Orientadores: Stela Márcia Pereira, Gláucia Maria Bovi Ambrosano / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-23T01:39:29Z (GMT). No. of bitstreams: 1 Menezes_LauradeFreitas_M.pdf: 1056891 bytes, checksum: 7814a88405461b90fc450386cd1c516b (MD5) Previous issue date: 2013 / Resumo: Este estudo seccional investigou o impacto dos Centros de Especialidades Odontológicas (CEOs) nos indicadores de procedimentos da atenção secundária no Estado de São Paulo, bem como sua relação com variáveis econômicas. A amostra contou com os 645 municípios do estado, divididos segundo a presença e ausência dos CEOs, no ano de 2009. As variáveis dependentes analisadas foram os procedimentos de endodontia, periodontia e cirurgia oral menor e as variáveis independentes selecionadas foram cobertura dos Centros de Especialidades, renda per capita e PIB per capita. A análise estatística dos dados foi feita através de teste Qui-quadrado e regressão logística múltipla, ajustada para a co-variável porte municipal. Como resultado, observou-se que os municípios que têm CEO apresentaram um maior número de procedimentos quando comparados aos que não o possuem (p<0,0001). A presença do CEO (p=0,0001; OR:49,06); (p<0,0001; OR:9,59); (p<0,0001; OR:26,39) foi considerada determinante para o maior número de procedimentos clínicos de Endodontia, Periodontia e Cirurgia Oral Menor, respectivamente. Pode-se concluir que os Centros de Especialidades Odontológicas impactaram, de forma substancial, o acesso aos serviços de atenção secundária no estado de São Paulo, independente do porte municipal / Abstract: This cross-sectional study investigated the impact of Specialized Dental Clinics (SDC) on indicators of secondary care procedures in the state of São Paulo, as well as its relation to economic variables. The sample consisted of the 645 municipalities in the state, with and without SDC in 2009. The dependent variables analyzed were endodontics, periodontics and minor oral surgery procedures and independent variables selected were specialized coverage, per capita income and per capita GDP. The statistical analysis was performed using chi-square test and multiple logistic regression, adjusted for covariate municipal size. Results showed that counties with SDC presented greater number of procedures when compared with those who do not have (p <0.0001). The presence of the SDC (p = 0.0001, OR = 49.06) (p <0.0001, OR: 9.59), (p <0.0001, OR: 26.39) was considered decisive for the largest number of clinical procedures of Endodontics, Periodontics and Minor Oral Surgery, respectively. In conclusion, Specialized Dental Clinics impacted access to secondary care services in the state of São Paulo, regardless of municipal size / Mestrado / Odontologia em Saude Coletiva / Mestra em Odontologia em Saúde Coletiva

Made available in DSpace on 2014-08-20T13:49:44Z (GMT). No. of bitstreams: 1 LILIAN MOURA DE LIMA.pdf: 1272342 bytes, checksum: e6c136314886322d6aa38853685abd38 (MD5) Previous issue date: 2011-10-07 / Household contacts of index cases tuberculosis have an increased risk of developing the disease due to the closeness and the time duration of exposure to the bacillus. For this reason the evaluation of these individuals is decisive to controlling the disease, since the early diagnosis and timely treatment stop the transmission chain of the disease reflecting on the reduction of incidence rates. To this purpose there are protocols and targets proposed by the World Health Organization in which the health services should be based in the proper evaluation of the contacts. The study aimed investigate the health services that diagnosticate tuberculosis in Pelotas in relation to the service offered to household contacts of the index case. It consists of a descriptive, quantitative and transversal cut study linked to the multicentric project entitled "Delay in the diagnosis of tuberculosis: analysis of causes in different regions of Brazil". The study sample was composed of 85 index cases of tuberculosis interviewed in the origin study in Pelotas and their 163 household contacts. The collection of these data took place between July and December 2009 in the control of tuberculosis program in Pelotas and the collection of medical records has occurred in January 2011 in this same service. It was used the database research of the multicentric study and it was built a database in Excel software with the data from medical records. The analysis of data was performed using descriptive statistics. The results show that attention to tuberculosis in Pelotas need to be rethought with the of involving primary care in the evaluation of household contacts in order to facilitate early