An investigation into children's agency : children's initiatives and practitioners' responses in Finnish early childhood education

This paper investigates adult–child interaction in the early years of education. The intention is to understand how children's initiatives and practitioners’ responses support and/or hinder children's agency. Our ethnographic data include 150 h of video data supplemented by observational field notes from a Finnish Early Childhood Education (ECE) centre with eight five-year-old children and two ECE practitioners. The video data were analysed abductively by using an Interaction Analysis method. The children's initiatives were found to manifest in several modes, namely asking a question, suggesting, challenging, refusing and ideating. The responses to these initiatives by the ECE practitioners included accepting, accepting after a rejection, adapting, rejecting or ignoring. The analysis points to ways in which adult–child relationships are negotiated in everyday activities, showing the relational nature of agency and suggesting that the ways in which adult engages in the child's initiations are an intricate part of children's agency.Peer reviewe

From the abstract to the concrete - Implementation of an innovative tool in home care

Background: The implementation of innovations in practice is a critical factor for change and development processes in health and home care. We therefore analyze how an innovative tool - a mobility agreement to maintain physical mobility of home care clients - was implemented in Finnish home care. Methods: Our study involves ethnographic research of 13 home care visits, two years after the mobility agreement was implemented. We analyze the emergence of contradictions, the motives of the actors and the use of artifacts supporting or inhibiting the implementation. Two in-depth cases illustrate the implementation of the mobility agreement in home care visits. Findings: Our findings show that, first, to achieve practice change and development, the innovation implementation requires the overcoming of contradictions in the implementation process. Second, it calls for the emergence of a shared motive between the actors to transform the abstract concept of an innovation into a concrete practice. Third, artifacts, customary to the clients are important in supporting the implementation process. Fourth, the implementation brings about a modification of the innovation and the adopting social system. Conclusions: Innovation implementation should be seen as a transformation process of an abstract concept into a concrete practice, enabled by the actors involved. Concept design and implementation should be closely linked. In health/home care innovation management, the implementation of innovations needs to be understood as a complex collective learning process. Results can be far reaching - in our case leading to change of home care workers' professional understanding and elderly clients' mobility habits.Peer reviewe

Addressing reoffending through addressing offender mental health: Exploring the viability of the Change Laboratory method as means of promoting social innovation in the delivery of integrated mental health care offenders in prison services.

Recidivism rates are a typical measure of the success of the criminal justice system. Effective collaboration is required between criminal justice services and mental health services to effectively achieve offender rehabilitation and reduce reoffending. Previous work on collaborative practice in the Norwegian prison systems (Hean et al., 2016) has concluded that more effective models of collaboration are required between the mental health and criminal justice services. It made the case for implementation of the Change Laboratory Method (CL) of interagency working and workforce transformation as a means of supporting interagency collaborative practice in this context. The CL has been used successfully and extensively by researchers internationally to transform interagency working practices in a wide range of countries (e.g., Finland, Brazil; New Zealand) and contexts (e.g. child protection, secondary health care and business) with an extensive list of products and work transformations arising from them (e.g. new adaptations of care pathways, new forms of service delivery) (Kerosuo & Engeström, 2003, Warmington et al., 2005, Tolviainen, 2007, Virkkunen et al., 2014). However, CLs as interventions are a new idea in Norwegian prison development, none as yet having been applied across organisational borders or specifically to the challenges facing collaboration between correctional and health and welfare services. It is essential therefore to explore first the feasibility of the such a possible intervention before implementation. The aim of this developmental project was therefore to conduct first the ethnographic phase of a CL intervention in a case study Norwegian prison, and identify issues that would benefit from future intervention, organizational development and learning. Second, the project explored the viability of the CL as a means of addressing these and improving collaboration between Correctional and Mental Health Services. The purpose of the first CL phase is for the interventionist team to describe the current situation of collaboration in the prison. The focus was to reveal challenges (theoretically described as contradictions) by seeing them as systemic causes of problems in collective activity instead of indications of individuals’ actions. Data from the first CL phase was gathered through interviews, observations and documentary data from an open department at the prison in Region West of the Norwegian Correctional Services. A cultural-historical activity theory approach guided the methods of data collection and analysis. This meant that the collaborative tools and voices of frontline workers, such as officers and mental health workers were brought to the fore. The analysis illustrated the complexity of the collaboration network in the prison, its variety of actors, and its challenges. This report presents the characteristics of current collaboration practices, examples of good practice as well as its challenges, and the complexity of the collaboration network between the mental health and prison services. These collaboration practices have developed with an aim to enhance the welfare of offenders and to reduce recidivism. However, the increasing needs of offender, of which loneliness and mental health were central, have come into play, which challenges the outputs of the services and collaboration between service providers. We report here three potential contradictions for future exploration by the prison that arose from the analysis. The first pertained to the challenges facing the BRIK assessment tool. BRIK is a tool used in the prison through which information on offender’s needs and resources are collected and evaluated by the officer and offender together. However, a lack of time to keep the content of BRIK regularly updated and ensuring the quality of its content ,is a challenge. In the report, we suggest that these challenges are connected to the fact that users of the tool (members of interagency meetings, offenders and officers) perceive the meaning and purpose of BRIK differently. For offenders, BRIK represents a tool to get more face-to-face time with the officer, which points to the inmate’s need of having more social contact. However, for the officer BRIK is one of their work tasks, a task required of them by Correctional Services authorities. For members of interagency meetings with health and other services, however, BRIK is a tool for understanding an offender’s motivation behind any specific request they might make of the meeting. This contradiction between different needs and meanings of purpose of BRIK challenges the effective use of the instrument. The second contradiction lay in observations that the prison officer`s purpose of work has changed over time but the development of tools to support their work has not kept up with these changing objectives. The third contradiction pertained to the suboptimal work organization, development, and flow of psychological knowledge in the prison. The purpose of this ethnographic phase of the CL presented in this report is not to fully elaborate these above contradictions collected by researchers as it essential to the model that these are articulated and understood by the prison, mental health and other prison based actors themselves when participating in future interventions. The contradictions raised by the ethnographic phase must be further revealed within this group of actors working together. Based on the potential contradictions raised in the ethnographic phase of the CL we now recommend a second phase of the CL in which our observations and findings of the collaborative network would be presented as mirror data to representatives of this network. This next phase would seek to open up new perspectives and motivate people in the prison to examine and develop their current practices further and collectively. During the process of CL, the organization would learn to solve their own contradictions and develop their activity. However, to ensure the implementation of this second phase ,careful negotiation, sensitivity and commitment of the researchers, prison management and frontline professionals involved, is required

