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

Patient safety is of particular importance within intensive care units (ICUs), where critically ill, vulnerable patients receive complex multidisciplinary care. Prior research has indicated that improving patient safety and reducing errors within healthcare requires a focus on systems and organisational culture issues. This thesis was concerned with three studies. One focused on assessing the patient safety culture and two on quality improvement initiatives within an intensive care unit (ICU) of a large teaching hospital. The first study involved a survey of ICU consultant, registrar and nursing staff regarding aspects of safety culture. This was conducted using an existing Hospital Survey on Patient Safety Culture. Of the twelve patient safety culture composites assessed, eight had scores lower than 50%, highlighting these as areas for improvement. Overall, while the survey results revealed that teamwork within the ICU was considered a strength, event reporting and patient care handovers and transitions were both considered areas with potential for improvement. The second study focused on the evaluation of a change initiative designed to improve the handover of patient clinical information in the ICU. This study involved a survey and interviews with consultant, registrar and nursing staff before and after the introduction of a Patient Management, Plan and Progress (PMPP) document. Examination of the survey responses involved both quantitative and qualitative analysis; respondent interview transcripts were analysed using thematic analysis. The results of this study revealed resistance to, and criticisms of, the introduction of the PMPP document; the initiative failed and use of the document was discontinued. The second initiative concerned an evaluation of the impact of a hospital-wide document on improving documentation of withdrawal of patient treatment within the ICU. This involved both quantitative and qualitative analysis, with a patient medical record audit of decisions to withdraw patient treatment within the ICU before and after the introduction of an Advance Care Plan (ACP) document. ICU consultant, registrar and nursing staff were interviewed regarding the process of withdrawal of patient treatment within the ICU. Interview transcripts were analysed using a modified grounded theory approach. Results revealed that the attempt to improve the documentation of withdrawal of treatment within the ICU failed, with the ACP document remaining unused in 89% of cases and incomplete in the remaining 11%. Also, documentation of decision-making and of the process within the medical records did not improve. Before-introduction findings revealed that only 26% of medical records met the pre-existing requirements for treatment withdrawal in the ICU, and after-introduction findings revealed that only 19% of medical records audited met the requirements of the ACP document. After-audit findings also revealed significant and inappropriate increases in the involvement of an ICU registrar both as primary and secondary decision-makers. In spite of an increased awareness of ICU staff concerning the importance of improving documentation, the medical record audit revealed less compliance with the standards required for documentation. Possible reasons for the document remaining essentially unused, as revealed from interviews with staff, included: previous criticisms by the coroner when they failed to complete a similar formalised document properly; perceived logistical issues associated with obtaining required staff signatures; disagreement concerning who should be involved in documenting the withdrawal of treatment process; and the existence of an ICU subculture of practice that, in one particular aspect of documentation, was not consistent with established hospital and ICU protocol and documentation requirements. The final chapter of this thesis considered implications of the results of the studies for the planning, development, implementation and evaluation of improvement programs within the ICU setting. The results were considered within the context of organisational change management theory and research, including factors that have been found to be critical in the success or failure of change programs, such as resistance to change, the involvement of key stakeholders in the change process, leadership, communication and organisational culture. It is suggested that management consultants with organisational change expertise in the planning, development, implementation and evaluation of such programs should be involved in future quality improvement initiatives. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297608 / Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2007

