Organizational learning through experience has been found to be associated with enhanced firm performance. Organizational experiments are a method of experiential learning that enable organizations to learn from experience and gain context-specific knowledge of how and why to implement new knowledge. Pilot projects, a type of organizational experiment, involve making intentional, systematic efforts to gather and analyze feedback in order to accurately assess the action-outcome relationships of adopting new knowledge prior to embarking on full-scale implementation. Despite the popularity of pilot projects used to test products, programs, and services as well as reports on the outcomes of such experiments, there is a dearth of research focusing on how organizational learning occurs during organizational experiments, and on the processes and structural mechanisms of organizational experiments that contribute to organizational learning. A qualitative, multiple-case study of eight pilot projects was carried out within nursing units across five acute health care organizations during Fall 2008. Interviews were conducted with 32 individuals, including pilot project leaders, nursing program managers and direct care nurses. An inductive approach to data analysis was applied and themes identified. Results were compared to 14 propositions that were developed based on the knowledge transfer, innovation diffusion, and organizational learning literature, and which were bracketed before data analysis to allow findings to emerge from the data. The findings advance existing organizational learning, innovation diffusion, and knowledge transfer models by illuminating the complexity of organizational learning processes. Several processes and structural mechanisms of organizational experiments were found to facilitate single-loop organizational learning, leading to incremental changes to meet existing goals and objectives. Although double-loop organizational learning, which may result in fundamental changes in an organization’s assumptions, norms, policies, goals and objectives was not observed, the study revealed a number of processes and structural mechanisms that have the potential to encourage this type of learning. Studies of organizational experiments are rare. Future directions for research and theory development are suggested to build on the findings of this study. Practical implications are offered to organizations in any industry interested in realizing the potential that organizational experiments have for double-loop learning and enhanced organizational performance.

眾所周知，現代社會如僅靠行政人員個人的經驗、智慧與直覺，不僅不足以制定具有前瞻性、能夠指道社會未來發展之政策，甚至無法解決許多當前發生的重大問題，如都市治安、公害防治、社會福利、交通問題、子女教育、都市發展、通貨膨漲等。因之，現代決策必須充分結合學術團體及個人的研究成果與各方智慧，共同完成決策，才能達到提昇決策品質、解決問題與福國利民的目標。 我國一向重視結合「學術與行政」，因此行政機關除鼓勵所屬人員自行從事研究發展工作外，還投入大量經費委託組織外的學者專家進行專業性的研究，如行政院環保署自七十六年成立以來，共投入二十八億餘元辦理委託研究；再如行政院研考會於民國六十九年至七十九年，共投入七千六百萬餘元辦理委託研究；經建會於八十年度即投入三千五百四十三餘萬元進行委託研究；單係環境科技之委託研究，七十七年度至八十年度行政機關及國營事業就投入六十二億二千九百萬元。另外行政院所屬機關中從事研究發展工作者有：經濟部、國防部、交通部、農委會、原能會、衛生署、環保署、教育部等。 國家投入如此豐沛的人力、物力、財力於委託研究上，各項委託研究成果的應用情形如何？是否有助於政府部門規劃出高品質之公共政策？還是僅生產出汗牛充棟的資訊，並未被充分應用？若未被充分應用，其原因何在？如何才能提升行政機關政策研究成果之應用率？凡此問題值得吾人深入追蹤探討與評估。 本文主要的研究問題如下： 根據西方文獻顯示，研究與應用配合情形不佳，我國行政機關應用委託研究的情形為何？委託研究成果與應用間存不存在差距？若存在差距究係何種因系造成？ 若存在差距，如何才能在研究與應用間建立橋樑，強化二者間的連結並提高委託研究成果的應用率？ 行政機關的委託研究成果對該機關業務產生的影響為何？即委託研究在行政工作上扮演何種角色？ 行政機關應用該機關委託研究成果行為，大多發生於政策過程的那一階段？以何種方式應用委託研究成果？ 為何有些委託研究成果被行政機關應用？有的未被應用？影響委託研究成果被中央銀級行政機關採用或拒絕的因素為何？ 目前「研究應用」領域中的理論，例如兩界論（two communities theory）知識特定理論(knowledge specific theory)、決策者限制理論(policy maker constraint theory)等，幾乎均為西方之產物，是否可以應用於我國，解釋我國行政機關應用研究成果的現象？