This research examines the application of the ISO 9000 model for quality management in healthcare. Exploratory case study is made of three healthcare provider organisations: community health service; independent practitioner association; Maori health network. Three research models are developed to examine identified gaps and areas of interest in healthcare quality management literature. The first model relates to differences between generic standards and specification standards. The second model relates to the fit of healthcare service delivery systems and ISO 9000. The third model relates to exploration of the linkages and co-ordination of an integrated care delivery network. One proposition and two hypotheses are developed in relation to the models, and are closely associated with gaps in healthcare service quality knowledge. Strong support is found for the first hypothesis though not the second hypothesis, and there are also some unexpected results. There is strong support that the process of implementing the ISO 9000 model will enhance healthcare management performance, even though the outcomes are unpredictable. There are indications supporting the notion that implementation of the ISO 9000 model will increase effective linkages and co-ordination within integrated care delivery networks. The body of evidence accumulated during the study did not, however, permit a valid conclusion regarding the hypothesis. The findings of the study can be extended to other healthcare service areas and through interpretation and extrapolation they add value to healthcare service quality research in general. In particular, the findings of the three case studies in this research suggest that future models for healthcare service quality should include a comprehensive generic model for quality management of individual and integrated healthcare service organisations.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / Achieving and sustaining business-IT alignment in organisations continues to be a management challenge into the new millennium. As organisations strive toward this end, researchers are attempting to better understand the alignment phenomenon. Empirical research into business-IT alignment is dominated by studies examining the relationship between business strategy, information technology and performance. Investigations into the factors enabling or inhibiting alignment are emerging. This research has traditionally taken a behavioural perspective. There is evidence of little research that examines the issue through a cognitive lens. This thesis builds on and extends the study of business-IT alignment by investigating the cognition of the key stakeholders of the alignment process - business and IS executives. Drawing on Personal Construct Theory (Kelly, 1955), this study uses a cognitive mapping methodology known as the repertory grid technique to investigate two questions: i) is there a positive relationship between business-IT alignment and shared understanding between business and IS executives?; and ii) are there differences in the cognitive maps of business and IS executives in companies that report high business-IT alignment and those that report low business-IT alignment? Shared understanding is defined as cognition that is held in common between and that which is distributed amongst business and IS executives. It is portrayed in the form of a cognitive map for each company. The study proposes that business-IT alignment is directly related to the shared understanding between business and IS executives and that the cognitive maps of these executive groups are less diverse in companies that report a high level of alignment. Eighty business and IS executives from six companies were interviewed. Cognitive maps were elicited from the research participants from which diversity between cognitive maps of business and IS executives are measured. A collective cognitive map was produced to illustrate the quality of the shared understanding in each company. The state of business-IT alignment in each company was also measured. The results of the study suggest that there is a strong positive link between business-IT alignment and shared understanding between business and IS executives. As expected, companies with a high-level of business-IT alignment demonstrate high quality shared understanding between its business and IS executives as measured and portrayed by their collective cognitive maps. The investigation further finds significant diversity in the structure and content of the cognitive maps of these executive groups in companies reporting a low-level of alignment. This study concludes that shared understanding, between business and IS executives, is important to business-IT alignment. Reconciling the diversity in the cognitive maps of business and IS executives is a step toward achieving and sustaining alignment. Practical approaches to developing shared understanding are proposed. A methodology to aid organisations in assessing shared understanding between their business and IS executives is also outlined. Finally research on business-IT alignment continues to be a fruitful and important field of IS research. This study suggests that the most interesting issues are at the interface between cognition and behaviour. The process of business-IT alignment in organisations is characterised by the individuality and commonality in the cognition of key stakeholders, its influence on the behaviour of these members and hence the organisational action taken.

Although there is a high risk of failure in the implementation of ICT projects (which appears to extend to health ICT projects), we continue to implement health information systems in order to deliver quality, cost-effective healthcare. The purpose of the research was to participate in and study the change management as a critical success factor in health ICT projects, and to examine people’s responses to change so as to develop understanding and theory that could be used in future change management programmes. The research was conducted within the context of a large infrastructure project that resulted from the emergence of a shared services organisation (from two participating District Health Boards in Auckland, New Zealand). Action research (AR) formed the basis of the methodology used, and provided the foundation for a change management programme: the AR intervention. Grounded theory (GT) was used for some of the data analysis, the generation of themes by means of constant comparison and the deeper examination of the change process using theoretical sampling. AR and GT together supported the development of theory regarding the change process associated with health ICT projects. Health ICT projects were revealed in the findings as exhibiting the properties of complex adaptive systems. This complexity highlighted the art of change management as a critical success factor for such projects. The fabric of change emerged as a composite of processes linked to project processes and organisational processes. The turning point in the change process from the before state to the after state is marked by a capability crisis which requires effective patterns of leadership, sensitive targeting of communication, effective learning, and management of increased workload and diminishing resources during the course of health ICT projects. A well managed capability crisis period as a component of change management can substantially contribute to health ICT project success.