diagnosis, appropriate clinical evaluation of contacts and interruption of transmission chain of TB in appropriate time. / Os contatos intradomiciliares dos casos índices de tuberculose têm risco aumentado de desenvolver a doença em virtude da proximidade e do tempo de exposição ao bacilo. Por este motivo a avaliação destes indivíduos é determinante para o controle da doença, já que o diagnóstico precoce e o tratamento oportuno interrompem a cadeia de transmissão da doença repercutindo na redução das taxas de incidência. Para tanto existem protocolos e metas propostos pela Organização Mundial da Saúde, nos quais, os serviços de saúde devem basear-se na avaliação adequada dos contatos. O estudo objetivou investigar os serviços de saúde que fazem o diagnóstico da tuberculose em Pelotas quanto ao atendimento oferecido aos contatos intradomiciliares do caso índice. Constitui-se de um estudo descritivo, quantitativo de corte transversal, vinculado ao projeto multicêntrico intitulado Retardo no diagnóstico da tuberculose: análise das causas nas diferentes regiões do Brasil . A amostra do estudo foi composta por 85 casos índices de tuberculose entrevistados no estudo de origem em Pelotas e seus 163 contatos intradomiciliares. A coleta destes dados deu-se entre julho e dezembro de 2009 no programa de controle da tuberculose de Pelotas e a etapa de coleta do prontuário em janeiro de 2011, neste mesmo serviço. Utilizou-se o banco de dados da pesquisa do estudo multicêntrico e com os dados do prontuário construiu-se um banco no software Excel. A análise dos dados foi realizada por meio da estatística descritiva. Os resultados evidenciam que a atenção a tuberculose em Pelotas necessita ser repensada no intuito de envolver a atenção primária na avaliação dos contatos intradomiciliares, visando facilitar o diagnóstico precoce, a avaliação clínica adequada dos contatos e a interrupção da cadeia de transmissão da TB em tempo oportuno.

M.Cur. / Occupational health nurses are qualified registered nurses with a post-graduate qualification in occupational health nursing as a specialised discipline, and provide the basic healthcare aspect of the occupational health programme. Their most important activity is to identify and assess the health hazard risks in the workplace. Health risk assessments are conducted by occupational health nurses to determine all the stresses, e.g. hazardous chemicals, vibration, insufficient lighting, noise exposure and thermal exposure, which may affect employees‟ health and working efficiency. The researcher conducted audits and, over a period of time, observed that 85% (n=23) of occupational health nurses in different settings conduct health risk assessments only to a certain extent. The following questions were raised: To what extent do occupational health nurses conduct health risk assessments? What are the possible reasons for them conducting the health risk assessments only to a certain extent, or not at all? What can be done to improve this? The purpose of this study was thus to explore and describe the extent to which occupational health nurses conduct health risk assessments; and the possible reasons for not conducting them or conducting them only to a certain extent. Guidelines were developed to assist occupational health nurses in conducting health risk assessments. A quantitative, descriptive design was used in this study. A sampling frame was developed from a list of all the members of the South African Society of Occupational Health Nursing Practitioners (SASOHN) in Gauteng. From the target population of occupational health nurses in Gauteng, a systematic cluster sampling method was used. A developed questionnaire was distributed by mail and e-mails, and reminders were sent by the researcher to the respondents (Burns & Grove, 2006). The researcher ensured validity and reliability throughout the study by means of theoretical review, content securing and statistical assistance (Burns & Grove, 2006). Ethical standards of the right to self-determination, right to privacy, right to confidentiality and autonomy, right to fair treatment and right to protection from discomfort and harm were adhered to. The findings revealed that the occupational health nurse is a mature, predominately female experienced practitioner who operates on behalf of a disproportionably large number of employees. Four factors influencing these nurses in conducting a health risk assessment to a certain extent were identified: competence, ignorance about the role of the occupational health nurse, workload and attitude. The researcher formulated guidelines to assist practising occupational health nurses to conduct health risk assessments.

