Yes / Clinical guidelines are an integral part of healthcare. Whilst much progress has been made in ensuring that guidelines are well developed and disseminated, the gap between routine clinical practice and current guidelines often remains wide. A key reason for this gap is that implementation of guidelines typically requires a change in the behaviour of healthcare professionals – but the behaviour change component is often overlooked. We adopted the Theoretical Domains Framework Implementation (TDFI) approach for supporting behaviour change required for the uptake of a national patient safety guideline to reduce the risk of feeding through misplaced nasogastric tubes.

Résumé : S'intéressant à l'action administrative de premier niveau, ce mémoire tente de mettre en lumière les limites juridiques et les facteurs organisationnels qui influent sur l'exercice par les agents d'indemnisation et les conseillers en réadaptation de la CSST de leurs fonctions. Tout comme des études empiriques réalisées dans d'autres juridictions à l'égard de différents régimes de sécurité sociale et desquelles elle est inspirée, cette étude révèle que l'exercice d'une discrétion administrative est inévitable. Y sont décrites et commentées les méthodes de gestion privilégiées par l'organisme et les fonctions exercées par les décideurs de manière à identifier la part d'appréciation ou de jugement que peuvent exercer les agents et les conseillers dans le cadre du régime québécois de réparation des lésions professionnelles, ainsi que les processus décisionnels, variables selon les fonctions particulières exercées, qui y mis en œuvres. Cette étude démontre également comment la structure administrative privilégiée par l'organisme est susceptible de contribuer au respect des droits des administrés, tout en comportant certains risques d'atteinte à l'équité des processus. / Abstract : This aim of this study is to expose the legal limits and organisational factors which may affect decision-makers' discretion in the context of the employment injuries compensation system in the province of Québec. The findings of this study align with some empirical studies concerning different social security regimes in other jurisdictions from which it is inspired. Indeed, it reveals that administrative discretion is inevitable. It describes and comments the management techniques implemented in the organization. It also describes the particular functions of two categories of street-level workers, the agents d'indemnisation and the conseillers en réadaptation, in order to identify the matters about which they may use their judgment or exercise a discretion, as well as the particular decision-making processes that occur at the front lines of service delivery. It shows how the administrative structure concurs to the respect of the clients rights but may neverheless undermine the processes fairness.

Since 1984, public service occupations in New Zealand have been subordinated to the over-determined bureaucratic structures of contemporary managerialism. The reactions of front-line public servants to New Management’s unfamiliar ‘market-place’ imperatives and the concomitant loss of occupational autonomy have received very little rigorous qualitative analysis. This study addresses that shortfall, taking as its cue a key question in the sociology of ‘profession’—what arouses or subdues the inclination of bureaucratised occupations to professionalise as a means of reclaiming autonomy? It explains the nature and meaning of strategies adopted by front-line practitioners in New Zealand’s Department of Conservation (DOC) to defend their marginalised work conventions and collegial culture. Symbolic interactionist analysis shows that profoundly personal values and beliefs connect vocationally motivated practitioners with their ‘mission’ (to conserve natural and cultural heritage). These powerful intuitive connections play a crucial role in subduing interest in resistance and organised strategic action, principally by converting conservation labour into the pursuit of personal fulfilment. Practitioners respond to managerial intrusions on their core work (the source of their fulfilment) by defending these personal connections rather than group interests. As a result of this introversion, perceptions of ‘community’ and occupational identity are disorganised and become a further reason for inaction. Practitioners resolve the conflict between self-interested pursuit of fulfilment and the altruistic goals of conservation by negotiating an unspoken bargain with DOC’s authority structures. The ‘pay-offs’ for deferral to managerial authority win the space to pursue fulfilment through immersion and conspicuous achievement in work, obviating the need for more concerted defensive action. Accordingly, managerialism has not acted as a professionalising catalyst for this group. NB: The abstract has been revised by the author in the electronic version of this thesis, since the print edition was published.

