<p>Coaching har blivit en trend i vårt samhälle och denna studie kan ses som en resa genom ”coachingdjungeln”. Undersökningen består av strukturerade telefonintervjuer blandat med litteratur- och artikelstudier där syftet var att ta reda på i vilken utsträckning NLP – <em>neurolingvistisk programmering</em> – förekommer i coaching av arbetslösa och hur det används. Urvalsgruppen finns i 14 av Sveriges 21 län och består av kommunala, privata och statligt anställda jobbcoacher som arbetar med individer som står utanför arbetsmarknaden. Resultatet visar att NLP i coaching av arbetslösa inte är en vanlig modell utan det lösningsfokuserade arbetssättet dominerar. Studien belyser att förhållningssätt, begrepp, metoder, inställning till klienter och kommunikativa verktyg är centralt inom all coaching. Undersökningens resultat visar att likheter finns mellan olika coaching- och vägledningsmodellers innehåll fast de kan ha olika benämningar inom respektive modell. Studien visar också coachingens för- och nackdelar samt tankar kring utbildning, professionalitet och yrkestiteln ”coach”.</p> / <p>Coaching has become a trend in our society and this study can be seen as an expedition through the “coaching jungle”. The inquiry consists of structured interviews by telephone mixed by studies of related literature and articles, where the purpose was to find out to what extent NLP – <em>Neuro Linguistic Programming </em>– occurs in coaching of the unemployed and to what extent it is used in coaching. The selection-group can be found in 14 of the 21 counties of Sweden and it contains job coaches from the local government, private and also staff from the public sector who works with unemployed. The results exhibit that NLP is not a regular model in coaching of unemployed – instead the solution-focused model is quite the dominant one among the selection-group in this inquiry. The study also illustrates approaches, concepts, various methods, attitudes to the clients as well as communicative tools which are all central parts of coaching.  The survey reveals that there are similarities between the contents of different coaching- and counselling models, even though they might have different names for it.  The study shows the pros and cons of coaching in general and also thoughts and opinions of education, professionalism and the job title “coach”.</p> / Examensarbete inom påbyggnadskurs i studie- och yrkesvägledning, studie- och yrkesvägledarprogrammet

Résumé exécutif. Introduction. La tuberculose est une maladie infectieuse qui constitue un fardeau pour la société et en ce sens qu’elle est responsable d’un important taux de mortalité spécifique, surtout dans les pays en développement. Malgré les grands progrès en termes de méthodes de diagnostic, de prévention et de traitement, près de 9 millions de nouveaux cas apparaissent chaque année au niveau mondial et les 30% se trouvent en Afrique. On estime que la tuberculose est responsable de près de 2 millions de morts par an, principalement parmi les populations les plus pauvres. Pourtant, la maladie peut être guérie à l’aide des médicaments dont le coût est inférieur à 18 USD par patient. Pour faire face à ce problème lié à la tuberculose, l’OMS a recommandé vers 1994 l’application de la stratégie « Directly Observed Treatment Short-course, (DOTS) ». Cette stratégie, constituée de 5 points clés, n’a donné que des résultats partiels. Par conséquent, les experts de l’OMS ont conçu et ont publié une autre stratégie appelée « Halte à la Tuberculose » en 2006. Cette nouvelle stratégie, allant au delà des 5 principaux points de la stratégie DOTS, fait appel à toutes les structures sanitaires publiques et privées et à tous les acteurs de santé, y compris la communauté, pour participer au dépistage et à la prise en charge des tuberculeux. A Madagascar, la lutte contre cette maladie est coordonnée par l’équipe du Programme national de lutte contre la tuberculose (PNT). Ce programme est fonctionnel depuis 1991 et applique les stratégies recommandées par l’OMS. Par ailleurs, il a conçu un manuel destiné aux prestataires de soins et aux différents responsables du niveau opérationnel. Le PNT s’est fixé comme principaux objectifs d’améliorer le système de dépistage et d’atteindre un taux de guérison de 85%. En 2006, 15 ans après la mise en œuvre du programme, le taux de notification des nouveaux cas de tuberculose à frottis positif (TPM+) était de 81 pour 100.000 habitants par an et la proportion de réussite au traitement pour ce dernier groupe de tuberculeux était encore de 78%. La létalité et le taux d’échec au traitement à Madagascar est relativement bas. La relativement faible proportion de réussite, inférieure à l’objectif, est avant tout liée au taux d’abandon élevé. Depuis 2006, le PNT a adopté le système décentralisé dans la prise en charge des malades. Généralement, un tuberculeux a un parcours long et ardu à effectuer à partir de l’apparition des premiers signes d’imprégnation tuberculeuse jusqu’à la guérison. Ce parcours est à la fois d’ordre géographique et thérapeutique. Bien que les malades présentent des signes cliniques quasiment identiques, demandant un schéma thérapeutique standard, ils vivent dans des contextes différents. Et chaque contexte a un effet spécifique sur l’adhésion au traitement. Pourtant, ces contextes sont rarement considérés dans les stratégies conçues au niveau national et international. Soulignons que Madagascar est un vaste pays de 590.000 km² ayant des contextes (contexte géographique, contexte culturel, nombre de formations sanitaires, etc.) très variables d’une région à l’autre et d’un district à l’autre. L’application des directives sans tenir compte ces différents contextes locaux pourrait être à l’origine de la non réussite su système de suivi des malades et donc du contrôle de la tuberculose. Inversement, les districts et les centres de diagnostic et de traitement (CDT) qui adaptent les directives selon leurs contextes et/ou qui prennent des initiatives répondant aux contextes des malades, ont plus de chance de réussir le contrôle de la tuberculose. Objectifs. D’une manière spécifique, la présente thèse vise à : - Situer la lutte contre la tuberculose à Madagascar ; - Identifier les mécanismes d’adaptation et les initiatives locales associés à la performance du PNT ; - Proposer une solution réaliste au travers des résultats obtenus. Méthodologie générale. Pour atteindre les objectifs, une série de 5 études a été menée. Chacune de ces 5 études