166 p. / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2012-12-19T17:50:09Z No. of bitstreams: 1 11.pdf: 1881060 bytes, checksum: c1c555cab7a10a96442c3c9da4bf8aa5 (MD5) / Made available in DSpace on 2012-12-19T17:50:09Z (GMT). No. of bitstreams: 1 11.pdf: 1881060 bytes, checksum: c1c555cab7a10a96442c3c9da4bf8aa5 (MD5) Previous issue date: 2010 / Esta pesquisa teve como objetivo compreender o impacto para a modernização administrativa da Polícia Militar da Bahia (PMBA) e qual a receptividade, dos atores envolvidos, decorrente da reforma que cria os Núcleos de Gestão Administrativa e Financeira (NUGAF). Esta mudança acarreta transformações não apenas no aspecto formal, mas também nas relações de poder e de confiança, pois altera parcialmente a cultura dominante na Corporação. Para tanto, protagonizou-se a observação direta sobre a realidade concreta e das relações de trabalho que ocorrem nos NUGAF e entre eles e as Unidades Operacionais (UOp). Também são aplicados à população finita composta de 51 Comandantes e Ex-Comandantes das UOp vinculadas aos NUGAF, questionários estruturados com questões fechadas numa escala tipo Likert, assim como, são realizadas entrevistas semi-estruturadas com pessoas relevantes nesse processo. Os dados resultantes da observação direta e das entrevistas são tratados qualitativamente a partir dos referenciais teóricos e da percepção e vivência deste pesquisador, que na condição de oficial superior da PMBA, teve a oportunidade de conviver, desde a implantação, com o objeto da pesquisa. Os dados oriundos do questionário estruturado recebem tratamento quantitativo de estatística descritiva, com o uso da técnica de análise multivariada para buscar o estabelecimento de correlações entre as variáveis, realizando agrupamentos sempre que pertinente com utilização da análise fatorial. Foram identificados cinco fatores, porém dois foram desprezados em razão da difícil caracterização. A caracterização dos outros três se mostraram aderentes com as análises qualitativas e da estatística descritiva. Os resultados sinalizam o impacto favorável dessa reforma para a modernização administrativa da PMBA, assim como, sugere que os Comandantes foram receptivos a essa mudança. Por outro lado, infere-se a necessidade de aperfeiçoamento e realinhamento das práticas decisórias e de gestão que possibilitem a valorização dos Comandantes das UOp vinculadas, viabilizem sua efetiva participação na gestão e otimizem a atuação dos NUGAF. / Salvador

P. 1 - 83 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-01-16T18:49:51Z No. of bitstreams: 1 CCC.pdf: 395443 bytes, checksum: 5b69c5bf7649750c984ac3a9248e4b66 (MD5) / Made available in DSpace on 2013-01-16T18:49:51Z (GMT). No. of bitstreams: 1 CCC.pdf: 395443 bytes, checksum: 5b69c5bf7649750c984ac3a9248e4b66 (MD5) Previous issue date: 2009 / Esta dissertação tem por objetivo analisar, sob a ótica do público interno, sob quais perspectivas residem as principais resistências ao processo de mudança organizacional ocorridas numa organização sem fins lucrativos, a partir da implantação do Sistema de Gestão Integrado (SGI). O presente estudo foi realizado no Serviço Nacional de Aprendizagem Industrial – Departamento Regional da Bahia (SENAI-BA) ao longo do período de 2006 a 2009. Realizou-se uma pesquisa bibliográfica sobre o tema mudança organizacional e suas resistências. A estratégia de pesquisa utilizada foi estudo de caso único exploratório e essencialmente qualitativo, com procedimentos metodológicos que incluíram análise documental, realização do grupo focal, observação participante e entrevistas com gerentes de Unidades Operacionais e membros da alta direção. A partir dos resultados obtidos, conclui-se que do processo de mudança organizacional vivenciado pela organização, quando da implantação do SGI, as resistências mais significativas estão concentradas nas perspectivas política, humana e cultural. / Salvador

