Objective: To identify principles and rules used by stakeholders in making limit-setting decisions for publicly funded dental care. Methods: A purposive sample, including administrators, academics, funders, clinicians and community representatives was surveyed using a 28-item questionnaire, in the first round of a proposed three-round modified Delphi study. Using open and closed-ended questions participants made and explained decisions on prioritizing populations and services. Open-ended text was analyzed with a thematic qualitative approach using open and axial coding. Results: Consensus emerged on two rationing principles; achieving equity and providing essential care. Rules for eligibility were defined as the inability to pay and/or assume full personal responsibility for securing dental care. Inclusion/exclusion of treatment categories rested on relieving pain/infection, preventing disease and maintaining/restoring function. Conclusions: Stakeholders presented principles and rules that suggest extending the distribution of publicly funded dental care to include, at a minimum, essential services for those unable to afford care.

Objective: To identify principles and rules used by stakeholders in making limit-setting decisions for publicly funded dental care. Methods: A purposive sample, including administrators, academics, funders, clinicians and community representatives was surveyed using a 28-item questionnaire, in the first round of a proposed three-round modified Delphi study. Using open and closed-ended questions participants made and explained decisions on prioritizing populations and services. Open-ended text was analyzed with a thematic qualitative approach using open and axial coding. Results: Consensus emerged on two rationing principles; achieving equity and providing essential care. Rules for eligibility were defined as the inability to pay and/or assume full personal responsibility for securing dental care. Inclusion/exclusion of treatment categories rested on relieving pain/infection, preventing disease and maintaining/restoring function. Conclusions: Stakeholders presented principles and rules that suggest extending the distribution of publicly funded dental care to include, at a minimum, essential services for those unable to afford care.

Objective: Many Canadian publicly funded recreation facilities have an obesogenic environment. Researchers recommend food and beverage policies to change these environments, however further research is needed to distinguish effective policy approaches. A promising, localized policy approach not yet well evidenced is the use of vending machine contracts with health stipulations to improve nutrition environments. The primary objective of this study was to determine whether a sample of Canadian publicly funded recreation facilities with healthy vending contracts had healthier vending machine nutrition profiles than those facilities with conventional contracts. A secondary research objective was to explore the additional influence of policy quality on the health profile of vending machines. Methods: This quantitative study used results from the baseline assessment done of the broader Eat, Play, Live (EPL) initiative. Vending machine audits and questionnaires were completed in participating publicly funded recreation facilities with vending machines (N=46). Vending product profiles were assessed using the Brand Name Food List which categorizes packaged foods according to the BC Guidelines for Vending in Public Buildings. Mann-Whitney U tests were used to determine if there were significant differences in the health profile of vending products between facilities with healthy vending contracts and those without. Results: Facilities with healthy vending contracts had significantly healthier vending product profiles compared to facilities with conventional contracts. On average, significantly less availability of unhealthy (DNS) products represented these healthier profiles. Vending profiles did not significantly differ based on higher quality contract health stipulations although sample size limited conclusions about this. Conclusion: Facilities with health stipulated in their contract differed from those without health stipulations. This suggests that healthy vending contracts (even with relatively generic stipulations) may be supportive of improved nutrition environments. / Graduate / 2019-03-29

Whistle-blowers have an important role as they reveals incongruities in organizations in order to enable improvement of working conditions. However, there is a risk of reprisals against the employees when expressing their discontent, which may prevent them from blowing the whistle. Since whistle-blowers in private sectors have less protection of freedom of expression against their employer, the protections of whistleblowing also become weaker in these organizations. Nowadays it is becoming increasingly common for businesses in the welfare sector to govern under private management, but still with public funding. A weak protection of whistleblowing therefore reduces the public's opportunity to gain insight into how public funds are used. Therefore the aim of the study is to examine the protection of whistleblowing in private sectors and especially highlight the problem with a weak protection in private organizations that are publicly funded. The Swedish law has no general regulation for the protection of whistle-blowers, which leads to a complex legal situation. It will additionally be new regulations introduced in this area, which might lead to further complexity. The second purpose of the study is therefore to analyse the new regulations and identify some possible consequences of the legislation. A legal dogmatic method is used in the essay with the purpose of investigating the current legislation. The study shows that employees in private sectors have a relatively expansive right to criticize their employer and the conditions at workplaces. The judgement depends on how the employee chooses to express their criticism and therefore there are several factors that must be taking into account. The new regulations will hopefully reduce the risk of reprisals related to whistleblowing. On the other hand there are some identified weaknesses in the legislation that might imply that the intention of the law not would be fulfilled. Therefore the question still stands if the whistle-blower’s situation in the private sector will be improved by the new regulations.