a son design spécifique. Mais d’une manière générale, ces études ont fait appel à des approches qualitatives et quantitatives. Elles nous ont amené à (i) interviewer des malades TB et éventuellement un membre de leur famille (ii) interviewer les prestataires de soins et les responsables du PNT dans différents niveaux (iii) exploiter les dossiers et les rapports relatifs à la prise en charge des tuberculeux. Les indicateurs utilisés par le PNT, dans le cadre du système de suivi des malades sous traitement sont le taux de réussite englobant le taux de guérison et le taux du traitement terminé, le taux d’échec, le taux de décès et le taux d’abandon. Il est constaté que la réussite au traitement est affectée par la résistance aux médicaments et la co-infection Tuberculose et VIH. Nous avons donc décidé de prendre le taux d’abandon comme l’indicateur principal permettant d’évaluer la performance du système de suivi des tuberculeux sous traitement. Méthodologie spécifique et résultats. Les 2 premières études sont des études rétrospectives visant à situer la lutte contre la tuberculose à Madagascar. L’une a ciblé spécifiquement les dossiers des malades dans le 3ème CDT de la ville d’Antananarivo et l’autre a visé tous les rapports de prise en charge des malades dans tout le pays de 1996 à 2004. Il a été observé que le taux d’abandon au traitement des tuberculeux à Madagascar est resté élevé depuis la mise en place du PNT en 1991 et la mise en route de la stratégie « DOTS » en 1994. Une diminution de ce taux a été constatée mais très lente, de l’ordre de 4,5 points (21,0% - 16,5%) en 9 ans (de 1996 à 2004). La 3ème étude a analysé la relation entre le niveau de performance du PNT et les améliorations organisationnelles sur le système de prise en charge des malades. Cette étude a ciblé un échantillon de 24 districts sanitaires ayant pris en charge au moins 100 malades par an entre 1996 et 2006. Elle a permis d’observer que le PNT a apporté des différentes améliorations organisationnelles sur la prise en charge des tuberculeux : amélioration de la couverture géographique en CDT, formation des agents de santé sur la stratégie DOTS etc. Par ailleurs, le PNT a obtenu de l’appui financier et technique de la part des organismes internationaux, plus particulièrement l’OMS, le Global Fund et la Coopération Française. Toutefois, en se référant aux taux annuels d’abandon au traitement, la performance de l’ensemble des 24 districts s’occupant la grande partie des tuberculeux ne s’est pas améliorée. En outre, l’analyse selon le district montre des niveaux de performance différents. La 4ème étude est une étude qualitative qui vise à identifier les adaptations des directives du PNT et les initiatives locales prises par les responsables de terrain et les prestataires de soins. Elle a été menée auprès des CDT d’un échantillon de 6 districts et a permis d’identifier une série d’adaptations des directives et d’initiatives locales expliquant la performance des CDT et des districts. Elles sont constituées principalement par (i) des initiatives renforçant la motivation des malades dans leur prise de traitement, comme la responsabilisation des malades et des membres de famille dans le suivi du traitement (ii) des initiatives assurant une meilleure accessibilité des soins, comme la création de centre d’hébergement et l’offre de frais de déplacement (ii) et des initiatives améliorant la qualité des soins comme le recrutement d’un agent spécifique tuberculose. La 5ème étude a été effectuée pour tester, sur l’ensemble des CDT à Madagascar, les facteurs de performance identifiés sur un échantillon de CDT inclus dans la 4ème étude. Le taux de réponse de cette étude était plus de 80%. L’analyse a permis d’observer que durant la période précédant la décentralisation, le taux d’abandon était de 16,8% (n=35.090), il a passé à 11,5% (n=28.688) après la décentralisation. Les CDT publics et les CDT intégrés dans les grands hôpitaux ont un taux d’abandon élevés par rapport aux autres CDT privés et/ou intégrés dans les formations sanitaires de base. La différence est significative quelle que soit la période. Il a été observé que les CDT performants ont effectué des adaptations et ont pris d’initiatives répondant aux contextes de leurs malades. En outre, plus le nombre d’initiatives augmente, plus la performance du CDT est élevée. Les principales initiatives associées à la performance d’un CDT sont : - L’incitation des malades à passer au CDT et au laboratoire lors de la réalisation des analyses des crachats ; - La distribution des médicaments à tour de rôle ; - La présence d’agent spécifique TB dans le CDT ; - La présence obligatoire ou sollicitée d’un membre de la famille lors des séances d’Information, Education et Communication (IEC) ; - L’implication des anciens malades dans les IEC de groupe et dans le soutien psychologique des malades ; - L’implication des ONG dans la prise en charge des malades ; - La délivrance des résultats des analyses sous pli fermé ; - La réalisation d’au moins 4 séances d’IEC personnelles ; - La réalisation régulière d’IEC de groupe ; - La présence de centre d’hébergement ; - L’implication des agents communautaires dans la prise en charge des malades. Toutefois, le niveau d’association de ces initiatives à la performance varie selon les caractéristiques du CDT (Grand hôpital versus Formation sanitaire de base ou hôpital de district ; CDT public versus CDT privé). Par ailleurs, certaines initiatives prises par les prestataires dans des contextes spécifiques n’étaient pas favorables à l’adhésion au traitement et ont conduit à des taux d’abandon plus élevés. L’autorisation donnée à un membre de la famille de récupérer les médicaments est associée à l’abandon au traitement dans les centres privés et dans les formations sanitaires de base. L’exigence de certificat de résidence des malades est associée à l’abandon au traitement dans les grands hôpitaux. Suggestions Etant des bonnes pratiques validées au travers d’une enquête auprès de plus de 80% des CDT, les initiatives identifiées au terme de la présente thèse méritent d’être diffusées auprès des managers de terrain du PNT et des prestataires de soins. Par contre, elles ne doivent pas être copiées directement. Nous suggérons une approche pratique évitant l’application mécanique de ces initiatives. Il s’agit d’une stratégie de « coaching » et est constituée de 2 axes stratégiques. Axe stratégique 1 : Définition des termes de référence de chaque formation sanitaire