即何種研究應用理論模式，最適合描述我國行政機關應用委託研究成果之情形？ 本文採用文獻探討、個案研究，紮根的理論研究法及次級資料分析四種方法搜集、組織、分析行政院環保署的實證資料，回答以上各項問題，期望對我國中央級行政機關—環保署應用委託研究成果情形及辦理委託研究工作，有較深入且廣泛的認識，並提出改進建議，以供有關機關參考。 本論文第一章基於文獻探討(閱讀前人的研究成果)，引發筆者的研究動機並確立本研究欲探究之問題與目的。由於筆者研究資源有限，故須在進行研究時縮小研究範圍，然後籍由四種研究方法搜集、組織並分析資料(第二章)：並於第三章中、界定本研究關鍵名詞--「研究應用」的意義與測量方式：第四、五、六、七章則為本研究果之陳述；第八章結論與展望部分，除將本研究所獲致的結果，再做一扼要整理敘述，還根據過去此領域之研究者及筆者的研究心得，為有興趣者，未來從事相關研究，提出進一步的研究建議。 本研究歸納國外文獻及國內實證資料後發現：行政機關中低度應用研究成果是一個中外均普遍的現象，研究者與行政人員間的確存在差距，但二者間差距並不大，支持兩界論樂觀派的說法。環保署委託研究成果或建議的採行情形，根據實証資料顯示比率並不高，將近50%的委託研究成果只有小部分被採用。而實際上，環保署委託研究成果的採行率可能更低。造成此種差距的因素很多，根據筆者推論，關鍵因素可能為決策的本質、研究者與行政人員的本質不同(兩界論)及官僚體系的層層過濾等三項，但委託研究成果對行政機關業務所造成的影響仍不容忽視且非常複雜又不易衡量，因每項研究成果造成的影響均可能有所不同，各種情形均有。個別委託研究對行政機關業務影響的大小，須視該項研究成果本身具備的條件、決策者的意向及外在環境等因素的配合情形而定。 應用研究成果的階段方面，根據環保署的實証資料顯示，環保署人員通常係在「研擬及評估問題的解決方案」、「研擬法規草案」、「界定或了解問題」時，最常參考引用委託研究成果，可知委託研究成果對政策制定過程影響最大的階段係在行政作業初期階段，因此可下結論環保署委託研究的主要功能為：行政機關解決問題、準備具體方案及作決策所須的基本資料。事實上，應用研究成果是一個非常複雜的過程與現象，應用研究成果的過程通常不是一次就結束，而是一點一點地、不定時地、可能由不同的人分別應用研究內容，因此欲回答委託研究成果通常係應用於決策或行政工作哪一階段，實難以一言蔽之。此外，關於應用研究的方式，一般而言可分為工具性應用、啟發性應用、及策略性應用三種。環保署的實證資料顯示，工具性應用最多；策略性應用次之啟發性應用最少。由於研究應用為一項複雜的現象，因此，任何一項委託研究均可能以多重的方式被應用，其應用方式端視行政機關人員的需求而定。如一項委託研究成果既可提供待解決問題的基本資料，又可作為行政人員說服反對者或民意代表的工具，則更可能是啟發行政人員產生新構想或採取新行動的刺激。 關於影響研究被行政機關應用與否的因素，大致可按因素性質歸入三個模式中：研究特性模式、應用者／應用機關特性模式及系絡模式。到底係那些特定因素造成的影響，尚須視委託研究個別的情形而定。 為強化研究與應用間的連結，提升委託研究成果的採行率，應自研究的規劃階段即開始重視「應用」的問題，即以應用為導向進行研究，以利日後完成研究，將成果應用於解決政策問題上。 誠如此領域眾多前輩所言，研究應用實為一動態且複雜的現象，但一步一步慢慢來，此領域還是可以且值得吾人探索的，本文於最後列出建構一般性的研究應用理論等七項未來可供進一步研究的方向，供有興趣的研究者參考。

Why is it that the international scientific consensus on climate change has not been followed by a proportionate policy response in Canada? Perhaps the relationships between the country’s science organizations and government agencies are not functioning properly. My research adopts an interdisciplinary approach (i.e. science studies and political science) to this issue, highlighting the relevant literature’s underlying consensus on co-production, a norm of deliberative two-way engagement between scientists and policy-makers. I hypothesize that relationships embodying elements of co-productive design (e.g. informal communication, appointed liaisons) are more likely to facilitate climate action. To test this, I examine three cases of climate science-policy partnership in Canada by interviewing participants from both sides. The partnership between the Pacific Climate Impacts Consortium and BC municipalities exhibits substantial influence on policy, tied to a considerable degree of co-productive design. The partnership between the Pacific Institute for Climate Solutions and the Climate Action Secretariat of the BC provincial government also displays notable design characteristics, but primarily facilitates side benefits and soft influences rather than concrete policy changes. The attempted partnership between the Canadian Foundation for Climate and Atmospheric Sciences and the federal government exhibits few elements of co-productive design and has been effectively terminated, demonstrating the prerequisite importance of political interest. The relevant literature is not sufficiently nuanced to fully predict or explain these situations, so I put forward a new theoretical model. My science-policy relationship hierarchy (SPRHi) suggests that each such case can be classified as incidental interaction, basic partnership, interactive dialogue, or true co-production. It specifies the conditions which must be met for any given relationship to improve, maximizing potential benefits and influences. Concrete policy changes seem to result only from true co-production, though, which generally requires exceptional external requirements and thus cannot be deliberately facilitated. As such, co-productive design ultimately does not offer a clear way to address Canada’s climate inaction. I suggest that further research be conducted on international coordination mechanisms, public attitudes, and (especially) political leadership. However, the soft influences of science-policy partnerships may affect these broader factors in unpredictable ways, so the importance of co-productive design should not be underestimated. / Graduate

