completed self-report measures of multiple psychosocial variables both before and after surgery through REDCap. A Quantitative Sensory Test (QST) was also performed by the patients to assess their sensory sensitivity and pain thresholds. Mechanical, pressure, and thermal scores were obtained with the use of von Frey hairs, a pressure Algometer, and a Thermode. The QST was administered on the patients' palm/ thenar eminence (distant non-surgical site), and on their lower back (surgical site). The QST results were compared to a previous study's median cohort data, to discern if the patients presented hyper- or hyposensitivity for that particular test. RESULTS: Due to the limitations of case studies, the results presented here should be considered strictly preliminary. Twin B experienced more significant pain during both the acute and chronic recovery phases after surgery, and showed lower sensitivities during most pre-op QST trials. Twin B also scored markedly higher on a number of sub-variables in the psychosocial surveys. A notable correlation was the parent protective measure, indicating that the mother may have been more protective of Twin B. CONCLUSIONS: What is unique to this study is that age, gender, Cobb angle, fusion length, and genetic disposition are all controlled for, allowing us to analyze the patients based on other risk factors. Twin B shows consistently higher pain scores while in the hospital as well as while recovering at home. The parent self-report measures support these findings, showing a slight bias in favor of Twin B in regards to protectiveness, which also coincides with large-scale studies. Although preliminary, it is important not to underestimate the role environmental and psychosocial factors play in post-surgical pain.

Initiating the use of Computerised information systems (CISs) has become a global trend, including in Taiwan. Although CISs sound promising for improving clinical effectiveness and efficiency, evidence demonstrating their actual benefits is still limited. How CISs influence nursing practice and professionalism is not widely known, and the actual implementation process is not well understood. Hence, this study explores (1) the impact of CISs on the role of nurses and their practice, (2) the context of developing and implementing CISs, and (3) the practice politics underlying the use of information technologies in a Taiwanese hospital. A single, embedded, qualitative case study was conducted. Data collection used multiple methods, combining elite interviews with nurse managers (n=13) and informatics staff (n=3), five focus groups with front-line registered nurses (n=25) and 47 hours of non-participant observation in six wards in the case-study hospital. Data analysis followed a thematic approach, comparing and contrasting patterns among multiple perspectives. Four major themes emerged from the analysis. Firstly, the development of CISs was a result of negotiated order and relied upon interdisciplinary collaboration. Through interdisciplinary interactions of negotiations, covert negotiations and renegotiations, the exercise of power and power imbalances were recognised. Secondly, a top-down approach was adopted in the implementation process. In order to move computerisation forward, head nurses acted as change agents in gaining compliance from nurses. Front-line nurses showed generally positive attitudes towards computerisation. Being daily system users, front-line nurses were relatively powerless and were compliant with the top-down implementation; however, they grumbled at the same time. Thirdly, through system design strategies to structure clinical activities and increase information transparency, CISs became helpful tools in achieving standardised practice, tightening up managerial surveillance and control and clearly defining employees' accountabilities. Finally, whilst convenience and efficiency were perceived as the results of computerisation, hardware problems and the burdens of the computerisation process created hidden work in nursing practice, which required nurses to care for computers whilst caring for patients. Through the lens of several social theories, the study findings indicated that power in developing and implementing CISs was not in the hands of the nursing profession. The findings manifested the disciplinary power of computer technology and also suggest that computerisation may de-skill the nursing profession which may reignite the technology and skilling debate. Although generally believed to facilitate performance efficiency, this study found that computer technology created unfavourable consequences, for example hidden work, which seems to be unrecognised in the literature. Computers became the nurses 'co-client' and consequently took time away from patient care so computerisation may not be as efficient and effective as expected. Finally, a qualitative case study was found to be an appropriate methodology to explore this complex issue comprehensively and holistically. However, this small, single case study was conducted in one location in Taiwan. More research is needed to verify the findings which may have significant implications for management, policy and practice.