par rapport à la prise en charge de la tuberculose. Objectif spécifique 1.1 : Transformer les CDT intégrés dans les hôpitaux universitaires et les hôpitaux régionaux en centre de traitement temporaire. Objectif spécifique 1.2 : Impliquer toutes les formations sanitaires dans la prise en charge des tuberculeux. Axe stratégique 2 : Création d’un système officiel de « coaching » au sein des acteurs de terrain du PNT. Objectif spécifique 2.1 : Définir la place de chaque CDT à part entière suivant le système de coaching. Objectif spécifique 2.2 : Mettre en route le système de coaching. D’une manière pratique, les CDT ayant mis en œuvre au moins 7 initiatives et qui ont un taux d’abandon inférieur ou égal à 10% sont considérés comme des « coachs » et les autres CDT sont ceux à appuyer. Le prestataire de soins d’un CDT à appuyer va effectuer dans un premier temps un stage d’imprégnation dans un CDT « coach ». L’objectif est de vivre, de discuter et de comprendre les différentes initiatives propices menées dans le CDT « coach ». Au terme de son stage, le prestataire appuyé aura à définir les grandes lignes d’initiatives qui seraient favorables dans son contexte. Après ce stage d’imprégnation, le prestataire d’un CDT coach accompagne le prestataire appuyé dans son CDT afin d’analyser son contexte et de spécifier les initiatives à mettre en œuvre. Il est suggéré d’effectuer, après 6 ou 12 mois de la mise en œuvre, une mini-évaluation au travers des indicateurs de routine du contrôle de la tuberculose en général et particulièrement au travers du taux d’abandon au traitement. Conclusion La considération des contextes des malades par les responsables de terrains et les prestataires de soins, au travers de la prise d’initiatives propices, n’est pas du hasard. Elle a été conditionnée par la connaissance des réalités locales, des contextes des malades et les expériences de ces agents de terrain. Il est temps de conceptualiser et de publier autant que possible, ces initiatives propices afin d’améliorer davantage la lutte contre la tuberculose. L’objectif étant de partager les expériences des agents de terrain par la diffusion de leurs bonnes pratiques auprès des autres acteurs et de conscientiser les responsables nationaux et internationaux que l’application mécanique des directives, sans tenir compte les réalités de terrain, va à l’encontre du contrôle de la maladie. Une démarche simple étiquetée « Système de coaching » va certainement servir comme outil efficace de mise en œuvre des différents systèmes de prise en charge et de suivi des malades. Mais lors de la mise en œuvre des ces bonnes pratiques, la phrase de Kelly « Local problems, local solutions… » devrait être considérée comme balise. Car la bonne pratique dans une zone peut ne pas être toujours efficace dans d’autres zones. Dans ce cas, nous encourageons les managers de terrain et les prestataires de soins à analyser leurs contextes locaux et les réalités de leurs patients et d’apporter des solutions et des initiatives adéquates. Les décideurs et les responsables centraux devraient faciliter cette démarche de prise de décision par la création officielle d’une atmosphère d’échange d’expériences entres tous les acteurs. Executive summary. Introduction Tuberculosis is an infectious disease that causes a burden to society, and in this case, it is responsible for a substantial specific mortality rate, especially in developing countries. Despite excellent progress in terms of diagnosis, prevention and treatment methods, nearly 9 million new cases occur each year and 30% are in Africa. It is estimated that TB kills 2 million people a year, mostly among the poorest populations. However, the disease can be cured with drugs costing less than USD 18 per patient. To resolve the problem related to TB, WHO recommended in 1994 the implementation of the strategy of "Directly Observed Treatment Short-course (DOTS). This strategy consists of 5 key points, gave only partial results. Therefore, the WHO experts have designed and issued another strategy called "Stop TB" in 2006. This new strategy, going beyond the 5 main points of the DOTS strategy, called on all public and private health facilities and all health workers, including community health workers, to participate on TB screening and treatment. In Madagascar, the fight against TB is coordinated by the staff of National Tuberculosis Program (NTP). This program is operational since 1991 and applies the strategies recommended by WHO. In addition, it designed a manual, referring to these strategies and, for healthcare providers and program managers at the operational level. The main objectives of NTP were to improve the screening system and to cure 85% among those detected. In 2006, 15 years after the implementation of the program, the notification rate of new smear-positive (TPM +) was 81 per 100,000 inhabitants and the treatment success rate for this group of tuberculosis patients was still 78%. The lethality and treatment failure rate of treatment in Madagascar is relatively low. The relatively low percentage of treatment success, below the target, is primarily related to the high defaulting rate. Since 2006, the NTP adopted the decentralized system regarding patient care. Normally, a TB patient has a long and hard way to do from the first signs of TB until treatment success. This way is both geographic and therapeutic. Although patients have almost identical clinical signs requiring a standard treatment, they have different contexts. And each context has specific effect on treatment adherence. However, strategies designed at national and international levels consider rarely the local contexts. Note that Madagascar is a big country of 590,000 km² with different contexts across regions and districts (geographical, cultural context, many health facilities, etc.). The application of the guidelines without regard to these different contexts of patients is one of the causes of non successful TB control. Conversely, districts and centers for diagnosis and treatment (CDT) which adapt the guidelines to their contexts and / or take initiatives responding to the patient contexts have a greater chance of successful TB control. Objectives The thesis aims to: • Describe the fight against tuberculosis in Madagascar; • Identify coping mechanisms and local initiatives related to the performance of the NTP; • Propose a realistic strategy based on the results. Overall Methods To achieve the objectives, a series of 5 studies was