Cette thèse analyse l'émergence, en France, de la question du non-recours à la Couverture maladie universelle complémentaire (CMU C) et à l'Aide complémentaire santé (ACS), ainsi que son institutionnalisation dans la branche Maladie de la Sécurité sociale. La CMU C et l'ACS ont été créées pour limiter les inégalités d'accès aux soins. Celles-ci se sont en effet accrues avec les augmentations continues des frais de santé laissés à la charge des patients. Au croisement de la socio-histoire, de la sociologie de l'action publique et de la sociologie des organisations, le processus d'institutionnalisation du non-recours est étudié de manière chronologique, au travers de séquences d'action qui ont : initié une attention pour le phénomène ; positionné ses enjeux au regard des restructurations de la protection maladie des plus démunis ; construit des représentations et structuré une stratégie d'action pour le traiter. Principalement problématisé autour d'un enjeu d'effectivité des droits CMU C et ACS, le non-recours est devenu peu à peu un instrument opérationnel de la correction des inégalités d'accès aux soins, définie comme axe prioritaire de la gestion du risque maladie. Sa prise en compte a engagé l'Assurance maladie dans des changements profonds de pratiques et d'organisation du travail. De manière surplombante, c'est une transformation du rapport de l'institution à ses ressortissants fragiles qui s'est enclenchée, afin de faire en sorte que les populations démunies se rapprochent de leurs droits. En ce sens, l'institutionnalisation du non-recours s'inscrit dans un mouvement qui vise à concentrer les moyens et les actions de la branche Maladie sur les populations dites fragiles. Une approche de l'action publique par le non-recours aux droits paraît ainsi pertinente pour comprendre comment l'intégration de problèmes émergents, peu visibles ou volontairement ignorés, leur mise en sens par des acteurs publics et l'institution de nouvelles catégories d'action viennent travailler les organismes administratifs bureaucratiques dans leurs fonctionnements, leurs logiques et leurs normes d'intervention les plus ancrés. L'approche par le non recours est, en l'occurrence, un traceur du changement opéré à l'aune des ressortissants de l'action publique. / This thesis analyzes the emergence, in France, of the issue of non take-up of Free Supplementary Health Insurance Coverage (“Couverture maladie universelle complémentaire” or “CMU-C”) and Assistance for Private Health Insurance (“Aide complémentaire santé” or “ACS”), as well as its institutionalization within the Health branch of the Social Security system. The CMU-C and the ACS have been created to limit the inequalities in access to healthcare. These have indeed risen with the continuous increase of health expenses left payable by the patients. At the crossroads of socio-history, sociology of public action and sociology of organizations, the process of institutionalization of non take-up is studied chronologically, through sequences of action which have: brought to attention the phenomenon; positioned its challenges in light of the health care restructurings for the most destitute; built representations and structured a plan of action to treat it. Problematized primarily around the challenge of operativity of the CMU-C and ACS benefits, the non take-up has gradually become an operational tool for the correction of inequalities in access to healthcare, which was defined as a priority in the management of health issues. Addressing it has committed the health system to profound changes in its practices and work organization. Overarching it, a transformation of the institution's relationship to its vulnerable nationals has been set into motion, to ensure that the destitute populations are brought closer to their benefits. In this respect, the institutionalization of non take-up is part of a movement that seeks to concentrate the resources and actions of the Health branch on the populations considered vulnerable. An approach of public action by the non take-up of benefits thus appears relevant for understanding how the integration of emerging problems, less visible or deliberately ignored, their sensegiving by public actors and the institution of new categories of action, come to challenge the bureaucratic administrations in their most entrenched functioning, logic and standards of intervention. The approach by the non take-up is, as it happens, an indicator of change operated with regard to public action beneficiaries.

