Ohjauksen käsitteet mielenterveys- ja päihdetyössä – näkyykö asiakkaan osallisuus?

Sosiaali- ja terveydenhuollon suunniteltujen uudistusten myötä asiakkaiden ja palveluiden ohjaus on noussut esiin yhtenä keskeisenä kehittämisen kohteena. Ohjauksen käsitteitä on useita, ja niiden käyttö vaihtelee kontekstin mukaan. Tässä tutkimuksessa mielenkiinnon kohteena oli erityisesti osallisuuden näkyminen ohjauksen eri käsitteissä ja niiden sisällöllisissä kuvauksissa. Osallisuus liittyy keskeisesti sosiaali- ja terveysalalla sekä asiakaslähtöisyyteen että mielenterveys- ja päihdetyössä yhtenä lähtökohtana olevaan toipumisorientaatioon. Tutkimuksen tarkoituksena oli selvittää, mitä ohjauskäsitteitä suomalaisissa mielenterveys- ja päihdetyötä koskevissa raporteissa on käytetty, mitkä ovat näitä käsitteitä kuvaavat tekstisisällöt ja mitkä näkökulmat näissä sisällöissä kuvastuvat. Tutkimus toteutettiin dokumenttianalyysina, ja aineisto analysoitiin sekä määrällisesti että laadullisesti. Analyysin tuloksena tunnistettiin kolme käytettyä ohjauksen käsitettä sekä kolme näkökulmaa, joista työntekijän näkökulma painottui eniten ja asiakkaan näkökulma vähiten. Tulosten perusteella voidaan todeta, että mielenterveys- ja päihdetyön alueella ohjauksen käsitteitä tulisi sekä sisällöllisesti kuvata tarkemmin että edelleen kehittää, jotta ne mahdollistavat asiakkaan osallisuuden. Tätä kehittämistyötä tulisi toipumisorientaation lähestymistavan mukaisesti tehdä yhdessä mielenterveys- ja päihdepalvelujen käyttäjien kanssa. Abstract Concepts of guidance in the context of mental health and substance abuse care – is client involvement enabled? Changes in the social and health care services as well as the development and utilization of the new technological methods in the everyday practice of the social and health care, have revealed a need to increase the competence of staff in different guidance activities. This need was recognized in several studies especially in the planning phase of the social and health care reform. In practice, several concepts are nowadays used when describing guidance. In the presented study the main interest was on the concepts used in the context of mental health and substance abuse care, in which the recovery approach with strong emphasis on client involvement is the main approach today. With the document analysis the aim was to describe which concepts of guidance have been used in the Finnish reports on mental health and substance abuse care, the content of these concept descriptions and the perspectives their present. Data was gathered with stepwise PRISMA process. As a result, three concepts describing the guidance were found and the most common perspective in these concepts was the employee’s perspective, two others being the client’s and service perspectives. Client perspective was the least described in the contents of these concepts, which indicates that the participation of the client is not made visible or well-supported in practice. It should be noted that this study has certain limitations, but the results are suggesting a need to develop the concepts of guidance towards more client-inclusive descriptions. It is recommended to work together with people with lived experience on mental health and substance abuse problems in this development process. Keywords: guidance, involvement, mental health and substance abuse services, document analysis

Being Heard, Exerting Influence, or Knowing How to Play the Game? Expectations of Client Involvement among Social and Health Care Professionals and Clients

Contemporary social and health care services exhibit a significant movement toward increasing client involvement in their own care and in the development of services. This major cultural change represents a marked shift in the client’s role from a passive patient to an active empowered agent. We draw on interaction-oriented focus group research and conversation analysis to study workshop conversations in which social and health care clients and professionals discussed “client involvement”. Our analysis focuses on the participants’ mutually congruent or discrepant views on the topic. The professionals and clients both saw client involvement as an ideal that should be promoted. Although both participant groups considered the clients’ experience of being heard a prerequisite of client involvement, the clients deviated from the professionals in that they also highlighted the need for actual decision-making power. However, when the professionals invoked the clients’ responsibility for their own treatment, the clients were not eager to agree with their view. In addition, in analyzing problems of client involvement during the clients’ and professionals’ meta-talk about client involvement, the paper also shows how the “client involvement” rhetoric itself may, paradoxically, sometimes serve to hinder here-and-now client involvement.

The role of client participation and psychological comfort in driving perceptions of audit quality

Purpose With increased competition under the establishment of the ASEAN Economic Community (AEC) in December 2015, CPA and Tax Auditors are free to export their services within AEC partner countries. Hence, it is crucial that the growing numbers of auditors in the region differentiate themselves by providing superior perceived audit quality and client value in order to retain (and attract) clients. Based on theoretical foundations of service-dominant logic and culture theory, the purpose of this paper is to investigate the role of client involvement in the audit process and client psychological comfort in influencing client perceptions of audit quality. Design/methodology/approach A survey was used to collect data from firms listed on the Thai Stock Exchange. The unit of analysis was the client firm. A key informant method was used whereby a senior manager, heavily involved in the auditor assessment and selection process answered all questions on behalf of their company. Data from 190 firms are subsequently analyzed with structural equation modeling. Findings Both client level of involvement and psychological comfort impact their perceptions of three dimensions of audit quality: service quality, independence and competence. Audit quality in turn is strongly associated with overall client satisfaction. Originality/value While various scholarly works have examined audit quality, this study does so in an emerging, highly collectivist culture (Thailand) where due to cultural norms, relationships take on added importance. More importantly, for the first time, the study shines the spotlight on the role that client involvement in the audit process, and client psychological comfort, play in influencing client perceptions of audit quality.

Identifying client project manager competency in Indonesian construction project

The influence of active client involvement towards project construction success is gaining recognition in the last few decades. The growing concern on the client involvement has drifted the perception towards client away from the passive role into contributor of project success. During client involvement in the construction project, a representative from client or client project manager (CPM) should be complemented with certain competencies in order to succeed in commissioning construction projects. Evidence shows that some public construction projects in Indonesia failed due to the lack of competency of client project managers. Whilst most of the previous studies concern on the competency of general project managers, this paper specifically investigates competency of project manager from client side who works as a civil servant, and commissioning public construction sectors. This paper aims to identify the important competencies required by CPM in construction projects in Indonesia and examine current Indonesian CPM competency standard. Relative Importance Index (RII) was employed to assess the important level of competencies. The findings will enrich understanding on client project manager competency and become a basis to undergird further empirical research in client project manager development areas.

Organizational culture influence on client involvement

Purpose Lack of client involvement in construction of public projects has been identified as the main cause of many operational problems. Organizational culture (OC) plays a major role in guiding and shaping behavior of organizations, which could lead to the lack of client involvement. The purpose of this paper is to investigate the influence of OC on client’s involvement in construction project delivery. Design/methodology/approach A questionnaire survey was distributed to various government agencies of the Kingdom of Saudi Arabia. Structural equation modeling is used to determine the significance of the impact of OC factors on the involvement of clients in construction projects. Findings This study suggests that OC plays a major role in influencing and increasing the client involvement in construction projects by emphasizing team orientation, which includes team contribution and team accountability. In addition, it is also important to value employee’s idea. Research limitations/implications This study was limited to government agencies as clients in construction projects, i.e. only public sector construction projects (not private sector projects). Therefore, researchers are encouraged to investigate client involvement in the private sector projects. Originality/value This paper provides empirical evidence of the relationships between OC and the client involvement in construction projects by emphasizing team orientation.