Made available in DSpace on 2016-07-18T17:54:20Z (GMT). No. of bitstreams: 1 DISSERTACAO Regina DEFESA 3DEZ2013.pdf: 6465764 bytes, checksum: af58ad60cf3d62c266c18ace881754ce (MD5) Previous issue date: 2013-12-03 / This research has as its theme the pedagogical function of the University Library throughout the educational training of undergraduate students at a private university in the state of São Paulo, Unoeste Universidade do Oeste Paulista. Its issue mostly refers to these questions: University Library, while an organization and provider of information resources, through professionals who work in it, can influence pedagogically academic life of undergraduate students of the institution? Is it possible to detect how this influence operates on its users? Is it possible to the Librarian, while performing such services to the students, develops the role of educator, participating in the process of their training? The main objective of this study was to evaluate the role of pedagogical education of the University Library played by its professional in academic undergraduate students of Unoeste. As specific goals, check if services provide support to the students and observe if they match their academic and informational expectation and requirements. Examine the potential and weaknesses of services offered to the students and also evaluate those students that are arriving and those who are leaving the University, and show the results, in order to analyse the existence of academic growth during the years they remained in the institution and used the Libraries services, and through it prove the importance of Library for their professional training. It s a quali-quantitative exploratory research, with field research as its source of information, as sought data directly from the population surveyed, and also, a case study, in which one particular case was favored, the undergraduate student, classroom modality, of this institution. To collect data, we applied an online form called SAV Evaluation System , in two stages to students from eight undergraduate courses at the first and last semester; firstly, 285 were evaluated, and at the second stage, 20% that corresponds to 90 students of the second semester students of 2013, totaling 375 students. To data analysis were used the answers from the forms and statistical graphics, during the first and second stages of this research, proving the relevance and informational support that Librarians and library services offered by the University play in the educational context, highlighting the educational influence of services offered to this intitution s students. / A presente pesquisa tem como tema, a função pedagógica educativa da Biblioteca Universitária na formação dos discentes de graduação, em uma universidade privada do interior do Estado de São Paulo, a Unoeste - Universidade do Oeste Paulista. A sua problemática se refere principalmente às questões: A Biblioteca Universitária, enquanto organização e provedora de recursos informacionais, por meio dos profissionais, que nela atuam, pode influenciar pedagogicamente a vida acadêmica dos discentes de graduação da instituição? É possível detectar, de que maneira se opera essa influência sobre os seus usuários? O Bibliotecário ao realizar tais serviços aos discentes desempenha a função de educador, participando no processo de formação profissional deles? O objetivo principal desse estudo foi avaliar o papel pedagógico educativo da Biblioteca Universitária desempenhado pelos seus profissionais, na formação acadêmica dos discentes de graduação na Unoeste. Quanto aos objetivos específicos, verificar se os serviços oferecidos fornecem apoio aos discentes e se atendem suas expectativas e exigências acadêmicas e informacionais. Examinar as potencialidades e fragilidades dos serviços oferecidos aos discentes e ainda, avaliar os alunos que estão saindo e os ingressantes na instituição, e demonstrar os resultados, se houve crescimento acadêmico no decorrer do período que esteve na instituição e utilizou os serviços das Bibliotecas, e desta forma comprovar a participação da Biblioteca em sua formação profissional. Trata-se de uma pesquisa quali-quantitativa de natureza exploratória, com campo, como fonte de informação, pois buscou os dados diretamente com a população pesquisada, e, também, de um estudo de caso, em que privilegiou um caso em particular, o de alunos de graduação, modalidade presencial, dessa instituição. Para a coleta de dados, foi aplicado um formulário on-line denominado de SAV Sistema de Avaliação , em duas etapas aos discentes de oito cursos de graduação no primeiro termo e no último termo; na primeira, foram avaliados 285 alunos, e na segunda etapa 20%, que corresponde a 90 alunos ingressantes no segundo semestre de 2013, totalizando 375 alunos. Para a análise dos dados, utilizou-se de respostas obtidas no formulário e gráficos estatísticos, tanto na primeira, como na segunda etapa da pesquisa, comprovando a relevância e o apoio informacional que os bibliotecários e os serviços oferecidos pela Biblioteca desempenham no contexto educacional, destacando a influência educativa dos serviços prestados para os discentes da instituição.

