The question  addressed  is how small  firms  compensate for  deficiencies in  their accountinginformation systems and what other means they apply to handle uncertainty in their environments. Empirical data was gathered from six small firms representing two different branches of the service industry: craft and culture. A qualitative method was employed and data comes from in depth interviews with the managers and has been structured according to the framework of Simons (1995). Data indicates that most of the studied firms lack significant portions of a formal managing accounting information system. Instead, they rely upon external information, through strategic networks of competitors, customers, employees and branch organizations, to make pricing and development decisions. A practical as well as a theoretical implication  is that management control frameworks need  to  explicitly  take  intoaccount trust and trustworthiness both in relation to environment and to employees.

Purpose: Cooperation between organizations is an often-suggested remedy for handling unsolved borderland problems. However, actual projects aiming at cooperation are seldom very successful. The purpose here is to highlight obstacles related to cooperation between different organizations based on a case study of a rehabilitation project where health care and several social service organizations (social insurance, social welfare, and the local employment agency) were involved. Data were gathered through participation and interviews. Findings: It seems that efficient cooperation requires an understanding of the participating organizations’ differences in work logic as well as work practices. Furthermore, only certain fairly standardized “normal” problems may be handled through organized cooperation while non-routine exceptional problem requires a more fully integrated work organization. Implications: Obstacles to cooperation are highlighted and ways to improve the possibilities of cooperation between organizations are suggested although such possibilities are generally hampered by differences in work logic.

Rationale, aims and objectives  Evidence-based medicine and clinical guidelines have been found difficult to implement in the clinical practice – mainly because lack of evidence quality and guidelines that, generally, do not account for variations in the medical cases. Variation in the medical cases enhances task uncertainty and uncertainty seems to be further enhanced through clinical guidelines. In this article, concept development is attempted, where task uncertainty is classified into a few medical problem-solving processes according to differences in medical technology and in the (initial) perception of the medical problem. Furthermore is argued the need for using different strategies in evaluating performance quality in medical health care depending on the variation in the degree of task uncertainty.

Method  Qualitative data about medical activities related to certain diseases are used to exemplify problem-solving processes representing different types of task uncertainty.

Results  It is argued that the main characteristics of medical problem-solving processes vary according to differences in medical technology and perception of perceived medical problem. Four main medical problem-solving processes are defined and demonstrated through empirical examples.

Conclusion  What may be regarded as rational behaviour is different for each type of problem-solving processes. Consequently, the processes need different organizational settings and need to be evaluated according to different criteria. Furthermore, from a practical point of view, development and education related to problem perception would seem as important as development of medical technology.

Purpose - Purpose - To study how changing information routines might influence patients’ service quality perceptions. A secondary aim was to test an instrument’s everyday feasibility for healthcare quality assessment.

Design/methodology/approach - Patients often show high grade satisfaction with general care although they display dissatisfaction with information they receive. A questionnaire survey is used to establish pa-tients’ satisfaction with an intervention consisting of introducing standardized guidelines for nursing performance and information provision. Patient satisfaction was assessed through a standardized questionnaire: ‘Quality from the Patient’s Perspective’ (QPP). A cross sectional interventional survey was applied to patients from gynaecological and haematological wards (n=71). A comparison group was used (n=67). Patients were given the questionnaire when their diagnosis was confirmed, after six months and 12 months. Data were collected succes-sively over 36-months.

Findings - Findings - The study group showed an increased satisfaction with information from nurses (p=0.001) but not physicians. However, patients tended to put greater emphasis on socio-cultural issues than information and some kind of cooperation seemed to represent high qual-ity from the patient’s perspective.

Research limitations/implications - Limitations – Successively lower response rate, mainly owing to cancer patients’ deteriorating medical conditions.

Practical implications - Implications for research, practice and/or society –The study seems to verify the concor-dance model’s relative merits and that the softer side of care appears to be more important to patients than specific improvements regarding information

Originality/value - Value - Result confirm that patients’ satisfaction with information had implications for overall quality; but social issues seemed more important and enhancing quality is best achieved through participation and cooperation.

PURPOSE:

The purpose of this paper is to study patients' attitudes to nurses and investigate what hampering factors occur in the actual nursing situation and what patient features might affect cooperative climates.

DESIGN/METHODOLOGY/APPROACH:

In-depth interviews were conducted with 11 male inpatients suffering prostate cancer. The interviews were personal narrations based on open-ended questions. The theoretical basis is founded in sense-making, trust and competence.

FINDINGS:

Existential issues related to nursing care were interpreted by nurses as a need for (technical) information. However, respondents indicated a need for professional support regarding their whole life. The social climate seems not to be optimal for existential talk owing to hospital routines. Patients' personal traits also affect the propensity to cooperation, and three types were distinguished: cooperating patients; passive patients; and denying patients. Nurses' competence may be regarded as hierarchical levels from optimising single items, over system optimisation and to optimisation from the patient perspective. The study indicates that not even first-level requirements are met.

RESEARCH LIMITATIONS/IMPLICATIONS:

Only patients' views were studied. Nurses' perceptions would add additional insights. Lack of personal relations and cooperation between patient and nurse may decrease service quality. Patient attitudes seem to be a major obstacle. For some patients, passively receiving technical information may be an excuse for not wanting to participate in mutual sense-making. The supposed need for technical information may also be an excuse for nurses to avoid more sensitive issues.

ORIGINALITY/VALUE:

Better quality of care involves changing patient perceptions and attitudes to what constitutes nursing competence.

Multiple rationality organizations are characterized by the simultaneously incorporation of different kinds of logic and control systems. They have to provide not only for efficiency but also to comply with e.g. ideal of fairness, sportsman­ship, equal rights, and aesthetic values. Elite sport clubs, theatres, and several municipality activities are examples of organizations that have to cope with multiple rationalities. These organizations are often governed through a combination of political and administrative control systems. They cope mainly by decoupling activities and reinterpret the situations but this often leads to paradoxes.