conducted. Each of these 5 studies has its specific design. Generally, these studies used qualitative approaches and quantitative. And they led us to (i) interviewing TB patients and possibly a family member (ii) interviewing healthcare providers and PNT managers in different levels (iii) exploring TB patient files and reports at the NTP. The main indicators used by the NTP in the monitoring of patients treated are the treatment success rate including cure rate and treatment completion rate, the failure rate, the death rate and the defaulting rate. It found that successful treatment is affected by drug resistance and co-infection TB / HIV. So, we decided to take the defaulting rate as the main indicator to evaluate the performance of the monitoring system of TB patients treated. Specific methods and results The first 2 studies were retrospective studies aimed at understanding the fight against tuberculosis in Madagascar. The first study used patient files in the 3rd CDT of Antananarivo and the second study used all reports of patients across the country from 1996 to 2004. It was observed that the defaulting rate of tuberculosis treatment in Madagascar remained high since the implementation of the NTP in 1991 and the launching of the strategy DOTS in 1994. A slow decrease rate is found, about 4.5 points (21.0% - 16.5%) in 9 years (1996 to 2004). The 3rd study analyzed the relationship between the performance level of the NTP and organizational improvements in the care system of patients. A sample of 24 health districts supported at least 100 patients per year between 1996 and 2006 was included in this study. And it was observed that the NTP has made significant improvements on the organizational management of tuberculosis: improved coverage in CDT, training health workers on DOTS etc. Furthermore, the NTP has obtained financial and technical supports from international agencies, particularly WHO, the Global Fund and the French Cooperation. However, referring to the annual defaulting rate, the performance, of all the 24 districts involved the majority of TB patients, was not improved. Moreover, analysis by the district shows different levels of performance. The 4th study is a qualitative study which aims to identify adaptations of NTP guidelines and local initiatives taken by the NTP local managers and the healthcare providers in terms of patients monitoring. It was conducted among a sample of CDT from 6 districts and has identified a series of adjustments to the guidelines and local initiatives explaining the performance of CDT and districts. The main initiatives identified are (i) initiatives that strengthen the motivation of patients in treatment adherence as empowering patients and family members in treatment monitoring (II) initiatives to ensure better accessibility of care, such as creation of shelter (ii) initiatives improving the care quality, such as the recruitment of specific agent tuberculosis. The 5th study was conducted to test on all CDT Madagascar, performance factors identified in the 4th study. The response rate of this study was more than 80%. The analysis noted that during the period before decentralization, the defaulting rate was 16.8% (n = 35,090), he rose to 11.5% (n = 28,688) after decentralization. The public CDT and the CDT integrated in big hospitals have a higher defaulting rate compared to other CDT. The difference is significant regardless of the period. It was observed that performing CDT has made adjustments and took initiatives responding to the contexts of their patients. In addition, the number of initiatives increases the level of performance of the CDT. The main local initiatives associated with the performance of the CDT are: • The encouragement of patients to go to the CDT and to the laboratory when performing tests of sputum; • The distribution of drug in turn; • The presence of TB specific agent in CDT; • The mandatory presence of family members in education sessions; • The involvement of former patients in group education sessions and in the counseling of patients; • The involvement of NGOs in the management of patients; • The delivery of analysis results in a sealed envelope; • The achievement of at least 4 personal education sessions; • The achievement of regular group education; • The presence of patient shelter; • The involvement of community health workers in the care of patients. However, the level of association between these initiatives and the performance of the CDT depends on the characteristics of the CDT (Big hospital versus basic health education; CDT private versus CDT public). Furthermore, some initiatives taken by providers in specific contexts did not improve the adherence to treatment, but they led to higher defaulting rate. The authorization given to a family member to recover the drugs is associated with treatment non-adherence in private clinics and health facilities basic. The requirement for a certificate of residence of patients is associated with treatment default in big hospitals. Suggestions As good practices validated through a survey of more than 80% of CDT, the initiatives identified at the end of this thesis deserve to be available to field managers of the NTP and to the healthcare providers. However, they should not be copied directly. We suggest a practical approach to avoid the mechanical application of these initiatives. It is a “coaching strategy” and consists by 2 strategic focuses. Strategic focus 1: Definition of terms of reference of each facility regarding tuberculosis diagnosis and treatment. Specific Objective 1.1: To transform CDT integrated in university hospitals and regional hospitals in temporary treatment center. Specific objective 1.2: To involve all health facilities in the treatment of tuberculosis. Strategic focus 2: Creation a formal system of coaching in the health workers of the NTP. Specific objective 2.1: Set up each CDT full following the coaching system. Specific Objective 2.2: To launch the coaching system. Practically, the CDT has taken at least 7 initiatives and has had a defaulting rate less than 10% are considered as "coaches" and the other ones are considered as CDT to be supported. The healthcare provider of the support CDT will perform impregnation stage at a CDT "coach". The goal is to practice, to discuss and to understand the different initiatives undertaken at the CDT "coach". After his training, the support provider will have to outline initiatives that would undertake in its context. After