Background and Objectives: To describe patterns of healthcare utilization among patients with generalized anxiety disorder (GAD) in general practitioner (GP) settings in Germany. Methods: Using a large computerized database with information from GP practices across Germany, we identified all patients, aged > 18 years, with diagnoses of, or prescriptions for, GAD (ICD-10 diagnosis code F41.1) between October 1, 2003 and September 30, 2004 ("GAD patients"). We also constituted an age- and sex-matched comparison group, consisting of randomly selected patients without any GP encounters or prescriptions for anxiety or depression (a common comorbidity in GAD) during the same period. GAD patients were then compared to those in the matched comparison group over the one-year study period. Results: The study sample consisted of 3340 GAD patients and an equal number of matched comparators. Mean age was 53.2 years; 66.3% were women. Over the 12-month study period, GAD patients were more likely than matched comparators to have encounters for various comorbidities, including sleep disorders (odds ratio [OR] = 6.75 [95% CI = 5.31, 8.57]), substance abuse disorders (3.91 [2.89, 5.28]), and digestive system disorders (2.62 [2.36, 2.91]) (all p < 0.01). GAD patients averaged 5.6 more GP encounters (10.5 [SD = 8.8] vs 4.9 [5.7] for comparison group) and 1.4 more specialist referrals (2.3 [2.9] vs 0.9 [1.7]) (both p < 0.01). Only 58.3% of GAD patients received some type of psychotropic medication (i.e., benzodiazepines, antidepressants, and/or sedatives/hypnotics). Conclusions: Patients with GAD in GP practices in Germany have more clinically recognized comorbidities and higher levels of healthcare utilization than patients without anxiety or depression.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

This thesis consists of a quantitative and a qualitative study. The quantitative study (articles I-III) aimed to examine how self-reported health in adolescence is associated with behavioral, parental, and school factors. Through a survey directed at all adolescents in grades 7-9, data were collected in 2005 in a region in northern Sweden (n=5060). Statistical methods were used to analyze the survey data: chi2tests, multivariate logistic regressions and multilevel logistic regressions. Results showed that even though most adolescents reported good health, there were also rather large proportions of adolescents who reported headaches, stomach aches and feelings of stress. Girls reported poor health to a higher extent than boys, a difference that was larger in grade 9 than in grade 7. The results also showed that being norm compliant was associated with good self-reported health. Furthermore, perceiving relations and communication with parents as poor was associated with poor self-reported health; however, this relationship could not explain gender differences in self-reported health. Continuing on, analyses showed that there exist greater variations in self-reported health between students (within a school) than between different schools. On an individual level, poor relations to