Thesis (Ph. D.)--Washington State University, May 2007. / Includes bibliographical references (p. 106-109).

The interaction patterns of 4 parent readers and 4 senior readers were investigated using grounded theory methodology during an intergenerational shared book reading activity with 16, 5 and 6 year olds. Parent and senior volunteers were observed during one on one reading with two different children who were divided up by gender using stratified random assignment to read with either a parent aged reader or a senior reader. To capture authentic interactions between the volunteer readers and children no preliminary training took place. Data were collected during pilot, pre-program, program, and post-program conditions. Open coding using a constant comparison method was used to establish patterns across conditions in the early phases of data collection. During open coding provisional categories were identified. Data from video observations, parent journals and interviews were then interpreted using axial coding methods to analyze the context, conditions and action/interaction strategies that were present and to determine connections between categories. From this information, broad categories were recombined based on trends and the observed antecedent and situational features. Selective coding was then used to test the provisional phenomenon. This was done using coding to identify any changes that took place between volunteer readers and each of the two children that he or she read with. The central phenomenon of scaffolding was identified across intervening conditions. The phenomenon of scaffolding was defined as a query and response pattern initiated by the adult, and used to direct the child's focus of attention during the literacy act. This took place as part of a transactional process where the elements of (a) the book being read, (b) the child and (c) the volunteer reader mutually conditioned and were conditioned by the other elements. The qualities that the reader brought to the transaction tended to differ when comparing senior and parent readers. The main differences observed occurred in three clusters of (a) Timing, Responsiveness, and Pace, (b) Use of Expression, Colloquialisms, Articulation and (c) Gestures, Feedback Methods and Range of Strategies. The pace of the senior readers was found to be slower than that of the parent aged readers. The senior readers also tended to make use of distinct pronunciation and did not use colloquialisms. They were also more inclined to use a wider range of supportive strategies. Both the senior readers and the parent readers were unaware of most of the strategies that they used to support the children. Further research on the question of the transactional process and the qualities brought to the shared reading experience by senior volunteer readers is required. Replication of the present study is suggested across a variety of conditions with different types volunteer readers and children. / Graduate

abstract: The emergence and fast growth of shared workspaces have attracted increasing attention from investors, practitioners, and researchers. Overall, this industry is still at an early stage of development and the business models of shared workspace providers are still evolving. To enhance the understanding of the different business models adopted by the leading shared workspace providers, I conduct an in-depth qualitative analysis of three current market leaders - Regus, WeWork, and UrWork – using the Business Model Canvas proposed by Osterwalder (2008). My analysis suggests that shared workspace providers creates value by offering three tiers of services: (1) satisfying users’ needs for physical office spaces, (2) helping them build an enterprise eco-system, and (3) facilitating the development of a user community. I further use the PEST model to analyze how the macro-environmental factors in China and U.S. may have contributed to the development of different shared workspace business models in these two countries. Based on the above analyses, I propose a list of factors that may be critical to investors’ valuations of shared workspace companies. / Dissertation/Thesis / Doctoral Dissertation Business Administration 2018

This thesis presents a structured approach to measure the performance of a shared services business unit. This approach links the activities in the areas at which a shared services business unit must excel to create sustainable value for the organisation to the organisational vision. The methodology developed can be used to measure the performance of a shared services business unit by all the stakeholders that have an interest in the organisation. The study concludes that measuring of the performance of a shared services business unit is dependent on the organisational vision and strategies as contained in a mission statement. The study further concludes that as the transformation of technology, business processes, people and customer satisfaction are required for continuous evolution of the shared services; the activities that make up these areas should form the basis of the performance measurement of shared services. These activities in the areas of technology, business processes, people and customer satisfaction should be derived from the organisational vision and mission, and be supportive of the organisational mission and vision. The author has studied shared services and performance measurement metatheories and has found that the principles applicable to measure the strategic performance of an organisation can be applied to a shared services business unit. Some of these principles are so straight forward that they are often overlooked and taken for granted. The empirical methodology in this thesis follows a structured approach where the sample framework was tested to determine if the sample elements comply with the requirements of shared services. Following on this the study had to determine if the remaining sample elements are measuring the performance of their respective organisations in a structured manner. Only once this has been established can the study determine the manner in which these sample elements measure the performance of their shared services. After this, the elements identified through the literature study and empirical research could be build into a hierarchy of performance measurement for a shared services business unit. In developing a hierarchy of performance measures for a shared services business unit, shared services organisations have been provided with a structured approach to measure the performance of their shared services business unit that will indicate the value created by the shared services to all stakeholders concerned. / Prof. A.L. Boessenkool