this stage of impregnation, the coach accompanies the trained at its CDT in order to analyze its context and to specify the initiatives to implement. It is suggested to perform after 6 or 12 months of implementation, a mini-assessment through routing indicators. Conclusion The consideration of TB patient contexts by local managers and healthcare providers, through taking good initiatives, is not randomly. It was conditioned by the knowledge of local situations and local contexts and conditioned by the experiences of health worker. It is time to conceptualize and publish as much as possible, these good initiatives to further improve the fight against tuberculosis. The goal is to share experiences of health workers through the dissemination of their good practices with others and raise awareness among national and international managers that the mechanical application of the guidelines, ignoring the local realities, does not lead to better disease control. A simple strategy labeled "System Coaching" will certainly serve as an effective tool for implementation of patient care systems and patient monitoring. But during the implementation of those practices, Kelly phrase "Local problems, local solutions ..." should be regarded as the benchmark. Because, a good practice in one area may not always be effective in other areas. In this case, we encourage local managers and healthcare providers to analyze their local contexts and realities of their patients in order to provide solutions and appropriate initiatives. Stakeholders and central managers should facilitate their approach by establishing a formal atmosphere experience exchanges between all health workers in terms of control of TB.

Coaching har blivit en trend i vårt samhälle och denna studie kan ses som en resa genom ”coachingdjungeln”. Undersökningen består av strukturerade telefonintervjuer blandat med litteratur- och artikelstudier där syftet var att ta reda på i vilken utsträckning NLP – neurolingvistisk programmering – förekommer i coaching av arbetslösa och hur det används. Urvalsgruppen finns i 14 av Sveriges 21 län och består av kommunala, privata och statligt anställda jobbcoacher som arbetar med individer som står utanför arbetsmarknaden. Resultatet visar att NLP i coaching av arbetslösa inte är en vanlig modell utan det lösningsfokuserade arbetssättet dominerar. Studien belyser att förhållningssätt, begrepp, metoder, inställning till klienter och kommunikativa verktyg är centralt inom all coaching. Undersökningens resultat visar att likheter finns mellan olika coaching- och vägledningsmodellers innehåll fast de kan ha olika benämningar inom respektive modell. Studien visar också coachingens för- och nackdelar samt tankar kring utbildning, professionalitet och yrkestiteln ”coach”. / Coaching has become a trend in our society and this study can be seen as an expedition through the “coaching jungle”. The inquiry consists of structured interviews by telephone mixed by studies of related literature and articles, where the purpose was to find out to what extent NLP – Neuro Linguistic Programming – occurs in coaching of the unemployed and to what extent it is used in coaching. The selection-group can be found in 14 of the 21 counties of Sweden and it contains job coaches from the local government, private and also staff from the public sector who works with unemployed. The results exhibit that NLP is not a regular model in coaching of unemployed – instead the solution-focused model is quite the dominant one among the selection-group in this inquiry. The study also illustrates approaches, concepts, various methods, attitudes to the clients as well as communicative tools which are all central parts of coaching.  The survey reveals that there are similarities between the contents of different coaching- and counselling models, even though they might have different names for it.  The study shows the pros and cons of coaching in general and also thoughts and opinions of education, professionalism and the job title “coach”. / Examensarbete inom påbyggnadskurs i studie- och yrkesvägledning, studie- och yrkesvägledarprogrammet

Bakgrund: Kvalitetsutveckling inom vården pågår i hela världen. Internationell forskning indikerar att förbättringscoacher kan vara en framgångsfaktor i förbättringsarbetet. Det är i dag oklart hur man kan utveckla interna coacher till att stödja kontinuerliga förbättringar. Studien utvärderar ett lokalt, tvärprofessionellt coachprogam inom vård och omsorg i ett geografiskt område i Sverige med en etablerad samverkanskultur. För att främja ökad kundcentrering ingick en pensionär i programmets planeringsgrupp. Deltagarna introducerades i grundläggande förbättringskunskap och i lösningsfokuserat arbetssätt som ett sätt att bättre kunna hantera komplexiteten i vård och omsorg. Programmet utformades med åtta gemensamma träffar under perioden mars till oktober 2011.   Syfte: Att identifiera faktorer i ett lokalt coachprogram som framstår som mest väsentliga för att medarbetare i vård och omsorg ska kunna gå in i rollen som förbättringscoacher. Metod: Studien är en observerande fallstudie med inslag av aktionsforskning och en induktiv kvalitativ ansats. Deltagare i studien var blivande coacher, pensionärer, planeringsgruppen och erfarna coacher. Sju semistrukturerade intervjuer med totalt 17 personer genomfördes, samt analys av lokala dokument och fyra enkäter. Data analyserades genom en manifest kvalitativ innehållsanalys och triangulering. Resultatet validerades av samtliga deltagare i studien. Resultat: Involvering av pensionärer ansågs vara en viktig faktor eftersom det förstärkte kundfokuseringen. Deltagarna i studien poängterade att kundfokus, ett lösningsfokuserat förhållningssätt, nätverk och systemförståelse var grundläggande för utvecklingen av coachrollen. Dessa faktorer bedömdes som viktigare än de specifika förbättringsverktygen. Diskussion: De mest väsentliga faktorerna kan delas in i det som uppmuntrade till idéer, vilja, görande och uthållighet. Pensionärsinvolveringen förstärkte kundfokuseringen, och det lösningsfokuserade arbetssättet framstod som ett bra komplement till de sedvanliga förbättringsverktygen. Det vore intressant att jämföra detta program med förbättringsprogram i andra kontexter. / Background: Internal improvement coaches can support quality improvement efforts. The study is about a local interprofessional coach training program in a region in Sweden with an established culture of collaboration. The