The study explores and describes the satisfaction that clients placed at Trinity Children and Family Services have with the agency's therapeutic services. Therapeutic services in this case refers to the therapy that the residents receive from their individual and group therapists, and their interactions with the unit case manager/dorm supervisor and unit counselors.

Increasing prevalence and severity of undergraduate psychopathology, combined with heightened burden on college campus counseling centers and the potential for sustained distress and self-harm, has necessitated comprehensive, vertically integrated on-campus mental health services. Initiatives include preventive interventions that: 1) foster resilience and adaptive coping, 2) ameliorate sub-threshold symptoms of pathology as secondary prevention, and 3) foster well-being and meaningful student experiences for greater fulfillment and thriving. A growing body of supportive data has led to some expansion of mental health and wellness services on college campuses, including the use of spiritually integrated mind-body practices to promote well-being. While college campuses’ wellness initiatives show promise, structured spiritual-mind-body (SMB) interventions have yet to be formally tested in either open or controlled clinical trials. The primary aim of this open-trial pilot study was to evaluate the feasibility and acceptability of an eight-session SMB-integrated wellness intervention, Awakened Awareness for Adolescents (AA-A), adapted specifically for late adolescent (ages 18 - 25) college students from Awakened Awareness for adults (AA) to support spiritual development and individuation. A secondary aim was to obtain preliminary data on changes in undergraduate students’ mental health and spiritual well-being across the AA-A intervention. Participants consisted of 77 non-clinically-referred undergraduates aged 18 - 24, who attended an average of M = 5.75 (SD = 1.42) out of the eight sessions. Measures included common psychopathology symptoms, spiritual well-being, psychological, and psychosocial variables using validated self-report assessments. Additionally, we explored the effect of spiritual well-being variables’ change scores as predictors of post-AA-A psychopathology symptom scores, controlling for pretest symptom scores. Differential effects between participants with high and low baseline depression symptoms were examined on outcome measures. Preliminary findings support the feasibility and acceptability of the AA-A intervention for college student’s mental health and spiritual well-being. Results include significant reductions in depression, anxiety, post-traumatic stress (PTS) symptoms, and significant improvements in numerous spiritual well-being, psychological, and psychosocial variables. Further, a recovery process from high rates of PTS symptomatology and spiritual decline may be initiated by SMB interventions that foster enhanced spiritual perception and build awareness of personal and relational spirituality.

Mistreatment experienced by women delivering in healthcare institutions is a concerning pattern reproduced and normalized in health systems globally, causing widespread harm. Women’s reports and observations of childbirth practices in institutions have revealed that disturbing proportions of deliveries are characterized by indignity, humiliation, and neglect. The enormity of the problem constitutes a social catastrophe, as potentially hundreds of thousands are affected daily at a profoundly important moment of personal, family, and social life. Growing global concern has elicited research on mistreatment’s prevalence and characteristics, with limited attention to developing explanatory theory. The observed patterns indicate that mistreatment is systemic; therefore, social theory is required to understand why mistreatment persists, despite official norms that prohibit mistreatment and promulgate respectful care. Diane Vaughan’s normalization of organizational deviance theory from organizational sociology, emerged from studies of how things go wrong in organizations. The theory posits that organizational structures and processes are distorted due to resource scarcity combined with production pressures resulting in normalized organizational deviance in daily micro-level transactions. Furthermore, regulatory systems are unable to capture and mitigate the problem. Vaughan’s multi-level framework provided an opportunity for analogical cross-case comparison to elaborate theory on mistreatment as normalized organizational deviance.To elaborate the theory, the Tanzanian public health system in the period of 2010-2015 was selected as a case because it was the site of a seminal study to measure the prevalence of mistreatment, explore its causes, and develop and test interventions to reduce its occurrence. My participation in designing and conducting this study provided understanding of the phenomenon which formed the foundation of this dissertation. Novel theory was first elaborated through a systematic review of literature on maternal health care and the government health system in Tanzania. A broad Scopus search identified 4,068 articles published on the health system and maternal health in Tanzania of which 122 were selected. Data was extracted using a framework based on the theory and reviews of mistreatment in healthcare. Relationships and patterns emerged through comparative analysis across concepts