Rollen av språk: Identifisering av faktorer som påvirker implementeringen av internasjonaliseringsstrategier

I dagens globaliserte virksomhetsverden øker organisasjoner stadig sin drift over landegrensene. Dette skaper et behov for en felles kommunikasjonsplattform, noe som ofte fører til at organisasjoner endrer sitt driftsspråk. Formålet med denne oppgaven er å gi innsikt i en slik endringsprosess ved å undersøke problemstillingen: «Hvilke faktorer påvirker implementeringen av en internasjonaliseringsstrategi som innebærer endring av driftsspråket for en organisasjon?» Forskningen retter seg mot små og mellomstore bedrifter (SMB) i Norge, der språket endres fra norsk til engelsk. En teknologiorganisasjon basert i Oslo (referert til som TechO) er brukt som en casestudie. Det er blitt formulert tre forskningsspørsmål for å finne ut om TechO hadde en plan for språkendringen, utforske utfordringene som oppstod, og forstå hvordan endringen har påvirket de ansattes arbeidsliv. Denne studien bruker et eksplorerende design med en abduktiv tilnærming. Det benyttes en kvalitativ metode for datainnsamling, hvor det også er gjennomført semistrukturerte intervjuer med seks informanter. Relevant litteratur om endringsledelse, organisasjonskultur og språk i en organisasjonskontekst er inkludert for å gi en bakgrunn for studien. Empirien diskuteres i lys av det teoretiske rammeverket og inkluderer teori om planlagt endring, implementering, språklig kunnskapskorridor og samarbeid. Funnene tyder på at det kan oppstå utfordringer selv når ansatte er komfortable med å snakke engelsk og har gode språkkunnskaper. Det ble identifisert tre faktorer som kan redusere utfordringene og legge til rette for en språkendring. For det første er det viktig å ha en plan. For det andre bør det utpekes en endringsagent. Og for det tredje er det nødvendig å forstå den iboende motstanden. Kommunikasjon er identifisert som et nøkkelverktøy og er gjennomgående i alle disse tre faktorene. En tydelig definert plan er nødvendig for å redusere usikkerhet og legge til rette for endringen. En dedikert endringsagent vil bidra til å opprettholde fremdrift i endringsprosessen og kommunisere de identifiserte tiltakene. Det er viktig å anerkjenne verdien som ligger i ens morsmål, da dette kan føre til motstand hvis et nytt språk blir påtvunget. Kontinuerlig støtte fra toppledelsen spiller også en viktig rolle i den innledende kommunikasjonen for å skape felles forståelse.Organizations today continue to increase their operations beyond national borders. This indicates the need for a common way to communicate, leading organizations to change their language of operation. The goal of this thesis is to provide insight into this change process by addressing the overall problem formulation: “What factors affect the implementation of an internationalization strategy whereby the language of operation for an organization changes?” This is focused on small to medium-sized enterprises (SMEs) in Norway where the language is changing from Norwegian to English. A technology organization based in Oslo, Norway (referred to as TechO), is used as the case study. Three research questions are formulated to determine if TechO had a plan for the language change, explore the challenges that are experienced, and understand how the change has affected employees’ working lives. This study uses an exploratory design with an abductive approach. A qualitative data collection method is used, and semi-structured interviews are held with six informants. Relevant literature on change management, organizational culture, and language in an organization setting is included to provide background for the study. The empirical data is discussed in light of the theoretical framework and includes theory on planned change, implementation, linguistic knowledge corridor, and collaboration. The findings indicate that challenges can arise even in cases where employees are comfortable speaking English and have good language skills. Three factors are identified to mitigate challenges and facilitate a language change. First, have a plan. Second, assign a change agent. Third, understand inherent resistance. In addition, communication is identified as the key tool that permeates these three factors. A well-defined plan is necessary to reduce uncertainty and thus facilitate the change. An assigned change agent will help to maintain momentum for the change and communicate the identified measures. It is important to recognize the value that is rooted in one’s native language, as this can lead to resistance if a new language is forced. Continued support from top leadership plays an important role in the initial communication with the goal of creating a shared understanding

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.

International audienceThe Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. Bill & Melinda Gates Foundation