Purpose: The purpose of this research project is to examine the employees´ perspective on the subject of a CRM implementation in SMEs. Methodology: A 5-point Likert scale questionnaire was used to collect 51 employee responses. All the questions were derived from previous existing literature. The questionnaire ended with three open-ended questions and was delivered to the employees by email. Conclusion: The main findings related to employees´ preconditions is that senior and middle managers must be involved and support their employees during the whole change process. Other conditions are that the system must be user-friendly and easy to learn, so that it does not interfere too much with the employees’ daily routines. With respect to employees’ point of view to implementing CRM this study suggest that the new system will improve communication with current customers. Notably, few of the employees feel anxious about the new system and do not think it will increase their current workload. Regarding age variances in the workforce, the research found three key points including a) functional areas are structured around customers b) a clear communication plan will improve change acceptance and commitment and, C) proper system training will help understand the employees´ role throughout the implementation. Practical Contribution: With this research, SMEs will more likely understand the importance of employee satisfaction due to an organisational change. This research has examined the intention of implementing a CRM system. Theoretical contribution: This study contributes to a continued consideration regarding organisational change by studying employees’ perspective and expanding the existing level of knowledge. / Syfte: Syftet med denna studie är att undersöka de anställdas perspektiv i termer av en CRM implementering i SMEs. Metod: En enkät bestående av 5-punkt Likert frågor tillsammans med avslutningsvis tre öppna frågor användes för att samla in data. Alla frågor var inspirerade från tidigare litteratur och forskning och levererades via email till alla anställda. Slutsats: Toppledning och mellanchefer måste involvera samt stödja sina anställda under hela implementationen för ett bättre förändringsbeteende. Systemet måste även vara lätt att använda, enkelt att lära sig samt inte störa de dagliga sysslorna för mycket. Med hänsyn till de anställdas perspektiv av att implementera CRM, denna studie föreslår att systemet kommer förbättra kommunikationen med nuvarande kunder. Anmärkningsvärt är att få anställda känner oro över det nya systemet och tror inte det kommer öka deras nuvarande arbetsbelastning. Angående åldersskillnader i arbetsstyrkan, hittade studien tre nyckelfaktorer, nämligen a) funktionella avdelningar är strukturerade runt kunden b) en tydlig kommunikationsplan kommer förbättra förändringsacceptans och c) tydlig systemträning kommer underlätta anställda förstå sin roll genom implementationen. Praktiska implikationer: Studiens praktiska bidrag är att belysa anställdas perspektiv i små och medelstora företag och vad de behöver för att acceptera en organisationsförändring. Studien har undersökt en kommande CRM implementation. Teoretiska implikationer: Denna studie bidrar till fortsatt hänsyn av organisationsförändring genom att studera de anställdas perspektiv och utöka nuvarande kunskapsnivå

More than half the world’s population now lives in urban areas putting the city on the frontline of the social and environmental challenge and yet, city planning presents many opportunities to move a city towards sustainability. The city development plan (DP) is a powerful vehicle for change. This research seeks to understand the gaps between an ideal catalytic development planning process and current reality, and provide recommendations to support the attainment of a city’s sustainability objectives. The Framework for Strategic Sustainable Development (FSSD) was used to define a generic “Golden Standard” planning process to help the local authority better leverage its internal resources and refine governance systems to achieve long-lasting cultural change from within to accelerate the city’s progression towards sustainability. A case study with the Dublin City Council’s Planning Department in Ireland provided valuable insight and limited practical application of the Golden Standard.

This dissertation covers the subject of how abstract concepts and complex situations can be concretized through research together with practitioners. The dissertation is based on four empirical studies. The researcher role, the practitioner participation and the methods for data collection and analysis have varied. In study I the concept ‘Närsjukvård’ was explored to understand how practitioners, managers and politicians in hospitals, primary health care and municipalities interpreted the concept. The researcher acted as consultant who collected data by interviews and questionnaires. Practitioners’ participation was limited. ‘Närsjukvård’ was interpreted as accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. Study II aimed to explore how people experienced leg ulcer care. The researcher acted as a consultant who performed the interviews and  analysed the data. Although the informants experienced their encounters with the nurses as satisfying, the study illuminated low participation in the care and low practitioner involvement in issues about daily living with the leg ulcer. The findings were brought back to the informants and the practitioners. The project did not proceed towards development and change. In study III the aim was to explore the Swedish concept ‘trygghet’ by using stories from daily life. Four older women were interviewed and the Story Dialogue method was used together with assistant nurses and registered nurses who participated in data collection and analysis. Two themes emerged: Sense of Security and factors strengthening the Sense of Security. Together with the assistant nurses, areas for improvements were identified. Study IV aimed to explore the discharge planning situation in order to     generate ideas for development. Members from a discharge planning network participated in the whole research process. Conditions for a successful coordinated discharge planning situation were a system including: the participation of the patient, the competence of the staff and the support from the organisation. The group arranged a workshop about communication and interdisciplinary   collaboration. The findings resulted in a form with self-evaluation questions. In conclusion, this thesis illustrates that it is possible to clarify abstract concepts and complex situations together with practitioners. To do this successfully, sense making activities and to start from practitioners’ experiences and their own context are key factors. The studies illuminate that building trust, relationship and sense of participation are essential in health and social care in general and specifically in the participatory action research process.