and system levels and then were compared with Vaughan’s theory and additional organizational theories, resulting in a nascent theory. A qualitative theory-driven approach was then applied to verify and expand the nascent theory using qualitative exploratory data from the study in Tanzania described above. The data included eight focus group discussions and 37 in-depth interviews involving 91 individuals representing community and health system stakeholders. Data were analyzed deductively and inductively using the theory’s framework while allowing for emergent constructs. Analysis based on the literature review revealed that normalized scarcity at the macro-level combined with production pressures that emphasized biomedical care and imbalanced power-dependence on limited financial sources altered values, structures, and processes in the health system. Meso-level actors strove to achieve production goals with limited autonomy and insufficient resources, resulting in workarounds and informal rationing. Biomedical care was prioritized, and emotion work was rationed in provider interactions with women, which many women experienced as disrespect. The nascent theory developed through literature review was largely supported by the qualitative data, while providing further nuance and elucidating new components. Moral distress, which occurs when one knows the right thing to do but is prevented from taking the right action due to institutional constraints, emerged as an important systems effect of organizational dysfunction. In addition, the qualitative data revealed that managers coped with dual roles as both managers and providers and that the service interaction includes families, not solely providers, women, and newborns. The challenges in the regulatory environment also were clarified, highlighting that monitoring and observing mistreatment was hindered due to structural secrecy and the nature of mistreatment. The nascent theory revealed the importance of emotional labor and emotion work in understanding mistreatment. Emotional labor has been widely acknowledged as an important aspect of healthcare provision, especially for a positive patient experience; yet there has been limited attention to emotion work as the underlying effort required to provide respectful maternity care and prevent mistreatment. Qualitative data from the exploratory formative research were further analyzed to explore the characteristics of emotion work. 22 interviews and 3 focus groups with 44 maternity providers from different levels of care provision in two districts were analyzed using thematic analysis combined with affinity diagramming. Six key themes were identified that provide a deeper understanding of the emotion work required of maternity providers, including 1) expected to love and care for patients; 2) controlling emotions; 3) managing patient expectations in the face of system shortages; 4) providers are human beings too; 5) nurses are perceived as harsh; and 6) limited system support for emotion work. The themes and corresponding sub-themes highlight that the nature of childbirth care, the context, and gender norms influence the ability to exert emotion work and thus provide respectful care. Emotion work was expected but good performance was unacknowledged by the system. Additional resources are required, not only to ensure the most basic of resources to provide quality of care, but to ensure sufficient organizational support to address the emotional demands of providers. Systems need to acknowledge the extra effort required for emotion work and support and train providers to provide this care, as well as help them to manage difficult emotions that they experience due to the nature of their work. Analogical comparison with another case of organizational deviance enabled a novel approach to elaborate theory. Normalization of organizational deviance proved useful for understanding mistreatment. This theory and others from organizational sociology that explore why things go wrong in organizations may be relevant for other areas of persistent systems failure and underperformance. Further theory testing in different contexts and types of health systems is needed to understand the generalizability of the nascent theory and advance its development. In addition, many of the constructs, such as emotional labor and moral distress, have not been widely applied in low- and middle-income settings and require deeper study. This theory reveals the systemic factors driving mistreatment and can guide the identification of system leverage points to transform health systems towards ensuring a respectful experience during childbirth for women and their newborns. Ensuring that adequate resources are provided to achieve targets is essential, but organizational support to address the emotional demands of providers must also be provided. These changes will ease the burden among providers and managers struggling to provide care in under-resourced health systems. The extra effort required for emotion work should be acknowledged and appropriate training provided, as well as support for providers to manage the difficult emotions that they experience due to the nature of their work. The findings may also have implications beyond childbirth, as the theory highlights the conditions that may lead to burnout and poor mental health among providers, an ongoing problem worldwide that was exacerbated by the COVID-19 pandemic.