Background: The process of shared decision making (SDM), a key component of interprofessional (IP) practice, provides an opportunity for the separate and shared knowledge and skills of care providers to synergistically influence the client / patient care provided. The aim of this study was to understand how different professional groups perceive IPSDM, their role as effective participants in the process and how they ensure their voices are heard. Methods: A sequential explanatory mixed methods design was used consisting of a realist review of the literature about IPSDM in intensive care, a survey of the IP team (n=96; RR-81.4%) about collaboration and satisfaction with the decision making process in NICU, semi-structured interviews with a sample of team members (n=22) working in NICU, and observation of team decision making interactions during morning rounds over a two week period. A tertiary care NICU in Canada was the study setting. Findings: The study revealed a number of key findings that are important to our increased understanding of IPSDM. Healthcare professionals’ (HCP) views differ about what constitutes IPSDM. The nature of the decision (triage, chronic condition, values sensitive) is an important influencing factor for IPSDM. Four key roles were identified as essential to the IPSDM process: professional expert, leader, synthesizer and parent. IPSDM involves collaboration, sharing, weighing and building consensus to overcome diversity. HCPs use persuasive knowledge exchange strategies to ensure their voices are heard during IPSDM. Buffering power differentials and increasing agreement about best options lead to well-informed decisions. A model was developed to illustrate the relationships among these concepts. Conclusions: Findings from this study improve understanding of how different members of the team participate in the IPSDM process, and highlight effective strategies to ensure professional voices are heard, understood and considered during deliberations.

This thesis examines strategies to address the inappropriate proton pump inhibitor (PPI) use. A scoping review was conducted to examine patient preferences and values towards PPI initiation and continued treatment, as well as their attitudes towards reducing PPI use (deprescribing). Symptom control (reflux, heartburn) was a driver for patients to seek treatment. Patients were concerned about symptoms returning if they reduced their PPI use but were interested in using less medication if possible. Patients were open to discussing PPI reduction and valued clear communication about rationale and potential benefits/harms. As such, shared and informed decision-making (including eliciting patient values) is important in the choice to continue a PPI or try deprescribing. A decision-support tool for clinicians, aimed at the decision to continue a PPI versus try deprescribing, was implemented over 12 months in one long-term care home in Ottawa. The tool led to a non-statistically significant decrease in PPI use after it was implemented, but PPI usage began to gradually increase after six months. Strategies to sustain use of deprescribing initiatives are needed. Finally, a consult patient decision aid (PtDA) was developed and piloted in three Ottawa area clinics, and aimed to facilitate shared decision-making surrounding the decision to continue or try to reduce a PPI during a healthcare visit. Based on a sample of 12 patients, the consult PtDA increased knowledge about the decision and increased decisional confidence. After receiving the consult PtDA, 8/12 (75%) patients chose to reduce their PPI use and 4/12 (25%) chose to continue their PPI.

The Thesis is conducted based on analysis of a business shared service centre, all factors to consider before the establishment, its scope, model, and the most important is to see advantages as well as to realize the shortcomings of this kind of business model. The country which is analyzed is the Czech Republic; more particular is the city of Prague; and the company is SAP Business Service Centre of Europe (BSCE). In this Thesis, first of all, the PEST (Political, Economic, Social and Technology) environmental analysis has been conducted. The work continues with the SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis of the company SAP AG, from which, we can see that opening a SAP BSCE is a part of SAP strategy which supposes to benefit the company. In order to establish the BSCE, the SAP management board has to consider the factors such as Organization, People, Processes and IT Infrastructure. After analyzing approximately 20 cities in Europe, SAP has chosen Prague as the best mix of quality and costs factors. SAP BSCE covers the functions of Human Resource and Finance and Administration, which provide services to internal and external customers of many countries in Europe, Middle East, and Africa. SAP BSCE has brought back many advantages such as cost-savings, high quality service, business availability and flexibility, and business transparency and legal compliance. On the other hand, there are still many short-comings, such as the high turn-over rate of staff, difficulties in harmonization and standardization of processes and IT infrastructure, and how to prove the quality of service. Despite these challenges, SAP BSCE has put efforts into trying to overcome these problems. At the end of the Thesis, as per analysis of SAP financial results of business activities during the crisis, it is proven the setting up a shared service centre was a good decision of SAP and it paid off with the contribution to help SAP overcome the impacts of crisis.

