In 1997 and 2002 the Østfold Hospital Trust conducted patient satisfaction surveys. This study presented the results of the 2002 survey and compares them with the 1997 results. This is done to ascertain if there are any changes with regards to the dimensions the hospital scored poorly on in 1997. The purpose of this study is to find out if the patient satisfaction survey conducted at the Østfold Hospital Trust in 1997 was a serious attempt to improve the quality of the health care provided or only a symbolic act. The concepts of innovation, rational choice and institutional theory were used as spectacles to analyse how the Østfold Hospital Trust acted on the results of the 1997 patient satisfaction survey. The choice of study design is not an "either / or" situation between the quantitative and qualitative approach, since both methods can strengthen each other. This study has therefore employed a form of methodological triangulation. The finding of the study showed that the Østfold Hospital Trust can be termed as innovative, when they implemented the patient satisfaction survey in 1997. This because there was no coercive forces from the hospital owners to implement such surveys. There were only signals in the form of strategy documents. In spite of the hospitals innovative action in implementing the non-mandatory survey in 1997, the hospital leadership did not use the results to improve quality. Based on the findings, the study can conclude that the implementation of the patient satisfaction survey in 1997 was more symbolic, rather than a quality improvement act. Looking further than 1997, it’s important to remark that the hospital leadership resolved a number measures to improve quality, based on the 2002 patient survey. At the time of writing the issue of patient feedback as a quality improvement tool is high on the agenda at the Østfold Hospital Trust. The development point in the direction of a paradigm shift / I 1997 og 2002 gjennomførte Sykehuset Østfold to pasienttilfredshetsundersøkelser. Dette studiet har presentert resultatet av undersøkelsen fra 2002 og sammenlignet det med resultatet fra 1997. Dette for å se om det er forskjell på dimensjonene sykehuset har scoret dårlig på i de to forskjellige undersøkelsene. Hensikten med studiet er å undersøke om pasienttilfredshetsundersøkelsen gjennomført ved Sykehuset Østfold i 1997 var et kvalitetsforbedringstiltak eller en symbolskhandling. Fra organisasjonsteori ble begreper som innovasjon, ”Rational Choice” og institusjonsteori brukt som briller for å analysere det som har skjedd. Valg av metode var ikke en enten eller situasjon i forhold til kvantitativ eller kvalitativ metode, siden metodene kan styrke hverandre. Studiet legger vekt på metodetriangulering Funnene fra studiet har vist at Sykehuset Østfold kan betegnes som en innovativ organisasjon da organisasjonen gjennomførte undersøkelsen i 1997. Dette fordi det ikke var krav fra omgivelsene for å gjennomføre undersøkelsen, kun signaler i form av strategidokumenter fra sentrale myndigheter. Selv om organisasjonen er innovativ hva gjelder initiering og implementering av pasienttilfredshetsundersøkelsen, har sykehusledelsen ikke brukt resultatet til kvalitetsforbedringstiltak. Ut fra funnene kan studiet konkludere med at gjennomføringen av pasienttilfredsundersøkelsen i 1997 var mer preget av en symbolskhandling enn et kvalitetsforbedringstiltak.Ser en utover 1997 er det viktig å nevne at sykehusledelsen har vedtatt flere kvalitetsforbedringstiltak basert på undersøkelsen fra 2002. Akkurat nå er pasienttilfredshetsundersøkelser som kvalitetsforbedringstiltak satt høyt på dagsorden av sykehusledelsen. Utviklingen kan betegnes som et paradigmeskifte / <p>ISBN 91-7997-135-0</p>

Cette thèse est fondée sur la nécessité de répondre aux difficultés d'enseigner les sciences en prenant en compte la singularité de l'élève et en donnant du sens aux apprentissages. Aujourd'hui, la ou les didactique (s) ne réponde (nt) que partiellement à cette problématique. Pour preuve, il existe toujours une catégorie d'élèves en difficulté voire en échec scolaire. Nous proposons ici une didactique instrumentale actualisée qui propose de répondre à cette situation.Celle-ci prend appui sur la théorie instrumentale de Vygotski qui mentionne que le développement culturel tire le développement biologique, que l'élève se construit par les concepts et que le langage est un des premiers instruments psychologiques qui instrumente la pensée. Partant d'un projet interdisciplinaire en sciences physiques et éducation physique et sportive, avec comme thème le concept d'atome, nous proposons de mettre en œuvre cette nouvelle didactique, en nous appuyant sur l'analyse des conceptions de 660 élèves de la 5ème à la terminale S sur l'objet considéré, en travaillant dans une Zone de Plus Proche Développement (ZPPD). L'activité maîtresse a été minutieusement choisie de façon à être adaptée et adaptable à l'ensemble des élèves, en identifiant les transformations des niveaux de savoir d'un élève, dans la cognomorphose et la cognogénèse, au cours de son apprentissage. Quatre expérimentations en collège et lycée ont été menées et ont permis de rendre compte des modes de pensée des élèves à chaque étape de l'apprentissage. Elles ont montré la pertinence de l'utilisation d'une carte conceptuelle, désignée d'étayage par Bruner, spécialement conçue et adaptée à des élèves des cycles 3 et 4 du collège et du lycée. Cette thèse, qui utilise pour étayer ses propres conclusions, des expérimentations et des méthodes liées directement aux principes de la didactique instrumentale qu'elle veut promouvoir, en plus de sa volonté de faire progresser la recherche dans ce domaine précis, a pour vocation d'apporter une réelle utilité professionnelle pour les enseignants de sciences / This dissertation is based on the need to respond to the difficulties of teaching science by taking into account the singularity of the learner, but also by giving sense to learning. Nowadays, didactic(s) only partially respond(s) to this problem. Evidence of it is that there are always a number of learners in difficulty or even failure at school. What we suggest is an updated instrumental didactic as a response to that situation.It is based on Vygotski's instrumental theory, which mentions that cultural development enriches biological development, and that learners construct themselves via concepts, and that language is one of the first psychological instruments that organizes human thought.Starting from an interdisciplinary project in Physical Sciences and Physical Education, with the concept of atom as a theme, we propose to implement that new didactic, based on the analysis of the conceptions of 660 secondary school goers from 1st year to 7th year (math mention) on the object of learning, working within their Zone of proximal development (ZPD).The main activity was carefully selected so as to be adapted and adaptable to any learner. To make it so we identified the changing levels of a student's knowledge in cognomorphosis and cognogenesis during their learning. Four experiments both in lower and higher secondary school were carried out and enabled us to account for the modes of thought of the students at each stage of the learning. They have shown the relevance of the use of a mind map, designed as a scaffolding device by Bruner, and specially designed towards learners in first and second year of lower secondary school as well as the higher secondary school.This dissertation, which, to back up its very own conclusions, uses experiments and methods directly related to the principles of the instrumental didactic that it wishes to promote. Besides it has for vocation to promote research in that specific field, and bring a real professional usefulness to science teachers