A wide range of people are interested in how local factors influence patient choice among hospitals. Administrators need to know why patients are admitted to their hospitals so they can develop more sophisticated marketing of their services in an increasingly competitive environment. Planners concerned with issues of patient accessibility need know the geographic patterns of hospital use To meet these needs, it becomes necessary to develop methods to estimate the probability that patients will be admitted to a particular hospital using models that incorporate location and size of competing hospitals. In this paper, the focus of econometric investigation and prediction is the probability that a patient will select e particular hospital. Four different service areas were delineated and studied in West Virginia to test the Huff Consumer Spatial Behavior model for estimating demand at four hospitals that may be facing closure. It was found that through application of the Huff model that in a small system of hospitals and patients, each patient location (i.e., zip code) will send patients to nearly every hospital. The model predicted sufficient demand for two of the four hospitals studied. Conventional methodologies were then compared to the Huff model. The model did not test for financial feasibility of any of the facilities nor did the model adequately address the issue of how patients select a particular facility. / Master of Science

Submitted in fulfillment of the requirements of the Master of Technology Degree in Information Technology, Durban University of Technology, Durban, South Africa, 2014. / This study aimed to explore user factors that may influence attitude and behaviour where technology acceptance is concerned. The Technology Acceptance Model (TAM) Framework was used as a tool to map this degree of acceptance in relation to the design of the current Encyclopaedia of South African Arts, Culture and Heritage (ESAACH). ESAACH is an encyclopaedia intended to address the dearth of reference material in South African arts, culture and heritage studies (ESAACH.org.za). The encyclopaedia is divided into broader areas of research such as: verbal arts, performing arts, visual arts, and heritage. It was originally established as a tool to provide support for education in arts, culture and heritage. There has been an increase in interest in the ESAACH online resource platform. This has resulted in the need to capture user perceptions and attitudes on the site in order to provide guidelines on the improvement of the site and to make usage of the encyclopaedia easier and less frustrating. The researcher investigates English Language Proficiency, Perceived Ease of Use and Perceived Usefulness and Computer Self-Efficacy as factors that influence an online user’s attitude towards intention to use and acceptance of an online encyclopaedia. There have been concerns expressed by website designers that because users may not be fully acquainted or familiar with using the Internet in general when accessing information, they anticipate some resistance or reluctance to make full use of available online content. The study included the administration of an online survey to a sample of 149 students from the Arts and Design and Library Information Studies departments whereby their demographics, antecedents and precedent constructs of the TAM were tested for co-relationships of user’s intention regarding usage and acceptance of the website. The TAM model was used as a tool to determine: whether a positive confidence in the students’ English language proficiency would affect intention to use the encyclopaedia and to predict whether positive Computer Self-Efficacy is an indicator for a positive effect regarding Ease of Use and/or Perceived Usefulness. Results confirmed that users perceived Computer Self-Efficacy as a positive contributor to the usefulness of the ESAACH online encyclopaedia. Although no significant relationship between English Language Proficiency and Perceived Ease of Use was demonstrated, the need for a design which caters for sensitivity to the language of users was identified.

Thesis (MBA)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The alignment of Sanlam Life with the transformation process of Sanlam, as a national financial services group, necessitated the implementation of an improved service delivery model in 1998. The vision to be world class, brought forward some challenges in terms of cost, service levels as well as the type of service channel. Strategically, it was decided that Sanlam Life should centralise its services, which had enormous implications for Sanlam Life's staff as well as its clients. This resulted in the establishment of a more "impersonal" service channel, which could, at the same time, deliver a more effective service in terms of speed and quality. Decentralised walk-in centres thus, had to make place for two, centralised, client contact centres and a personal, face-to-face, service was replaced with a technologically effective call