Lung cancer is the most common cause of cancer-related deaths in the United States. Prevention and early detection of lung cancer are imperative in decreasing lung cancer mortality. Screening for lung cancer with low-dose computed tomography (LDCT) decreases lung cancer by 20%. Several organizations introduced lung cancer screening (LCS) guidelines in 2013, including Centers for Medicare and Medicaid (CMS) and the United States Preventive Services Task Force. However, LCS participation for eligible patients remains low, due in part to the complexity of the LCS process. The goal of this practice improvement project was to increase the knowledge of rural primary care providers regarding LCS guidelines and the related CMS requirements and to increase their confidence in initiating shared decision-making (SDM) discussions. An educational intervention consisting of a LCS educational session and a toolkit was implemented in two rural clinics. Providers at both clinics reported a benefit to the educational intervention. Pre-, immediate post-, and two-month post-education surveys were collected to evaluate the impact of the educational intervention, including provider knowledge of LCS guidelines and CMS requirements, and confidence in SDM. Project results demonstrated an increased knowledge of LCS guidelines and CMS requirements with the greatest knowledge at immediate post-education and a high level of knowledge remaining at two months post-education. A small, nonsignificant, increase in provider confidence in initiating SDM discussions occurred. At both clinics, data collected through chart audit demonstrated an improvement in documentation needed to determine LCS eligibility and increased the percentage of patients identified at high risk for lung cancer and thus, eligible for LCS. At one clinic these changes were significant. The data were further examined for SDM discussions and referrals for LDCT or to specialist for LCS with one clinic increasing SDM documentation and LDCT referrals post-education. In conclusion, although further research is needed in implementation processes of LCS, specifically in consistent documentation to improve determination of LCS eligibility of patients, this practice improvement project found education increased provider knowledge and ability to complete requirements needed to improve LDCT screenings for lung cancer.

Resultatet visar på att självledarskap och innovation i ett delat ledarskap upplevs på samma positiva sätt som i teorin både från ett ledarskapsperspektiv och ett medarbetarperspektiv. Upplevelser av ansvarsfördelningen visar sig stämma överens med teorin då bägge perspektiven anser att ansvar är något som enkelt kan delas. Otydligheter i roller upplevs olika utifrån de två perspektiven. Ledare antyder att det kan ses som en tillgång eftersom gemensamma och fly-tande roller möjliggör en trygghet och mindre sårbarhet ur ett organisatoriskt perspektiv. Med-arbetarna påpekar hur viktigt det är med en tydlig rollfördelning för att undvika frustation och förvirring. Resultatet kan även tolkas om hur viktigt det är med olika ledarskapsstilar, vilket är raka motsatsen mot vad som presenteras i teorin. Personkemi mellan de som delar ledarskapet visar sig vara något väsentligt, precis som i teorin. Resultatet antyder även på en överensstäm-melse mellan teori och praktik gällande tillsättandet av en ny ledare, då ledarna beskriver hur positivt det varit att de själva fått välja vem som ska tillsättas.

Assistive robots have the potential to enable persons with motor disabilities to live more independent lives. Object retrieval has been rated a high-priority task for assistive robots. A key challenge in creating effective assistive robots lies in designing control interfaces that enable the human user to control the robot. This thesis builds on prior work that uses a laser pointer to allow the person to intuitively communicate their goals to a robot by creating a `clickable world'. Specifically, this thesis reduces the infrastructure needed for the robot to recognize the user's goal by augmenting the laser pointer with a small camera, an inertial measurement unit (IMU), and a laser rangefinder to estimate the location of the object to be grasped. The robot then drives to the approximate target location given by input from the laser pointer while using an onboard camera to detect an object near the target location. Local autonomy on the robot is used to visually navigate to the detected object to enable object retrieval. Results show a successful proof of concept in demonstrating reasonable detection of user intent on a 1.23 x 1.83 meters squared test grid. Testing of the estimation of object location in the odometry frame fell within range of successful local autonomy object retrieval for an environment with a single object. Future work includes testing on a wide variety of dropped objects and in cluttered environments which is needed to validate the effectiveness of the system for potential end users.