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With the growth of information technology, patient attitudes are shifting – away from passively receiving care towards actively taking responsibility for their well- being. Handling doctor-patient relationships collaboratively and providing patients access to their health information are crucial steps in empowering patients. In mental healthcare, the implicit consensus amongst practitioners has been that sharing medical records with patients may have an unpredictable, harmful impact on clinical practice. In order to involve patients more actively in mental healthcare processes, Tele-Board MED (TBM) allows for digital collaborative documentation in therapist-patient sessions. The TBM software system offers a whiteboard-inspired graphical user interface that allows therapist and patient to jointly take notes during the treatment session. Furthermore, it provides features to automatically reuse the digital treatment session notes for the creation of treatment session summaries and clinical case reports. This thesis presents the development of the TBM system and evaluates its effects on 1) the fulfillment of the therapist’s duties of clinical case documentation, 2) patient engagement in care processes, and 3) the therapist-patient relationship. Following the design research methodology, TBM was developed and tested in multiple evaluation studies in the domains of cognitive behavioral psychotherapy and addiction care. The results show that therapists are likely to use TBM with patients if they have a technology-friendly attitude and when its use suits the treatment context. Support in carrying out documentation duties as well as fulfilling legal requirements contributes to therapist acceptance. Furthermore, therapists value TBM as a tool to provide a discussion framework and quick access to worksheets during treatment sessions. Therapists express skepticism, however, regarding technology use in patient sessions and towards complete record transparency in general. Patients expect TBM to improve the communication with their therapist and to offer a better recall of discussed topics when taking a copy of their notes home after the session. Patients are doubtful regarding a possible distraction of the therapist and usage in situations when relationship-building is crucial. When applied in a clinical environment, collaborative note-taking with TBM encourages patient engagement and a team feeling between therapist and patient. Furthermore, it increases the patient’s acceptance of their diagnosis, which in turn is an important predictor for therapy success. In summary, TBM has a high potential to deliver more than documentation support and record transparency for patients, but also to contribute to a collaborative doctor-patient relationship. This thesis provides design implications for the development of digital collaborative documentation systems in (mental) healthcare as well as recommendations for a successful implementation in clinical practice.
In light of the debate on the consequences of competitive contracting out of traditionally public services, this research compares two mechanisms used to allocate funds in development cooperation—direct awarding and competitive contracting out—aiming to identify their potential advantages and disadvantages.
The agency theory is applied within the framework of rational-choice institutionalism to study the institutional arrangements that surround two different money allocation mechanisms, identify the incentives they create for the behavior of individual actors in the field, and examine how these then transfer into measurable differences in managerial quality of development aid projects. In this work, project management quality is seen as an important determinant of the overall project success.
For data-gathering purposes, the German development agency, the Gesellschaft für Internationale Zusammenarbeit (GIZ), is used due to its unique way of work. Whereas the majority of projects receive funds via direct-award mechanism, there is a commercial department, GIZ International Services (GIZ IS) that has to compete for project funds.
The data concerning project management practices on the GIZ and GIZ IS projects was gathered via a web-based, self-administered survey of project team leaders. Principal component analysis was applied to reduce the dimensionality of the independent variable to total of five components of project management. Furthermore, multiple regression analysis identified the differences between the separate components on these two project types. Enriched by qualitative data gathered via interviews, this thesis offers insights into everyday managerial practices in development cooperation and identifies the advantages and disadvantages of the two allocation mechanisms.
The thesis first reiterates the responsibility of donors and implementers for overall aid effectiveness. It shows that the mechanism of competitive contracting out leads to better oversight and control of implementers, fosters deeper cooperation between the implementers and beneficiaries, and has a potential to strengthen ownership of recipient countries. On the other hand, it shows that the evaluation quality does not tremendously benefit from the competitive allocation mechanism and that the quality of the component knowledge management and learning is better when direct-award mechanisms are used. This raises questions about the lacking possibilities of actors in the field to learn about past mistakes and incorporate the finings into the future interventions, which is one of the fundamental issues of aid effectiveness. Finally, the findings show immense deficiencies in regard to oversight and control of individual projects in German development cooperation.