teachers, bullying and truancy were associated with poor general health. The qualitative study  (article IV) sought to examine barriers to and facilitators of utilization of local school survey results within a school setting. In 2011, 21 school district managers and principals within a Swedish municipality were interviewed. Analyses were performed using a qualitative content analysis. The results from the qualitative study showed that the dissemination and utilization of school survey results appeared as two interrelated phases in one process. Barriers and facilitators differed qualitatively depending on the phase, dissemination or utilization. In conclusion, professionals as well as researchers need to consider the complexity of adolescent health and its social determinants. Adolescent health is a concern for multiple sectors in society, which highlights the need for further development of collaborations between professionals in relevant fields, such as health care, school and social services. / Den här avhandlingen består av en kvantitativ och en kvalitativ studie. Syftet med den kvantitativa studien (artikel I-III) var att undersöka sambandet mellan ungdomars självrapporterade hälsa och deras normrelaterade beteende samt föräldra- och skolfaktorer. Data samlades in under 2005, genom en enkät som riktade sig till alla ungdomar i årskurs 7-9 i en region i norra Sverige (n=5060). De statistiska metoder som användes i den kvantitativa studien var bland annat chi2- test, logistisk regression samt flernivåanalys. Resultaten visade att även om de flesta ungdomar rapporterade en god allmän hälsa, så var det också en relativt stor andel som rapporterade huvudvärk, magont samt upplevelser av stress. Flickor rapporterade sämre hälsa än pojkar, en skillnad som var större i åk 9 jämfört med åk 7. Resultaten visade också att normföljsamhet hade ett signifikant samband med god självrapporterad hälsa. De ungdomar som upplevde relationen och kommunikationen med sina föräldrar som dålig, rapporterade också dålig hälsa i högre utsträckning än övriga. Sambandet mellan självrapporterad hälsa och föräldrarelationer kunde inte förklara skillnaderna i ohälsa mellan pojkar och flickor. Vidare, analyser visade att det fanns större variationer i självrapporterad hälsa mellan ungdomar (inom en skola) än mellan olika skolor. Dåliga relationer med lärare, skolk, samt att bli utsatt för mobbning hade ett signifikant samband med dålig självrapporterad hälsa, på en individuell nivå. Syftet med den kvalitativa studien (artikel IV) var att undersöka vilka faktorer inom skolan som möjliggör och som utgör barriärer för användningen av enkätresultaten från en lokal skolenkät. 2011 genomfördes 21 intervjuer med skolområdeschefer och rektorer inom en kommun i Sverige. Analyser av intervjumaterialet genomfördes med hjälp av kvalitativ innehållsanalys. Resultaten från denna studie visade att spridningen och användningen av resultaten från skolenkäten kan beskrivas som två relaterade faser i en process. De faktorer som underlättade samt utgjorde barriärer för spridningen och användningen av enkätresultaten var kvalitativt olika varandra beroende på vilken fas i processen respondenterna hänvisade till. Dessa resultat illustrerar den mångfacetterade komplexitet som inryms i ungdomars hälsa och dess sociala determinanter, en komplexitet som både forskare och professionella behöver ta hänsyn till. Ungdomars hälsa angår ett flertal samhällssektorer, vilket visar på betydelsen av en fortsatt utveckling av samverkan mellan professionella inom exempelvis hälso- och sjukvården, skolan och socialtjänsten.

