Effective implementation of quality improvement (QI) initiatives is associated with enhanced clinical outcomes, increased patient and provider satisfaction, and reduced length of hospital stay. However resources and effort invested in the QI initiatives do not always meet clinical or patient expectations. As a prerequisite for changing this situation the aims of this qualitative study were to examine: (a) the process underlying implementation of QI initiatives in the emergency department (ED); and, (b) the use of an implementation audit checklist to improve performance. This qualitative exploratory study was conducted over a four-week period. Purposive intensity sampling was employed to recruit six ED healthcare providers who were: (a) a male or female ED registered nurse or ED physician; and, (b) involved with designing, planning and implementing QI initiatives in the ED. Numerical and free text data were collected from six implementation audit checklists. Data were also collected from six face-to-face interviews. Findings are consistent with previous studies. Critical features of effective implementation are: prioritization of initiatives; diligence in planning; staff and leadership engagement; on-going evaluation; collaborative teamwork; and, resources. The implementation audit checklist consisting of step-by-step guidelines, definition of capacity and resource allocation is perceived as a promising intervention tool for use by multidisciplinary healthcare professionals. This checklist, a facilitator for transferring implementation theory into operational and clinical practice, has potential to improve emergency department performance.

Background Sustainability involves progressing economic, social and environmental goals together in an attempt to meet current needs without compromising with the needs of future generations. Universities can play an important role in educating young people in sustainability. Many future managers study at business schools which makes this discipline particularly interesting in terms of creating sustainability across society. Swedish universities are by law encouraged to embed sustainability which requires significant changes at all levels including the work of lecturers. Aim The purpose of this study is to examine lecturers’ attitudes and perceptions on making changes to embed sustainability into the courses they teach. Methods A qualitative research method with semi-structured interviews was applied. An interview guideline was developed and eight lecturers from basic and intermediate education programmes at Umeå Business School and Economics (UBSE) were recruited. Data was transcribed and analysed in relation to the theoretical framework of change models. Findings Eight lecturers were interviewed and overall they reported positive attitudes towards making changes to incorporate sustainability into their courses but many of them found it difficult to do so in practice. Obstacles to make such changes included being limited in the decision-making of changes to the syllabus, limited knowledge, time constraints and motivation. Findings show that management plays an essential role in making changes and that a number of key persons (change agents) who want to implement more sustainability to the courses already exist in the organisation. ConclusionsLecturers are important to fulfil changes to their existing courses to incorporate sustainability but in need of more time and training in this subject. A sustainable approach at UBSE positively affects lecturers’ attitudes to incorporate sustainability to their teaching.

Syftet med studien är att utifrån ett socialpsykologiskt- och relationellt perspektiv, skapa en djupare förståelse och förklaring för hur medarbetarna på kundservice "En väg in" i Varbergs kommun upplevt denna organisationsförändring. Urvalet bestod av sex medarbetare och två personer ur ledningsgruppen. En kvalitativ metod med semistrukturerade intervjuer har använts, samt en hermeneutisk ansats. För att analyseraoch tolka det empiriska materialet har tidigare forskning och vetenskapliga artiklar valts ut, samt teorierna Jacobsens (2013) förändringsledarskap och motstånd, Maslows behovstrappa (Aronsson m.fl. 2012), Herzbergs tvåfaktorsteori (Aronsson m.fl. 2012, Herzberg [1968]/2003) och McCelland motivationsteori om de mänskliga behoven (Aronsson m.fl. 2012) som kompletteras med, Scheffs (1994) sociala band och differentiering. Det mest centrala som framkommit i studien är betydelsen av bristande kommunikation, delaktighet och kontroll. Samt att medarbetarna haft olika inställningar till förändringen och att avdelningen ej har hunnit skapa en gemensam organisationskultur. Yrkesrollerna hämmar medarbetarna att skapa starka sociala band med varandra. / The purpose of this study is that from a social psychological - and relational perspective, create a deeper understanding and explanation of how the employees of customer service "En väg in" in Varberg municipality experienced this organizational change. The sample consisted of six employees and two individuals from the management team. Qualitative approaches with semi structured interviews were used, as well as a hermeneutical approach. In order to analyze and interpret the empirical material previous research and scientific articles were selected and the theories Jacobsen (2013), change management and resistance, Maslow's hierarchy of needs (Aronsson et al 2012), Herzberg two-factor theory (Aronsson et al 2012, Herzberg [1968] / 2003) and McClelland's motivation theory of human needs (Aronsson et al 2012), supplemented by, Scheff (1994) social bonds and differentiation. The most central that emerged in the results is the importance of lack of communication, participation and control. And that the employees had different settings to the change and that the department has not had the time to create a mutual organizational culture. Professional roles inhibit employees to create strong social bonds with each other.