Getting palliative medications right across the contexts of homes, hospitals and hospices: protocol to synthesise scoping review and ethnographic methods in an activity theory analysis.

This is the final version. Available from BMJ Publishing via the DOI in this record. INTRODUCTION: Prescribing and medication use in palliative care is a multistep process. It requires systems coordination and is enacted through activities of patients, informal carers and professionals. This study compares practice to idealised descriptions of what should happen; identifying when, how and why process disturbances impact on quality and safety. Our objectives are to:Document an intended model (phase 1, scoping review).Refine the model with study of practice (phase 2, ethnography).Use the model to pinpoint 'hot' (viewed as problematic by participants) and 'cold' spots (observed as problematic by researchers) within or when patients move across three contexts-hospice, hospital and community (home).Create learning recommendations for quality and safety targeted at underlying themes and contributing factors. METHODS AND ANALYSIS: The review will scope Ovid Medline, CINAHL and Embase, Google Scholar and Images-no date limits, English language only. The Population (palliative), Concept (medication use), Context (home, hospice, hospital) framework defines inclusion/exclusion criteria. Data will be extracted to create a model illustrating how processes ideally occur, incorporating multiple steps of typical episodes of prescribing and medication use for symptom control. Direct observations, informal conversations around acts of prescribing and medication use, and semistructured interviews will be conducted with a purposive sample of patients, carers and professionals. Drawing on activity theory, we will synthesise analysis of both phases. The analysis will identify when, how and why activities affect patient safety and experience. Generating a rich multivoiced understanding of the process will help identify meaningful targets for improvement. ETHICS AND DISSEMINATION: Ethical approval granted by the Camden & Kings Cross NHS Regional Ethics Committee (21/LO/0459). A patient and public involvement (PPI) coinvestigator, a multiprofessional steering group and a PPI engagement group are working with the research team. Dissemination of findings is planned through peer-reviewed publications and a stakeholder (policymakers, commissioners, clinicians, researchers, public) report/dissemination event.Marie Curie Research Gran

Tipping the balance: A systematic review and meta-ethnography to unfold the complexity of surgical antimicrobial prescribing behavior in hospital settings.

