Lost in translation: a multi-level case study of the metamorphosis of meanings and action in public sector organisational innovation

This paper explores the early implementation of an organisational innovation in the UK National Health Service (NHS) - Treatment Centres (TCs) - designed to dramatically reduce waiting lists for elective care. The paper draws on case studies of eight TCs (each at varying stages of their development) and aims to explore how meanings about TCs are created and evolve, and how these meanings impact upon the development of the organisational innovation. Research on organisational meanings needs to take greater account of the fact that modern organisations like the NHS are complex multi-level phenomena, comprising layers of interlacing networks. To understand the pace, direction and impact of organisational innovation and change we need to study the interconnections between meanings across different organisational levels. The data presented in this paper show how the apparently simple, relatively unformed, concept of a TC framed by central government, is translated and transmuted by subsequent layers in the health service administration, and by players in local health economies and, ultimately in the TCs themselves, picking up new rationales, meanings, and significance as it goes. The developmental histories of TCs reveal a range of significant re-workings of macro policy with the result that there is considerable diversity and variation between local TC schemes. The picture is of important disconnections between meanings, that in many ways mirror Weick’s (1976) ‘loosely coupled systems’. The emergent meanings and the direction of micro-level development of TCs appear more strongly determined by interactions within the local TC environment, notably between what we identify as groups of ‘idealists’, ‘pragmatists’, ‘opportunists’ and ‘sceptics’ than by the framing (Goffman 1974) provided by macro and meso organisational levels. While this illustrates the limitations of top down and policy-driven attempts at change, and highlights the crucial importance of the front-line local ‘micro-systems’ (Donaldson & Mohr, 2000) in the overall scheme of implementing organisational innovations, the space or headroom provided by frames at the macro and meso levels can enable local change, albeit at variable speed and with uncertain outcomes

From compliance to concordance: meeting the needs of patients?

Abstract of a pharmacy practice research paper presented at the British Pharmaceutical Conference, Glasgow, 23-26 Sep 2001. Interviews with 21 English speakers of Pakistani origin with type 2 diabetes. Results suggest that it may be more appropriate to link concordance to an approach which seeks to sensitively elicit patient narratives as a basis for shared understanding

From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument

<b>Background</b> Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.<p></p> <b>Methods</b> A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.<p></p> <b>Results</b> The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.<p></p> <b>Conclusions</b> To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study

Systems, interactions and macrotheory

A significant proportion of early HCI research was guided by one very clear vision: that the existing theory base in psychology and cognitive science could be developed to yield engineering tools for use in the interdisciplinary context of HCI design. While interface technologies and heuristic methods for behavioral evaluation have rapidly advanced in both capability and breadth of application, progress toward deeper theory has been modest, and some now believe it to be unnecessary. A case is presented for developing new forms of theory, based around generic “systems of interactors.” An overlapping, layered structure of macro- and microtheories could then serve an explanatory role, and could also bind together contributions from the different disciplines. Novel routes to formalizing and applying such theories provide a host of interesting and tractable problems for future basic research in HCI

Mean field and pairing properties in the crust of neutron stars

Properties of the matter in the inner crust of a neutron star are investigated in a Hartree-Fock plus BCS approximation employing schematic effective forces of the type of the Skyrme forces. Special attention is paid to differences between a homogenous and inhomogeneous description of the matter distribution. For that purpose self-consistent Hartree Fock calculations are performed in a spherical Wigner-Seitz cell. The results are compared to predictions of corresponding Thomas Fermi calculations. The influence of the shell structure on the formation of pairing correlations in inhomogeneous matter are discussed.Comment: 11 pages, 9 figure

Self-consistent simulation of quantum wires defined by local oxidation of Ga[Al]As heterostructures

We calculate the electronic width of quantum wires as a function of their lithographic width in analogy to experiments performed on nanostructures defined by local oxidation of Ga[Al]As heterostructures. Two--dimensional simulations of two parallel oxide lines on top of a Ga[Al]As heterostructure defining a quantum wire are carried out in the framework of Density Functional Theory in the Local Density Approximation and are found to be in agreement with measurements. Quantitative assessment of the influence of various experimental uncertainties is given. The most influential parameter turns out to be the oxide line depth, followed by its exact shape and the effect of background doping (in decreasing order).Comment: 5 pages, 6 figures; revised figures, clarified tex