This thesis presents health care organizations as heterogenic and highly complex in nature with particular normative structures underpinning their formal rational structures. It seeks to explore the evolution of organization structure as applied to a medical corporation in Qatar and to examine the nature of organizational culture and multi professional cohesiveness. In doing so it assesses a range of models on organizational design and change. The three hospitals that compose the corporation are investigated through triangulated interpretative qualitative and quantitative methodologies and the application of the Competing Values Framework. The comprehensive approach of the investigation resulted in a series of conclusions on the evolution of hospital organizational structures, the link between life cycle and structure, forms of organizing health services, characertistics of professional structures, the nature and success of change management strategies, coordination mechanisms, organizational and professional cultures, and health service, organizational and team effectiveness assessment. Findings demonstrated that autonomous and sometimes conflicting professions worked in harmony and cohesiveness as a consequence of shared core values and the human relations focus of health organizations. In examining organizational design it showed that coordination mechanisms were preferred to integration mechanisms with the former playing an important role in conflict resolution and human relations. Finally, findings indicated that when organizational design has shortcomings, the organization substitutes through other mechanisms.

In an increasingly environmentally awareworld, companies are influenced bysustainability thinking and there ismuch talk about certifications,reporting requirements, andenvironmental work. Meanwhile, projectshave become a common way to conductbusinesses, however, without significantenvironmental consideration in theproject process. By using changemanagement in corporate culture andorganizational behavior, we examine howa process of implementation of newapproaches and methods may look like andhow the new work method affects itsusers.This thesis deals with the subject whereenvironmental and sustainabilitythinking is incorporated in projectmanagement. Our ambition is that theresults will lead to greaterunderstanding and awareness in companiesand eventually be developed and fullyutilized. The conclusions first presentthe changes needed to be done in theorganization and its culture and thensome concrete steps to take towards moreeco-friendly project management methodstogether with proposals for reporting.Because the subject is in thedevelopment phase, this is a preliminarystudy and an introduction to a moresustainable project management. Finallythe conclusions present suggestions forfurther studies to get deeperunderstanding in the field. / Miljömedvetenheten och arbetet med att spara på våra resurser tar allt mer fart runt om isamhället. Uttryck som återvinning, energismarta lösningar, förnyelsebar elproduktion ochhållbar avfallshantering får alltmer uppmärksamhet. Detta är högst välmotiverat då vårtnuvarande konsumtionssamhälle inte skulle finnas kvar länge till då vi förbrukar allt mernaturtillgångar, produkter och energi på daglig basis. Aldrig förr har väl uttrycket ingen kangöra allt men alla kan göra något känts så aktuellt som nu. Självklart gäller detta hushåll ochprivatpersoner men framför allt företag och större organisationer vilka ofta spenderar ochförbrukar väldiga resurser. Dessutom är det oftast de som både har pengar och makt attverkligen påverka utgången av konsumerandet.Något annat som blir allt vanligare bland företagens arbetsmetoder är att bedriva sinverksamhet i projektform. I vissa fall har själva företagsidén blivit att man nischat sig helt tillatt skapa och leda projekt åt andra företag, så kallade managementkonsulter.Detta visar alltså flera åtskiljda växande intressen på frammarsch, men bedrivs de utan någrasamband? Företagens befintliga miljöarbete består mestadels i att sätta upp mål vilkaförhoppningsvis kan leda till någon form av certifiering eller intyg på att en viss nivå haruppnåtts. Dessa miljömål har ofta bristfälliga uppföljningar samtidigt som det finns en uppsjöav olika rapporteringsmodeller och certifieringar vilket försvårar kontinuerlig uppdatering avaktuell status inom området.Denna uppsats är gjord på uppdrag av företaget CGI Sweden vilket i vår uppstartsfas hetteLogica. I och med namn- och ägarbytet är de numer ett av världens största IT-konsultbolagmed många stora kunder över hela världen. De har identifierat ett behov av att på projektbasiskunna genomföra kontinuerliga uppföljningar av miljörapportering vilket skulle underlätta förföretag att uppnå sina hållbarhetsvisioner. CGI Sweden miljörapporterar enligt GRI-standardvilket vi haft som utgångspunkt när arbetet startades. Uppsatsens huvudfokus behandlarpotentiella vägar att gå när företag skall genomföra kultur- och organisationsförändringarsamt börja med sitt miljöarbete på projektnivå. Tankar som genomsyrar studien är hurorganisations- och kulturförändringar sker inom företag, om och i så fall hur företag beaktarmiljöarbete inom projektledningen idag, hur stort intresset är att integrera hållbarhet i sinprojektledning, hur man med hjälp av GRI kan utveckla en potentiell framtida metod och vaddetta skulle innebära.En stor del av uppsatsens empiriska material är insamlat från ett flertal intervjuer med insattaprojektledare, chefer och miljöansvariga från företagsvärlden för att få en så tydlig bild sommöjligt av rådande situation och branschernas framtida syn på våra tankar.Utifrån en sammanställning och analys av intervjuerna, GRI-rapporteringar samt teorier omhur förändringsarbete går till har flertalet rekommendationer i form av förslag och tänktalösningar till problemet framkommit och presenteras i resultatet. Detta mynnar ut i slutsatservilka belyser några konkreta steg som är applicerbara. Vi har genom detta arbete även kommitfram till flera tänkvärda förslag till vidare studier.