program included participants from different health care disciplines and was organized over eight days between March and October 2011. A senior citizen was involved in faculty and participated during all training sessions. The participants were introduced to basic improvement knowledge and a solution focused approach.Purpose: To explore essential elements of a local coach training program and what appears to be crucial in moving into the role of being an improvement coach.Method: The study is a mix methods case study with elements of action research and an inductive qualitative approach. Participants in the study were prospective coaches, senior citizens, the program team, and experienced coaches. Data were collected through seven semi-structured group interview sessions with a total of 17 individuals, document analysis and 4 questionnaires. Data were analyzed using a manifest content analysis and triangulation. The results were validated by all participants in the study.Results: The data suggest that the involvement of a senior citizen was essential for strengthening customer focus. Participants in the study pointed out that customer focus, developing a value base, networking skills with a solution focused approach and systems thinking were fundamental to the development of the coaching role. These factors were assessed as more important than improvement tools.Discussion: The results can be divided into those which encouraged ideas, will, execution, and endurance. Senior citizen involvement enhanced customer focus and the solution-focused approach seems to be a valuable addition to the usual improvement tools. It would be interesting to compare this program with other improvement programs or in other contexts.

Das Interesse an Untersuchungen über Erfolgsfaktoren von Projekten im Umfeld digitaler Produktionen1 rührt auch daher, dass immer noch viele Projekte in Schieflage geraten oder gar scheitern. Die Gründe hierfür liegen meist im mangelhaften Management dieser Projekte. Hier besteht Bedarf nach Fachkompetenz der bspw. durch die Inanspruchnahme von Projekt-Coaching gedeckt werden kann. Projekt-Coaching unterstützt die Projektbeteiligten bei der Bewältigung von Projektmanagementaufgaben durch eine fachliche und persönliche Beratung. Die Zusammenarbeit zwischen dem Coach und der zu beratenden Person (Coachee) beruht auf dem zu Grunde liegenden Vertrauensverhältnis und dem intensiven persönlichen Kontakt. Die Interaktion im Coaching-Prozess ist somit mit einem hohen Kommunikations-, Koordinations- und Zusammenarbeitsaufwand verbunden, was jedoch bei zeitkritischen Projekten häufig nicht durchführbar ist. Oftmals fehlt vielen Unternehmen mit Coaching-Bedarf auch ein direkter Zugriff auf einen Pool geeigneter Projekt-Coaches. Findet ein Coaching-Prozess statt, ist dieser mit mehreren persönlichen Gesprächen verbunden, die meist in Form von Präsenzterminen stattfinden. Diese müssen geplant, koordiniert, vorbereitet, durchgeführt und nachbereitet werden, was vor allem bei örtlich verteilten Akteuren einen hohen organisatorischen Aufwand bedeutet.

Developing professional expertise of prospective teachers not only in terms of theoretical knowledge but also in terms of competencies of designing challenging and cognitively activating learning opportunities in the mathematics classroom is certainly one of the key aims of internship phases in pre-service mathematics teacher training. As mathematics-related theoretical contents of teacher training and practice-related learning opportunities of school internships are not always linked in an optimal way, this paper aims at discussing a model of an intensive internship phase combined with a triple coaching approach partly integrated in a course accompanying the internship phase.

Attention Deficit Hyperactivity Disorder (ADHD) är ett neuropsykiatriskt funktionshinder som inte bara har ökat bland barn, utan även hos vuxna. Enligt Socialstyrelsen beror denna ökning på att det finns en större kunskap om diagnosen och symtomen märks tydligare i och med att vi nu lever i ett informationssamhälle med högre kognitiva krav. I framförallt USA har det blivit populärt att använda sig av ADHD-coacher som ett komplement till medicin och terapi. Metoden existerar i Sverige, men den ingår inte som en behandlingsform som erbjuds eller föreslås till individer som får diagnosen ADHD. Syftet med denna studie är att ge mer kunskap om ADHD-coaching samt att jämföra denna metod med andra behandlingsalternativ som ges till en individ med ADHD diagnos. Jag har utgått ifrån ett salutogent perspektiv med Antonovskys KASAM som stöd, då jag tittat på det kognitiva området och vidare empowerment i förhållande till det psykosociala stödet. Resultatet av studien visar på att det finns effektiva behandlingsmetoder för ADHD, men att införa ADHD-coaching som metod kan motiveras då denna metod är specifikt inriktad på ADHD och visar på effekt i U.S.A. Empirin i studien består av vetenskapliga artiklar och facklitteratur i ämnet. Det framgår också i studien att det finns behov av fler vetenskapliga studier både om ADHD-coaching som metod och om andra behandlingsmetoder för framförallt vuxna med ADHD diagnos. / Attention Deficit Hyperactivity Disorder (ADHD) is a neuropsychiatric impairment that not only has increased in children but also in adults. It is considered by the Swedish National Board that the increase directs us to a greater knowledge of the diagnosis and the symptoms are more noticeable now since we live in an information society with higher cognitive demands. Foremost in USA, it has become popular to use ADHD coaches as a method complementary to medicine and therapy. The method does exist in Sweden, but it is not a treatment that individuals are informed of or even suggested as a complementary. The purpose of this study is to increase awareness of ADHD Coaching and comparing the method to other treatments for people with ADHD. The results showed that there are effective methods for ADHD, but ADHD Coaching would be a good complementary as it is tailored for the symptoms of ADHD. Viewed from Antonovskys salutogenic perspective, I have used KASAM to support the cognitive aspect and I have used empowerment to support the psychosocial aspect of treatments. My studies and empirical material includes peer reviewed articles and literature on the subject. The results show a need for more empirical studies of ADHD Coaching as well as therapeutically methods for adults with ADHD in particular.

