Contemporary global challenges like global warming, rapid urban development, and the current unstable security situation, lead to an increase in large-scale crises (e.g., forest fires) alongside frequent smaller emergencies (e.g., house fires and traffic accidents). The increase in emergencies strains professional response organizations, necessitating additional resources. Civilian volunteers are therefore increasingly being integrated into the response system. The development is mediated by information and communication technologies (ICTs) which enable communication between professional responders (e.g., the municipal rescue services, the emergency medical services, the Public Swedish Answering Point) and citizens. While many studies focus on spontaneous volunteer activities emerging on social media, fewer examine organized volunteerism initiatives at the local emergency response level. Over a decade ago, a municipal rescue service in northern Sweden established an initiative recruiting volunteers as first responders and equipping them with basic response tools. The volunteers undergo training in tasks such as cardiopulmonary resuscitation (CPR) and fire extinguishing. They are dispatched to predefined response tasks using simple ICT applications like SMS lists or mobile apps. This initiative has expanded to other areas due to perceived benefits such as shorter response times and reduced casualties and material damage. The phenomenon can be labelled as an emerging form of ICT-enabled or digitalized co-production of public services. However, previous research indicates a research gap in understanding, describing, and defining this type of co-production. The overall aim of the thesis is to describe how these ICT-enabled initiatives emerge and develop over time and identify the related effects on the response system. This is expected to provide recommendations on how they can be developed and supported. This aim is divided into three specific objectives, where each has been addressed through a research paper: 1- identifying how the existing literature describes ICT-enabled/digitalized volunteerism in large- and small-scale emergencies, 2- identifying how these initiatives emerge and operate, and can be maintained in small-scale emergencies, introducing more systematized knowledge on this concept, 3- initially evaluating the contributions of volunteers in the initiatives. Leaning on a case study approach inspired by action research, a combination of data collection methods has been adopted, e.g., a literature review, interviews, and incident reports filled out by volunteers. For the data analysis, the theoretical lens of ICT-enabled/digitalized co-production of public services has been applied. The first paper is a literature review study that examines digitally enabled volunteering activities in crises and small-scale emergencies. It highlights the prevalence of studies on volunteers using social media for crowdsourcing in crises, often termed digitalized volunteerism which entails virtual and, or physical contributions by volunteers to the response efforts. In contrast, fewer studies focus on volunteers' role in local small-scale emergencies, labelled as "hybrid" ICT-enabled or digitalized coproduction. The term hybrid here refers to the loose affiliation of the volunteers where they collaborate with the rescue services but are not officially associated through binding contracts. Hence, they are in between spontaneous and organized volunteerism. Both volunteering modes support professional response systems and display similar needs for steering, financial support, coordination, and integration of ICT artifacts. However, crises require increased coordination to manage uncertainties, risks, and data overload effectively. The second paper presents three models describing the emergence of hybrid digitalized co-production initiatives in urban and rural areas, as defined in Paper 1, along with how national authorities can support them. These models i.e., Rural, Urban, and National consist of three phases: Recruitment, Response, and Maintenance. Each model exhibits distinct characteristics. In rural areas for example, there is a need for more regular training due to low alerting frequency, and the possibility of using simple dispatch ICTs as