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Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England.

Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign.

It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.

Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.

This paper presents an account of the UK campaign for the voluntary Living Wage, an example of civil regulation. The purpose of this paper is to identify and characterize the actors involved in the campaign, describe methods used and examine direct and indirect consequences of the campaign.

A mixed-method design is employed, reflecting the broadly framed purpose of the research. The research used semi-structured interviews with campaigners, union representatives and employers, observation of campaign activities and the creation of a database of Living Wage employers.

The campaign originated in the community organizing movement, but has involved a broad range of labor market actors, both “new” and “old.” A continuum of campaigning methods has been used, stretching from community mobilization to appeals to employer self-interest and corporate social responsibility. The campaign has recruited 3,000 employers, led to wage increases for thousands of workers and registered indirect effects by shaping the policies of governments, employers and unions.

The research presents a novel account of the UK’s distinctive Living Wage campaign, a notable example of the civil regulation of the labor market.

This study aims to analyse the differences between professional interaction mediated by video conferencing and direct professional interaction. The research identifies diverging interests of office workers for the purpose of addressing work ethical and business ethical issues of professional collaboration, competition, and power in future hybrid work models.

Based on 28 qualitative interviews conducted between November 2020 and June 2021, and through the theoretical lens of phenomenology, the study develops explanatory hypotheses conceptualising four basic intentions of professional interaction and their corresponding preferences for video conferences and working on site.

The four intentions developed on the basis of the interviews are: the need for physical proximity; the challenge of collective creativity; the will to influence; and control of communication. This conceptual framework qualifies a moral ambivalence of professional interaction. The authors identify a connectivity paradox of professional interaction where the personal dimension remains unarticulated for the purpose of maintaining professionality. This tacit human connectivity is intertwined with latent power relations. This plasticity of both connectivity and power in direct interaction can be diminished by transferring the interaction to video conferencing.

The application of phenomenology to a collection of qualitative interviews has enabled the identification of underlying intention structures and the system in which they affect each other. This research identifies conflicts of interests between workers relative to their different self-perceived abilities to persevere in competitive professional interaction. It is therefore able to address consequences of future hybrid work models at an existential and societal level.

The purpose of this paper is to present the findings of an early stage, exploratory case study of a proposed housing with care initiative (the Crichton Care Campus (CCC)). This sought the perspectives of a range of key stakeholders on the proposed model and how it might be best realised. The analyses of these findings show their relevance to debates on integrated housing with care, and reflect on the methodology used and its potential relevance to similar projects.

The study used a transactive planning approach, where grounded views are sought from a variety of stakeholders. A purposive sample identified informants from relevant health, social care and housing organisations and nine semi-structured interviews were conducted. These were transcribed and data analysis was undertaken on an “interactive” basis, relating care theory to empirical expressions.

The authors identify two contrasting orientations – inclusive “community-oriented” and professional “service-oriented”. This distinction provides the basis for a rudimentary conceptual map which can continue to be used in the planning process. Two significant variables within the conceptual map were the extent to which CCC should be intergenerational and as such, the degree to which care should come from formalised and self-care/informal sources. The potential to achieve an integrated approach was high with stakeholders across all sectors fully supporting the CCC concept and agreeing on the need for it to have a mixed tenure basis and include a range of non-care amenities.

This paper offers originality in two respects. Methodologically, it describes an attempt to undertake early stage care planning using a needs led transactive methodology. In more practical terms, it also offers an innovative environment for considering any approach to care planning that actively seeks integration – based on an acknowledgement of complexity, a variety of perspectives and possible conflicts. The authors propose that the concepts of “community-orientation” and “service-orientation” are used as a helpful basis for planning negotiations, making implicit divergences explicit and thus better delineated.

Despite many calls to strengthen connections between health systems and communities as a way to improve primary healthcare, little is known about how new collaborations can effectively alter service provision. The purpose of this paper is to explore how a health authority, municipal leaders and physicians worked together in the process of transforming primary healthcare.

A longitudinal qualitative case study was conducted to explore the processes of change at the regional level and within seven communities across Northern British Columbia (BC), Canada. Over three years, 239 interviews were conducted with physicians, municipal leaders, health authority clinicians and leaders and other health and social service providers. Interviews and contextual documents were analyzed and interpreted to articulate how ongoing transformation has occurred.