The introduction of new information technology (IT) in an organisation is one way of changing the conditions for how tasks and work processes can be designed and performed, as well as how people in the organisation interact with each other. Today, many Swedish workers rely completely on IT to be able to perform their jobs, while experiencing a combination of continuous and intermittent IT-related changes that affect this ability. The introduction of new or updated IT systems in an organisation is an example of what is referred to as an IT-related change process in this thesis. Because IT has become such an integral part of modern organisations, many change processes in organisations are simultaneously enabled and constrained by the IT systems involved in a change process. In this thesis, I introduce the concept of inertia in sociotechnical systems to analyse IT-related change processes in organisations, and how achieving the goals of these processes is complicated by organisational, social, and physical aspects in addition to technology. The context of this thesis is the Swedish public sector domains of health-care and higher education, and the result of research studies and experiences from four action research projects in these settings. The contribution of this thesis adds to the contributions of the included papers through the definition of inertia in sociotechnical systems and its subsequent application. The thesis shows that the concept of inertia in sociotechnical systems can be used to understand IT-related change processes as changes to the characteristics of a sociotechnical system, and, in the context of organisations, how these processes affect and are affected by an organisation’s characteristics. This is illustrated in the thesis through the application of the concept on examples of IT-related change processes from the included papers and research projects. In addition, the thesis shows that the use of vision seminar methods can benefit Swedish organisations, since new IT is often introduced without clearly defined, expressed, understood, and accepted goals.

L'industrie des télécommunications connait une profonde évolution. Face au développement denouveaux usages sur les téléphones mobiles, les acteurs historiques de la téléphonie mobile(opérateurs de réseaux et fabricants de terminaux) doivent s'adapter à un nouvel environnementtechnologique et concurrentiel. Concrètement, ce nouvel environnement s'appuie technologiquementsur l'extension des usages d'objets numériques (logiciels et contenus pouvant être professionnels,personnels ou de loisir), il sert donc de tremplin pour des acteurs plus ou moins matures venant desindustries logicielles, culturelles et de l'Internet. Partant de ce constat, notre thèse repose sur l'idée queles acteurs historiques de la téléphonie mobile doivent s'adapter à ce nouvel environnement afin demaintenir leur position, ainsi qu'apprendre à se coordonner avec les nouveaux entrants de l’industrie,car la coordination est nécessaire à l'émergence du marché des services mobiles. Nous commençonsdonc par faire une analyse historique de l’émergence de l’industrie des services mobiles afin depositionner les enjeux de la coordination. Ensuite, nous étudions des projets « open source » desystèmes d’exploitation pour smartphones pour analyser l’intérêt d’une stratégie ouverte. Enfin, nousconstruisons un modèle de simulations évolutionnistes afin d’analyser les stratégies des acteurs en lienavec la structure de l’industrie et son effet sur la structure technologique. / The telecommunications industry currently undergoes a dramatic evolution. Faced with thedevelopment of new uses on mobile phones, incumbents of the mobile phone industry (networkoperators and devices manufacturers) must adapt to a new technological and competitive environment.This new environment technologically relies on expansions of uses of digital objects (software andcontents that can be either of professional, personal or leisure use) and thereby serves as a launchingpad for actors more or less mature coming from software industries, copyright-based industries or theInternet industry. Based on this observation, our thesis rests on the idea that incumbents of the mobilephone industry must adapt to this new environment in order to maintain their position, and must learnto coordinate with those new actors as coordination is required for this market to emerge. We thereforestart with a historical analysis of the emergence of the mobile services industry so as to position theissues at stake regarding coordination. We then focus on “open source” projects for smartphoneoperating systems in order to analyse the interest of an open strategy. Last, we design an evolutionistsimulation model so that to analyse the actors’ strategies linked with the structure of the industry andits effects on the technological structure.

