Transforming the NHS through transforming ourselves

Abstract Background: Leadership development impacts on quality of care and workplace cultures for staff. Clinical Leadership embracing transformational and other collective leadership approaches are key enablers to developing effective workplace cultures at the micro-systems level. Following the development of a shared purpose and values framework, an internal, inter-professional clinical leadership programme was set up to grow a critical community of transformational leaders across one NHS organisation in England. This programme had previously been unsuccessful in engaging medical doctors. Aims and Objectives: This paper shares how a dedicated practice development based clinical leadership programme set out to support medical doctors across one organisation with their leadership journey, equipping them to become both transformational and collective leaders and facilitators with the skills to begin to develop and sustain effective workplace cultures, that are person centred, safe and effective. Methods: Practice development methodology with its collaborative, inclusive and participative approach for developing person centred cultures combined with clinical leadership strategies, formed the basis of the programme which emphasised the use of active and action learning drawing on the workplace as the main resource for learning, development and improvement. Self-assessment and co-creation of insights about clinical leadership together with collaborative analysis of evaluation data led to the syntheses of insights through the use of reflection and action planning. Findings/Results: Findings are presented at two levels: 1) Five individual authentic reflections by authors to illustrate their leadership journeys which also demonstrate how a range of tools were used and their impact from reflections. Insights and learning include recognition of the benefits of peer support and networking; development of a disciplined approach to learning and self-management; 2) A collaborative reflection and critique that embraced the feeling of a sense of team ethos and community cohesion, for the first time in a safe environment; as well as, a sense of collective shared purpose and values. Conclusions: We conclude that the programme helped to identify the impact of leadership on workplace cultures and to begin to embed ways of working that are collaborative, inclusive, participative and celebratory. This unique approach by one organisation to leadership development has enabled a journey of self-transformation for medical clinical leaders to commence. Practical implications arising from our learning: • An internal model grows clinical leadership capacity across the organisation through peer support and networking and collective leadership. • Investing in a safe confidential space for clinical leads and other staff groups is a strategy for leadership development practice. • There is need to develop more skilled critical companions to support leadership, improvement and development activities • Clinical leadership development, informed by practice development methodology, demonstrates potential for enabling transformative and collective leadership for achieving person-centred cultures in the workplace. Keywords: Clinical leadership, collective leadership, critical companionship, micro-systems, transformational leadership, workplace cultur

Calcutta Botanic Garden and the colonial re-ordering of the Indian environment

This article examines three hand-painted colour maps that accompanied the annual report of the Calcutta Botanic Garden for 1846 to illustrate how the Garden’s layout, uses and functions had changed over the previous 30 years. The evolution of the Calcutta Botanic Garden in the first half of the nineteenth-century reflects a wider shift in attitudes regarding the relationship between science, empire and the natural world. On a more human level the maps result from, and illustrate, the development of a vicious personal feud between the two eminent colonial botanists charged with superintending the garden in the 1840s

Information architecture for effective Workload Control: an insight from a successful implementation

The implementation of Workload Control (WLC), a Production Planning and Control concept uniquely designed for Make-To-Order companies, has been a constant challenge. Scholars argued that WLC is largely developed through simulations of well-defined environments while much more complex circumstances (e.g. information availability) have emerged in field research. A recent trend of WLC research is to improve the practical applicability of the concept, where empirical evidence is essential. However, success in WLC implementation remains impeded. The availability of data has been a significant area that frustrates the implementation process. While there is a tendency to simplify data requirements in recent WLC theory development, it is important to understand and maintain the information that is essential for the concept to be effective. For the first time in the field, this paper details the information architecture for WLC. Key informational entities of relevance to the input/output control functions in WLC as well as performance measurement are discussed based on evidence from a successful implementation. The paper not only sheds light for practitioners on how to construct an information system that facilitates successful WLC implementation but also has implications for future development of WLC mechanisms coping with information uncertainties in practice

Earthquake-Resistant Fiber Reinforced Concrete Coupling Beams Without Diagonal Bars