The purpose of this research was to determine if patient journey process modeling could act as a change management tool to support electronic health record (EHR) adoption, at a tertiary-care mental health centre. This research study was based on a pre/post design, which evaluated the attitudes of clinicians??? pre and post implementation of the EHR. A survey was used to assess the attitudes of various healthcare professionals, such as physicians, nurses and a spectrum of allied health disciplines, at various phases of the planning and implementation process. In addition to the surveys, current and future state PaJMa (patient journey modeling architecture) models representing technology use and process flows of all units were created by observational studies, and served as change management tools. These PaJMa models were then presented as part of an intervention that was held in the form of an educational session to highlight the benefits of technology, and to address the common concerns identified from the initial survey results. The centre for mental health sciences facility was used as the case study to apply the PaJMa model and assess its change management functionality. Since, the organization was moving from paper to electronic based patient charts it was an ideal choice for this research. It was predicted that the attitudes and opinions of clinicians towards the EHR implementation, and EHRs in general, would change and become more positive with increased knowledge and education. This in-turn would increase EHR adoption and hence lead to a successful implementation.

Changing artifacts is intrinsic to the development and maintenance of software projects. The changes made to one artifact, however, do not come about in isolation. Software models are often vastly entangled. As such, a minuscule modification in one ripples in- consistency through several others. The primary goal of the this thesis is to investigate techniques and processes for the synchronization of artifacts in model driven development environments in which projects comprise manifold interdependent models, each being a live document that is continuously altered and evolved. The co-evolution of these artifacts demands an efficient mechanism to keep them consistent in such dynamic environments. To achieve this consistency, we intend to explore methods and algorithms for impact anal- ysis and the propagation of modifications across heterogenous interdependent models. In particular, we consider large scale models that are generated from other models by complex artifact generators. After creation, both the generated artifacts, and also the ones they are generated from, are subject to evolutionary changes throughout which their mutual consistency should be maintained. In such situations, the model transformation is the pri- mary benchmark of consistency rules between source and target models. But the rules are often implanted inside the implementation of artifact generators and hence unavailable. Trivially, the artifacts can be synchronized by regeneration. More often than not however, regeneration of such artifacts from scratch tends to be unwieldy due to their massive size. This thesis is a summary of research on effective change management methodologies in the context of model driven development. In particular, it presents two methods of in- crementally synchronizing software models related by existing model transformations, so that the synchronization time is proportional to the magnitude of change and not to the size of models. The first approach treats model transformations as black-boxes and adds to it incremental synchronization by a technique called conceptualization. The black-box is distinguished from other undertakings in that it does not require the extraction, re- engineering and re-implementation of consistency rules embedded inside transformations. The second approach is a white-box approach that uses static analysis to automatically transform the source code of the transformation into an incremental one. In particular it uses partial evaluation to derive a specialized, incremental transformation from the exist- ing one. These two approaches are complementary and together support a comprehensive range of model transformations.

People trying to understand, develop and maintain software have faced greater challenges as the complexity of software systems has increased. These challenges include the difficulty of cleanly separating different intertwined parts of a system, or relating parts of the system spread across many modules. This makes it difficult to neatly identify an area of interest, which in turn makes it difficult to understand or edit that area. The ability to separate these areas of interest, called concerns, into their own modules has been shown to improve the situation. Several approaches have been developed to enable this separation: aspect-oriented programming allows program code to be divided into smaller modules that better match areas of interest; reverse engineering tools help programmers extract information from an existing system; requirements traceability tools track individual requirements through the development process. This thesis describes a technique that works in a wide variety of circumstances. This technique allows users to create simple diagrams that describe the concern and then annotate this diagram with query expressions which link the diagram to related development artefacts like source code or documents. This research has used the tool in a set of common scenarios and compared the results to those achieved using other approaches.

The policy shift towards sustainability has led to increased diversity of stakeholders in land management. This thesis explores how capacity building projects affect the way stakeholders are included in emerging platforms for change. It does so by combining action research and narrative analysis in a case study of a project that aimed to develop social capability in rural Victoria, Australia. The thesis concludes with ways to improve capacity building methodologies and the reflexive performance within platforms for change.

The construction industry has long been criticized as being not advance enough to use information communication technology (ICT) and slow to adopt knowledge management (KM). This research demonstrates how using an effective and efficient ICT systems can improve KM, and that an enterprise resource planning (ERP) system can be one tools to help improve KM. An ERP system is also a powerful tool to help integrate business processes which has particular use in the construction industry. The principle objective of this research was to explore the drivers and inhibiters that determined successful adoption and use of an ERP system at its actual implementation stage. Secondly, it aimed to identify successful factors of a partnering strategy and its integration into the ERP system. The third objective was to investigate the appropriate leadership style that influenced the ERP system and the partnering strategy, and to identify the impact of culture on the leadership style. The research was conducted within the context of a Hong Kong construction organization. This research makes a contribution in two spheres: PM and the construction industry. The first implication for PM theory is to illustrate how knowledge has been efficiently managed within a construction organization by using ICT/ERP.