Förändring och förbättring utgör komplex materia, och det finns många aspekter som kan påverka om resultaten blir hållbara över tid. Syftet med denna studie var att undersöka vad som krävdes för en förbättring, som ett resultat av en större organisatorisk förändring, att bli hållbara över tid i ett verkligt sammanhang. Studien hade en induktiv ansats och den valda metoden var en litteraturstudie. Systematiska sökningar gjordes i databaserna Academic Search Elite, Business Source Complete och SCOPUS för artiklar publicerade under åren 2010–2021, vilket resulterade i 39 artiklar för analys. En tematisk analys genomfördes med hjälp av ett släktskapsdiagram, genom vilket åtta teman framkom. Dessa var: Kollektiva visioner och mål, Kommunikation, Ledarskap, Personlig utveckling, Positiv organisationskultur, Minska variation, Resurser, och Systemtänkande. Dessa åtta teman innehöll relaterade subteman, element och faktorer. Studiens slutsatser var att hållbar förändring är ett komplext område. Även om denna studie påvisade åtta teman, innebär detta inte per automatik att alla teman måste ges samma uppmärksamhet; förbättringens kontextuella behov kan avgöra vad som ska prioriteras.  Begränsningar i studien omfattade att nära nog alla 39 artiklar ägde rum i västerländska länder och i en vårdkontext. Dessa båda aspekter begränsade studiens generaliserbarhet till viss del / Change and improvement are complex matters, and there are many aspects that can impact if the results are sustainable over time. The aim of this study was to investigate what was required for an improvement, as a result of a major organisational change, to become sustainable over time in a real-world setting. The study used an inductive approach and the chosen method was a literature review. Systematic searches were carried out in the databases Academic Search Elite, Business Source Complete, and SCOPUS for articles published between the years 2010–2021, which yielded 39 articles for analysis. A thematic analysis was carried out using an affinity diagram, through which eight themes emerged. These were: Collective visions and goals, Communication, Leadership, Personal growth, Positive organisational culture, Reduce variability, Resources, and System thinking. The eight themes contained related sub-themes, elements and factors. The conclusions of the study were that change sustainability is a complex field. While this study revealed eight themes to consider, it does not automatically mean that they must be given equal attention; contextual needs of the improvement could determine what to prioritise. Limitations of the study included that nearly all of the 39 articles were set in western countries and in a healthcare setting, both of which somewhat limit the generalisability of the study. / <p>2021-06-06</p>

Purpose – The purpose of the study is to explore and identify activities that contributes to the abilities that are necessary in order to enable the transformation towards a value-based business model. The purpose will be answered through the development of a transformation framework that can guide organisations and aid in order to succeed with the transformation process. Method –  A qualitative approach was found to be optimal for answering the purpose of the study. A single case study was performed  and the data was collected through interviews at a market leading Swedish IT-company. The chosen research approach was inductive which meant that the theoretical background was developed within the area and acted as a pillar for the following interviews. In total 25 interviews, divided in three interview waves were conducted and further analysed with a thematical analysis. Findings – The case study resulted in a transformation framework that consists of ten abilities that are distributed across three transformation stages. The abilities are divided into the three main themes value-based selling, value-based pricing and organisational change that is needed within the process of the transformation towards a value-based business model. 33 activities were identified to develop the abilities.  Theoretical and Managerial Implications – The case study contribute to the clearly limited research in the area of value-based business models within the IT-industry by empirically building on previous research from other industries and further developing it. Through the identification of activities and abilities and further compiling the transformation framework organisations have received a tool that will be able to aid the process of transforming the business model towards a value-based. Limitations and Future Research – The case study is limited to a single company within the IT-industry. Therefor further research is recommended with a wider data collection to examine the degree of generalisability of the case study to both confirm the identified activities and abilities but also further exploration. / Syfte – IT-branschen är en snabbt föränderlig bransch med en hög innovationshastighet. Organisationer söker nya teknologier för att utöka sin konkurrenskraft, men nya digitala förutsättningar leder ofta till förändring av nyckelaktiviteter vilket medför ett behov av att utveckla ledningsmetoder för att styra dessa komplexa omvandlingar. Fallstudiens syfte är att utforska och identifiera aktiviteter som bidrar till de förmågor som är nödvändiga för att möjliggöra transformationen mot en värdebaserad affärsmodell inom IT-branschen. Fallstudiens syfte besvarades genom utvecklingen av ett transformationsramverk som vägleder organisationer att lyckas i transformationsprocessen. Metod – Studien utfördes som en explorativ fallstudie med en kvalitativ forskningsansats. Fallstudieföretaget är ett marknadsledande IT-bolag i Sverige. Den kvalitativa forskningsansatsen ledde till att 25 intervjuer genomfördes i tre intervjuvågor och resultatet utvecklades med hjälp av tematisk analys. Resultat – Fallstudien resulterade i ett transformationsramverk som består av tio förmågor utspridda i tre transformationsfaser. Förmågorna berör värdebaserad försäljning, värdebaserad prissättning och den organisationella förändringen som krävs för att transformeras till en värdebaserad affärsmodell. Förmågorna genererades genom den tematiska analysen där 33 aktiviteter identifierades som bidrar till förmågorna nödvändiga för att möjliggöra transformationen. Teoretiskt och praktiskt bidrag – Fallstudien bidrar till den tydligt begränsade forskningen inom värdebaserade affärsmodeller inom IT-branschen genom att empiriskt byggt vidare på tidigare forskning inom andra branscher och utvecklat den vidare. Genom identifiering av aktiviteter och förmågor nödvändiga för transformationen mot en värdebaserad affärsmodell och sammanställt dessa i ett vägledande transformationsramverk har organisationer fått ett vägledande verktyg som underlättar transformationsprocessen. Begränsningar och framtida forskning – Fallstudien är begränsad till ett enskilt fallstudieföretag inom IT-branschen. Därav rekommenderas framtida forskning med en bredare datainsamling för att undersöka generaliserbarheten av fallstudien samt för att bekräfta de identifierade aktiviteterna och förmågorna, men även för att möjligtvis identifiera ytterligare aktiviteter och förmågor.