cost-effective solutions. Conversely, urban areas have more alerts, necessitating more advanced ICTs, with less emphasis on regular training compared to rural areas. At the macro-level, the national model highlights roles that national actors can play such as facilitating a joint Application Programming Interface (API), joint insurance solutions, and an ICT system that can register incoming and active volunteers. The third paper is an initial evaluation of these initiatives at emergency sites, focusing on ICT-enabled dispatch, estimated response times, tasks performed, and collaboration with professionals, to assess the effects of using volunteers. This approach contrasts with previous studies that took an overall perspective and only used qualitative data. A total of 53 incident reports were collected from volunteers, revealing that volunteers arrived before professionals in twothirds of incidents, contributing to an average gain of 5 minutes. Additionally, volunteers performed a broader range of tasks than previously described, and often continued collaboration with professionals on-site, despite the initial expectation of handing over tasks upon the arrival of professional response actors. Also, comparing this data with the rural model from Paper 2, similarities and differences emerged. For instance, there was a higher number of alerts, and the basic ICTs used for dispatch were deemed insufficient, contrary to the model's perception. The thesis’ scientific contribution is a clearer conception of digitalized co-production of, above all, local emergency response as an emerging phenomenon. In the three papers, the ICT dispatch was identified as central and needs further development to enhance this co-production form. The thesis also sheds light on the need to integrate the initiatives into the official governmental frameworks. Furthermore, the thesis provides a primary understanding of how the concept works on the ground and provides an initial evaluation of the effects. In the practical field, the thesis offers insights into the importance of volunteers as additional resources to the official response systems, highlights challenges, hindrances, and enablers, and suggests potential solutions and improvements. Future work will include a further collection of incident reports for more reliable assessments and complementary interviews with volunteers. Also, the potential role of volunteers in larger crises, for example, as part of civil preparedness, will be further explored. / Samhällsutmaningar, såsom klimatförändring och det nuvarande globala säkerhetsläget leder till en ökning av storskaliga kriser. Samtidigt måste frekventa, mindre olyckor (till exempel bostadsbränder och trafikolyckor) även fortsättningsvis. Stora kriser kräver omedelbar hantering men frekventa olyckor leder också till förlust och skador på liv och egendom. Båda innebär en stor belastning på professionella räddningsaktörer. Ett sätt att hantera utmaningarna är samarbetet med frivilliga aktörer i räddningsinsatser. Utvecklingen av information och kommunikationsteknik (IKT) spelar en central roll här eftersom tekniken underlättar tvåvägskommunikation mellan professionella räddningsaktörer (tex räddningstjänst, ambulanssjukvård och larmoperatörer) och frivilliga aktörer. De flesta studier på området fokuserar på spontanfrivilliga som använder sociala medier för krishantering medan färre studier fokuserar på mer organiserade former av frivillighet på lokal nivå och för mindre olyckor. För mer än 10 år sedan initierade en kommunal räddningstjänst i norra Sverige ett initiativ för att rekrytera civila frivilliga som första insatspersoner. Initiativet innebär att de civila insatspersonerna utbildas för att utföra vissa uppgifter, till exempel hjärt-lungräddning, och släcka mindre bränder. De utrustas med enkel utrustning och larmas ut på vissa typer av olyckor med hjälp av grundläggande IKT som SMSlistor eller specialutvecklade appar. Över tid har initiativet spridit sig till fler områden och alltfler räddningstjänster och nationella myndigheter ser att första insatspersoner kan bidra till kortare responstider, vilket minskar antalet skadade människor och mindre materiell förlust. I litteraturen benämns detta fenomen ibland som en framväxande form av digitaliserad samproduktion av