0 / SPK / specialcollections@tulane.edu

This essay presents a case study about the development of income levels in the medical sector during Sweden´s period of modernization, 1890-1920, focusing specifically on the five wage groups which comprised the medical staff at Uppsala´s Ulleråker hospitalum (=mental asylum). This institution, though different in it´s stated mission from hospitals and the like, was similarily organized, and staffed with employees belonging to the same categories as regular hospital staff - they shared similar social backgrounds, education levels, work tasks and conditions. This was thanks to the centralized nature of the Swedish medical sector, which was governed mainly by the Medicinal Board, which in turn was influenced by the government on one side, and influential individuals, schools for medical education and employee organisations/unions on the other. The objective of the essay is to establish a timeline of the wage development, and to identify factors which influenced this development. Furthermore, it seeks to identify differences between genders, wherefore the male orderlies and female nursing aides are given special focus throughout. Although the hospitalum has been the subject of previous books, the financial records have never been used in research before. The essay begins with presenting a history of Swedish societal development - and the simultaneous development of the medical sector - before moving on to establish a timeline of the nominal wage data. Using methodology developed by previous historical wage development research, it then calculates the real wages with the help of a converted consumer price index. It also makes use of a separate, in-depth study to try and showcase differences between genders; primarily, it calculates the share of bonuses of total income and what the maximum earning capacity of the male and female staff was. The essay concludes that the wage development was influenced by multiple factors. Primarily, education level was a crucial factor for the employee in securing higher wages. Not only did it serve as basis for securing higher wages, it also came with the bonus of educational organisations oftentimes aiding their graduates in discussion with prospective employers. Secondarily, collective bargaining (and, from 1904, unions), along with influential members of the national doctor´s corp (who were realizant about the need for better work conditions in order to retain talented employees) allowed the staff to directly influence decisions in the Medicinal Board, and use the conditions at other medical institutions as motivation for implementing improvements. Additionally, larger societal trends also played a part. In particular, the real wages show clearly that the wage development to a great extent followed the trends in cost of living, and obviously the extreme influence of World war I also necessitated extreme adjustments - though, interestingly, these adjustments consisted more of increased bonus payouts that wage increses, perhaps due to bonuses being easier to lower or discontinue after the expensive times were over. In all, education appears to have been the most important factor in securing high wages - other research reveals some wage groups used professionalization to improve their work conditions, to the detriment of lower level wage groups. Since market forces had little impact on the medical sector, due to it not producing marketable goods and services or competing for workers, collective bargaining and larger societal developments became the main influences for less educated staff.

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本研究以大量客製化的方式，在兼顧成本及客製化的雙重需求下，歸納出醫療產業可採取九種大量客製化模式，平衡醫療供需及促進醫療創新。如：〝共享〞─相同的元件，可以被橫跨使用在不同的產品，達到範疇經濟。〝替換〞─不同的元件可以使用在相同的基礎元件上。〝裁切〞─元件可以依客戶的需求做裁減。〝混搭〞─混搭不同的元件形成一個獨特的產品。〝平台化〞─建立一個標準架構，使其可以承載不同的元件。〝介面化〞─允許不同的元件做任意的組合。〝移除〞─移除指定元素，進而產生客製化的產品或服務。〝置入〞─依顧客的需求對於既有的標準產品或服務，進行置入。〝取代〞以置入的方式取代另一被移除元素。 此外，本研究涵蓋非醫療產業(硬體、軟體及服務業)與醫療產業(醫療服務及醫療生技)的跨產業分析比較，一方面可得知醫療服務及醫療生技如何進行大量客製化，另一方面借鏡觀形，了解醫療服務及醫療生技仍有待改進的地方。 最後，為了方便企業找出適合的大量客製化模式，本研究共整理醫療服務及醫療生技的12種大量客製化應用方式，而且這十二種應用方式，並非互相排斥，可混合運用於企業的營運模式之中。

L’objectif de la thèse est d’analyser le processus de construction d’un outil de contrôle de gestion inter-organisationnel mobilisant de multiples organisations publiques et privées, en prenant le cas de l’expérimentation du « Tableau de bord de pilotage de la performance », nommé ainsi par l’institution portant le projet (ANAP). La grille de lecture de l’anthropologie symétrique permet de proposer des résultats autour de trois thématiques : la trajectoire de l’outil, le rôle des acteurs et actants dans le processus de construction et les stratégies des acteurs. L’ensemble des résultats amène à proposer des pistes d’amélioration du processus. Parmi celles-ci, il est proposé de sélectionner les controverses les plus décisives et de les traiter avec transparence afin d’éviter la démobilisation des acteurs, de favoriser les rôles non prévus mais souhaitables et d’adapter les modalités de participation aux acteurs en fonction des stratégies qu’ils déploient. / The aim of the thesis is to analyze an inter-organizational management control system construction, mobilizing multiple public and private organizations in the process. Our research is based on a field research involving PhD in experimental project of the first common tool for all social-medical sector: a management control system called "performance management Dashboard" by the institution which support the project (ANAP). Symmetrical anthropology reading grid, a part of the theory of translation, can provide results on three themes: the management control trajectory, the role of actors and actants in the construction process and actors’ strategies. All these results lead us to suggest ways of improving the process. Among these recommendations, it is offered to select the most critical controversies and deal with transparency to avoid actors’ demobilization, promote unanticipated but desirable roles and adapt the modalities of participation for actors based on strategies they deploy.