Leadership of healthcare commissioning networks in England : a mixed-methods study on clinical commissioning groups

Objective: To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation. Design: Mixed-method, multisite and case study research. Setting: Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 population. Methods: Semistructured interviews with 56 lead GPs, practice managers and staff from the local health authorities (primary care trusts, PCT) as well as various healthcare professionals; 21 observations of clinical commissioning group (CCG) board and executive meetings; electronic survey of 58 CCG board members (these included GPs, practice managers, PCT employees, nurses and patient representatives) and subsequent social network analysis. Main outcome measures: Collaborative relationships between CCG board members and stakeholders from their healthcare network; clarifying the role of GPs as network leaders; strengths and areas for development of CCGs. Results: Drawing upon innovation network theory provides unique insights of the CCG leaders’ activities in establishing best practices and introducing new clinical pathways. In this context we identified three network leadership roles: managing knowledge flows, managing network coherence and managing network stability. Knowledge sharing and effective collaboration among GPs enable network stability and the alignment of CCG objectives with those of the wider health system (network coherence). Even though activities varied between commissioning groups, collaborative initiatives were common. However, there was significant variation among CCGs around the level of engagement with providers, patients and local authorities. Locality (sub) groups played an important role because they linked commissioning decisions with patient needs and brought the leaders closer to frontline stakeholders. Conclusions: With the new commissioning arrangements, the leaders should seek to move away from dyadic and transactional relationships to a network structure, thereby emphasising on the emerging relational focus of their roles. Managing knowledge mobility, healthcare network coherence and network stability are the three clinical leadership processes that CCG leaders need to consider in coordinating their network and facilitating the development of good clinical commissioning decisions, best practices and innovative services. To successfully manage these processes, CCG leaders need to leverage the relational capabilities of their network as well as their clinical expertise to establish appropriate collaborations that may improve the healthcare services in England. Lack of local GP engagement adds uncertainty to the system and increases the risk of commissioning decisions being irrelevant and inefficient from patient and provider perspectives

Leading for Learning Sourcebook: Concepts and Examples

Provides a detailed discussion of ideas and methods that educators can use to enhance leadership in learning. Offers examples of leaders using the ideas and tools for assessment, planning, and teaching. Includes four annotated longitudinal cases

Leading for Learning: Reflective Tools for School and District Leaders

Provides reflective ideas and tools for educators to enhance leadership in learning. Includes key ideas, real examples, and reflective questions that leaders can use can use to assess their organizations, enact strategic plans, and teach colleagues

Assessing relevance

This paper advances an approach to relevance grounded on patterns of material inference called argumentation schemes, which can account for the reconstruction and the evaluation of relevance relations. In order to account for relevance in different types of dialogical contexts, pursuing also non-cognitive goals, and measuring the scalar strength of relevance, communicative acts are conceived as dialogue moves, whose coherence with the previous ones or the context is represented as the conclusion of steps of material inferences. Such inferences are described using argumentation schemes and are evaluated by considering 1) their defeasibility, and 2) the acceptability of the implicit premises on which they are based. The assessment of both the relevance of an utterance and the strength thereof depends on the evaluation of three interrelated factors: 1) number of inferential steps required; 2) the types of argumentation schemes involved; and 3) the implicit premises required

Building capacity: teachers thinking and working together to create new futures.

This paper is based on research illuminating organisation-wide processes used during a whole school revitalisation process, IDEAS (Innovative Designs for Enhancing Achievement in Schools). It explores the organisation-wide processes that engage teachers in futuristic thinking and the creation of shared meaning. The paper explores how teachers engaging in processes of school revitalisation think and work together to add significant value to their successful practices. The school revitalisation process at the heart of this research centres on the work of teachers and recognises the fundamental importance of teacher leadership in successful school change. Creative organisation-wide processes link personal pedagogical work with the work of the broader professional community of the school. This linking of personal and school wide pedagogical aspirations and understandings provides a foundation for culture building and the creation of new futures. It enables the professional community to build the capacity of the school to add value to classroom and school wide practices - improving teaching and learning as a result

Learning by Seeing by Doing: Arithmetic Word Problems

Learning by doing in pursuit of real-world goals has received much attention from education researchers but has been unevenly supported by mathematics education software at the elementary level, particularly as it involves arithmetic word problems. In this article, we give examples of doing-oriented tools that might promote children\u27s ability to see significant abstract structures in mathematical situations. The reflection necessary for such seeing is motivated by activities and contexts that emphasize affective and social aspects. Natural language, as a representation already familiar to children, is key in these activities, both as a means of mathematical expression and as a link between situations and various abstract representations. These tools support children\u27s ownership of a mathematical problem and its expression; remote sharing of problems and data; software interpretation of children\u27s own word problems; play with dynamically linked representations with attention to children\u27s prior connections; and systematic problem variation based on empirically determined level of difficulty

An Enduring Philosophical Agenda. Worldview Construction as a Philosophical Method\ud

Is there such a thing as a philosophical method? It seems that there are as many philosophical methods as there are philosophies. A method is any procedure employed to achieve a certain aim. So, before proposing a method, we have to tackle the delicate question: “what is the aim of philosophy?”. At the origin of philosophy, there is a questioning about the world. The worldview approach developed by Leo Apostel elegantly explicit those fundamental questions. As we answer them, we come up with a worldview. Using this framework, this paper consider answering this enduring philosophical agenda as the primary aim of philosophy. We illustrate the approach by pointing out the limitations of both a strictly scientific worldview and a strictly religious worldview. We then argue that philosophical worldviews constitute a particular class of possible worldviews. With the help of three analogies, we give guidelines to construct such worldviews. The next step is to compare the relative strength of philosophical worldviews. Precise evaluation standards to compare and confront worldviews are proposed. Some problems for worldview diffusion are then expounded. We close with basic hypotheses to build a comprehensive philosophical worldview

Discovering Functional Communities in Dynamical Networks

Many networks are important because they are substrates for dynamical systems, and their pattern of functional connectivity can itself be dynamic -- they can functionally reorganize, even if their underlying anatomical structure remains fixed. However, the recent rapid progress in discovering the community structure of networks has overwhelmingly focused on that constant anatomical connectivity. In this paper, we lay out the problem of discovering_functional communities_, and describe an approach to doing so. This method combines recent work on measuring information sharing across stochastic networks with an existing and successful community-discovery algorithm for weighted networks. We illustrate it with an application to a large biophysical model of the transition from beta to gamma rhythms in the hippocampus.Comment: 18 pages, 4 figures, Springer "Lecture Notes in Computer Science" style. Forthcoming in the proceedings of the workshop "Statistical Network Analysis: Models, Issues and New Directions", at ICML 2006. Version 2: small clarifications, typo corrections, added referenc