Results from large-scale tests on fibre-reinforced concrete coupling beams subjected to large displacement reversals are reported. The main goal of using fibre reinforcement was to eliminate the need for diagonal bars and reduce the amount of confinement reinforcement required for adequate seismic performance. Experimental results indicate that the use of 30 mm long, 0.38 mm diameter hooked steel fibres with a 2300 MPa minimum tensile strength and in a volume fraction of 1.5% allows elimination of diagonal bars in coupling beams with span-todepth ratios greater than or equal to 2.2. Further, no special confinement reinforcement is required except at the ends of the coupling beams. The fibre-reinforced concrete coupling beam design was implemented in a high-rise building in the city of Seattle, WA, USA. A brief description of the coupling beam design used for this building, and construction process followed in the field, is provided

UPDATE ON FRICTION BONDING OF MONOLITHIC U-MO FUEL PLATES

Friction Bonding (FB), formerly referred to as Friction Stir Welding, is an alternative plate fabrication technique to encapsulate monolithic U-Mo fuel foils inside 6061-T6 aluminum alloy cladding. Over the past year, significant progress has been made in the area of FB, including improvements in tool material, tool design, process parameters, cooling capability and capacity and modeling, all of which improve and enhance the quality of fabricated fuel plates, reproducibility of the fabrication process and bond quality of the fuel plates. Details of this progress and how it relates to the observed improvements and enhancements are discussed. In addition, details on how these improvements have been implemented into the last two RERTR mini-plate irradiation campaigns are also discussed

The history and evolution of the clinical effectiveness of haemophilia type a treatment: a systematic review.

First evidence of cases of haemophilia dates from ancient Egypt, but it was when Queen Victoria from England in the 19th century transmitted this illness to her descendants, when it became known as the "royal disease". Last decades of the 20th century account for major discoveries that improved the life expectancy and quality of life of these patients. The history and evolution of haemophilia healthcare counts ups and downs. The introduction of prophylactic schemes during the 1970s have proved to be more effective that the classic on-demand replacement of clotting factors, nevertheless many patients managed with frequent plasma transfusions or derived products became infected with the Human Immunodeficiency Virus (HIV) and Hepatitis C virus during the 1980s and 1990s. Recombinant factor VIII inception has decreased the risk of blood borne infections and restored back longer life expectancies. Main concerns for haemophilia healthcare are shifting from the pure clinical aspects to the economic considerations of long-term replacement therapy. Nowadays researchers' attention has been placed on the future costs and cost-effectiveness of costly long-term treatment. Equity considerations are relevant as well, and alternative options for less affluent countries are under the scope of further research. The aim of this review was to assess the evidence of different treatment options for haemophilia type A over the past four decades, focusing on the most important technological advances that have influenced the natural course of this "royal disease"

Why is there no queer international theory?

Over the last decade, Queer Studies have become Global Queer Studies, generating significant insights into key international political processes. Yet, the transformation from Queer to Global Queer has left the discipline of International Relations largely unaffected, which begs the question: if Queer Studies has gone global, why has the discipline of International Relations not gone somewhat queer? Or, to put it in Martin Wight’s provocative terms, why is there no Queer International Theory? This article claims that the presumed non-existence of Queer International Theory is an effect of how the discipline of International Relations combines homologization, figuration, and gentrification to code various types of theory as failures in order to manage the conduct of international theorizing in all its forms. This means there are generalizable lessons to be drawn from how the discipline categorizes Queer International Theory out of existence to bring a specific understanding of International Relations into existence

Monolithic Fuel Fabrication Process Development

The pursuit of a high uranium density research reactor fuel plate has led to monolithic fuel, which possesses the greatest possible uranium density in the fuel region. Process developments in fabrication development include friction stir welding tool geometry and cooling improvements and a reduction in the length of time required to complete the transient liquid phase bonding process. Annealing effects on the microstructures of the U-10Mo foil and friction stir welded aluminum 6061 cladding are also examined

Update On Monolithic Fuel Fabrication Development

Efforts to develop a viable monolithic research reactor fuel plate have continued at Idaho National Laboratory. These efforts have concentrated on both fabrication process refinement and scale-up to produce full sized fuel plates. Advancements have been made in the production of U-Mo foil including full sized foils. Progress has also been made in the friction stir welding and transient liquid phase bonding fabrication processes resulting in better bonding, more stable processes and the ability to fabricate larger fuel plates