The topic of collaboration is delicate, several different factors are involved in making collaborations successful. The word successful is a charged word where it then implies success for everyone involved in this collaborative work. This thesis aims to investigate the notion of success by both academia and public sector in collaborations where academia plays a crucial part. The thesis descent from a critical realist standpoint where the purpose is to find the underlying mechanisms and structures of the events, in this case, within collaborative work. With a cross-sectional design the empirical data was collected through workshops with representatives from the public sector and publicly funded organisations and interviews were held with researchers, staff and students from Mälardalen University.  The data was analysed through a thematic analysis with deductively generated themes. The theory the thematic analysis was based on consider subjects such as university third mission, quadruple helix, Involving businesses in education, Innovation intermediation, the multifaceted roles of innomediaries, the process and success of innomediaries, collaboration structures, spaces for collaboration, system approach, cross-boundary teams and the researcher’s role. Lastly, the results is a set of capabilities built upon the found underlying structures and mechanisms, these capabilities are seen as valuable for academia.

Society has changed since Cooperative Extension and the 4-H youth program began. Over time the purpose for Extension has been challenged. Yet, there has been little empirical literature published on the administrators' role and perspectives of the organizational environment or on the resulting leadership behaviors. A qualitative study was conducted to develop a baseline. State Extension Directors (n=7) and State 4-H Program Leaders (n=13) from 15 regionally-representative states were interviewed. Participants were asked to conduct a SWOT Analysis on both the Extension system and the 4-H program in their state and their leadership behaviors were explored. Extension administrators emphasized the organization's relevance to society and that the mission would remain focused on agriculture, although with an expanded focus on agriculture as more than production. Administrators did recognize many specific environmental shifts, including a changing funding model; challenges and importance of serving a diversifying population; the tension between urbanizing populations and shrinking rural communities; and, the changing role of technology for programming. Administrators described that they were experiencing shifting focus friction from historic audiences that were afraid of losing services due to the aforementioned environmental factors. Administrators' leadership behaviors were reflective of the Adaptive Leadership behavior construct introduced by Heifetz (1994). Communication was the key behavior that is required to lead effectively. In order to successfully implement a strategy, trust with stakeholders needed to be established. Diversity in feedback was important for the administrators to feel confident in their ability to understand the changes in the organizational environment. / PHD / Extension and 4-H are educational organizations affiliated with Land-Grant Universities to provide research-based information to the citizens of all U.S. states and territories. Established in 1862, the purpose and need for Extension has been challenged overtime. There has been little empirical literature published on the administrators’ role and perspectives of the organizational environment, these leaders being the individuals who are creating and implementing organizational direction. Twenty administrators (7 State Extension Directors and 13 State 4-H Program Leaders) which were representative of 15 regionally-representative states were interviewed. Participants were asked to conduct the Strengths, Weaknesses, Opportunities, and Threats analysis for both the State 4-H program and Cooperative Extension organization. Extension administrators emphasized the organization’s relevance to society and that the mission will remain focused on agriculture -food and health. Administrators did recognize many specific environmental factors they were responding to, including: changes in the funding model; challenges and importance of serving a diversifying population; tension between urbanizing populations and shrinking rural communities; increasing service competition; and, the changing role of technology in program delivery. Administrators described friction with historic audiences who fear the loss of services due to organization adaptation in response to the aforementioned changes. Communication was the key behavior that was embedded in all other leadership characteristics. Trust with stakeholders needed to be established to successfully implement strategy. Diversity in feedback was important for the administrators’ confidence in their ability to understand the changes in the organizational environment.

This thesis aims to fill the gaps in the literature of the theory of constraints (TOC) in publicly funded health systems. While TOC seems to be a natural fit for this resource-constrained environment, there are still no reported application of TOC’s drum-buffer-rope tool and inadequate customizations with regards to defining system-wide goal and performance measures. The “Drum-Buffer-Rope for an Outpatient Cancer Facility” chapter is a real world case study exploring the usefulness of TOC’s drum-buffer-rope scheduling technique in a publicly funded outpatient cancer facility. With the use of a discrete event simulation model populated with historical data, the drum-buffer-rope scheduling policy is compared against “high constraint utilization” and “low wait time” scenarios. Drum-buffer-rope proved to be an effective mechanism in balancing the inherent tradeoff between the two performance measures of instances of delayed treatment and average patient wait time. To find the appropriate level of compromise in one performance measure in favor of the other, the linkage of these measures to system-wide performance measures are proposed. In the “Theory of Constraints’ Performance Measures for Publicly Funded Health Systems” chapter, a system dynamics representation of the classical TOC’s system-wide goal and performance measures for publicly traded for-profit companies is developed, which forms the basis for developing a similar model for publicly funded health systems. The model is then expanded to include some of the factors that affect system performance, providing a framework to apply TOC’s process of ongoing improvement in publicly funded health systems. The “Connecting Low-Level Performance Measures to the Goal” chapter attempts to provide a framework to link the low-level performance measures with system-wide performance measures. It is claimed that until such a linkage is adequately established, TOC has not been fully transferred to publicly funded health systems.