Made available in DSpace on 2015-05-14T13:16:10Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1646557 bytes, checksum: e1d0a719291de29faab4a64d75b68b02 (MD5) Previous issue date: 2012-11-08 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The aim of this dissertation was to develop an explanatory model of the resistance to organizational change, taking as independent variables the organizational climate and human values, considering the self-perceived performance as the variable to be explained in the model. Study 1 aimed at verifying the psychometric properties of the measures of resistance to change, self-perceived performance and organizational climate. Participants were 306 employees from a private company of João Pessoa (PB). These had mean age of 28 years (sd = 7.38), being mostly male (77.5%). They answered five instruments: Resistance to Change Scale, Organizational Climate Scale, Basic Values Survey, Self-perceived Performance Scale and demographic information, which were used in the subsequent studies. Results indicated satisfactory psychometric properties of the instruments, allowing the use to reach the objective of the present dissertation. Study 2 aimed at knowing the correlation between the variables resistance to change, organizational climate, human values and self-perceived performance, seeking to structure the explanatory model of resistance to change. Participants were 240 employees from two public companies and one private from Paraíba, with mean age of 38 years (sd = 12.42), and being mostly female (56.7%). Three models were developed: the first (M1) with the direct influence of organizational climate (posture of the leadership and pleasant environment) and of idealist values in the resistance to change and of this in the self-perceived performance; the second model (M2), in the same direction of the first, but with the organizational climate influencing directly the self-perceived performance; and, finally, the third model (M3), also in the same direction of the second, but with de direct influence of idealist values in the self-perceived performance. Results indicated the M2 as more satisfactory, presenting adequate fit indexes. Study 3 aimed to test the models developed in the previous study. Participants were 227 employees from a public company of João Pessoa (PB), which has unities in the country of the state. They had mean age of 40 years (sd = 10.45) and mostly were male (83.3%). Unlike the Study 2, in this the M3 was the more adequate, in which organizational climate and idealist values influence directly in the self-perceived performance. Finally, the Study 4 replicated the three developed models, and the more adequate was the one produced in Study 3. The final product of this dissertation was the development of the theoretical model values/organizational climate - resistance to organizational change - selfperceived performance. Thus, after the elaboration, testing and replication of the model, we have organizational climate and human values as explanatory variables of the resistance to change and the influence of this in the self-perceived performance. Therefore, it is understood that a positive perception from the employee about his work environment, specially concerning the posture of the leadership and the pleasant environment, influence the attitude of resisting or not to changing. Similarly, individuals guided by idealist values tend to resist less to the process of changing. Furthermore, organizational climate, idealist values and resistance to change have a direct impact on the individual s perception about his performance. / O objetivo principal desta tese foi desenvolver um modelo explicativo da resistência à mudança organizacional, tendo como variáveis independentes o clima organizacional e os valores humanos, considerando o desempenho autopercebido como variável a ser explicada pelo modelo. O Estudo 1 objetivou verificar os parâmetros psicométricos das medidas de resistência à mudança, desempenho autopercebido e clima organizacional. Participaram 306 funcionários de uma empresa privada de João Pessoa (PB). Estes tinham idade média de 28 anos (dp = 7,38), sendo a maioria do sexo masculino (77,5%). Responderam a cinco instrumentos: Escala de Resistência à Mudança Organizacional, Escala de Clima Organizacional, Questionário dos Valores Básicos, Escala de Autoavaliação de Desempenho e informações demográficas, os quais também foram utilizados nos estudos seguintes. Os resultados indicaram parâmetros psicométricos satisfatórios destes instrumentos, podendo ser utilizados para alcançar os objetivos da presente tese. O Estudo 2 objetivou conhecer as correlações entre as variáveis resistência à mudança, clima organizacional, valores humanos e desempenho autopercebido, buscando estruturar o modelo explicativo da resistência à mudança. Participaram 240 funcionários de duas empresas públicas e uma privada da Paraíba, com idade média de 38 anos (dp = 12,42), sendo a maioria do sexo feminino (56,7%). Foram elaborados três modelos: o primeiro (M1) com a influência direta do clima organizacional (postura da liderança e ambiente agradável) e dos valores idealistas na resistência à mudança e desta no desempenho autopercebido; o segundo modelo (M2), na mesma direção do primeiro, mas com o clima organizacional influenciando diretamente no desempenho autopercebido; e, por fim, o terceiro modelo (M3), também na mesma direção do segundo, porém com a influência direta dos valores idealistas no desempenho autopercebido. Os resultados indicaram o M2 como mais satisfatório, apresentando índices de ajuste adequados. O Estudo 3 teve por objetivo testar os modelos elaborados no estudo anterior. Participaram 227 funcionários de uma empresa pública de João Pessoa (PB), que possui unidades no interior do Estado. Tinham idade média de 40 anos (dp= 10,45) e a maioria foi do sexo masculino (83,3%). Diferente do Estudo 2, neste o M3 foi o mais adequado, no qual o clima organizacional e os valores idealistas influenciaram diretamente no desempenho autopercebido. Por fim, o Estudo 4 tratou de replicar os três modelos elaborados, sendo que o mais adequado reproduziu aquele do Estudo 3. O produto final desta tese foi o desenvolvimento do modelo teórico valores/clima organizacional - resistência à mudança organizacional - desempenho autopercebido. Assim, após a elaboração, testagem e replicação do modelo, têm-se o clima organizacional e os valores humanos como variáveis explicadoras da resistência à mudança e a influência desta no desempenho autopercebido. Portanto, entende-se que a percepção positiva do funcionário sobre o seu ambiente de trabalho, principalmente no diz respeito à postura da liderança e ao ambiente agradável, influenciam na atitude de resistir ou não à mudança. Do mesmo modo, indivíduos guiados por valores idealistas tendem a resistir menos ao processo de mudança. Além disso, o clima organizacional, os valores idealistas e a resistência à mudança apresentam impacto direto sobre percepção do indivíduo acerca de seu desempenho.