offentliga tjänster. Tidigare studier pekar också på ett kunskapsgap när det gäller att beskriva och konceptualisera sådan samproduktion. Avhandlingens övergripande syfte är att beskriva hur dessa initiativ uppstår och utvecklas över tid och identifiera de relaterade effekterna på räddningssystemet. Detta för att kunna ge rekommendationer om hur initiativen kan utvecklas och stödjas. Avhandlingen består av tre delstudier (artiklar). Artikel 1 identifierar hur den befintliga litteraturen beskriver IKT-aktiverat/digitaliserat frivilligarbete vid stora kriser och mindre lokala olyckor. Artikel 2 beskriver hur initiativ uppstår, fungerar och kan upprätthållas över tid vid mindre olyckor. Artikel 3 utvärderar initialt de civila insatspersonernas bidrag till räddningsinsatser. Avhandlingen genomförs som en fallstudie, inspirerad av aktionsforskning där en kombination av datainsamlingsmetoder använts, till exempel en litteraturöversikt, intervjuer och händelserapporter ifyllda av frivilliga. Teoretiska perspektiv runt IKTaktiverad/ digitaliserad samproduktion av offentliga tjänster tillämpas i dataanalysen. Första artikeln är en litteraturöversikt kring digitaliserad frivillighet i kriser och frekventa olyckor. Den visar att insatser av spontanfrivilliga i kriser och sociala medier som en form av "crowdsourcing" är ett väl diskuterat område. Ibland benämns som "digitaliserad frivillighet" och inkluderar både virtuella och fysiska bidrag från frivilliga responsinsatser. Ett fåtal studier fokuserar på frivilligas bidrag till mindre men samtidigt mer frekventa olyckor. När de gör det kallas konceptet ofta "hybrid" IKT-aktiverad eller digitaliserad samproduktion av räddningsinsatser. Hybrid avser här att insatspersonerna samverkar med den kommunala räddningstjänsten men utan officiellt bindande avtal. Därför befinner de sig någonstans mellan spontant och organiserat frivilligarbete. Båda typerna av frivillighet kan stödja de professionella insatssystemen och har liknande behov av styrning, ekonomiskt stöd, samordning och integration av teknik i de professionella responsssystemen. Stora kriser har dock större behov av koordinering för att hantera osäkerheter, risker och undvika "information overload". Den andra artikeln beskriver de digitaliserade hybrida initiativen definierade i Artikel 1 och hur de kan stödjas. Detta genom tre modeller, där två av modellerna relaterar till lokal nivå och stad respektive landsbygd. Den tredje relaterar till nationellt stöd och styrning. Modellerna inkluderar tre faser: Rekrytering, Respons och Underhåll. Varje modell uppvisar likheter och olikheter. I landsbygdsområden finns till exempel ett behov av mer regelbunden träning på grund av låg utlarmningsfrekvens, och det går att använda enkla IKT-lösningar som kostnadseffektiva alternativ. Å andra sidan har stadsområden fler utlarmningar, vilket kräver mer avancerade IKT-lösningar, men samtidigt mindre regelbunden träning då de civila insatspersonerna får mer erfarenhet. På makronivå identifieras roller och uppfifter som nationella aktörer kan ta, såsom att underlätta ett gemensamt applikationsprogrammeringsgränssnitt (API), erbjuda gemensamma försäkringslösningar och utveckla ett IKT-system som kan registrera inkommande och aktiva insatspersoner. Artikel 3 syftar till att initialt utvärdera hur de digitaliserade initiativen fungerar på skadeplatser genom att fokusera på utlarmning, uppskattade responstider, utförda uppgifter, samarbete med professionella, etc. Med andra ord att initialt titta på initiativens effekter. En händelserapport distribuerades till civila insatspersoner och resulterade i 53 ifyllda rapporter. De visar bland annat att insatspersonerna anlände före professionella i två tredjedelar av insatserna och bidrog till en genomsnittlig tidsvinst på 5 minuter. Dessutom visar resultatet att de civila insatspersonerna utför en större bredd av uppgifter än vad tidigare beskrivits inom initiativen och dessutom ofta fortsätter samarbeta med professionella aktörer när de senare anlänt. De civila insatserpersonerna är även villiga att medverka vid storskaliga kriser. Jämfört med landsbygdsmodellen från Artikel 2 framkom likheter och skillnader. Till exempel var det så pass många larm att de IKT-lösningar som användes för att skicka ut larmen bedömdes som otillräckliga