Stakeholder Perceptions of Strategic Changes at HUS : MBA Business Project Report

The purpose of this research was to explore the stakeholder perceptions of strategy execution at Hospital District of Helsinki and Uusimaa (HUS) in 2007 – 2009. The primary objective was to verify which factors have had the main inhibitory impact on the overall acceptability of the strategy during the strategy process. Furthermore, the research aimed at identification of future success factors to reach the required strategy acceptance among key stakeholders. Research data was collected in a telephone survey for HUS personnel and semi-structured interviews for other key stakeholders. The data was analyzed in a framework of stakeholder theory and change management. In addition, the special characteristics of Finnish health care sector, strong professions and political governance model were taken into account. According to the research findings the strategy of HUS failed in 2008 due to challenges in several factors affecting the stakeholder acceptability. The strategy acceptance was compromised due to challenges in the areas of capability to change, effects on stakeholders’ positions, influencing possibilities, goal clarity, change complexity, management capability, and pace of change. The success of future strategies at HUS will require ability to attract a sufficient level of strategy acceptance from the multiple stakeholders. The crucial success factors include respect to the prevailing organizational culture, active stakeholder management and partnership with primary health care, demonstration of reforming real strategic choices, integration of the overall strategy to execution of operational level strategies, dialogue matching the stakeholder needs and empowering the middle management, and considerate adjustments to the pace of change as may be needed in case of challenges in the identified success factors

Bone Stress Injuries of the Foot and Ankle

Bone stress injuries of the foot have been known for more than 150 years. For a century, their primary diagnostic imaging tool has been radiography. However, currently the golden standard for establishing the diagnosis of stress injuries is magnetic resonance imaging (MRI). Although the injury type has been fairly well documented in the earlier literature, little information is available on the healing of stress injuries located in e.g. the talus and calcaneus. The current study retrospectively evaluated the stress injuries of the foot and ankle treated at the Central Military Hospital over a period of eight years in patients who underwent MRI for stress injury of the foot. The imaging studies of the patients were reevaluated to determine the exact nature of the stress injury. Moreover, the hospital records of the patients were reviewed to determine the healing of stress injuries of the talus and calcaneus. Patients with a stress fracture in the talus were recalled for a follow-up examination and MRI scan one to six years after the initial injury to determine if the fracture had completely healed, clinically and radiologically. The bone stress injuries of the foot were found to affect more than one bone in a majority of the cases. The talus and the calcaneus were the bones most commonly affected. In the talus, the most common site for the injuries was the head of the bone, and in the calcaneus, the posterior part of the bone. The injuries in these bones were associated with injuries in the surrounding bones. Stress injuries in the calcaneus seemed to heal well. No complications were seen in the primary healing process. The patients were, however, sometimes compelled to refrain from physical training for up to months. In the talus, minor degenerative findings of the articular surface were seen in half of the patients who participated in a follow-up MRI scan and radiographs taken one to six years after the initial injury. Half of the patients also reported minor exercise related symptoms in the follow-up. The symptoms were, however, not noticeable in everyday life.Jalkaterän luuston rasitusvammoista on tiedetty jo yli 150 vuoden ajan. Aikaisemmin niiden diagnoosi tehtiin ensisijaisesti röntgenkuvien avulla, mutta nykyisin rasitusvammojen diagnosointi tapahtuu magneettikuvauksella. Vaikka vammatyyppi on melko hyvin dokumentoitu aiemmassa kirjallisuudessa, telaluun ja kantaluun rasitusvammojen paranemisesta on olemassa vain vähän tietoa. Retrospektiivisessa tutkimuksessamme tutkittiin Keskussotilassairaalassa kahdeksan vuoden ajanjakson aikana jalkaterän rasitusvamman vuoksi magneettikuvauksessa käyneitä potilaita. Potilaiden magneettikuvat käytiin läpi rasitusvamman tarkan luonteen selvittämiseksi ja sairauskertomuksista etsittiin tietoja telaluun ja kantaluun rasitusvammojen paranemisesta. Ne potilaat, joilla todettiin telaluun rasitusmurtuma, kutsuttiin seurantakäynnille ja magneettikuvaukseen 1-6 vuotta vamman jälkeen. Näin selvitettiin kliinisesti ja kuvantamistutkimusten avulla, oliko murtuma täysin parantunut. Useimmissa tapauksissa rasitusvammoja todettiin useammassa kuin yhdessä jalkaterän luussa. Telaluu ja kantaluu olivat yleisimpiä vammapaikkoja. Telaluussa rasitusvamma sijaitsi useimmiten luun päässä, kun taas kantaluun vammat olivat pääasiassa luun posteriorisessa osassa. Näiden luiden rasitusvammoihin liittyi usein vaurioita myös ympäröivissä luissa. Kantaluun rasitusvammat näyttivät paranevan hyvin. Primaarisessa paranemisprosessissa ei havaittu komplikaatioita, mutta joissakin tapauksissa potilaat joutuivat keskeyttämään urheilun jopa kuukausiksi. Telaluun rasitusvamman vuoksi seurantamagneettitutkimukseen osallistuneista potilaista puolella todettiin lieviä rappeumamuutoksia. Seurantaan osallistuneista potilaista puolet ilmoitti myös havainneensa lieviä oireita liikunnan yhteydessä. Oireita ei kuitenkaan esiintynyt jokapäiväistä elämää haittaavasti. Vain pieni osa vammoista näkyi luotettavasti tavallisissa röntgenkuvissa. Mikäli jalkaterän tai nilkan kipua selvitettäessä röntgenkuvassa ei näy poikkeavaa tulee lisäselvittelynä ottaa magneettikuvaus, muuton luuston rasitusvamma jää useimmiten diagnosoimatta varusmiehellä tai urheilijalla