Context. The subject presented in this research is the fact that people resist IT induced change and want to maintain their current situation when implementing a new information system.  If no strategy is set to deal with it, resistance to change leads to Information System failure. Objectives. In this study, the author is investigating how to anticipate and handle resistance to change when implementing a new information system in order to succeed. This is followed by introducing the factors affecting user satisfaction which in turn affects user acceptance. Methods The data collection involves interviews in order to assemble appropriate, justifiable and relevant data, in addition to surveys to measure and validate the hypotheses in this thesis. The banking sector in Lebanon was selected as a source of data collection. Results. Three factors Perceived ease of use(PEOU), Perceived Usefulness (PU), and User Involvement react together to satisfy user and hence to make the user accept change. Conclusions. Based on the studies conducted so far with respect to this topic, there exists an indirect relationship between the three factors discussed in this thesis, the user satisfaction, and the user acceptance. The more the user finds the system easy to use (simple way of work with less efforts) and useful (the extent to which person’s work is improved) and the more he/sh  is involved, the more he is satisfied and hence the more he is willing to accept the change and causes system success.

Organisationer påverkas idag av vår föränderliga värld. Kommunala verksamheter är en verk-samhet som ständigt är i kontakt med organisationsförändringar där en av de främsta anled-ningarna till misslyckande är förändringsmotstånd. Det är därför centralt att studera vilka faktorer som orsakar förändringsmotstånd inom en kommunal verksamhet. I en organisationsförändring har ledaren en viktig roll för att genomdriva förändringen lyckosamt. För att ledaren ska ha möjlighet att genomföra en lyckad organisationsförändring krävs en god kommunikation. Det är därför centralt att studera hur en enhetschef kan kommunicera för att hantera det upplevda förändringsmotståndet. Syftet med denna studie är därmed att bidra med kunskap kring varför förändringsmotstånd uppkommer samt hur detta kan hanteras av enhetschefer via kommunikation. Studien har genomförts via en kvalitativ metod där intervjuer samt observationer är underlag för det presenterade empiriska materialet. Intervjuerna genomfördes på en enhet inom vård och omsorg som genomgått en omlokalisering för cirka tre år sedan. Intervju-erna utfördes med hjälp av sammanlagt elva anställda där två var enhetschefer, en projektledare, fyra gruppledare och fyra medarbetare. De anställdas anställningstid varierade för att tillgodose alla perspektiv under omlokaliseringen. Denna studie består av en teoretisk referensram som bland annat behandlar organisationsförändringar, förändringsmotstånd samt kommunikation vid organisationsförändringar. Teorin beskriver nio orsaker till förändringsmotstånd samt identifierar olika former av förändringsmotstånd. För att belysa kommunikationen beskrivs bland annat olika tillvägagångssätt som en organisation kan använda sig av vid förmedling av information samt en strategisk kommunikation. Intervjuerna resulterade i många känslomässiga uttryck där de anställda förmedlade att omlokaliseringen bidrog till många negativa känslor. Vi har identifierat åtta faktorer som orsakar förändringsmotstånd utifrån vår teoretiska referensram. Utifrån vårt empiriska material kan vi även fastställa att kommunikationen var bristande samt att de anställda föredrog en strategisk kommunikation, till följd av den uttryckta kritiken har vi utformat en strategisk kommunikation som är tillämpningsbar inom denna enhet. / Organizations are today affected by our changing world. Municipal enterprises are organiza-tions that are constantly in contact with organizational changes, where one of the main reasons for failure is the resistance to change. It is therefore crucial to study which factors that can cause the resistance to change. In an organizational change, the leader has an important role to make the change successful. In order for the leader to be able to implement a successful organ-izational change, good communication is required. It is therefore crucial to study how a unit manager can communicate to handle the perceived change resistance. The purpose of this study is to contribute with knowledge about why resistance to change occurs and how unit managers through communication can manage this. The study has been conducted through a qualitative method where interviews are the basis for the empirical material. The interviews were held on a health and social care unit that had relocation for almost three years ago. A total of eleven employees where interviewed, two were unit managers, one project manager, four group lead-ers and four co-workers. The time of their employment varied to accommodate all perspectives during the relocation. This study consists of a theoretical framework that deals with organiza-tional changes, the resistance to change and the communication during organizational changes. The theoretical framework describes nine reasons why resistance to change occurs and identi-fies different forms of change resistance. In order to highlight the communication, various approaches are described which an organization can use for convey information and strategic communication. The interviews resulted in many emotional expressions where the employees described that the relocation contributed too many negative feelings. We can identify eight factors that causes resistance to change based on our theoretical framework. Based on our em-pirical material, we can also determine that the communication was lacking, and that employ-ees preferred a strategic communication. As a result of the expressed critique we have designed a strategic communication that is applicable within this unit.