och behöver utvecklas. Detta visar även på att modellen behöver revideras och förfinas. Avhandlingens vetenskapliga bidrag är ökad kunskap om det framväxande fenomenet digitaliserad samproduktion (civila insatspersoner som förstainsatsaktörer) av räddningsinsatser. I alla tre artiklarna identifierades IKT-stödet som centralt och som behöver vidareutvecklas för att upprätthålla och förbättra denna form av samproduktion. Avhandlingen belyser också behovet av nationell koordinering och stöd. Vidare ger avhandlingen en primär förståelse för hur konceptet fungerar i praktiken och en initial utvärdering av effekter av att använda insatspersoner. För praktiker ger avhandlingen kunskap om civila insatsperson som ytterligare resurser till de professionella responssystemen, identifierar utmaningar, hinder och möjliggörare, samt föreslår potentiella lösningar och förbättringar. Framtida arbeten kommer att inkludera ytterligare insamling av händelserapporter för mer tillförlitlig utvärdering och kompletterande intervjuer med insatspersoner. Dessutom kommer den potentiella rollen för civila insatspersoner i större kriser, till exempel som en del av civil beredskap, att utforskas vidare. / <p>Funding agency: The Swedish Civil Contingencies Agency (MSB) through the Centre of Advanced Research in Emergency Response (CARER)</p>

Yes / The importance of including members of the public has been accorded a significant position in health planning, service delivery and research. But this position masks a lack of clarity about terms that are used. This paper identifies terms that are in common use in the lexicon of community based involvement and engagement in health with the intention of clarifying meaning and thus reducing ambiguity. We define and distinguish between key terms related to inclusion, we consider the terminology attached to community processes and to the challenges of inclusion and we engage with the strengths and weaknesses of the commonly used metaphor of "a ladder of participation". We wish to contribute to the clear communication of intentions, challenges and achievements in pursuing varied forms of inclusion in health.

京都大学 / 新制・課程博士 / 博士(文学) / 甲第25045号 / 文博第950号 / 新制||文||743(附属図書館) / 京都大学大学院文学研究科行動文化学専攻 / (主査)准教授 Stephane Heim, 教授 Mitsuyo Wada-Marciano, 准教授 丸山 里美, 教授 松田 素二 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DGAM

There has been an increasing demand for commercial organisations to foster real-time interaction with customers, because harnessing customer competencies has been shown to be a major contributor towards various benefits, such as growth, innovation and competition. This may drive organisations to embrace the development of multimodal interaction and complement Electronic Customer Knowledge Management Systems (E-CKMS) with metaphors of audio-visual nature. Although the implementation of E-CKMS encounters several challenges, such as lack of trust and information overload, few empirical studies were devoted to assess the role of audio-visual metaphors, and investigate whether these technologies can be put into practice. Therefore, this thesis describes a comparative evaluation study carried out to examine the implication of incorporating multimodal metaphors into E-CKMS interfaces on not only usability of E-CKMS, but also the user's trust, knowledge and acceptance. An experimental E-CKMS platform was implemented with three different modes of interaction: Visual-only E-CKMS (VCKMS) with text and graphics, Multimodal E-CKMS (MCKMS) with speech, earcons and auditory icons and Avatar-enhanced multimodal E-CKMS (ACKMS). The three platforms were evaluated by three independent groups of twenty participants each (total=60) who carried out eight common tasks of increasing complexity and design based on three different styles. Another dependent group of forty-eight participants (n=48) was instructed to interact with the systems under similar usability conditions by performing six common tasks of two styles, and fill a questionnaire devised to measure the aspects of user acceptance. The results therein revealed that ACKMS was more usable and acceptable than both MCKMS and VCKMS, whereas MCKMS was more usable than VCKMS, but less acceptable. Inferential Statistics indicated that these results were statistically significant.