Submitted by Timbo Noeme (noeme.timbo@metodista.br) on 2016-08-08T18:43:10Z No. of bitstreams: 1 BrunaSantos.pdf: 1745061 bytes, checksum: b0768d59f3d825b89e4d93698d3463fb (MD5) / Made available in DSpace on 2016-08-08T18:43:10Z (GMT). No. of bitstreams: 1 BrunaSantos.pdf: 1745061 bytes, checksum: b0768d59f3d825b89e4d93698d3463fb (MD5) Previous issue date: 2015-08-19 / The research aimed to analyze the main reasons why state-owned enterprises (SOEs) from São Paulo-Brazil use coaching and mentoring as a knowledge sharing practice.The 2009 decree No. 53963,sanctioned by the Governor of São Paulo established the Knowledge and Innovation Management Policy for SOEs. Kuniyoshi and Santos (2007) conducted a research, in which identifies practices and knowledge management initiatives adopted by some companies, among them, coaching and mentoring. The pratical process requires not only financial investment but time and adequate people, thus instigates research actions in the organizational context of the SOEs. This study seeks to contribute to the development of studies in the public area. The method used in this qualitative study is exploratory type. The object of this research were the São Paulo SOEs, that currently add up to 21. We conducted a case study with interview and document analysis in two of these SOEs, Sabesp, company sanitation sector water and sewage, aimed to analyze the coaching practice and the Institute for Technological Research (IPT), national reference metrology, aimed to analyze the practice of mentoring. Since there are no exclusive practices to Knowledge Management, and the success of a practice is related to the context in which it operates. In the case of Sabesp, the coaching practice is used as one of the activities within both programs, aimed at developing human capital as a competitive force. IPT aimed at the implementation of mentoring program, specifically the sharing tacit knowledge. It has been discovered that coaching and mentoring practices are used as a way of making a company unique before others, even SOEs with no focus on competitiveness, but they use knowledge strategically to improve the quality of service to society. / A pesquisa teve como objetivo geral analisar as principais razões pelas quais as empresas públicas paulistas utilizam coaching e mentoring como práticas de compartilhamento de conhecimento. No ano de 2009, foi instituído pelo governador do Estado de São Paulo, o decreto nº 53.963 que instituiu a Política de Gestão do Conhecimento e Inovação para as empresas públicas. Kuniyoshi e Santos (2007) realizaram uma pesquisa, na qual identificaram práticas e iniciativas de gestão do conhecimento adotadas por algumas empresas, dentre elas, coaching e mentoring. As práticas são processos que necessitam de investimento não somente financeiro, mas de tempo e pessoas adequadas, por serem processos mais complexos, instigam a investigação de ações no contexto organizacional de empresas públicas. Este estudo busca contribuir para o desenvolvimento de estudos na área pública. O método utilizado neste estudo de abordagem qualitativa é do tipo exploratória. O objeto desta pesquisa foram as empresas públicas paulistas, que, atualmente, somam 21. Foi realizado estudo de caso, com entrevista e análise documental em duas destas empresas, A Sabesp, empresa do segmento de saneamento de água e esgoto, teve como objetivo analisar a prática de coaching e, o Instituto de Pesquisa Tecnológicas (IPT), referência nacional em metrologia, teve como objetivo analisar a prática de mentoring. Uma vez que não existem práticas exclusivas à Gestão do Conhecimento, e o sucesso de uma prática está relacionado ao contexto na qual está inserida. No caso da Sabesp, a prática de coaching é utilizada como uma das atividades dentro de dois programas, visando desenvolver o capital humano como força competitiva. O IPT teve como objetivo da aplicação do programa de mentoring, especificamente, o compartilhar conhecimento tácito. Foi constatado que as práticas de coaching e mentoring podem ser utilizadas como recurso capaz de tornar a empresa singular perante as demais, mesmo empresas públicas não tendo foco em competitividade, mas utilizam o conhecimento de forma estratégica para melhorar a qualidade de atendimento à sociedade.