abstract: The alternative project delivery methods (APDMs) today are being increasingly used by owner organizations in the architecture, engineering, and construction (AEC) industry. Yet the adoption of these methods can be extremely difficult to accomplish and requires significant change management efforts. To facilitate the APDM adoption, this research aimed to better understand how AEC owner organizations have changed from only using the design-bid-build method to also successfully implementing APDMs from an organizational change perspective. This research utilized a literature review, survey and interviews to fulfill the research objectives. The dissertation follows a three paper format. The first paper focuses on identifying organizational change management (OCM) practices that, when effectively executed, lead to increased success rates of adopting APDMs in owner AEC organizations. The results of the first paper indicated that the five OCM practices with the strongest correlations to successful APDM adoption were realistic timeframe, effective change agents, workload adjustments, senior-leadership commitment, and sufficient change-related training. The second paper focuses on investigating AEC employees’ reactions to the adoption of APDMs. The findings of the second paper revealed that employees in AEC organizations react favorably to adopting a change in their project delivery systems. The findings further revealed that increasing the use of OCM practices is related to decreased employee resistance to change. The third paper aimed to provide guidelines detailing on how to lead APDM adoption. The findings of the third paper indicated that there was a general sequence of four implementation phases, which were preparing and planning, pilot project testing, expanding to the intended scale, and sustaining and evaluating. The phases include specific OCM practices that increase the probability of successful APDM adoption. The dissertation results can help in guiding the senior managers of construction organizations and OCM consultants to effectively implement APDMs for the first time in the construction sector. / Dissertation/Thesis / Doctoral Dissertation Construction Management 2020

Individuals with substance abuse or mental illness/neuropsychiatric disorderssuffer a higher risk of developing comorbidity. Due to the complexity of comorbidity individuals may often need multiple support from both social services and health care. Previous studies have shown that the relationship is a crucial aspect of the recovery process between the social worker and the client. It needs to be based on mutual trust, user participation and clarity. Social workers had to balance between individuals right over their own life situations and the responsibility to decide on compulsory care when the person opposes help and exposes their life to serious injury. The study aimed to investigate how socialworkers described the experience of responding to and support individuals living with comorbidity. The method chosen was semi-structured interviews with six social workers from four municipalities in Skåne. The findings showed attempts to contemplate different challenges of individuals. There were noted difficulties when investigating a person due to their mental health. Furthermore, their experiences were described as motivating and humane work. Their experience described the role of a social worker as a representative between a zero tolerance society and to start working with the client where they were. In addition, it was noted as important to familiarize oneself with aspects that the substance abuse contributed to. The insights into why individuals resorted to substance use opened up discussions about alternative solutions that did not include addiction. The reflections that emerged were adaptations of how meetings were designed and how the individuals were made involved, through the help of different strategies to examine the individual’s wishes.

Behavioral momentum theory (BMT) has become a prominent method of studying the effects of reinforcement on operant behavior. BMT represents a departure from the Skinnerian tradition in that it identifies the strength of responding with its resistance to change. Like in many other operant research paradigms, however, responses are considered to be momentary phenomena and so little attention has been paid to non-rate dimensions of responding. The current study takes up the question of whether or not the degree of effort defining a discriminated operant class has any meaningful effect on its resistance to change. Using a force transducer, rats responded on a two-component multiple VI 60-s VI 60-s schedule where each component was correlated with a different force requirement. Resistance to change was tested through prefeeding and extinction. Proportional declines in response rate were equal across components during all disruption tests. Differentiated response classes remained intact throughout. The negative result suggests several future research directions.