Due to physical, cognitive and emotional impairments, many individuals are unemployed or under-employed following a traumatic brain injury. The research evidence links the rigour of a vocational evaluation to future employment outcomes. Despite this link, no specific guidelines exist for vocational evaluations. Using the research evidence and a diverse panel of clinical and academic experts, the primary objective of this doctoral research was to develop an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. The objective of the guideline is to make explicit the processes and factors relevant to vocational evaluation, to assist evaluators (i.e. clients, health and vocational professionals, and employers) in collaboratively determining clients’ work abilities and developing recommendations for work entry, re-entry or vocational planning. The steps outlined in the Canadian Medical Association's Handbook on Clinical Practice Guidelines were utilized to develop the guideline and include the following: 1) identifying the guideline’s objective/questions; 2) performing a systematic literature review; 3) gathering a panel; 4) developing recommendations; 4) guideline writing; 5) pilot testing. The resulting guideline includes 17 key recommendations within the following seven domains: 1) evaluation purpose and rationale; 2) initial intake process; 3) assessment of the personal domain; 4) assessment of the environment; 5) assessment of occupational/job requirements; 6) analysis and synthesis of assessment results; and 7) development of evaluation recommendations. Results from an exploratory study of the guideline’s implementation by occupational therapists in their daily practices revealed that clinicians used the guideline to identify practice gaps, systematize their evaluation processes, enhance inter-professional and inter-stakeholder communication, and re-conceptualize their vocational evaluations across disability groups. Statistically significant improvements were also noted in clients’ participation scores on the Mayo-Portland Adaptability Inventory–4 following guideline use. This guideline may be applicable to individuals with TBI, clinicians, health and vocational professionals, employers, professional organizations, administrators, policy makers and insurers.

Due to physical, cognitive and emotional impairments, many individuals are unemployed or under-employed following a traumatic brain injury. The research evidence links the rigour of a vocational evaluation to future employment outcomes. Despite this link, no specific guidelines exist for vocational evaluations. Using the research evidence and a diverse panel of clinical and academic experts, the primary objective of this doctoral research was to develop an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. The objective of the guideline is to make explicit the processes and factors relevant to vocational evaluation, to assist evaluators (i.e. clients, health and vocational professionals, and employers) in collaboratively determining clients’ work abilities and developing recommendations for work entry, re-entry or vocational planning. The steps outlined in the Canadian Medical Association's Handbook on Clinical Practice Guidelines were utilized to develop the guideline and include the following: 1) identifying the guideline’s objective/questions; 2) performing a systematic literature review; 3) gathering a panel; 4) developing recommendations; 4) guideline writing; 5) pilot testing. The resulting guideline includes 17 key recommendations within the following seven domains: 1) evaluation purpose and rationale; 2) initial intake process; 3) assessment of the personal domain; 4) assessment of the environment; 5) assessment of occupational/job requirements; 6) analysis and synthesis of assessment results; and 7) development of evaluation recommendations. Results from an exploratory study of the guideline’s implementation by occupational therapists in their daily practices revealed that clinicians used the guideline to identify practice gaps, systematize their evaluation processes, enhance inter-professional and inter-stakeholder communication, and re-conceptualize their vocational evaluations across disability groups. Statistically significant improvements were also noted in clients’ participation scores on the Mayo-Portland Adaptability Inventory–4 following guideline use. This guideline may be applicable to individuals with TBI, clinicians, health and vocational professionals, employers, professional organizations, administrators, policy makers and insurers.