Orientadora: Profa. Dra. Gabriela Spanghero Lotta / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Políticas Públicas, São Bernardo do Campo, 2018. / O trabalhador de linha de frente é descrito na literatura como o conjunto de atores diretamente responsáveis pelas atividades essenciais dos órgãos públicos, ocupando dessa forma uma posição de interface entre o Estado e o cidadão, o que os coloca como um ator com grande influência. Ele determina o acesso dos cidadãos a direitos e benefícios governamentais, sendo por meio da sua atuação na implementação das políticas públicas que a população consegue (ou não) acessar os serviços públicos. O presente trabalho analisa a atuação dos técnicos de referência na medida socioeducativa de liberdade assistida no Município de São Paulo. Por meio da análise da literatura de implementação e da ação dos trabalhadores de linha de frente, buscamos compreender quais os fatores que influenciam a improvisação pragmática (adaptação entre as regras e as circunstâncias na implementação) e do uso da agência (habilidade de formar julgamentos) na atuação dos técnicos de referência. Para tal, entrevistamos quatorze técnicos de referência de duas Organizações Sociais. Concluímos com a análise, que a relação estabelecida entre o técnico de referência e os adolescentes atendidos é feita por meio de interações entre as identidades e as posições sociais que cada um desses atores estabelecem ao longo do processo socioeducativo. Essas interações são resultados da convergência de dois ou mais fatores analisados (fator individual/pessoal, fator organizacional, fator profissional, fator sistema, fator julgamento e fator merecimento), influenciando dessa forma a improvisação pragmática e o uso da agência na sua atuação. / The frontline worker is described in the literature as the set of actors directly responsible for the essential activities of public agencies, thus occupying a position of interface between the State and the citizen, which places them as an actor with great influence. It determines citizens' access to governmental rights and benefits, and through their actions in the implementation of public policies, the population is able (or not) to access public services. The present study analyzes the performance of reference technicians in the socioeducative measure of assisted freedom in the city of São Paulo. Through the analysis of the implementation literature and the action of front-line workers, we seek to understand which factors influence pragmatic improvisation (adaptation between rules and circumstances in implementation) and agency use (ability to form judgments) in the performance of reference technicians. To this end, we interviewed fourteen reference technicians from two Social Organizations. We conclude with the analysis that the relationship established between the reference technician and the adolescents served is made through interactions between the identities and social positions that each of these actors establish throughout the socio-educational process. These interactions are the result of the convergence of two or more analyzed factors (personal factor, organizational factor, professional factor, system factor, judgment factor and merit factor), thus influencing pragmatic improvisation and the use of the agency in its performance.