This thesis describes the AP1 system, which serves as a platform for model-based CASE technology. AP1 is a set of libraries and tools that support different activities in the software development process. It provides different layers of reusable CASE functionality, and thus facilitates CASE tool development and integration. Some key problems of software development are addressed, such as the storage and management of artifacts, their creation and modification, and the generation of program code. The main parts of the abstract platform are a typed repository for models and model data, and a generic editor that acts as an integrated software development environment (IDE). The former enables data integration; the latter serves as a basis for presentation integration. Both parts have an extensible and customizable architecture that makes it possible for developers to adapt the system to their own individual needs. The thesis discusses different data models, explaining why the parsimonious data model was chosen for the repository. A mapping onto the relational data model is given that makes it possible to leverage a RDBMS for data management. On top of the RDBMS, the AP1 system implements new mechanisms for caching, event notification and change control, resulting in a unique architecture. The thesis introduces novel concepts of robustness and reflection for user interfaces, and delineates their implementation in the generic editor. Furthermore, a concept for code generators is presented that offers a particularly high degree of type-safety, which we call generator type-safety.

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As alterações comunicativas têm sido descritas em muitas pesquisas como sendo uma das primeiras preocupações dos pais de crianças do espectro do autismo, além de serem consideradas parâmetro de diagnóstico e indicações de intervenções terapêuticas. O objetivo deste estudo foi, a partir da percepção dos pais e/ou cuidadores, buscar compreender as variáveis relevantes quanto às dificuldades comunicativas percebidas por eles. Considera-se que a interpretação e a atitude dos pais frente aos comportamentos, não somente das crianças, mas também das outras pessoas, tenha influência no processo comunicativo da díade. O questionário envolve aspectos fundamentais para o relacionamento interpessoal, tanto no âmbito comunicativo quanto social. Ele é dividido em 24 questões fechadas que abrangem quatro domínios (impressão dos pais sobre si mesmos, em relação às outras pessoas, em relação a seus filhos e atitudes dos pais em relação a seus filhos) e uma questão aberta. Neste estudo o questionário foi aplicado a um grande grupo de pais e/ou cuidadores em diferentes regiões do Brasil e as variáveis sociodemográficas consideradas foram idade da criança, posição entre outros irmãos; idade e nível de escolaridade dos cuidadores. Os resultados foram estatisticamente analisados e indicaram que, de uma forma geral, os dados sociodemográficos não apresentaram relação significativa com as respostas obtidas no questionário. Em relação aos domínios, a impressão dos pais a respeito das reações das outras pessoas às manifestações de seus filhos originou a maior parte das dificuldades relatadas. Três questões específicas destacaram-se como aquelas em que houve um volume significativo de concordâncias: elas dizem respeito à dificuldade de comunicação das outras pessoas com a criança, hábitos de comunicação da díade e preocupação com o futuro e a falta de informações a respeito do tema. O tratamento dos dados possibilitou identificar as dificuldades recorrentes apontadas pelos cuidadores. Caberá ao fonoaudiólogo usar essas informações e, ao mesmo tempo, valorizar o há de individual e peculiar a cada família nos processos de orientação. / Communication disorders have been described in several studies as one of the first worries of autism spectrum children\'s parents and also as a diagnostic and therapeutic intervention parameter. The aim of this study was to, based on the perception of parents and caregivers, understand the relevant variables of the communication difficulties they undergo. It is considered that their interpretation and attitudes towards the child\'s behavior and also towards other people\'s behavior influences the communication processes. The questionnaire that was used involves fundamental aspects of the interpersonal relationship in the communicative as well as in the social domain. It has 24 multiple choice questions about four domains (parents\' impressions about themselves, about other people and about their children and parent\'s attitudes about their children) and one open question. In this study the questionnaire was applied to a great number of parents and caregivers from different regions of Brazil and the social-demographic variables considered were child\'s age and position among peers; parents\' or caregivers\' age and educational level. The results were statistically analyzed and show that generally the social demographic data are not related to the presented answers. In what refer to the domains, the parents/caregivers impressions about other people\'s reactions to their children\'s behavior produced most of the reported difficulties. Three specific questions are highlighted as the ones with the largest agreement rates: they refer to the difficulties to communicate with other people, the dyad\'s communication habits and worries about the future and lack of information about the issue. The data analysis allowed the identification of recurrent difficulties pointed out by parents/caregivers. The speech-language pathologist should use this information and, at the same time consider aspects that are individual and peculiar to each dyad during the orientation processes.