Background: All treatments, especially funded by social means, should be subject to cost-effectiveness studies to ensure that the best possible optimization decision it taken between different treatment options. Within the health care area this is a well-developed area. For odontology in general, and orthodontic treatment in specific, this is an unknown territory and cost-effectiveness studies are rare. Malocclusion can be treated with several different systems. The sales pitch from system providers for braces - such as self-ligated brackets (SLB) promises e.g. shorten treatment duration, shorter chairtime, fewer visits, but the purchase cost of SLB systems is higher. Due to lack of results from unbiased RCT there is no guidelines. It is up to the dentist to use the treatment method/system of their own choice. Purpose: The purpose of this thesis is to estimate the cost-effectiveness of SLB compared to conventional brackets (CB) to determine which of the two systems that should be considered as the preferred choice of treatment in a publicly funded system. Method: Through an incremental cost-effectiveness ratio (ICER) calculate the most costeffective system from a societal perspective which includes all costs. To estimate the health care cost, the Reference price list will be used as baseline for production cost for CB. With the use of secondary resources examine the cost driving components to estimate the production cost of SLB. To estimate the non-health care cost a matrix with downtime from work and travel costs was estimated accounting for travel to disclose the magnitude of these cost. The Outcome of the different treatment alternatives will be measured from different perspectives, such as state specific and general profiles. Treatment duration and foregone education will also be investigated. Conclusions: When all production costs for SLB has been adjusted it shows that the total cost of SLB is slightly cheaper. The reduced number of visits required, less chairtime and shorter treatment period are the positive sides of the higher purchase cost of the SLB. Most of the outcome results are not statistically significant, but there is a tendency, with better average values for SLB. SLB seems to be the cheaper and with more effective outcome though not to the extent the provider promises. The difference of treatment duration is minimal and has no significant advantage. The foregone education for the patient is not possible to quantify in monetary terms but could have significant impact depending on different geographical areas but will small differences between the systems. Hence, in lack of unbiased studies and just focusing on average values, SLB dominates CB and should be the preferred choice of treatment until new long-term studies has been published. / Bakgrund: Alla behandlingar, särskilt de som är offentligt finansierade, borde ha genomgått kostnadseffektivitetsbedömningar för att kunna fatta bästa möjliga beslut. Inom sjukhälsovård är detta ett välutvecklat område. Inom tandvård generellt, men kanske ortodonti i synnerhet, är detta ett outforskat område och kostnadseffektivitetsstudier är sällsynta. Malocklusion kan behandlas med flera olika system. Säljargument från olika tandställningsleverantörer, som t.ex. självligerande brackets (SLB) ger löften om t.ex. kortare behandlingsperiod, kortare tid i tandläkarstolen, färre besök men till en högre inköpskostnad. I brist på resultat från oberoende RCT saknas riktlinjer. Det är upp till den enskilda tandläkaren att välja den behandlingsmetod/system som hen finner bäst. Syfte: Syftet med uppsatsen är att undersöka kostnadseffektiviteten mellan SLB jämfört med konventionella brackets (CB) för att avgöra vilket av dessa två system borde anses vara föredraget behandlingsalternativ i ett offentligt finansierat system Metod: Med kostnadseffektivitetskvoten (incremental cost-effectiveness ratio, ICER) beräkna det mest kostnadseffektiva systemet från ett samhällsperspektiv som inkluderar alla kostnader. För att uppskatta direkta behandlingskostnaden kommer Referensprislistan att användas som produktionskostnadsbas. Med hjälp av sekundära källor som undersöker de kostnadsdrivande komponenterna, uppskatta produktionskostnaden för SLB. För att mäta de indirekta behandlingskostnaderna skapas en matris för att påvisa kostnaden med ställtid från arbete och resekostnader. Resultatet av de olika behandlingsalternativen kommer att mätas från olika perspektiv, såsom generella hälsoprofiler och tillståndsspecifika. Behandlingsperiod och missad utbildnings kommer också att undersökas. Slutsats: Efter det att produktionskostnaderna har blivit justerade visas att totalkostnaden för SLB är något billigare. Färre antal besök, kortare tid i behandlingsrummet är det positiva sidorna av det högre inköpspriset för SLB. De flesta av resultaten är inte statistiskt signifikanta men det finns en tendens mot bättre effekt med SLB. SLB tycks vara det billigare och mest effektiva systemet om än inte i den utsträckning som säljargumenten hävdar. Skillnaden i behandlingsperiod är minimal och har igen avgörande betydelse. Den missade utbildningen är svårligen kvantifierbar i monetära termer men kan ha en avgörande betydelse beroende på olika geografiska platser men med små skillnader mellan systemen. Följaktligen, i brist på oberoende studier och med ett fokus på medelvärde är SLB det dominerande valet över CB och borde vara det föredragna behandlingsalternativet fram till dess att nya långsiktiga forskningsrön har blivit publicerade.