The global challenges of our time are unprecedented and urgent action is needed. Transformational learning and leadership development are key leverage points for supporting society’s transition towards sustainability. Many even claim that learning on an individual, organisational and societal scale is required for society’s successful transitioning towards sustainability. However, in this relatively new field, practitioners, scholars and educators grapple with what best promotes transformational learning and with how to best design and operate learning experiences that truly build capacity for leadership for sustainability. The aim of this work was to establish an improved understanding of this and to find recommendations for practitioners and educators with ambitions to create systems change for sustainability by building the capacity of people to be sustainability leaders. As an educator and facilitator of sustainability work for over a decade, working at the crossroads of local government and community change, lecturing on leadership for sustainability in Australia and currently being embedded within the faculty of the Master’s in Strategic Leadership towards Sustainability (MSLS) program in Sweden, I have rested this thesis firmly within an action-oriented transformations research paradigm in which the only way to understand a system is through a comprehensive collaborative attempt to change it. One case of action research explored an organisational change for sustainability program that spanned over five years in a local government in Perth, Western Australia and the learning and policy interventions that supported this change. Participant observation with field notes, interviews, surveys and document analysis were particular methods used in this case. Two further cases focused on the MSLS program and its practices and specific components that support such leadership development and transformational learning. Feedback surveys from students and an open question survey to alumni were key methods used in these cases. The findings suggest that community and relationships are essential for supporting and growing sustainability leadership capacity; that hope and agency are irreplaceable components for leading sustainability change; that self-reflection and dialogue are skills that will help sustainability leaders navigate complex and uncertain futures and that these can be learned. Findings also indicate that creating a shared language for sustainability work helps bridge disciplinary divides and practitioner silos, and that skills of dialogue are required to capitalise on participation. Also, the integration of the components of community, place, content, pedagogy and disorientation with hope and agency can help support transformation in sustainability leadership education and provide synergistic reinforcement of the sustainability transformation required. This thesis provides added evidence that learning can be a key leverage point for sustainability transformations in an organisation and suggests how such learning can be most effectively achieved through a conscious design of learning environments, including the use and integration of the mentioned components to improve sustainability leadership for impact in society.

The world is changing and humanitarian organisations need to be equipped to change with it. This case study has examined the internal democracy within the association of Medécins Sans Frontières (MSF), the creation of social capital and how it can be used to create bottom-up medical organisational change though motions. The selection of 6 motions was made to investigate if they have created the change they intended to create. The aim of this study is to test the hypothesis that members have the power to create organisational change and that such changes depend on a high degree of internal membership democracy. Internal democracy is in turn a precondition for the formation of social capital. In total were 12 in depth interviews conducted with members, former and current board members as well as the executive. In addition to this has an analysis of video recoded motion debates and feedback session been analysed along with other relevant internal documentation. The study has found that the association of MSF is founded on democratic principles as a mean to guide and hold the executive responsible and fulfils formal criterion for a democracy. The internal democracy has a series of weaknesses in it, like lack of participation from members and unequal weight of influences of different members and national associations. It is also facing threats of executive manipulation due to weak boards. Despite this the association has created a strong social capital that unfortunately is unevenly distributed among the members and its social capital is at risk of declining. Regarding motions there is a lot of potential in this formal tool of influence, but often it is not the motion itself but what the motion writers and audience do with the information as well as if the executive agrees with the motions that create the intended change. It can be interpreted as if down-top approaches to operational medical organisational change only will be achieved if the “top” agrees to the change. In conclusion, the assumption of this thesis has thus been proven to a certain extent. Members have the power to create organisational change through motions but their ability to do that depends on a high degree of internal democracy but also on informal contacts. Social capital is built in the process in the social networks that each association form individually as well as together with all MSF associations. However it is not necessarily a precondition to organisational change even though it is a product of the existing internal democracy. MSF has the opportunity to strengthen the democratic process and to be better equipped to create organisational change in the future.