Innovation sustainability in challenging health-care contexts : embedding clinically led change in routine practice

The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change – especially organizational change led ‘bottom-up’ by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities

A Herschel PACS and SPIRE study of the dust content of the Cassiopeia A supernova remnant

Using the 3.5-m Herschel Space Observatory, imaging photometry of Cas A has been obtained in six bands between 70 and 500 μm with the PACS and SPIRE instruments, with angular resolutions ranging from 6 to 37”. In the outer regions of the remnant the 70-μm PACS image resembles the 24-μm image Spitzer image, with the emission attributed to the same warm dust component, located in the reverse shock region. At longer wavelengths, the three SPIRE bands are increasingly dominated by emission from cold interstellar dust knots and filaments, particularly across the central, western and southern parts of the remnant. Nonthermal emission from the northern part of the remnant becomes prominent at 500 μm. We have estimated and subtracted the contributions from the nonthermal, warm dust and cold interstellar dust components. We confirm and resolve for the first time a cool (~35 K) dust component, emitting at 70-160 μm, that is located interior to the reverse shock region, with an estimated mass of 0.075

The medium-term sustainability of organisational innovations in the national health service

Background: There is a growing recognition of the importance of introducing new ways of working into the UK's National Health Service (NHS) and other health systems, in order to ensure that patient care is provided as effectively and efficiently as possible. Researchers have examined the challenges of introducing new ways of working-'organisational innovations'-into complex organisations such as the NHS, and this has given rise to a much better understanding of how this takes place-and why seemingly good ideas do not always result in changes in practice. However, there has been less research on the medium-and longer-term outcomes for organisational innovations and on the question of how new ways of working, introduced by frontline clinicians and managers, are sustained and become established in day-to-day practice. Clearly, this question of sustainability is crucial if the gains in patient care that derive from organisational innovations are to be maintained, rather than lost to what the NHS Institute has called the 'improvement-evaporation effect'. Methods: The study will involve research in four case-study sites around England, each of which was successful in sustaining its new model of service provision beyond an initial period of pilot funding for new genetics services provided by the Department of Health. Building on findings relating to the introduction and sustainability of these services already gained from an earlier study, the research will use qualitative methods-in-depth interviews, observation of key meetings, and analysis of relevant documents-to understand the longer-term challenges involved in each case and how these were surmounted. The research will provide lessons for those seeking to sustain their own organisational innovations in wide-ranging clinical areas and for those designing the systems and organisations that make up the NHS, to make them more receptive contexts for the sustainment of innovation. Discussion: Through comparison and contrast across four sites, each involving different organisational innovations, different forms of leadership, and different organisational contexts to contend with, the findings of the study will have wide relevance. The research will produce outputs that are useful for managers and clinicians responsible for organisational innovation, policy makers and senior managers, and academics

Understanding innovators' experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: A qualitative study

This article is made available through the Brunel Open Access Publishing Fund - Copyright @ 2011 Barnett et al.Background: Healthcare service innovations are considered to play a pivotal role in improving organisational efficiency and responding effectively to healthcare needs. Nevertheless, healthcare organisations encounter major difficulties in sustaining and diffusing innovations, especially those which concern the organisation and delivery of healthcare services. The purpose of the present study was to explore how healthcare innovators of process-based initiatives perceived and made sense of factors that either facilitated or obstructed the innovation implementation and diffusion. Methods: A qualitative study was designed. Fifteen primary and secondary healthcare organisations in the UK, which had received health service awards for successfully generating and implementing service innovations, were studied. In-depth, semi structured interviews were conducted with the organisational representatives who conceived and led the development process. The data were recorded, transcribed and thematically analysed. Results: Four main themes were identified in the analysis of the data: the role of evidence, the function of inter-organisational partnerships, the influence of human-based resources, and the impact of contextual factors. "Hard" evidence operated as a proof of effectiveness, a means of dissemination and a pre-requisite for the initiation of innovation. Inter-organisational partnerships and people-based resources, such as champions, were considered an integral part of the process of developing, establishing and diffusing the innovations. Finally, contextual influences, both intra-organisational and extra-organisational were seen as critical in either impeding or facilitating innovators' efforts. Conclusions: A range of factors of different combinations and co-occurrence were pointed out by the innovators as they were reflecting on their experiences of implementing, stabilising and diffusing novel service initiatives. Even though the innovations studied were of various contents and originated from diverse organisational contexts, innovators' accounts converged to the significant role of the evidential base of success, the inter-personal and inter-organisational networks, and the inner and outer context. The innovators, operating themselves as important champions and being often willing to lead constructive efforts of implementation to different contexts, can contribute to the promulgation and spread of the novelties significantly.This research was supported financially by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH)

A cool dust factory in the Crab Nebula: a Herschel study of the filaments

Whether supernovae are major sources of dust in galaxies is a long-standing debate. We present infrared and submillimeter photometry and spectroscopy from the Herschel Space Observatory of the Crab Nebula between 51 and 670 μm as part of the Mass Loss from Evolved StarS program. We compare the emission detected with Herschel with multiwavelength data including millimeter, radio, mid-infrared, and archive optical images. We carefully remove the synchrotron component using the Herschel and Planck fluxes measured in the same epoch. The contribution from line emission is removed using Herschel spectroscopy combined with Infrared Space Observatory archive data. Several forbidden lines of carbon, oxygen, and nitrogen are detected where multiple velocity components are resolved, deduced to be from the nitrogen-depleted, carbon-rich ejecta. No spectral lines are detected in the SPIRE wavebands; in the PACS bands, the line contribution is 5% and 10% at 70 and 100 μm and negligible at 160 μm. After subtracting the synchrotron and line emission, the remaining far-infrared continuum can be fit with two dust components. Assuming standard interstellar silicates, the mass of the cooler component is 0.24+0.32 – 0.08 M ☉ for T = 28.1+5.5 – 3.2 K. Amorphous carbon grains require 0.11 ± 0.01 M ☉ of dust with T = 33.8+2.3 – 1.8 K. A single temperature modified blackbody with 0.14 M ☉ and 0.08 M ☉ for silicate and carbon dust, respectively, provides an adequate fit to the far-infrared region of the spectral energy distribution but is a poor fit at 24-500 μm. The Crab Nebula has condensed most of the relevant refractory elements into dust, suggesting the formation of dust in core-collapse supernova ejecta is efficient