This thesis aims to fill the gaps in the literature of the theory of constraints (TOC) in publicly funded health systems. While TOC seems to be a natural fit for this resource-constrained environment, there are still no reported application of TOC’s drum-buffer-rope tool and inadequate customizations with regards to defining system-wide goal and performance measures. The “Drum-Buffer-Rope for an Outpatient Cancer Facility” chapter is a real world case study exploring the usefulness of TOC’s drum-buffer-rope scheduling technique in a publicly funded outpatient cancer facility. With the use of a discrete event simulation model populated with historical data, the drum-buffer-rope scheduling policy is compared against “high constraint utilization” and “low wait time” scenarios. Drum-buffer-rope proved to be an effective mechanism in balancing the inherent tradeoff between the two performance measures of instances of delayed treatment and average patient wait time. To find the appropriate level of compromise in one performance measure in favor of the other, the linkage of these measures to system-wide performance measures are proposed. In the “Theory of Constraints’ Performance Measures for Publicly Funded Health Systems” chapter, a system dynamics representation of the classical TOC’s system-wide goal and performance measures for publicly traded for-profit companies is developed, which forms the basis for developing a similar model for publicly funded health systems. The model is then expanded to include some of the factors that affect system performance, providing a framework to apply TOC’s process of ongoing improvement in publicly funded health systems. The “Connecting Low-Level Performance Measures to the Goal” chapter attempts to provide a framework to link the low-level performance measures with system-wide performance measures. It is claimed that until such a linkage is adequately established, TOC has not been fully transferred to publicly funded health systems.

La valorisation des résultats est considérée comme un objectif prioritaire du service public de la recherche depuis maintenant trente ans. Ce phénomène s’est encore accentué avec l’émergence de l’économie de la connaissance. Les productions immatérielles de la recherche scientifique sont désormais clairement perçues comme des richesses qu’il convient d’exploiter sur un marché pour générer de la croissance.Pour atteindre cet objectif, les acteurs de la recherche publique sont encouragés par les pouvoirs publics à mobiliser les mécanismes de la propriété intellectuelle, en rupture avec le modèle de science ouverte. Le recours à la propriété intellectuelle pour les besoins de la valorisation fait ainsi naître une tension entre, d’une part, une logique économique et entrepreneuriale et, d’autre part, les normes d’ouverture et de partage qui prévalaient jusqu’alors au sein la recherche scientifique publique.La présente étude se propose d’examiner les rapports complexes qu’entretient la propriété intellectuelle en tant qu’institution juridique avec la mission de valorisation des résultats de la recherche publique. Les points de contact sont en effet nombreux, qu’il s’agisse de délimiter ce qui, au sein des résultats, peut être approprié et selon quelles modalités, d’identifier qui, parmi les acteurs de la recherche, doit être considéré comme propriétaire, ou encore de favoriser le transfert des résultats vers le secteur industriel et commercial. Il apparaîtra que la logique et les mécanismes de la propriété intellectuelle ne sont pas incompatibles avec les normes de la recherche publique. Au contraire, la propriété intellectuelle doit être considérée comme un instrument privilégié dans la mesure où elle aménage un équilibre subtil entre réservation et diffusion des connaissances qui répond parfaitement aux objectifs de la valorisation / For the last thirty years, valorisation of research results has been deemed a main objective for public research organisations. This trend has been emphasised by the emergence of a knowledge-based economy. Immaterial productions of scientific research are now plainly seen as assets that need to be used on the market to encourage growth.In order to achieve this goal, public research stakeholders are pressed by authorities to summon intellectual property rights, in contradiction with the open science model. The use of intellectual property rights for the needs of valorisation gives rise to a tension between a business-oriented perspective and the norms of sharing and openness that prevail among the scientific community.The aim of this thesis is to study the intricate interactions existing between intellectual property and valorisation of public research results. There are numerous points of contact, such as defining what is subject matter for intellectual property among scientific research results and who is entitled to the intellectual property rights, or fostering the technology transfer toward industry. It will be shown the mechanisms underlying intellectual property do not collide with the norms of public research. Quite the opposite, intellectual property is to be favoured since it can provide public research organisations with a subtle balance between reservation and dissemination of knowledge, hence fulfilling the goals of valorisation