Identity dynamics as a barrier to organizational change

This article seeks to explore the construction of group and professional identities in situations of organizational change. It considers empirical material drawn from a health demonstration project funded by the Scottish Executive Health Department, and uses insights from this project to discuss issues that arise from identity construction(s) and organizational change. In the course of the project studied here, a new organizational form was developed which involved a network arrangement with a voluntary sector organization and the employment of “lay-workers” in what had traditionally been a professional setting. Our analysis of the way actors made sense of their identities reveals that characterizations of both self and other became barriers to the change process. These identity dynamics were significant in determining the way people interpreted and responded to change within this project and which may relate to other change-oriented situations

Paradox as invitation to act in problematic change situations

It has been argued that organizational life typically contains paradoxical situations such as efforts to manage change which nonetheless seem to reinforce inertia. Four logical options for coping with paradox have been explicated, three of which seek resolution and one of which ‘keeps the paradox open’. The purpose of this article is to explore the potential for managerial action where the paradox is held open through the use of theory on ‘serious playfulness’. Our argument is that paradoxes, as intrinsic features in organizational life, cannot always be resolved through cognitive processes. What may be possible, however, is that such paradoxes are transformed, or ‘moved on’ through action and as a result the overall change effort need not be stalled by the existence of embedded paradoxes

Financial incentives for smoking cessation during pregnancy: a randomised controlled trial

<b>Background</b> In the UK, smoking during pregnancy kills 4000 babies annually and costs an extra £20–90 million for pregnancy and infant care. Only 5–10% of pregnant smokers quit when offered current interventions. We aimed to assess efficacy, cost-effectiveness, and acceptability of adding £400 of shopping vouchers to routine pregnancy smoking cessation services.<p></p> <b> Methods</b> This study was a phase 2, single-centre, single-blinded, parallel-group individually randomised controlled superiority trial with qualitative and health economic components. Participants were self-reported pregnant smokers referred to Stop Smoking Services between Dec 15, 2011, and Feb 28, 2013, in Greater Glasgow and Clyde, Scotland. Randomisation, with allocation concealed from staff and participants, was by computer generated permuted blocks of four. 306 participants were randomised to routine care and 306 to the intervention (routine care plus incentives), giving 90% power to detect an increase in smoking cessation from 4•0% in women in the control group to 11•4% in women given incentives. Assessors of the primary outcome were masked to allocation. Women in both groups were offered routine care—namely, the offer of face-to-face contact to set a quit date, 10 weeks’ free nicotine replacement therapy, and support calls weekly for 4 weeks. In addition, women in the intervention group were offered £50 in vouchers for setting a quit date, £50 if carbon monoxide confirmed smoking cessation after 4 weeks, £100 after 12 weeks, and £200 in late pregnancy (34–38 weeks’ gestation). The primary outcome, analysed by intention to treat, was self-report of quitting in late pregnancy corroborated by cotinine in saliva (<14・2 ng/mL) or urine (<44・7 ng/mL). Cost-benefit analysis used routine and trial derived data. Ethics approval supported telephone consent. This trial is registered with Current Controlled Trials, ISRCTN87508788.<p></p> <b>Findings</b> Significantly more smokers who were offered incentives quit than did controls (69/306 [23%] vs 26/303 [9%], 95% CI 8・3–19・5). Three control participants opted out. The relative risk of smoking in late pregnancy was 0・85 (95% CI 0・79–0・91). No harms were reported, and incentives were acceptable to clients and health workers. Short-term incremental cost per quitter was ￡1127 and longer-term cost per quality-adjusted life year gained was ￡482.<p></p> <b>Interpretation</b> This trial provides evidence for the efficacy and cost-effectiveness of financial incentives, which must now be tested in other centres and with varied cessation services.<p></p&gt