電影作為跨文化傳播的重要媒介，反映當下他國與該國權力結構的認知，對一國的國家形象塑造有著重大作用。國家形象就是他國人民對一個國家的概念性印象，在傳統好萊塢的商業大片上，中國的形象多半遭受「東方主義」的臆測，中國政府亟於透過文化宣傳的方式來改善中國的國家形象，其中中美合拍電影傳達出的中國意象扮演重要角色。觀察近年來的中美合拍片，相較於過去的好萊塢電影，中美合拍電影的中國形象似乎獲得大幅提升，但仍存在東方主義對「他者」的視角。 中美合拍片有將「中國國家形象」與「中國人形象」與之區分，分別對應「專制的中國政府」與「順從無主見」的人民，最終只能希冀西方的拯救者來救贖之現象。就連東方的導演都「自我東方化」，電影傳達的中國形象，其實是透過中國導演觀察與西方的差異，自我建構出的「東方形象」。 雖然中美合拍片裡中國形象仍是西方對東方的「再現」，但中國政府透過合拍的攝製法規與審查制度，「一手拿棍棒，一手拿紅蘿蔔」。一方面獎勵遵守中國規則的劇組，提供資源協助，一方面針對不符合中國期望的電影情節，在審查過程中要求刪除甚至擱置。 中美合拍片不但存在國際社會的文化爭霸，更有一國之內政治社會與市民社會的交互作用，在國際社會上，中美合拍電影的中西方文化元素交相呼應，同樣的符號在個別電影中有不同的詮釋。在政治社會與市民社會的面向上，中國政府以電影審查制度控制電影內容，來維護既有的意識型態；但電影劇組仍可以透過導演或主演的個人聲望、隱晦的針砭手法，迫使官方妥協，重構出新的意識型態。中國政府與合拍片商在彼此爭霸中，互有消長與妥協，故中美合拍片中的中國形象，呈現正負面兼有之的特徵。 / Film as an important medium for intercultural communication, it becomes one of the effective ways to promote a nation’s image. The national image is the conceptual impression of the people from other countries. In traditional Hollywood commercial movies, the image of China suffered “Orientalism” speculation. By co-producing films with American, government of China has tried to get rid of the stereotype of China’s national images. In recent year, compared to the previous Hollywood movies, the images of China in Sino-U.S. co-production films seem to get significantly improved. However, some of them still implicate Orientalism speculation. Sino-U.S. co-production films distinguish “the national image of China” from “the image of the Chinese people”, describing a society that an autocratic government and a crowd of lackey, hoping a savior from the west would liberate them. Even Chinese directors have “self-orientalization” issues, the image of China that they described in the movie is just a reflection compared with the west. Although the image of China in Sino-U.S. co-production film is the “representation”, the government of China still could use “carrot and stick” to receive the hegemony. On the one hand, they encourage and reward the producer for obeying the regulations; on the other hand they use censorship as a punishment. Sino-U.S. co-production film not only consists of the cultural hegemony of the international community, but also includes the interaction between political society and civil society in the domestic system. In the international community, the same symbols of Western/Eastern cultural elements has different interpretations of individual Sino-US co-production films, and in the political society and civil society, the Chinese government regulates movie contents building the movie censorship system to secure the existing ideology; But the director or big shots still can use their expand their personal Influence, or metaphor in the script, to force the authority to compromise and reconstructs a new ideology.

Throughout the last years, the service encounter has gone through drastic changes due to rapid technological developments. The research area of service marketing is therefore putting a stronger focus on the academic field of technology-infused service encounters. Marketers have moreover also started to implement self-service technology (SST) within their service encounters, in order enhance their service delivery. This phenomenon has also been visible within the hospitality industry, whereby the hotel industry has experienced an increasing adoption of SST encounters. Consequently, hotels’ implementation of SST kiosks has enhanced the hotel guests’ participation level within the service encounter. Therefore, this thesis aims to gather insights on the emerging SST customer roles, by investigating the guests’ attitude towards the SST encounter. This leads to the investigation of distinctive SST customer roles within hotels’ self-check-ins.   The choice of the research topic was driven by the fact that existing research about SST implementation in the service encounter, lacks an investigation of the customers’ perspective. Thereby, a research gap was identified that outlays the customers’ enhanced participation as service co-producers. Previous research has focused on investigating customers’ technology acceptance, rather than their own identification as co-producers. Thereof, this thesis will put an emphasis on hotel guests’ attitude towards SST, as a specific aspect of the technology acceptance process. Moreover, this thesis will focus its investigation on self-check-ins within hotels that do not incorporate a human interaction point for their guests. Consequently, in order to investigate the SST customer roles more thoroughly, this thesis will also consider the viewpoint of the hotel. Therefore, qualitative interviews among nineteen hotel guests and one hotel representative were conducted.   