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This chapter examines why managed clinical networks are an appropriate approach to sustainable healthcare, and discusses the conditions for the effectiveness of these multi-stakeholder, clinician-led modes of organizing. It describes the development of a national clinical network to achieve system-wide improvement in the provision of publicly funded cardiac surgery services in New Zealand, and the subsequent evolution of a broader network encompassing the whole cardiac care patient pathway.

The case study of the two cardiac clinical networks focuses on the emergence and evolution of the networks over a four-year period from 2009. Data were collected from interviews with key stakeholders of both networks and from internal and published documentary evidence. Analysis of the case study is informed by network theory and prior studies of managed clinical networks.

Progress made towards the achievement of the goals of the initial cardiac surgery network encouraged a broadening of focus to the entire cardiac care pathway and the establishment of the national cardiac network. An important benefit has been the learning and increase in understanding among the different stakeholders involved. Both clinical networks have demonstrated the value of clinician engagement and leadership in improving the delivery of health services, and serve as a best practice model for the development of further clinical networks for health services that require a national population base.

The case study analysis of the two cardiac clinical networks identifies five mutually reinforcing themes that underpin network effectiveness: network structure, management and governance, and internal and external legitimation. These themes encompass a number of factors suggestive of successful managed clinical networks, and offer insights into the use of such networks in organizing for sustainable healthcare.

The use of data in the twenty-first century to improve expert decision-making has radically transformed what it means to be an expert in multiple fields, including behavioural healthcare. This chapter summarises the impact on information technology on the field, including use of digital platforms to enable video therapy and online cognitive behavioural therapy programmes. The chapter is intended for practitioners seeking information on how to be a twenty-first century expert, where years of education and experience matter less compared to evidence of performance in the form of solid outcome data. Key to the use of outcome data is expertise in how to use questionnaires in therapy and how to interpret results, both at the individual client level as well as overall results across multiple clients. A twenty-first century expert measures are not simply to measure outcomes but to improve results over time. Failure to incorporate the use of data into routine practice ignores an evidence based practice with decades of evidence as to its effectiveness, potentially resulting in suboptimal care.

Purpose – This chapter explores the pharmaceutical industry's strategic utilization of empowerment discourse in two realms: direct-to-consumer advertising (DTCA) and clinical drug development.

Methodology – It draws upon two research projects that examine the role of the pharmaceutical industry in the political economy of healthcare in the United States: Ronald's policy analysis and participant observation of DTCA policy hearings and Fisher's participant observation and interviewing of the clinical trials industry.

Findings – Empowerment rhetoric is mobilized by the pharmaceutical industry to create specific expectations about patient-consumer behavior, particularly the responsibilities associated with the consumption of drugs.

Research implications – The social and economic implications of DTCA and drug trials must be understood within their broader historical and contemporary contexts of health advocacy, consumerism, and medical neoliberalism.

Practical implications – The chapter offers alternative constructions of healthcare subjects and pharmaceutical practices that can mitigate the power of the pharmaceutical industry and bring about better pharmaceutical governance.

Originality/value of chapter – By analyzing findings from two empirical projects, this chapter is able to shed light on trends in the pharmaceutical industry's discourse about empowerment and consumption from the clinical testing to marketing of new drugs.

In the previous chapter, the reader will have become familiar with the idea of screening for traumatic experiences within organisations as a way to identify those who may benefit most from interventions and support. In this chapter, I present an overview of the trauma therapy literature in the first instance and then explore some of the debates regarding specific trauma-informed treatments versus general therapeutic approaches. The multicultural competency literature is discussed, and the multicultural orientation approach of cultural humility, cultural opportunity and cultural comfort is highlighted in a practice context. This chapter concludes with a case study vignette that brings it all together with a clinical example of what trauma-informed therapy through a multicultural lens might look like. As such I operationalise choice, collaboration , trust and transparency, and cultural principles from the trauma-informed care literature. Although applied here to specific trauma-informed organisations, some of the methods and processes that I unpack can be used in non-specific organisations where social/case managers are employed and wish to operationalise choice and collaboration in a structured way.

Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.

Design/methodology/approach – This case study of Alegent Health was based on 7 years of data collection. It includes observations of meetings, large-group interventions, and other activities; site visits to different hospitals in the system to observe changes in practice; interviews with Alegent Health executives, primary care physicians, hospital presidents, specialist physicians and physician groups, and health systems staff and nurses; and a variety of archival data including meeting minutes, video tapes, conference proceedings, and web site material.

Findings – The Alegent Health system has evolved over time according to the principles of agility. It built a series of new capabilities that contribute to improved clinical outcomes, sustained financial results, and more socially and ecologically responsible results. Designing health care systems based on agility is a more effective and sustainable approach than relying on legislative or other criteria.

Originality/value – The discussion of sustainability in health care has focused primarily on specific projects or how to respond to specific technological, regulatory, or clinical changes. Alegent Health's experience provides important lessons, opportunities, and challenges that can help advance our understanding of effective health care and use organizational agility to create more sustainable health care systems. This chapter provides health care system administrators an alternative design option.

Purpose – To provide a model for mentoring teachers through the process of improving instruction and intervention.

Design/methodology/approach – The chapter describes the Gradual Increase of Responsibility model for coaching, an adaptation of Pearson and Gallagher's (1983) Gradual Release of Responsibility model that can be used by coaches as they support teachers in a clinic or school setting.

Findings – Content describes stages of the coaching model that provide less scaffolding as teachers gain confidence and competence. These stages include modeling, recommending, questioning, affirming, and praising.

Research limitations/implications – The Gradual Increase of Responsibility (GIR) model provides a process that coaches can follow to support instructional improvement. GIR requires that coaches have instructional expertise; it provides them with a guide for their work with teachers to incorporate effective practices.

Practical implications – The GIR model can be applied by coaches in both clinical and school settings, with teachers who instruct students at both elementary and secondary levels.

Originality/value of paper – This chapter provides examples for each stage of the GIR process, clearing indicating how coaches can guide teachers to take on increased responsibility for strong, intentional instruction and intervention.

Evidence-based practice (EBP) can have a powerful impact on school-aged children. Yet this impact may not be realized if classroom teachers do not use empirically supported interventions and/or fail to include the best research available when they make important educational decisions about children. Whether classroom teachers use EBP may be influenced, in part, by what they learned or failed to learn in their preservice preparation programs. This chapter describes recent efforts to assess preservice teachers’ understanding and use of empirically supported interventions and provides four examples of how such practices were taught to preservice general educators in a small, regional teacher preparation program. We discuss four contemporary educational reform movements (i.e., federal policies mandating EBP, state-level policies linking growth in pupil learning to teacher evaluation, clinically rich teacher preparation, and the emergence of a practice-based evidence approach) that should increase interest and use of EBP in teacher education and offer recommendations for how teacher educators might infuse EBP into their traditional teaching, research, and service functions in higher education.

This chapter describes the disordered eating in sport problem and provides a critical overview of research in the area. It offers specific insights into how cultural practices in elite sport may be implicated.

In contrast to dominant medical perspectives, disordered eating in sport is discussed as a product of high-performance cultural contexts. The ways that practice commonplace in elite sport might contribute to disordered eating onset and maintenance are described. In turn, I also consider the experiential struggles of athletes with eating disorders and how this relates to dominant discourses in elite sport.

Elite sport culture, with its emphasis on surveillance, sacrifice, and success, reinforces disordered eating practices. Much of what is conventionally considered disordered eating, can be normalized when situated in the context of high-performance sport. Nevertheless, when functional disordered eating slides into mental illness, the mental toughness ethos works to silence and stigmatize athletes.

Research must broaden its focus to explore how social practices in elite sport normalize disordered eating and how prevention approaches can become more culturally informed and less individually driven.