Organisational culture and quality of health care

concerned with assessing and improving the quality of health care. The USA, in particular, has identified specific concerns over quality issues1 2 and a recent report from the Institute of Medicine pointed to the considerable toll of medical errors.3 In the UK a series of scandals has propelled quality issues to centre stage4 5 and made quality improvement a key policy area.6 But how are quality improvements to be wrought in such a complex system as health care? A recent issue of Quality in Health Care was devoted to considerations of organisational change in health care, calling it “the key to quality improvement”.7 In discussing how such change can be managed, the authors of one of the articles asserted that cultural change needs to be wrought alongside structural reorganisation and systems reform to bring about “a culture in which excellence can flourish”.8 A review of policy changes in the UK over the past two decades shows that these appeals for cultural change are not new but have appeared in various guises (box 1). However, talk of “culture” and “culture change” beg some diffi- cult questions about the nature of the underlying substrate to which change programmes are applied. What is “organisational culture” anyway? It is to this issue that this paper is addressed

What counts as good evidence

Making better use of evidence is essential if public services are to deliver more for less. Central to this challenge is the need for a clearer understanding about standards of evidence that can be applied to the research informing social policy. This paper reviews the extent to which it is possible to reach a workable consensus on ways of identifying and labelling evidence. It does this by exploring the efforts made to date and the debates that have ensued. Throughout, the focus is on evidence that is underpinned by research, rather than other sources of evidence such as expert opinion or stakeholder views.Publisher PD

Triggering One-Year Limitations on Section 10(b) and Rule 10b-5 Actions: Actual Or Inquiry Discovery

Securities fraud lawsuits under Rule 10b-5 are governed by the one and three year limitative period in section 9(e) of the Securities Exchange Act. The one-year period is triggered by the plaintiff\u27s discovery of the facts constituting the violation. Courts differ, however, on the correct discovery standard for section 9(e). This Comment addresses whether courts should apply an inquiry notice standard or an actual notice standard to trigger the one-year limitative period

Knowledge mobilisation: new insights for theory and practice

Knowledge creation, flow and promulgation are enmeshed in complex institutional and organisational arrangements. The concern over the under-use of research given this complexity has led to the development of strategies aimed at mobilising knowledge. Huw Davies and Sandra Nutley describe the objectives of a new UK project exploring and linking the theory and practice of knowledge mobilisation

Understanding change in the public sector:a local authority case study

Increasingly managers in the public sector are being required to manage change, but many of the models of change which are available to them have been developed from private sector experience. There is a need to understand more about how the change process unfolds in the public sector. A case study of change in one local authority over the period 1974-87 is provided. The events surrounding housing decentralisation and the introduction of community development are considered in detail. To understand these events a twofold model of change is proposed: a short wave model which explains a change project or event; and a long wave model which considers how these projects or events might be linked together to provide a picture of an organisation over a longer period. The short wave model identifies multiple triggers of change and signals the importance of mediators in recognising these triggers. The extent to which new ideas are implemented and the pace of their adoption is influenced by the balance of power within the organisation and the political tactics which are used. Broad phases in the change process can be identified, but there is not a simple linear passage through these. The long wave model considers the way in which continuity and change feed off one another. It suggests that periods of relative stability may be interspersed with more radical transformations as the dominant paradigm guiding the organisation shifts. However, such paradigmatic shifts in local government may be less obvious than in the private sector due to the diverse nature of the former

Missing in action? The role of the knowledge mobilisation literature in developing knowledge mobilisation practices

This project was funded by the National Institute for Health Research Health Services and Delivery Research programme (project number 11/2004/10).Despite a burgeoning literature and the development of new theories about knowledge mobilisation in the past 15 years, findings from this online survey in 2014 of over 100 research agencies (n=106; response rate 57%) show the challenges of making effective use of formal and informal learning. Many agencies rely on traditional knowledge ‘push’ activities; formal use of theoretical models and frameworks is patchy; and knowledge-sharing between agencies and the comprehensive evaluation of knowledge mobilisation programmes are limited. Closer links between research agencies, and between these and knowledge mobilisation researchers, could enhance future knowledge mobilisation practice and theory.PostprintPeer reviewe

Knowledge mobilisation: creating, sharing and using knowledge

Postprin

Activating lone parents: an evidence-based policy appraisal of welfare-to-work reform in Britain

The 2008 welfare reform introduced by the previous Labour government requires (most) lone parents with older children to be available for work. This article examines the potential effect of this reform on the employment rate of lone parents and whether the age of the youngest child is a good indicator of ‘ability to work’. The reform will not lead to the desired increase as the target group is too small and the levels of multiple disadvantages within the group too high. ‘Ability to work’ needs to be conceptualised more broadly if it is to mean ‘ability to get a job’