Yes / Integrated models of care intend to provide seamless and timely access to health and social care services. This study investigated the integration of musculoskeletal services across community and secondary care boundaries, including the introduction of a single point of access from which patients were triaged. Staff (n = 15) involved in service development and delivery were interviewed about how, why and to what extent integration impacted service delivery. The analysis focused on staff experiences of using an on-line patient self-referral form and co-located clinics to enhance decision-making in triage, and on the provision of educational materials and de-medicalising language in patient consultations to support self-management. Single point of access, including online self-referral, were operationalised during data collection, but co-located clinics were not. Triage staff explained that the volume of referrals and quality of information provided in online self-referrals sometimes constrained decision-making in triage. Secondary care staff discussed concerns that the single point of access might not consistently identify patients with hard to diagnose conditions that require timely surgical intervention. This concern appeared to constrain staff engagement with integration, potentially inhibiting the delivery of co-located clinics. However, triage staff accessed support to inform secondary care referral via alternate modes. Patient circumstances, for example, need for reassurance, necessitated multiple self-management strategies and innovative approaches were developed to provide patients ongoing and professionally led support. Findings emphasise that restructuring services requires engagement from diverse stakeholders. Collaborating with stakeholders to address their concerns about the impact of restructures on well-established pathways may help cultivate this engagement. / Newcastle upon Tyne Hospitals NHS Foundation Trust

This study aimed to create a holistic understanding of the physician experience in relation to telemedicine. This study examined a Tele-NICU and a Tele-ER program at a large metropolitan pediatric specialty hospital with a Level IV NICU that provides telemedicine consults to 16 remote sites across Texas. Twenty-four semi-structured interviews were conducted with physicians and nurses at remote hospitals, physicians who provide consultations from the pediatric specialty hospital, and managers of the tele-specialty programs. These interviews were coded using the consolidated framework for implementation science to contextualize program strengths and weaknesses and reviewed to make recommendations for future program development. Remote site participants reported that the programs are useful when they are in need a second opinion and providing reassurance to patient's families. Barriers to program use include issues with the tele-carts, insurance acceptance, and hesitation to request a consult. Study findings demonstrate the need to treat each tele-specialty programs as independent to suit the differing needs of both remote sites and the consulting physicians. This study demonstrates the importance of understanding physician's perspectives, culture, and the role of hospital settings in telemedicine program acceptance and refutes telemedicine as a monolithic solution to limited healthcare access.

The purpose of this study is to provide a content analysis of specific studies that involve sustainable information and communication technology (ICT) use in K-12 education in the U.S. The results from the content analysis were used to identify factors that may contribute to the sustainable implementation of technologies in K-12 instruction. Factors from specific studies from 2000 to 2018 that have implemented ICT in instruction for three years or more were analyzed. The findings from the analysis may be helpful in developing a conceptual framework listing possible sustainability factors for K-12 school districts using technology in instruction. The results may also be beneficial to educational policy makers, school administrators, and educational stakeholders.

The Purpose of the study was to highlight the primary care managers' perception of the barriers and opportunities in the implementation of the national guidelines for harmful drinking and alcohol abuse in KalmarCounty. The data was collected by questionnaires which were directed to all primary care managers in the county. The response rate was low, 40%. The data collection was complemented at a later stage with a non-response analysis. To analyze the results implementation theory with following terms were used: wants to, understand and know. In this study, the managers response showed an ambivalence and the willingness to use the national guidelines were not evident. On the one hand, patients with for harmful drinking and alcohol abuse is a tasks for primary care, but on the other hand, it was considered to a greater extent to be social services responsibility. The understanding of the use of guidelines existed and primary care has a tradition of making use of the guidelines, however in this case the respondents lack education. The ability to implement the national guidelines seemed lacking, which may be due to increased tasks and radical changes involving time constraints.

Uppsatsen inleds med att olika definitioner och kategoriseringar av bristfälliga och misslyckade informationssystem behandlas. Olika tidigare identifierade anledningar tillbrister och misslyckanden presenteras sedan. Några bristande informationssystem hos en kommun undersöks för att finna vad som brister. En modell har tagits fram för att undvika framtida brister och misslyckanden. Tydliga brister som har framkommit inkluderar dålig användarinvolvering och dålig projektstyrning från kommunen. / The essay starts with defining and categorizing of information systems with flaws or failure. Flaws and failures identified from previous studies are then presented. A few informationsystems with flaws in a municipality are then examined to find what in them that flaws. To avoid future flaws and failure a model has been developed. Some significant flaws that has emerged include poor involvement of users and the lack of project management in the municipality.