Submitted by Marcio Lemos (marciolemos@globo.com) on 2013-05-08T04:16:35Z No. of bitstreams: 1 Dissertação Márcio Lemos - Publicação.pdf: 949249 bytes, checksum: 6ecd430f3e427e95566f5e303e34978c (MD5) / Rejected by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br), reason: A submissão foi rejeitada porque está embargada para sempre. As Defesas dos Mestrado da FGV deverão ficar disponíveis na Biblioteca Digital para consulta"sem embargo", a menos que o aluno envie um documento explicando o motivo para que seja anexado ao impresso. OBS.: FAVOR SUBMETER NOVAMENTE SEM O EMBARGO. ÁUREA SRA on 2013-05-09T13:31:18Z (GMT) / Submitted by Marcio Lemos (marciolemos@globo.com) on 2013-05-09T15:21:16Z No. of bitstreams: 1 Dissertação Márcio Lemos - Publicação.pdf: 949249 bytes, checksum: 6ecd430f3e427e95566f5e303e34978c (MD5) / Approved for entry into archive by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br) on 2013-05-10T12:46:56Z (GMT) No. of bitstreams: 1 Dissertação Márcio Lemos - Publicação.pdf: 949249 bytes, checksum: 6ecd430f3e427e95566f5e303e34978c (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2013-05-15T12:46:54Z (GMT) No. of bitstreams: 1 Dissertação Márcio Lemos - Publicação.pdf: 949249 bytes, checksum: 6ecd430f3e427e95566f5e303e34978c (MD5) / Made available in DSpace on 2013-05-15T12:47:05Z (GMT). No. of bitstreams: 1 Dissertação Márcio Lemos - Publicação.pdf: 949249 bytes, checksum: 6ecd430f3e427e95566f5e303e34978c (MD5) Previous issue date: 2012-12-27 / This research aims to contribute to understand the bonds of loyalty that guide the actions of the Brazilian civil servants. Following the literature review, interviews were conducted to collect and analyze the perceptions of professionals. The study focused on public safety employees of Brazilian Federal District, as forensics experts, police chiefs and officers, including those working on the front lines, as well as leaders. Adapted the theoretical reference from Maynard-Moody and Musheno (2003), and from De Graaf (2010), about the loyalty of civil servants, the study tried to gather narratives that illustrate everyday situations in which decisions are taken and discretion is exercised. Accordingly, we sought to investigate instances the most representative of responsibility, as well as potential tensions and conflicts, especially in a scenario where governance and accountability are in evidence. Regulations are always strictly observed? Or is there a judgment of moral evaluation that considers other facets and interests? Answered these questions, we proceeded to the comparison between the results and those from the research references. Finally, also sought to engage in topics that can be implemented as a development of this research. / Esta pesquisa tem por objetivo contribuir para compreensão dos vínculos de lealdade que orientam a atuação dos servidores públicos brasileiros. Após a revisão bibliográfica, foram realizadas entrevistas a fim de coletar e analisar as percepções dos profissionais. O estudo focou em funcionários da segurança pública do DF, como peritos criminais, delegados e policiais, abrangendo aqueles que atuam na linha de frente, assim como chefes e dirigentes. Adaptou-se o referencial teórico de Maynard-Moody e Musheno (2003), assim como o de De Graaf (2010), acerca da lealdade dos servidores públicos e buscou-se reunir narrativas que ilustrassem situações cotidianas em que as decisões são tomadas e a discricionariedade é exercida. Nesse sentido, procurou-se investigar as instâncias de reponsabilidade mais representativas, assim como possíveis tensões e conflitos, sobretudo em um panorama em que governança e accountability estão em evidência. Os regulamentos são sempre rigorosamente cumpridos? Ou haveria um juízo de ponderação moral abrangendo outras facetas e interesses? Respondidas estas questões, procedeu-se o cotejo entre os resultados obtidos e aqueles oriundos das pesquisas referenciais. Por fim, também se procurou entabular tópicos que possam ser desenvolvidos como desdobramentos desta pesquisa.

Purpose: The purpose of this research was to study the interplay between middle managers (MMs) and front-line managers (FLMs) in strategy implementation (SI). To successfully manage and run a complex technology corporation a well-performed strategy is essential. By comparing MMs’ and FLMs’ different views and responsibilities in the SI process, both theoretical and empirical. Methodology: Theoretical material regarding leadership, middle and front-line manager roles and responsibilities, as well the strategy implementation process, obstacles and success factors are compared in the study. Supplemented by a general pilot study and primary interviews covering their view of the SI-process, obstacles and leverages, leadership, and their roles description. In total, ten pilot interviews and 12 primary interviews have been conducted, with MMs and FLMs, equally represented. Findings: In large, the main findings regarding the creation of a dynamic interplay between MMs and FLMs were three identified key attributes. Firstly, success in the SI process and constructive dynamic require a clear distribution of tasks and responsibilities between MMs and FLMs or the key responsibilities in the process. Secondly, select key people for the SI process, picked from different levels in the organization with different viewpoint and expertise. Making sure that there are total transparency and knowledge sharing between all key members and organizational levels. This will enable a greater involvement and commitment in the SI-process. Finally, to create a successful SI-process and a dynamic interplay between MMs and FLMs, strategic work must be rewarded equally compared to operational excellence and product-development efforts. / Syfte: Syftet med denna studie var att få en förståelse för samspelet mellan Mellanchefer (MM) och Linjechefer (FLM) vid genomförandet av en strategiimplementering (SI). För att lyckas kontrollera och driva en komplex teknikorganisation är en väl genomförd strategi essentiell. Detta gjordes genom att jämföra MMs och FLMs olika syn och ansvarsområden i SI-processen, både teoretisk och empirisk. Metodik: Det teoretiska materialet som har jämförts i studien inkluderar ledarskap, Mellanchefers och Linjechefens roller och ansvar, samt strategiimplementeringsprocessens hinder och framgångsfaktorer. Detta kompletterades med en övergripande pilotstudie och med primära intervjuer som visade på MMs and FLMs respektive syn på hinder, hävstänger och ledarskap under SI-processen samt deras syn på sin roll. Sammantaget hölls 10 pilotintervjuer och 12 primära intervjuer, där mellanchefer och linjechefer var lika representerade. Resultat: Rapporten konkluderar tre viktiga attribut för skapandet av ett dynamiskt samspel mellan mellanchefer och linjecheferna. För det första, krävs en tydlig fördelning av uppgifter och ansvar mellan MMs och FLMs alternativt mellan de nyckelpersonerna som är inblandade och ansvarig i processen. För det andra, är det viktigt att välja rätt nyckelpersoner i SI-processen och att plocka dessa från olika nivåer i organisationen då de besitter olika erfarenheter. Viktigt är att skapa en total transparens och kunskapsöverföring mellan alla nyckelpersoner i processen samt mellan de olika organisatoriska nivåerna. Detta kommer att resultera i ett större engagemang och en känsla av mer inflytande på SIprocessen. Slutligen, för att skapa en framgångsrik SI-process och ett dynamiskt samspel mellan MMs och FLMs, måste det strategiska arbetet belönas lika mycket som operativa och produktspecifika insatser.