and correspondence centre. After a period of approximately two years of operational functioning, it was decided by Sanlam Life Exco to do a thorough diagnosis of the overall functioning of the Client Contact Centre (CCC).The specific aims of this diagnosis can be summarised as follows: • To gain insight into the level of employee satisfaction and morale. • To identify the factors which contribute to employee satisfaction and morale. • To evaluate the efficiency of the service delivery processes. • To ascertain what the current culture is within the CCC, in order to decide if it is the type of culture that should be vested in the rest of Sanlam Life. In preparation to the diagnostic survey and with the aim to improve the effectiveness of the CCC, the principles of organisational diagnosis will be discussed in this study, and will include the following: • The importance of a diagnostic model, which is central to the diagnostic process as well as further action plans. • A description of the diagnostic process and the importance of feedback and action planning in order to ensure organisational improvement. The results of the diagnostic survey of the Sanlam Life CCC, indicated the work climate can primarily be described as negative, and that improvement of especially the work processes and management behaviour, is required. The negative perception of the CCC staff around their service delivery, however does not correlate with the experience of the Sanlam Advisors regarding CCC service. This finding is contradictory to that of previous research, which indicated a positive relationship between employee and client satisfaction. This finding should thus be investigated to a greater extent. Organisation diagnosis is a sensitive process, which can create the expectation with employees that something will be done with the information. The greatest challenge therefore does not only lie in the diagnosis itself, but in the utilisation of the information for continuous improvement. / AFRIKAANSE OPSOMMING: Die belyning van Sanlam Lewens met die transformasieproses van Sanlam, as nasionale finansiële dienstegroep, het die implementering van 'n verbeterde diensleweringmodel in 1998 genoodsaak. Die visie om wêreldklas te wees, het sekere uitdagings gestel op die gebied van koste, diensvlakke asook die tipe dienskanaal. Strategies is besluit dat Sanlam Lewens moet sentraliseer, wat enorme implikasies ingehou het vir Sanlam Lewens se personeel asook hul kliënte. Dit het gelei tot die totstandkoming van 'n meer "onpersoonlike" dienskanaal wat terselfdertyd meer effektiewe diens in terme van spoed en kwaliteit tot gevolg sou hê. Gedesentraliseerde instapkantore moes dus plek maak vir twee, gesentraliseerde, kliëntekontaksentrums en persoonlike, aangesig-tot-aangesig, dienslewering is vervang deur 'n tegnologies effektiewe inbel- en korrespondensiesentrum. Na 'n tydperk van ongeveer twee jaar van operasionele funksionering, het die uitvoerende bestuur van Sanlam Lewens besluit dat 'n deeglike diagnose na die algehele funksionering van die Kliëntekontaksentrum (KKS) gedoen moet word. Die spesifieke doelwitte van die diagnose kan as volg opgesom word: • Om insig te verkry ten opsigte van die vlak van werknemertevredenheid en moraal. • Om die faktore wat bydra tot werknemertevredenheid en moraal te identifiseer. • Om die effektiwiteit van die diensleweringsprosesse te bepaal. • Om te bepaal wat die huidige kultuur binne die KKS is, sodat daar besluit kan word of dit die tipe kultuur is wat in die res van Sanlam Lewens gevestig moet word. As voorbereiding tot die diagnostiese ondersoek in die Sanlam Lewens KKS en ook met die doel om die effektiwiteit van die KKS te verbeter, word die beginsels van organisasiediagnose in hierdie studie bespreek, en bestaan uit die volgende: Die vestiging van 'n begrip van organisasie-effektiwiteit en die bydrae wat organisasiediagnose kan lewer tot volgehoue organisasieverbetering. • Die belang van 'n diagnostiese model, wat sentraal staan tot die diagnostiese proses asook verdere aksieplanne. • 'n Omskrywing van die diagnostiese proses en die belang van terugvoer en aksiebeplanning ten einde organisasieverbetering te verseker. Die resultate van die diagnostiese ondersoek na die funksionering van die Sanlam Lewens KKS het aangedui dat die werksklimaat in die KKS hoofsaaklik as negatief beskou kan word en dat verbetering ten opsigte van veral werksprosesse en bestuursgedrag nodig is. Die negatiewe persepsie wat by KKS personeel bestaan ten opsigte van hul dienslewering korreleer egter nie met die ervaring van Sanlam Adviseurs ten opsigte van KKS diens nie. Hierdie bevinding is teenstrydig met vorige navorsing, wat 'n positiewe verband gevind het tussen werknemer- en kliëntetevredenheid, en moet dus verder ondersoek word. Organisasiediagnose is 'n sensitiewe proses wat die verwagting by werknemers skep dat iets met die inligting gedoen gaan word. Die grootste uitdaging lê dus nie net in die diagnose nie, maar in die gebruik van die inligting vir volgehoue verbetering.