The findings of this thesis revealed that SST customer roles cannot be predetermined within a hotel self-check-in. Instead, the hotel guests define their own SST customer roles through a reflection upon their purpose of the hotel stay, expectations of the check-in encounter, arising special needs and perceived benefits of the self-check-in. This determines their individual ‘role file card’, which can be utilized into the proposed SST customer roles archetypes of: technology enthusiast, beneficiary, traditionalist and contradictor. In regard to that, it has been identified that the information provided prior to the hotel guests’ stay, influences the reflection upon their SST customer roles. Moreover, it was discovered that with their increased responsibility over the check-in process, the hotel guests identified themselves as co-producers. Therefore, the findings outlined that the guests would want the price of the hotel stay to reflect their increased involvement in the service delivery.   From a theoretical perspective this thesis bridged the identified research gap of investigating hotel guests’ attitude towards SST, in order to classify the different customer roles that arise within a hotel’s self-check-in. Moreover, the findings revealed practical implications for hotel managers in regards of the need to provide their guests with more information about the SST encounter. Thereby, hotel managers will be enabled to increase their guests’ satisfaction with the SST encounter, as the guests’ expectations would be coherent with the hotel’s offerings.

Submitted by Maicon Juliano Schmidt (maicons) on 2015-07-20T13:46:14Z No. of bitstreams: 1 Carlos Henrique Benevenuto Rech.pdf: 1068014 bytes, checksum: c9904bf8f8682ca8fbe74f92302643a8 (MD5) / Made available in DSpace on 2015-07-20T13:46:14Z (GMT). No. of bitstreams: 1 Carlos Henrique Benevenuto Rech.pdf: 1068014 bytes, checksum: c9904bf8f8682ca8fbe74f92302643a8 (MD5) Previous issue date: 2014-06-24 / Nenhuma / Este trabalho analisou as capacidades organizacionais e operacionais de um banco para a coprodução de serviços de telecomunicações de dados. Nele, o construto capacidade para coprodução de serviços de telecomunicação foi operacionalizado através da mensuração de oito dimensões formadoras das capacidades organizacionais e operacionais de coprodução de serviços, desenvolvidas em estudo exploratório anterior de Teixeira (2010) e ampliado através de estudo posterior desenvolvido por Przyczynski (2013). Buscando ampliar os estudos desenvolvidos por esses autores, foi selecionada uma grande instituição financeira no Brasil para aplicação de pesquisa que contou com uma amostra final de 299 agências. Os resultados estatísticos demonstraram que 6 construtos são responsáveis por 27,8% da percepção de falhas. Também sugeriu que os construtos Capacitação Funcional, Gerenciamento de Instalações e Gerenciamento de Equipamentos exercem maior influência sobre Percepção de Falhas, seguidos de Planejamento Estratégico e, por fim, Segurança. Quanto à significância, Capacitação Funcional foi altamente significativa, seguida de Gerenciamento de Equipamentos e Gerenciamento de Instalações. / This work analyzed the organizational and operational capabilities of a bank for co-production of data telecommunications services. The construct ability to co-produce telecommunication services has been operationalized through the measurement of eight dimensions forming organizational and operational capabilities of service co-production, developed in previous exploratory study of Teixeira (2010) and expanded later by study developed by Przyczynski (2013). Seeking to expand the studies developed by the authors, a large financial institution in Brazil has been selected in order to apply the survey instrument to a final sample of 299 branches. Statistical results show that 6 constructs are responsible for 27.8% of service failure. Results also suggest that the constructs Functional Training, Facilities Management and Equipment Management exerts greater influence on Perception of Failure, followed by Strategic Planning and, finally, Security. As for significance, Functional Training was highly significant, followed by Equipment Management and Equipment Facilities.