This is the final version. Available from Public Library of Science via the DOI in this record. Data Availability Statement: All relevant data are within the paper and its Supporting Information filesSurgical specialties account for a high proportion of antimicrobial use in hospitals, and misuse has been widely reported resulting in unnecessary patient harm and antimicrobial resistance. We aimed to synthesize qualitative studies on surgical antimicrobial prescribing behavior, in hospital settings, to explain how and why contextual factors act and interact to influence practice. Stakeholder engagement was integrated throughout to ensure consideration of varying interpretive repertoires and that the findings were clinically meaningful. The meta-ethnography followed the seven phases outlined by Noblit and Hare. Eight databases were systematically searched without date restrictions. Supplementary searches were performed including forwards and backwards citation chasing and contacting first authors of included papers to highlight further work. Following screening, 14 papers were included in the meta-ethnography. Repeated reading of this work enabled identification of 48 concepts and subsequently eight overarching concepts: hierarchy; fear drives action; deprioritized; convention trumps evidence; complex judgments; discontinuity of care; team dynamics; and practice environment. The overarching concepts interacted to varying degrees but there was no consensus among stakeholders regarding an order of importance. Further abstraction of the overarching concepts led to the development of a conceptual model and a line-of-argument synthesis, which posits that social and structural mediators influence individual complex antimicrobial judgements and currently skew practice towards increased and unnecessary antimicrobial use. Crucially, our model provides insights into how we might 'tip the balance' towards more evidence-based antimicrobial use. Currently, healthcare workers deploy antimicrobials across the surgical pathway as a safety net to allay fears, reduce uncertainty and risk, and to mitigate against personal blame. Our synthesis indicates that prescribing is unlikely to change until the social and structural mediators driving practice are addressed. Furthermore, it suggests that research specifically exploring the context for effective and sustainable quality improvement stewardship initiatives in surgery is now urgent.Health Education England/National Institute for Health Researc

Dialectics of distributed leadership in an interorganizational entrepreneurship hub

Abstract In this study, we widen the understanding of how the dialectics of distributed leadership develop as part of discursive interactions in an interorganizational setting directed at renewal. Using a dialectical perspective, we analyzed developmental meetings of an entrepreneurship hub and identified three dialectics, namely disagreement versus encouragement, organizational dependency versus interorganizational engagement and status quo versus transformation, by which the discussion reached the resolution. Our study widens the current understanding of distributed leadership and offers a nuanced account of how dissent and consent act as equally important forces for the development of the distributed leadership practice, as well as for reaching the collective resolution directed at organizational renewal. Our study also highlights the significance of co-created visual representations for converting complex discursive dialectics into a more tangible form. More generally, our study opens an approach in leadership to study tension-laden organizational dynamics in discursive and processual terms, especially in complex interorganizational contexts

Snellmanin sivistyskäsitys jatkuvan oppimisen ja työorganisaatioiden kehittämisen lähtökohtana ja haasteena

Abstrakti Snellmanilainen sivistyskäsite syventää keskustelua jatkuvasta oppimisesta. Se kuitenkin edellyttää uudenlaisia tutkimusavusteisia menetelmiä ja oppimisympäristöjä, joissa työntekijät, kehittäjät ja johtajat yhdessä kehittävät työtään ja osaamistaan ja tuottavat ratkaisuja ongelmiin

Organizational arrangements as a key to enhancing innovativeness and efficiency:analysis of a restructuring hospital in Finland

Abstract Background: Challenged to innovate and improve efficiency both at the policy level and in everyday work, many health care organizations are undergoing radical change. However, in many earlier studies, the significance of individuals’ perceptions of their organization and its innovativeness and efficiency during restructuring is not well acknowledged. Our study examines how various organizational arrangements; performance-, hierarchy-, tradition-, and leader-focused types, as well as collaborative and fragmented ones, connect to reaching innovativeness and efficiency in health care during restructuring. Methods: We built on previous organization and management research, innovation studies, and on research focusing in health care restructuring, and conducted an exploratory quantitative case study in a public sector hospital in Finland. Data comprising 447 responses from 19 professional groups across the hospital was analyzed using hierarchical regression analysis. Results: Our results demonstrate that multiple, co-existing organizational arrangements can promote innovation and efficiency. The perceptions of the organizational members of the nature of their organization need to be generally positive and reflect future-orientation to show positive connections with efficiency and innovativeness; fragmentation in the members’ perceptions of the character of their organization and their inability to go beyond established organizational traditions pose risks of inefficiency and stagnation rather than fruitful exploration. Our study further shows, somewhat surprisingly, that while collaborative organizational arrangements are positively related to increases in perceived efficiency, the same does not apply to innovativeness. Conclusions: Our study addresses understudied, yet inherently important aspects in providing high-quality health care: the relationships between different organizational arrangements and exploitation and exploration-related outcomes. In particular, examination of individuals’ perceptions (that may have even more weight for the subsequent developments than the actual situation) adds insight to the existing knowledge that has addressed more objective factors. Implications on how to support high levels of performance are drawn for management of professional and pluralistic organizations undergoing restructuring. Our findings also generate information that is useful for policy making concerned with public sector health care