Herschel images of NGC 6720: H-2 formation on dust grains

Herschel PACS and SPIRE images have been obtained of NGC 6720 (the Ring nebula). This is an evolved planetary nebula with a central star that is currently on the cooling track, due to which the outer parts of the nebula are recombining. From the PACS and SPIRE images we conclude that there is a striking resemblance between the dust distribution and the H2 emission, which appears to be observational evidence that H2 forms on grain surfaces. We have developed a photoionization model of the nebula with the Cloudy code which we used to determine the physical conditions of the dust and investigate possible formation scenarios for the H2. We conclude that the most plausible scenario is that the H2 resides in high density knots which were formed after the recombination of the gas started when the central star entered the cooling track. Hydrodynamical instabilities due to the unusually low temperature of the recombining gas are proposed as a mechanism for forming the knots. H2 formation in the knots is expected to be substantial after the central star underwent a strong drop in luminosity about one to two thousand years ago, and may still be ongoing at this moment, depending on the density of the knots and the properties of the grains in the knots

The origin of dust in galaxies revisited: the mechanism determining dust content

The origin of cosmic dust is a fundamental issue in planetary science. This paper revisits the origin of dust in galaxies, in particular, in the Milky Way, by using a chemical evolution model of a galaxy composed of stars, interstellar medium, metals (elements heavier than helium), and dust. We start from a review of time-evolutionary equations of the four components, and then, we present simple recipes for the stellar remnant mass and yields of metal and dust based on models of stellar nucleosynthesis and dust formation. After calibrating some model parameters with the data from the solar neighborhood, we have confirmed a shortage of the stellar dust production rate relative to the dust destruction rate by supernovae if the destruction efficiency suggested by theoretical works is correct. If the dust mass growth by material accretion in molecular clouds is active, the observed dust amount in the solar neighborhood is reproduced. We present a clear analytic explanation of the mechanism for determining dust content in galaxies after the activation of accretion growth: a balance between accretion growth and supernova destruction. Thus, the dust content is independent of the uncertainty of the stellar dust yield after the growth activation. The timing of the activation is determined by a critical metal mass fraction which depends on the growth and destruction efficiencies. The solar system formation seems to have occurred well after the activation and plenty of dust would have existed in the proto-solar nebula.Comment: 12 pages, 11 figure

Herschel images of Fomalhaut An extrasolar Kuiper belt at the height of its dynamical activity

Context. Fomalhaut is a young (2 ± 1 × 108 years), nearby (7.7 pc), 2 M⊙ star that is suspected to harbor an infant planetary system, interspersed with one or more belts of dusty debris. Aims. We present far-infrared images obtained with the Herschel Space Observatory with an angular resolution between 5.7′′ and 36.7′′ at wavelengths between 70 μm and 500 μm. The images show the main debris belt in great detail. Even at high spatial resolution, the belt appears smooth. The region in between the belt and the central star is not devoid of material; thermal emission is observed here as well. Also at the location of the star, excess emission is detected. We aim to construct a consistent image of the Fomalhaut system. Methods. We use a dynamical model together with radiative-transfer tools to derive the parameters of the debris disk. We include detailed models of the interaction of the dust grains with radiation, for both the radiation pressure and the temperature determination. Comparing these models to the spatially resolved temperature information contained in the images allows us to place strong constraints on the presence of grains that will be blown out of the system by radiation pressure. We use this to derive the dynamical parameters of the system. Results. The appearance of the belt points toward a remarkably active system in which dust grains are produced at a very high rate by a collisional cascade in a narrow region filled with dynamically excited planetesimals. Dust particles with sizes below the blow-out size are abundantly present. The equivalent of 2000 one-km-sized comets are destroyed every day, out of a cometary reservoir amounting to 110 Earth masses. From comparison of their scattering and thermal properties, we find evidence that the dust grains are fluffy aggregates, which indicates a cometary origin. The excess emission at the location of the star may be produced by hot dust with a range of temperatures, but may also be due to gaseous free-free emission from a stellar wind

Detection of anhydrous hydrochloric acid, HCl, in IRC+10216 with the Herschel SPIRE and PACS spectrometers Detection of HCI in IRC+10216

We report on the detection of anhydrous hydrochloric acid (hydrogen chlorine, HCl) in the carbon-rich star IRC +10216 using the spectroscopic facilities onboard the Herschel satellite. Lines from J = 1–0 up to J = 7–6 have been detected. From the observed intensities, we conclude that HCl is produced in the innermost layers of the circumstellar envelope with an abundance relative to H2 of 5 × 10-8 and extends until the molecules reach its photodissociation zone. Upper limits to the column densities of AlH, MgH, CaH, CuH, KH, NaH, FeH, and other diatomic hydrides have also been obtained