Non-fiction film shares a long and relatively uncharted history with the museum. Today, filmmaking is a widespread yet critically neglected area of modern museological practice. This practice-based PhD situates itself within these critical gaps to examine the knowledge producing potential of film archives and film practice at the Manchester Museum. Its primary historical sources are a group of taxidermy objects at the Manchester Museum, an archive of 16mm acetate films at the North West Film Archive and a collection of travel journals at Cheshire Archives and Local Studies. These diverse collections were generated by Maurice Egerton, the 4th Baron of Tatton in Cheshire during his travels in Africa in the first decades of the twentieth century. This thesis brings all three together for the first time since their moment of production. These collections recur throughout the thesis as I ask how film archives can complicate and enrich our understanding of collections and how filmmaking practice might continue to bring new types of knowledge into the museum and archive. Two research films are submitted with and discussed within the thesis. The first, 'Living Worlds at the Manchester Museum', adapts observational methods from visual anthropology to record objects and staff during the re-display of the mammal gallery at the Manchester Museum in 2011. The second, 'Articulating Archives' is the result of a creative collaboration in 2014 with Year 8 secondary school students and the institutions and archives named above. Within the production and analyses of these films I draw on diverse critical sources to suggest that film can illuminate properties of materiality, embodied knowledge and performed engagement that textual accounts fall short of capturing.

Bakgrund. Att få en allvarlig bristning i samband med förlossning kan ge kvinnor smärta, lidande, och låg livskvalitet under lång tid. Syfte. Syftet med förbättringsarbetet har varit att förbättra eftervården genom att införa strukturerad uppföljning, öka kvalitén i bedömning och diagnostik, förbättra informationen till patienten och utveckla former för patientdelaktighet i förbättringsarbetet. Syftet med studien har varit att ur ett verksamhetsperspektiv beskriva erfarenheterna av patientdelaktigheten i förbättringsarbetet. Metod. Förbättringsarbetet har designats med hjälp av Förbättringstrappan och utgått från ett patientprocessorienterat perspektiv. Metod för studien var kvalitativ i form av en fallstudie. Resultat. Genom förbättringsarbetet följs kvinnorna upp via bristningsregistret, uppföljningsbesök med 3D- ultraljud görs på en specialinrättad mottagning. Vidare får kvinnorna individuell fysioterapeutinformation innan hemgång, en vårdkedja har införts och former för patientdelaktighet har utformats och använts. Dessa är frågeformulär, intervjuer, workshops och patientföreträdare i förbättringsnätverket. Resultatet från studien visar att formerna för patientdelaktighet ger skilda förutsättningar för delaktigheten. Resultatet visar på betydelsen av organisatoriska förutsättningar, värdet av patientdelaktighet, utmaningar vid införande och vilket reellt inflytande som patientdelaktigheten haft under processen och för resultaten av förbättringsarbetet. Slutsatser. Patientdelaktighet skapar värde i flera dimensioner. Patientdelaktighet behöver designas, anpassas till kontexten och förbättringsarbetets mål och dess syfte behöver vara tydligt uttryckt. / Background. Perineal tears during childbirth can lead to after-delivery complications that leads to great suffering and low quality of life for a long time. Purpose. The purpose has been to improve after-delivery care by systematic follow-up, increasing the quality of diagnostics and management of these women, improving the information for the patient and developing new ways of improving including patients in the improvement work. The purpose of the study has been to study the effect of patient participation in the improvement work. Method. "The improvement ramp" and patient process-oriented perspective has been used to design the improvement work. The method of the study was qualitative in the form of a case study. Results. Follow-up using 3D-ultrasound is introduced. A care chain has been introduced and ways of patient participation have been designed and used. These are questionnaires, interviews, workshops and patient representatives in the improvement network. The results of the study show that the ways of patient participation provide different conditions for participation. The result shows the importance of organizational conditions, the value of patient participation, challenges in the introduction and the real influence that patient participation has had during the process and on the results of the improvement work. Conclusions. Patient-participation in QI creates values in several dimensions. Patient-participation needs to be carefully designed in compliance with context, goals and purpose.