The primary purpose of this research study was to provide an in-depth analysis of a pre-diabetes self-management education program located in a Midwest health care center and to evaluate the effectiveness of the program. The study was designed to answer the following research questions: (1) How was the DSME program developed and how is it being implemented? (2) To what extent do the program's elements align with the National Standards for Diabetes Self-Management Education? (3) What factors affect completion of the entire program by participants? (4) What factors affect non-completion of the entire program by participants? (5) How do participants perceive their experience in the program? (6) What are the immediate effects of the program in terms of weight loss and exercise adoption? (7) What are the long-term effects of the program in terms of maintenance of weight loss, maintenance of physical activity, and prevention of T2D? (8) To what extent are the AADE Standards for Outcome Measurement of DSME being met? Effective DSME programs are typically those that meet nationally recognized guidelines and outcomes measures. Data were collected to determine the effectiveness of this program using the following methods: interviews, document reviews, observations, and a survey. Descriptive statistics in the form of frequencies and percentages were used to describe the results. Analysis of the qualitative data was conducted and themes emerged. Recommendations were provided as to how the program can be improved upon to make it more effective.

The purpose of this dissertation research was to ascertain information from ninth-grade students about their perspective in reference to Response to Intervention (RTI) in their school and how it is impacting them as well as their perceived future implications on their education. In order to accomplish this overall objective, the following three research questions framed this study: 1. What are the perceptions of ninth-grade students concerning RTI? 2. What elements of RTI do they see as beneficial for them to progress to their sophomore year? 3. What are the RTI teachers doing to assist ninth-grade students to progress successfully to their sophomore year? A rural school in the Midwest was selected for this qualitative case study research. Document analysis of two websites, six papers, and student grades and test scores were used. Forty, ninth-grade students were surveyed, four students from this population were interviewed, and two core/RTI teachers were interviewed along with the building principal. Participants in the study self-selected pseudonyms for research anonymity purposes. The surveys were conducted in the ninth-grade English classes on one day, and interviews were conducted on separate days, face-to-face, and later transcribed for accuracy. There are three themes which emerged from the data: (1) students’ sense of accomplishment, (2) students’ sense of belonging, and (3) students’ sense of maturity. These findings describe students’ self-pronounced perceptions of their 8th hour RTI class and RTI’s effects on their learning. Based on this study’s findings, it is recommended that additional investigation into elements of RTI and student perceptions be conducted. Data collection and assimilation from one school year to the next and progress monitoring using norm-referenced tests need to be increasingly used in high schools. The schools should monitor RTI and student achievements and keep a record to improve their instruction. One way to screen the effects of RTI is to access students’ RTI perceptions and conduct longitudinal data collection and analysis from many school districts and populations.

Fire in Midwestern ecosystems historically has provided many benefits, including promoting forest succession, maintaining wildlife habitat and reducing fuel loads. The Southeastern Illinois Prescribed Burn Association (SIPBA) is the only association of its kind in southern Illinois, designed to reintroduce prescribed fire to landowners in a practical context. The objectives of this research project were: 1) Interview members and crewpersons to collect data on the formation, maintenance, and future of SIPBA, 2) Outline the most common/salient issues driving landowners and stakeholders concerning the use of prescribed fire on their land in southern Illinois, and 3) Provide a conceptual model of the results to serve as a guide for future development of publicly conducted and implemented prescribed burning activities across southern Illinois and, ultimately, the Midwest. This study was implemented by semi-structured interviews of 28 key members of SIPBA. The responses from this population were collected and coded using NVivo 9 qualitative analysis software (NVivo 9 2011). Results indicate that challenges include stubborn remnants of the "Smokey Bear" attitude from the U.S. Forest Service anti-fire campaign, and that liability for an escaped wildfire is a reality for both the individual and for the association. In spite of these and other challenges identified by participants, landowners see SIPBA as a cost-effective solution to their land management needs. The results were interpreted as guidance for future dialogue between landowners and stakeholders and state and federal agencies in implementing prescribed burning programs. Implications include: "fire sells itself." Relatively little effort is needed to attract interest and recruit membership, and the benefits of a prescribed burn are easily evident. Alleviating concerns of the risks associated with fire is a primary objective for the organization, and there is a feeling of "safety in numbers" among membership. Finally, outside funding appears to be the limiting factor for both the capacity and potentially the longevity of the association, meaning that the development of a sustainable funding scheme could allow prescribed burn associations to remain in the Midwest. This case study of SIPBA membership is intended to facilitate cooperation between landowners and local burn associations, and also to serve as a model for the formation of future associations in similar areas of the Midwest.