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This paper aims to extend the consideration of distributed leadership in health-care settings. Leadership is typically studied from the classical notion of the place of single leaders and continues to examine distributed leadership within small teams or horizontally. The purpose is to develop a practical understanding of how distributed leadership may occur vertically, between different layers of the health-care leadership hierarchy, examining its influence on health-care outcomes across two hospitals.

Using semi-structured interviews, data were collected from 107 hospital employees (including executive leadership, clinical management and clinicians) from two hospitals in Australia and the USA. Using thematic content analysis, an iterative process was adopted characterized by alternating between social identity and distributed leadership literature and empirical themes to answer the question of how the practice of distributed leadership influences performance outcomes in hospitals?

The perceived social identities of leadership groups shaped communication and performance both positively and negatively. In one hospital a moderating structure emerged as a leadership dyad, where leadership was distributed vertically between hospital hierarchal layers, observed to overcome communication limitations. Findings suggest dyad creation is an effective mechanism to overcome hospital hierarchy-based communication issues and ameliorate health-care outcomes.

The study demonstrates how current leadership development practices that focus on leadership relational and social competencies can benefit from a structural approach to include leadership dyads that can foster these same competencies. This approach could help develop future hospital leaders and in doing so, improve hospital outcomes.

The paper aims to analyse how the medical profession, the pro‐competition organisation, and the rural community have responded to the rural doctor shortage with reference to international medical graduates (IMGs) as reported in Australian newspapers.

Utilising the commercially available database LexisNexis during 2003, the author keyed in “overseas trained doctors” and retrieved 641 Australian newspaper articles. The qualitative data analysis software NVivo2 has assisted the author to organise the data, informed by critical realism and narrative analysis.

While the medical profession is undoubtedly committed to serving the health needs of the Australian public, the medical community is less than united in addressing the rural doctor shortage, especially through the employment of large numbers of IMGs. The handling of IMGs has led to tensions not only between the locally trained and IMGs, but also between rural and non‐rural doctors, and between younger and established doctors. The medical professional institutions seemed relatively detached from the adverse consequences of the shortage of doctors in the rural community. This contrasts the efforts demonstrated by the Rural Doctors Association and the rural community.

This paper concludes with a critical realist and narrative analysis and resolving of the rural doctor shortage and recommends close communication and consultation among the diverse interest groups rather than their engaging in blaming one another. This would be an obvious starting point to address the rural doctor shortage, which may partly be achieved by the effective use of services by IMGs.

Like the blind men describing the elephant, the authors in this month's Stack grapple with leadership. It may be that, in the end, leadership is impossible to define, analyze, or teach, but, at least, these authors sincerely describe the part of it they know.

This paper describes how one specialist learning disability health service has attempted to increase its focus on meeting the complex needs of people with profound learning disability (PLD) both with and without additional physical, sensory and medical impairment. Through individual assessment and intervention, carer consultation, training and supervision, research, and audit and advice to management, a multi‐disciplinary group has influenced the development of more proactive community teams for people with learning disability. This is in the context of both the publication of Signposts for Success (NHSE, 1998) and of a changing organisational culture which has embraced essential lifestyle planning, person‐centred teams, supported living and direct payments. The challenge remains of ring‐fencing sufficient resources (of time, skill and equipment), given the high‐profile and competing demands of people with milder learning disabilities but with complex mental health needs and/or challenging behaviour.

This study investigated business-to-business (B2B) repeated purchase intent and its relationships with customer value and customer satisfaction. Additionally, it explored the link between willingness to purchase again, switching costs and product returns management. Modern customers are more likely to switch suppliers; however, previous research suggests that this behaviour can be attenuated by a robust returns management experience. The purpose of this study was to provide a revised model of B2B repeated purchase intent that integrates the concept of product returns management and switching costs with existing B2B customer repurchase intent models.

First, a qualitative inquiry based on semi-structured interviews was conducted to test and develop a quantitative survey. Then a survey was then sent to business owners operating in the audiology industry. Finally, there were 317 responses.

The authors reveal the complex relationship between returns management and repeated purchase intent. Specifically, the authors’ results indicate that the effect of product returns on repurchase intent is opposite to the effect of customer value, depending on the value of customer value. The authors’ findings indicate that even when switching costs are low, firms can positively impact the intent to purchase again in the future if they increase the level of customer satisfaction. In addition, the authors’ findings indicate that in the context of B2B a high/low level of customer satisfaction does not trigger a positive effect of managing product returns on repurchase intent.

This study was the first to introduce the concept of product returns management to research on B2B repurchase intent.

There are many definitions of profound and multiple learning disabilities. Most definitions include having a high degree of learning disability in conjunction with at least one other severe impairment, such as visual, auditory or physical impairments (Male, 1996; Ware, 1996; Lacey, 1998). Bunning (1997) adds that people with such disabilities are very reliant on others for support, including support in taking part in communicative events. Establishing reliable and consistent methods of communication may be exceptionally difficult (Florian et al, 2000). However, it is important to consider the individuality and extreme diversity of this population (Detheridge, 1997; Hogg, 1998), which includes variability in communication strengths and needs (Granlund & Olsson, 1999; McLean et al, 1996). Communication is often given little attention when services are planning ways of supporting individuals to participate, develop independence and make choices (McGill et al, 2000). While the individual's communication strengths and needs should remain central within any discussion, the significant others and the environment will also have an important influence. This article explores some of the communication issues experienced by people with profound and multiple learning disabilities and highlights the importance of the communication partnership within interventions.

December 14, 1966 Negligence — Contractor — Faulty equipment supplied by sub‐contractor — Standards for guard rails ordered from reputable sub‐contractors — Sub‐contractors supplied by well known manufacturers — Defective standards supplied — Use of guard rail by building owners' employees for purpose for which not intended — Collapse of guard rail because of defective standard — Injury causing death to independent contractor — Defect in standards not apparent on visual inspection — Whether duty to inspect — Liability of building owners — Liability of contractors and sub‐contractors — Applicability of Building (Safety, Health & Welfare) Regulations, 1948 (S.I. 1948 No. 1145).