There are several success factors defined for the implementation phase that should be achieved in order for an implementation project to be successful. Several studies focus on the supplier's commitment and success factors to implement a system that end users will accept. But there are identified success factors which clients themselves should implement or give attention to during the implementation phase to have the end users accepting the system and keeping the time frame of the project. How has the client's efforts and capacity affected the result of the implementation and the timing of deployment? The aim with this study is to apply and develop a model for implementation of information systems which is based of success factors from a client perspective. The aim is also to identify advice on how to successfully implement a system, that the system is deployed on time and that the users is accepting the system. Our theoretical framework is presenting eight identified success factors within the client organisation. This has been applied in a case study with semi-structured interviews. The result is a model from a client perspective which shows the connection between the success factors in the implementation phase. The model can be used by providers to inform clients about the success factors that affect the implementation project. It may then be easier for the client to see what needs to be done and how one action affects another. Further, a number of recommendations extracted from the model is presented, which affects the result, the users’ acceptance and if the information system is deployed on time. / Syftet med denna studie är att utifrån framgångsfaktorer ur ett beställarperspektiv tillämpa och vidareutveckla en modell för implementation av informationssystem. Syftet är även att identifiera råd för en lyckad implementering som innebär att systemet driftsätts efter utsatt tid samt att användarna finner acceptans för systemet. Vårt teoretiska ramverk presenterar åtta identifierade framgångsfaktorer inom beställarorganisationen och det har vi tillämpat i en fallstudie med semistrukturerade intervjuer. Resultatet blev en modell ur ett beställarperspektiv som redovisar sambandet mellan framgångsfaktorer i implementeringsfasen. Modellen kan användas av leverantörer för att informera beställare om de framgångsfaktorer som påverkar ett implementeringsprojekt. Det kan då bli tydligare och enklare för beställaren att se vad som behöver göras och hur en åtgärd påverkar en annan. Vidare redovisas ett antal rekommendationer utifrån modellen som påverkar resultatet för att driftsätta informationssystem i tid och som påverkar användarnas acceptans.

From the perspective of a system developer, this study presents an in-depth analysis of the CiRM implementation process in Malaysian local government. The study was motivated by the lack of studies examining the CiRM implementation process initiatives in the local government sector. Furthermore, the performance of the Malaysian Government in this initiative has been subjected to various criticisms, i.e., not properly servicing its public. This raises the question as to what has happened during the period of the CiRM implementation process in Malaysia. As there has been a demand for local governments to invest more in CiRM projects, the need for existing and potential system developers in the Malaysian government to have an implementation framework that could guide their effort in implementing the system has become more vital. This study combines the case study research and grounded theory approaches. Twenty in-depth face-to-face interviews were conducted with system developers from ten local governments (i.e., five interviews from four pilot-cases and fifteen interviews from six primary-cases). The analyses of these data were divided in three main phases. The first phase involved a within and cross-case analyses of the pilot cases. The second and third phases involved a within and cross-case of the primary cases. These analyses enabled a set of determinants on CiRM implementation in the Malaysia local governments to be developed. The determinants were established by fitting their characteristics to the lifecycle of the CiRM system implementation process. Some of the determinants were found to be common to the existing literature while others were found to be enhancing the existing knowledge in CiRM implementation process. These determinants were then developed to shape a theoretical framework for the CiRM implementation process in the local Malaysian governments. This framework not only describes the main determinants in the implementation process, but also the forces and activities that lie within it.

The thesis provides a comparative analysis of the implementation of the EMPRETEC programme in Ghana and Namibia. The EMPRETEC programme is a unique entrepreneurship and business development programme developed by the United Nations Centre on Transnational Corporations in the late 1980s. Since then, it has been implemented in nearly 30 countries to support business development. The central aim of this research is to identify the major factors that influenced the implementation process of the EMPRETEC programme in Ghana and Namibia and to analyse how they afforded or constrained the achievement of seven so-called Critical Programme Components (CPCs). These CPCs are: 1) targeting high growth entrepreneurs; 2) developing an entrepreneurship training workshop that is adapted to the local context; 3) ensuring direction of the programme by a coalition of private and public sector leaders; 4) mobilising support from the private sector; 5) promote linkages among clients; 6) promote business linkages with foreign firms; and 7) establish a sustainable foundation. The theoretical concepts of the research are based on the implementation literature which emerged as part of the policy sciences during the second half of the last century. A new approach is developed to study the highly complex implementation process: in a first step, an analytical framework is developed that comprises five analytical lenses: 1) a contextual lens focusing on the context in which the entire implementation process is embedded; 2) an inter-organisational lens focusing on interactions of the involved stakeholders; 3) an organisational lens for the identification of institutional strengths and weaknesses; 4) an intra-organisational lens for the analysis of intra-agency relationships; and 5) an individual lens focusing on the individuals who were involved in the implementation of the programmes. These lenses cover the entire spectrum and levels of the implementation process. In a second step, 15 major implementation factors are derived from implementation theory. These factors and their influence on the implementation process are then assessed with the help of 100 distinct measures. The influence of the 15 factors on the implementation process and the seven CPCs is subsequently analysed and finally tested using evidence from 18 additional EMPRETEC centres. The study's contribution to knowledge is twofold: (i) The study provides insights into the underlying factors that influenced the implementation of the EMPRETEC programme in Ghana and Namibia. Overall, the implementation conditions were more favourable in Ghana as compared to Namibia. The research hints at the importance of the context and implementers' (both organisations' and individuals') characteristics as crucial factors for successful implementation. Finding the right implementers and aligning implementation objectives to existing development discourses and implementers' ideologies can help to improve effective implementation. (ii) The study proposes an innovative approach to study implementation processes across narrow cases. Based on third-generation implementation models, a unique data collection and analytical framework is suggested that allows comparing and testing various implementation factors and their influence on the implementation process. The emerging results are of high relevance to governments, donors, private organisations and other stakeholders, as many lessons could be derived to improve the implementation and effectiveness of donor interventions, especially in the area of business development programmes.