Sultana (Vitis vinifera L.) canes and their exposure to light

During three seasons, each of a number of Sultana vines were provided with three types of cane. These cane types differed, during the two seasons covering shoot development and fruit ripening, in their position within the vine canopy, and hence in exposure to solar radiation. On each vine, two canes (S) were placed outside and two canes (B) below the main body of the canopy formed in the main by the four T-canes.In all the yield components determined mainly by bud development, i.e. % bud burst, % fruitful/burst nodes and bunches/node the B-canes were inferior to the Sand T-canes, which did not differ significantly from each other. In one season, time of bud burst did not differ, but in the other season the buds of the S-canes burst first and the buds of the B-canes last. In the season when yield itself was measured, S-canes yielded about 20% more than T-canes and about 50% more than B-canes, despite the absence of any differences in yield components related to berry development, i.e. mean berry weight and concentration of sugar. There were no high-yielding B-canes, but some low-yielding S- and T-canes.It is concluded that individual shoots on the same vine respond directly to their aerial environment, and that proper cane selection or the choice of a training system allowing full exposure of the developing prospective canes can increase the productivity of Sultana vines.Die Tragruten der Sorte Sultana (Vitis vinifera L.) und ihre BesonnungIn einem dreijährigen Freilandversuch wurden an einer Anzahl von Rebstöcken der Sorte Sultana drei Typen von Tragruten herangezogen. Diese Rutentypen nahmen vom Beginn ihrer Entwicklung als Triebe bis zur Traubenreife unterschiedliche Stellungen innerhalb des Blattwerkes ein und wurden demnach unterschiedlich besonnt. An jedem Rebstock befanden sich zwei Ruten (S) außerhalb und zwei Ruten (B) unterhalb des hauptsächlich durch die vier T-Ruten gebildeten Blattwerkes. In jenen Ertragsfaktoren, die hauptsächlich durch die Knospenentwicklung bestimmt werden, nämlich in % Knospenaustrieb, % fruchtbare je ausgetriebene Knospen und in der Anzahl der Gescheine je Knospe waren die B-Ruten den S- und T-Ruten unterlegen. Unterschiede zwischen den beiden letzteren waren statistisch nicht gesichert. In einem der beiden Jahre wurden keine Unterschiede im Zeitpunkt des Knospenaustriebes gefunden, aber im anderen Jahre trieben im Durchschnitt die S-Knospen zuerst und die B-Knospen zuletzt.In dem Jahr, in dem der Traubenertrag gemessen wurde, lag dieser bei den SRuten um 20% höher als bei den T-Ruten und um etwa 50% höher als bei den B-Ruten. Dabei waren keine Unterschiede in der Beerenentwicklung, nämlich im Einzelbeerengewicht und in der Zuckerkonzentration des Saftes, festzustellen. Es gab keine B-Ruten mit großen, aber einige S- und T-Ruten mit kleinen Erträgen.Diese Ergebnisse zeigen, daß die einzelnen Triebe einer Rebe direkt auf ihre oberirdische Umwelt reagieren und daß man die Produktivität der Sorte Sultana durch Erziehungsarten, die eine volle Besonnung der nächstjährigen Tragruten ermöglichen, und durch entsprechende Wahl der Tragruten verbessern kann

Thermoelectric properties of Co, Ir, and Os-Doped FeSi Alloys: Evidence for Strong Electron-Phonon Coupling

The effects of various transition metal dopants on the electrical and thermal transport properties of Fe1-xMxSi alloys (M= Co, Ir, Os) are reported. The maximum thermoelectric figure of merit ZTmax is improved from 0.007 at 60 K for pure FeSi to ZT = 0.08 at 100 K for 4% Ir doping. A comparison of the thermal conductivity data among Os, Ir and Co doped alloys indicates strong electron-phonon coupling in this compound. Because of this interaction, the common approximation of dividing the total thermal conductivity into independent electronic and lattice components ({\kappa}Total = {\kappa}electronic + {\kappa}lattice) fails for these alloys. The effects of grain size on thermoelectric properties of Fe0.96Ir0.04Si alloys are also reported. The thermal conductivity can be lowered by about 50% with little or no effect on the electrical resistivity or Seebeck coefficient. This results in ZTmax = 0.125 at 100 K, still about a factor of five too low for solid-state refrigeration applications

Supersymmetry of FRW barotropic cosmologies

Barotropic FRW cosmologies are presented from the standpoint of nonrelativistic supersymmetry. First, we reduce the barotropic FRW system of differential equations to simple harmonic oscillator differential equations. Employing the factorization procedure, the solutions of the latter equations are divided into the two classes of bosonic (nonsingular) and fermionic (singular) cosmological solutions. We next introduce a coupling parameter denoted by K between the two classes of solutions and obtain barotropic cosmologies with dissipative features acting on the scale factors and spatial curvature of the universe. The K-extended FRW equations in comoving time are presented in explicit form in the low coupling regime. The standard barotropic FRW cosmologies correspond to the dissipationless limit K =0Comment: 6 page