Submitted by Adriana Amorim de Castro e Silva (adriana_aces@yahoo.com.br) on 2017-01-05T15:20:05Z No. of bitstreams: 1 DISSERT ADRIANA AMORIM_VF.pdf: 1774076 bytes, checksum: c6df63e051f55b576d488d40a8dc0933 (MD5) / Approved for entry into archive by Janete de Oliveira Feitosa (janete.feitosa@fgv.br) on 2017-01-09T11:55:09Z (GMT) No. of bitstreams: 1 DISSERT ADRIANA AMORIM_VF.pdf: 1774076 bytes, checksum: c6df63e051f55b576d488d40a8dc0933 (MD5) / Made available in DSpace on 2017-01-17T12:37:39Z (GMT). No. of bitstreams: 1 DISSERT ADRIANA AMORIM_VF.pdf: 1774076 bytes, checksum: c6df63e051f55b576d488d40a8dc0933 (MD5) Previous issue date: 2016-12-07 / Esta dissertação teve como problema de pesquisa 'como as empresas brasileiras, contratantes do serviço de coaching externo, avaliam e/ou medem os resultados do coaching executivo?' Os objetivos desta pesquisa referem-se a: entender como a avaliação e medição de resultados em coaching tem sido tratada na literatura dentro e fora do Brasil, quais modelos são discutidos, trazer novos insumos para a discussão sobre avaliação e medição de resultados em coaching por parte das empresas brasileiras que contratam este serviço, bem como dar visibilidade ao mercado de coaching sobre como as empresas aferem os resultados do coaching. A metodologia utilizada foi a pesquisa qualitativa, de caráter exploratório-descritivo, considerando uma amostragem não probabilística, usando a seleção por julgamento. Para isto foram realizadas entrevistas semiestruturadas em profundidade com nove profissionais de RH responsáveis pela cadeia de valor do coaching: contratação, acompanhamento e avaliação de resultados. A técnica de análise das entrevistas foi a análise de conteúdo à luz das seguintes categorias: acompanhamento, avaliação de resultados, novas formas e eficácia. Os resultados da pesquisa demonstraram que as empresas não possuem uma metodologia própria de avaliação de resultados de coaching e que utilizam as desenhadas pelas consultorias fornecedoras de coaching, embora haja controvérsias quanto à adoção destas. De maneira geral, as empresas desejam uma forma de avaliação que seja capaz de demonstrar os resultados, sejam eles comportamentais ou financeiros, de forma mais tangível. / This dissertation had as research problem 'how Brazilian companies, that hire the external coaching service, evaluate and/ or measure the results of executive coaching?' The objectives of this research refer to understand how the evaluation and measurement of results has been treated in literature in and out of Brazil; which models are discussed, bring new inputs to the discussion on evaluation and measurement in coaching results by Brazilian companies that hire this service and give visibility to the coaching market about how companies appraise coaching results. The methodology used was the qualitative research, exploratory and descriptive, considering non-probability sample, by judgment selection. For this purpose, were conducted in-depth semi-structured interviews with nine HR professionals responsible for coaching’s value chain: contracting, monitoring and evaluation of results. The interviews’ analysis technique was content analysis in light of the following categories: monitoring, results evaluation, new forms and effectiveness. The survey results showed that companies do not have an own methodology for evaluating coaching results and use the ones drawn by coaching supplying consulting, although there is controversy regarding the adoption of these. In general, companies want a form of evaluation that is able to demonstrate results, whether behavioral or financial, more tangibly.

O objeto desta dissertação são as atividades motivacionais modernas, ou seja, atividades voltadas para a criação de um estímulo em indivíduos que, supõe-se, necessitam de um sentido para seu trabalho e/ou sua vida. Tais atividades demandam interrupções da rotina e uma reflexão sobre a própria trajetória do praticante, e há uma oferta variada de produtos com esse fim, oferecidos por empresas especializadas. Neste trabalho nos concentramos em analisar palestras motivacionais, um grupo de encontro de fim de semana chamado Leader Training e o coaching associado à programação neurolinguística (PNL). Buscamos realizar observações participantes, entrevistas e análises de material de divulgação, livros, vídeos e sítios da internet a fim de conseguir apreender essas práticas em suas diversas facetas. Nossa análise e interpretação buscou compreender os mecanismos e estratégias dessas atividades para construção de sua eficácia, por meio de narrativas e performances que buscam realinhar as intenções dos participantes com uma noção convencional de sucesso e felicidade, observando as diferentes maneiras como o discurso científico é acionado e o religioso é sutilmente sugerido na elaboração de seus conteúdos. Operando comparações das descrições de campo com a teoria antropológica, em intersecção com uma análise baseada nos pressupostos dos science studies na sua forma de conceber o moderno em suas simetrias com o não-moderno, acreditamos ter contribuído com a ampliação do olhar sobre o objeto. / The object of this dissertation are the \"modern motivational activities\", i.e. activities aimed at creating an incentive in individuals who, one assumes, require a meaning to their work and/or their life. Such activities require routine interruptions and a reflection on the participants own trajectory, and there is a wide range of products for this purpose, offered by specialized companies. In this dissertation, we focus on analyzing motivational talks, a weekend group meeting called Leader Training and coaching associated with Neuro-Linguistic Programming (NLP). We seek to conduct participant observation, interviews and analysis of promotional materials, books, videos and websites in order to be able to understand these practices in its various facets. Our analysis and interpretation sought to understand the mechanisms and strategies of these activities to build their effectiveness through narratives and performances, that seek to realign the intentions of the participants with a conventional notion of success and happiness, noticing the different ways in which scientific discourse is triggered and the religious is subtly suggested in the development of its contents. We believe that we have contributed to broaden the view on the subject, operating comparisons of field descriptions with the anthropological theory, in intersection with an analysis based on the assumptions of Science Studies in their way of conceiving the modern in its symmetries with the non-modern.