Four overall strategies with nine approaches were apparent. The strategies were partnering for innovation, keeping the focus on people in communities, taking advantage of opportunities for change and encouraging experimentation while managing risk. The strategies have bumped the existing system out of the status quo and are achieving transformation. Key components have been a commitment to a clear end-in-view, a focus on patients, families, and communities, and acting together over time.

This study illuminates how partnering for primary healthcare transformation is messy and complicated but can create a foundation for whole system change.

The purpose of this paper is to explore the prevalence of potential problem gambling among Finnish prisoners; the associations between problem gambling and demographics, substance use and crime-related factors; and problem gamblers’ support preferences.

Prisoners (n=96) from two Finnish prisons were recruited between December 2017 and January 2018. The estimated response rate was 31 percent. Gambling problems were measured using the Brief Biosocial Gambling Screen. The participants were asked to report their gambling both for one year prior to their incarceration and for the past year. The independent variables were demographics (age, gender and marital status), substance use (alcohol, smoking and narcotics) and crime-related factors (crime type, prison type and previous sentence). Statistical significance (p) was determined using Fischer’s exact test.

Past-year pre-conviction problem gambling prevalence was 16.3 percent and past-year prevalence 15 percent. Age, gender, smoking, alcohol or illicit drug use were not associated with past-year problem gambling before sentencing. One-third of the prisoners (33.3 percent) who were sentenced for a property crime, financial crime or robbery were problem gamblers. One-quarter (24 percent) of all participants showed an interest in receiving support by identifying one or more support preferences. The most preferred type of support was group support in its all forms.

It is recommended that correctional institutions undertake systematic screening for potential problem gambling, and implement tailored intervention programs for inmates with gambling problems.

This study provides a deeper understanding of problem gambling in prisons. Problem gambling is associated with crime and also seems to be linked with serving a previous sentence. Early detection and tailored interventions for problem gambling may help to reduce reoffending rates.

Customer experience research predominantly anchors the customer journey on a specific offering, implying an inherently firm-centric perspective. Attending calls for a more customer-centric approach, this study aims to develop a goal-oriented view of customer journeys.

This study interprets the results of a phenomenological study of a transformative journey toward a sober life with the self-regulation model of behavior to advance understanding of customer journeys.

The consumer's journey toward a higher-order goal encompasses various customer journeys toward subordinate goals, through which consumers engage in iterative cognitive and behavioral processes to adjust or maintain their experienced situation vis-à-vis the goal. Experiences drive behavior toward the goal. It follows that negative experiences may contribute to goal attainment.

This study highlights the importance of looking at the consumers' higher-order goals to obtain a more holistic understanding of the customer journey.

Companies and organizations should extend their view beyond the immediate goals of their customers to identify relevant touchpoints and other customer journeys that affect the customer experience.

This study proposes conceptualization of the customer journey, comprising goal-oriented processes at different hierarchical levels, and it demonstrates how positive and negative customer experiences spur behaviors toward the higher-order consumer goal. This conceptualization enables a more customer-centric perspective on journeys.

The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings.

A qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n = 36) and observations (n = 46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis.

While each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process.

The paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them.

The paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.

UK fellowship schemes have been set up to address low-level engagement of doctors with leadership roles. Established in 2013, the Welsh Clinical Leadership Fellowship (WCLF) programme aims to recruit aspiring future clinical leaders and equip them with knowledge and skills to lead improvements in healthcare delivery. This paper aims to evaluate the 12-month WCLF programme in its first two years of operation.

Focused on the participants (n = 8), the authors explored expectations of the programme, reactions to academic components (provided by Academi Wales) and learning from workplace projects and other opportunities. The authors adopted a qualitative approach, collecting data from four focus groups, 20 individual face-to-face or telephone interviews with fellows and project supervisors and observation of Academi Wales training days.

Although from diverse specialties and stages in training, all participants reported that the Fellowship met expectations. Fellows learned leadership theory, developing understanding of leadership and teamwork in complex organisations. Through workplace projects, they applied their knowledge, learning from both success and failure. The quality of communication with fellows distinguished the better supervisors and impacted on project success.

Small participant numbers limit generalisability. The authors did not evaluate longer-term impact.

Doctors are required to be both clinically proficient and influence service delivery and improve patient care. The WCLF programme addresses both the need for leadership theory (through the Academi Wales training) and the application of learning through the performance of leadership roles in the projects.

This work represents an evaluation of the only leadership programme in Wales, and outcomes have led to improvements.