This study sought to determine if time spent engaging in online gaming, interpersonal communication skills, and introvert personality traits are predictors of an individual’s likelihood of experiencing symptoms of social anxiety. A sample of 128 participants (82 males and 46 females) completed measures of demographics, interpersonal communication skills, problematic online gaming, social anxiety, and introversion. Participants were recruited through Amazon Mechanical Turk. There were significant correlations among social anxiety and interpersonal communication skills, problematic online gaming, and introversion. There was no significant correlation among social anxiety and time spent playing Massively Multiplayer Online Role-Playing Games (MMORPG), a specific form of online video game. It was also found that interpersonal communication skills, problematic online gaming, and introversion were all significant predictors of social anxiety. However, time spent playing MMORPGs was not a significant predictor of social anxiety.

The purpose of this study was to gain a better understanding of the factors that constitute a positive and negative supervisor-supervisee relationship as perceived by speech-language pathology graduate students. Clinical practicum experiences were analyzed using qualitative methods via recorded in-depth participant interviews. After the data were collected and transcribed, the narratives were analyzed to draw useful inferences and discover underlying themes using a phenomenological methodology approach. Two overlaying themes, ASHA’s Task 1 of Supervision and Anderson’s Continuum Model of Supervision, were identified from the participants’ interviews and were used to categorize the data. Results indicate the most likely factors attributed to a positive clinical experience included constructive feedback, respect, positive praise, clear expectations and structured clinical guidance while the factors that were most likely attributed to a negative experience were lack of constructive feedback, lack of perceived respect, negative criticism, unclear expectations, and minimal clinical guidance.

The current study examined the effects of bite blocks on articulatory kinematics when producing /r/ within a phrase. Participants consisted of 20 young adults (10 males, 10 females) with no speech, language or hearing disorders. Participants produced the carrier phrase, I say __ with the nonsense words /əri/ (high front vowel), /əræ/ (low front vowel), /əru/ (high back vowel), /ərɑ/ (low back vowel). A Northern Digital Instruments Wave electromagnetic articulograph measured the articulatory movements while the speaker produced the stimuli in two conditions (Pre bite block and post bite block). Bilateral bite blocks were made using Express dental putty, which is a silicone impression material, in order to create an inter-incisal gap of 10 mm. The hull area (i.e., a boundary enclosing the total distance the sensor traveled during the target phrase) of the data for each sensor (i.e., tongue back, tongue mid, tongue front, lower lip, mandibular central incisor) was calculated for the individual nonsense words /eɪərɑ/, /eɪəræ/, /eɪəri/, and /eɪəru/. Results revealed kinematic differences across vowel phrases and between genders. The hull area of the tongue and jaw were significantly different for the vowel phrases /eɪəræ/, /eɪəri/, and /eɪəru/ compared to /eɪərɑ/. The hull area for the jaw for /eɪərɑ/ was significantly larger than the other vowel phrases. The between-gender analyses showed larger hull areas for males than females. Different motor equivalent strategies for tongue movements were observed when speakers produced /eɪərɑ/ and there were individual differences in compensating for the presence of the bite block

The Computerized Profiling (CP) software extracts several quantitative measures from a transcribed sample of a client's language. These analyses include the Mean Length of Utterance in Words (MLU-W) and in Morphemes (MLU-M), the Mean Syntactic Length (MSL), the Syntactic Complexity Score (SCS), Developmental Sentence Scoring (DSS), the Index of Productive Syntax (IPSyn), and the Picture-Elicited Screening Procedure for LARSP (PSL). The validity of these measures was examined by comparing them to the number of finite nominal, adverbial, and relative clauses contained in samples from 54 first-, 48 third-, and 48 fifth-grade students and 24 young adults. The DSS and SCS correlated highly with the frequency of complex constructions; MLU-W, MLU-M, and MSL correlated moderately; and IPSyn and PSL correlated minimally at best.