Å lede i et politisk styringsunivers : en studie av ledelse i helseforetak

De 10-15 siste årene er det iverksatt flere store reformer som påvirker styring og ledelse av sykehusene/helseforetakene i Norge. En av de største sykehusreformene trådte i kraft i 2002. Sykehusreformen innebar en statlig overtakelse av sykehusene og en foretaksorganisering. Nøyaktig 10 år senere ble Samhandlingsreformen iverksatt. Samhandlingsformen skal bidra til et bedre samarbeid mellom spesialisthelsetjenesten og kommunehelsetjenesten. I reformen er det lagt økt vekt på blant annet avtalte behandlingsforløp og forpliktende samarbeidsavtaler mellom kommuner og helseforetak. Den kommunale helse- og omsorgstjenesten skal styrkes, og spesialisthelsetjenesten skal videreutvikles. Problemstillingen for oppgaven er «Hvordan har den statlige styringen av helseforetakene utviklet seg i perioden 2002-2012, og på hvilken måte påvirker dette lederrollen i helseforetakene». For å få svar på denne problemstillingen har vi utført en dokumentanalyse av de årlige oppdragsdokumenter fra Helse- og omsorgsdepartementet til et regionalt helseforetak, og vi har utført kvalitative intervjuer av sentrale aktører i helse- og omsorgssektoren. Vi finner at den statlige styringen av helseforetakene er blitt sterkere i perioden 2002 til 2012. Lederne i helseforetakene opplever at den statlige styringen påvirker deres mulighet til å lede fordi styringen er så detaljert og omfanget av spesifikke styringskrav er så stort at det ikke er mulig å oppfylle alle krav. Til tross for sterk statlig styring mener lederne at de har et relativt stort handlingsrom. Vi tolker det som at lederne skaper seg, og definerer et handlingsrom som er større enn det som fremkommer av oppdragsdokumentene. Hvordan handlingsrommet defineres, påvirkes av de ulike ledernes egenskaper og utøvelse av lederrollen. Ut fra våre funn vedrørende Samhandlingsreformen, virker lederne i kommunene og helseforetakene godt forberedt, og stiller seg positive til reformen. Til tross for at nye statlige styringsvirkemidler utfordrer lederrollen i helseforetakene, mener lederneTo lead within a political management universe A Study of Leadership in Public Health Care Institutions During the last 10 to 15 years the Norwegian authorities have implemented several major reforms that affect the government and management of the hospitals/health authorities. One of the most important Norwegian hospital reforms ever was implemented in 2002. This reform involved State owned hospitals and enterprise organization. 10 years later The Coordination Reform was implemented to improve the cooperation between the Norwegian specialist health care and the local council health care. There is, among other, an increased emphasis on agreed clinical pathways and binding agreements beetween local councils and health authorities. The local council health care services are to be strengthened, and the specialist health care to be further developed. The main issue in our paper is as follows: "The development of state control of the health enterprises in the years from 2002-2012, and how this affects the role of the leader in the health enterprises." To answer this we have analyzed the annual commissioned documents from the Ministry of Health and Care Services to the Regional health authorities, and we have conducted qualitative interviews of key participants in the health care sector. Our belief is that State control of the health authorities has increased between 2002 and 2012. The managers of the health authorities said that their experience of State control affects their possibility to lead since the control is so detailed and the amount of specific management requirements so comprehensive that it is impossible to meet these requirements. All the same, despite this state control, the managers of the health authorities claim to have a relatively large room for action. Our interpretation of this is that these leaders create and define a certain room for action which is more extensive than the overall impression in the commissioned documents. How this room for action is defined is influenced by the different leaders and their exercise of the leadership role. Based on our findings about The Coordination Reform, the managers in the local councils and the health authorities seem well prepared and are positive to the reform. Despite the fact that new management tools challenge the role of the managers in the health authorities, these managers claim that coordination is of utmost priority and that the new management systems work - so far.Master i styring og ledels

Täter-Opfer-Ausgleich in Deutschland. Auswertung der bundesweiten Täter-Opfer-Ausgleichs-Statistik für die Jahrgänge 2006 bis 2009, mit einem Rückblick auf die Entwicklung seit 1993

Ziel des Projektes ist die bundesweite Erfassung von Täter-Opfer-Ausgleich im Jugend- und Erwachsenenstrafrecht und die Erstellung einer Bundesstatistik über diese strafrechtliche Maßnahme der Diversion

Täter-Opfer-Ausgleich in Deutschland. Auswertung der bundesweiten Täter-Opfer-Ausgleichs-Statistik für den Jahrgang 2010

Ziel des Projektes ist die bundesweite Erfassung von Täter-Opfer-Ausgleich im Jugend- und Erwachsenenstrafrecht und die Erstellung einer Bundesstatistik über diese strafrechtliche Maßnahme der Diversion

Täter-Opfer-Ausgleich in Deutschland. Auswertung der bundesweiten Täter-Opfer-Ausgleichs-Statistik für die Jahrgänge 2011 und 2012

Ziel des Projektes ist die bundesweite Erfassung von Täter-Opfer-Ausgleich im Jugend- und Erwachsenenstrafrecht und die Erstellung einer Bundesstatistik über diese strafrechtliche Maßnahme der Diversion

Microglia jointly degrade fibrillar alpha-synuclein cargo by distribution through tunneling nanotubes

Microglia are the CNS resident immune cells that react to misfolded proteins through pattern recognition receptor ligation and activation of inflammatory pathways. Here, we studied how microglia handle and cope with alpha-synuclein (alpha-syn) fibrils and their clearance. We found that microglia exposed to alpha-syn establish a cellular network through the formation of F-actin-dependent intercellular connections, which transfer alpha-syn from overloaded microglia to neighboring naive microglia where the alpha-syn cargo got rapidly and effectively degraded. Lowering the alpha-syn burden attenuated the inflammatory profile of microglia and improved their survival. This degradation strategy was compromised in cells carrying the LRRK2 G2019S mutation. We confirmed the intercellular transfer of alpha-syn assemblies in microglia using organotypic slice cultures, 2-photon microscopy, and neuropathology of patients. Together, these data identify a mechanism by which microglia create an on-demand functional network in order to improve pathogenic alpha-syn clearance