The clinical significance of magnetic resonance imaging of the hand : an analysis of 318 hand and wrist images referred by hand surgeons

Magnetic resonance imaging (MRI) is a common diagnostic tool in hand surgery. However, there is limited knowledge on the kind of findings that are relevant in treatment planning. We analysed the findings and utility of arm, wrist, metacarpal, and finger MRIs taken in a tertiary hand surgery clinic of 318 consecutive images from 316 patients referred by a hand surgeon or hand surgeon resident. Ganglions (28%), findings on the extensor carpi ulnaris tendon (18%) and on the triangular fibrocartilage (18%) were the most common findings and increased with patient age; the clinical significance of these findings was minimal. The correlation between the clinical scaphoid shift test or the fovea sign test and MRI was also non-significant. Despite findings on MRI, the diagnosis remained unsolved in 76 (24%) cases. However, MRI had a role in reassuring the patient, and in 70% of the cases, further follow-up was unnecessary. This study demonstrates that the indications for wrist and hand MRI must be considered thoroughly and interpretation of the MRI report requires knowledge.Peer reviewe

In Vivo Evaluation of the Potential of High-Frequency Ultrasound for Arthroscopic Examination of the Shoulder Joint

Objective. Accurate arthroscopic evaluation of cartilage lesions could significantly improve the outcome of repair surgery. In this study, we investigated for the first time the potential of intra-articular ultrasound as an arthroscopic tool for grading cartilage defects in the human shoulder joint in vivo and compared the outcome to results from arthroscopic evaluation and magnetic resonance imaging findings. Design. A total of 26 sites from 9 patients undergoing routine shoulder arthroscopy were quantitatively evaluated with a clinical intravascular (40MHz) ultrasound imaging system, using the regular arthroscopy portals. Reflection coefficient (R), integrated reflection coefficient (IRC), apparent integrated backscattering (AIB), and ultrasound roughness index (URI) were calculated, and high-resolution ultrasound images were obtained per site. Each site was visually graded according to the International Cartilage Repair Society (ICRS) system. "Ultrasound scores" corresponding to the ICRS system were determined from the ultrasound images. Magnetic resonance imaging was conducted and cartilage integrity at each site was classified into 5 grades (0 = normal, 4 = severely abnormal) by a radiologist. Results. R and IRC were lower at sites with damaged cartilage surface (P = 0.033 and P = 0.043, respectively) and correlated with arthroscopic ICRS grades (r (s) = -0.444, P = 0.023 and r (s) = -0.426, P = 0.03, respectively). Arthroscopic ICRS grades and ultrasound scores were significantly correlated (rs = 0.472, P = 0.015), but no significant correlation was found between magnetic resonance imaging data and other parameters. Conclusion. The results suggest that ultrasound arthroscopy could facilitate quantitative clinical appraisal of articular cartilage integrity in the shoulder joint and provide information on cartilage lesion depth and severity for quantitative diagnostics in surgery.Peer reviewe

Comparison of 1.5T and 3T MRI scanners in evaluation of acute bone stress in the foot

Peer reviewe

Non-surgical and surgical treatments for rotator cuff disease : a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation

Background Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear. Methods In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up. Results At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI -3 to 10, p=0.25) for pain and 3.4 (95% CI -0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery. Conclusions Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment.Peer reviewe