本研究旨在探討台灣和中國電視劇產業合作狀況，以及深入理解從解嚴初期至今，兩岸電視劇交流無論是法規或產業的變化對台灣影視工作者的勞動條件和創作自主性的影響。本文援引Ryan（1992:108）對文化生產的概念，將台灣影視工作者，據其不同的生產位置分成「創意階段」和「再製階段」工作者，分別探討其勞動條件的變化。最後，再回歸兩岸合拍電視劇之政策，企圖給予台灣合拍電視劇之政策建議。 研究結果發現在兩岸電視劇的合作模式從「中國協拍，台灣主導」轉而變成「中國主導，台灣委製」的情況，而這樣的變化使台灣影視工作者的勞動處境顯得更為嚴苛。兩岸開放初期，中國電視劇製作業未臻成熟，使無論是創意或再製階段的台灣影視工作者在中國皆有較佳的工作機會與酬勞；然而，隨著中國電視劇產業的成長，投入於電視劇之製作費用明顯高於台灣時，台灣影視工作者的工作機會漸受限於中國市場的需求。在酬勞上，因中國資方會比照台灣電視劇製作費用來衡量，使得台灣影視工作者的酬勞漲幅低於中國影視工作者。 在創作自主上，本研究發現中國電視劇政策上的變化，對兩岸合作電視劇無論在人員選用和劇本安排上皆有很大的影響。同時，因為台灣缺乏鄉土劇和偶像劇以外劇種的生存空間，使得出走到中國的台灣影視工作者選擇服膺於中國電視劇的生產邏輯，傾向不牴觸中國當前的社會文化脈絡，如：台灣電視製作團隊為了通過中國官方的審批制度，製作出分別討好海外與中國市場之不同版本的電視劇。 綜合上述，兩岸電視劇產業呈現「中國大而台灣弱」的景況，台灣影視人才、技術外移中國的結果可能使台灣影視產業面臨「產業空洞化」的危機。因此，建議政府應有黃金時段限播外片之政策，建立良善的獎勵與輔導機制，例如：影視基金的規劃與落實。如此才有機會吸引台灣影視工作者回流，增加本地影視工作者之工作機會和多元劇種的生存空間。 / Increasingly, seeing as domestic TV market shrank could leave local TV drama workers jobless, Taiwan TV workers chose to develop their career within larger market. Due to linguistic and cultural similarities, Chinese vast market becomes the best choice for Taiwan TV workers who are looking for new opportunities. The study aims to explore the TV drama cooperation between Taiwan and China, and to review two side’s TV drama co-production policies from 1988 until now, and to figure out the impact of the two side’s TV drama industrial change on Taiwan television workers which involve labor condition and creativity autonomy. According to Ryan （1992:108）’s conception, the essence of the organizational division of labor in corporate production systems is divided into two distinct stages: creation and reproduction. Therefore, the definition of television workers includes creation stage workers and reproduction stage workers. As the result of the study, the rise of China TV drama industry has changed the partnership between Taiwan and China. In the past, China was represented as the assistance in the process of TV dramas production. Recently, China holds the initiative completely from research and pre-production stage to post-production stage. This situation forces the labor of Taiwan TV drama facing the more stringent labor condition. Compare to the initial Taiwan -China TV drama co-production period, Taiwan television labors’ wages do not grow. Even more, Taiwan reproduction stage workers facing the crisis of jobless in TV drama co-production model. Although the creative stage labors still have the advantage of job opportunities in Taiwan-China TV drama co-production, their creativity autonomies are limited by china’s censorship regime. For example, Taiwan TV production team might produce two different kinds of drama products catering to overseas markets and Chinese censorship required. In conclusion, to prevent the crisis of Taiwanese TV drama industrial hollowing-out effect such as the emigration of talent and technology. The study recommends our government must emphasize the importance of this phenomenon through prime time broadcast restrictions and audio-visual fund.