No description available.

No description available.

This study explores the experiences of the Swedish front-line social workers (socialsekreterare) in the municipal income support unit, Young Adults, monthly assessing the income support applications as well as daily processing the activation programs for young adult clients with mental ill-health combined with social-medicinal vulnerabilities, also referred to as young adults with complex needs. Furthermore, this study aims to illuminate the ever changing conditions of the Swedish welfare state and its underlying driving forces through the lens of the social workers. 9 Semi-structured distance interviews with 11 social workers from 6 municipalities belonging to 5 regions in Sweden, were conducted for the collection of qualitative data. It has been analyzed by the inductive-deductive coding as well as a theoretical frame consisting of concepts such as discretiona and advocacy of M. Lipsky, and reciprocal interaction (Wechselwirkung), form and contents, and call of G.Simmel. The result and analysis show that the rehabilitative approach based on the interactions and relations with the clients, is prevalent through the social workers’ processing of the activation program. It seems to be effective in a dyad, between the social workers and the client while the social workers’ discretion is maximized for the utilization of the agency (unit) activation resources. However, it proved not to be as effective in a triad or more when an extern agent outside of the unit, Young Adults begins to be involved. The tension is a fact and the social workers’ discretion is minimized when they have to process the activation program for the clients who are neither “active enough” to have a job in the ordinary labor market, nor “sick enough” to be eligible for the stately activity compensation (aktivitetsersättning) from the Social Insurance Agency (Försäkringskassan) which heavily relies on the medicinal expertise for its decision making. The social workers’ experience to fail to deliver the best possible results out of the activation programs, and the client relationship built on the rehabilitative approach turns out to be unsustainable, which can indicate the discrepancy between the rehabilitative approach as well as the activation programs, as content, and the unit, Young Adults, as form. Even though the social workers daily carry the ideological as well as the social-political tensions between the medicalization and the activation through the ever changing reality of the Swedish welfare state, their mandate to make an impact on the decision making of the activity compensation program, is rather limited, reflecting the Swedish welfare state’s expectation for the professionalism of the social workers. Rather striking that the social workers, however, confess that they in spite of the pressure of organizational efficiency as well as socio-economic discourse of digitalization undermining the concept of the unit, Young Adults, are not willing to give up the rehabilitative approach for the client’s sake but also to protect their unit, Young Adults, which postulate that they are not the gatekeepers in the agency but the advocate for the clients. In this moment, they also seem to know, and even have the call, the essential, if not mandatory, element needed to be landed in the perfect society of G. Simmel.