Master of Regional and Community Planning / Department of Landscape Architecture and Regional and Community Planning / Jason Brody / From start to finish, implementing large public infrastructure projects, like a park, can be challenging. Funding shortages, public opposition, and physical limitations are all potential problems that can halt a project’s development. This study explores the complexities of implementation by using a proposed park designed by the Kansas City Design Center as a case study for examination. The visioning process, or first stage of implementation, is explored by examining the factors that influenced the design. Through interviews, this report then examines how the actors and processes of project implementation work together or against each other in project development. Applying the learned knowledge of implementation to the proposed park of the Kansas City Design Center presented multiple challenges, as well as opportunities for the park. After understanding implementation and its application to the Rail Park, three main strategies are proposed to move the Kansas City Design Center’s proposed park past the visioning stage. The three strategies are: to collaborate between actors, garner public support, and project phasing. General conclusions about implementation in this study found that there will be challenges and not all can be anticipated, but it is important to plan for those that can be. Being flexible and persistent to move a project forward is necessary in order to accommodate stakeholders’ concerns and unforeseen problems. Knowledge of implementation and its complexities will assist actors, developers, and students to advance visions into reality.

Mining equipment are becoming very sophisticated and complex. At the same time, mining companies modernise its operation by increased mechanisation and automation (Dhillon, 2008). That requires well-developed and planned maintenance strategy. A proper maintenance strategy and appropriate maintenance actions, are essential to keep equipment safe & reliable, decrease the overall costs, and it helps to eliminate workplace hazards. Maintenance strategies and maintenance actions, in turn, are changed and developed more than any technology (Moubray, 1997). Changing and developing of the maintenance can be due to many factors, perhaps due to the complexity of the systems or due to the development of the technology. One of the best research (developed technology) that has been done in this area is the research by Nowlan and Heap about Reliability Centered Maintenance (RCM) in 1978. RCM is defined as, “a zero-based, structured process used to identify the failure management strategies required to ensure an asset meets its mission requirements in its operational environment in the safest and cost – effective manner” (Regan, 2012). The RCM is one of the best powerful asset management strategies. RCM can be applied to any asset, nuclear power plant, aeroplane, or truck ship. According to (Nowlan & Heap, 1978), the main goal of implementation an RCM process is to provide the stated function of the facility with required reliability and availability at the lowest cost. In this master thesis, an RCM analysis process has been described in details. Moreover, two types of implementation approaches of an RCM analysis process have also been described. The intention of describing these two approaches is to see what the differences between them are and which one can be recommended for using in mining. The first approach is according to (Hinchcliffe & Smith, 2004) and the second approach is according to (Regan, 2012). Moreover, in this master thesis, there are also two case studies that have been analysed. The intention of analysing these two case-studies is to see how the RCM has been implemented. As a result of the research carried out in this master thesis, some basic streamline RCM analysis process has been recommended for using in mining. This recommended RCM analysis process could be applicable to be used in every industry section. The result of this work can be summarised that RCM is an applicable tool which can be used in mining for selecting the right maintenance approach for different equipment, systems or subsystem. RCM analysis process is discussed from different perspective. In the discussion, the misconceptions about the implementation of an RCM analysis process have been discussed. Altogether, Reliability Centered Maintenance is one of the most powerful asset management strategies that can be used in every industry section. If the RCM is applied by right people and by the right way, the result can be profitable for the mining companies.