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The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study.

Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants.

Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups.

This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.

The purpose of this paper is to explore change within the commissioning of third sector mental health services in England.

A case study methodology based on survey and interview data of a sample of third sector organisations and commissioners within an English conurbation.

Normative commissioning models based on sequential cycles were not fully implemented with the main focus being on the procurement and contracting elements. There were examples of commissioning being an enabler of service improvement but overall it seems to have been limited in its ability to bring about whole system change. Barriers included commissioners’ capacity and competence, ineffectual systems within their organisations, and fragmentation in commissioning processes between user groups, organisations and sectors.

The case study conurbation may not represent practice in all urban areas of England and there may be particular issues of difference within rural localities. The view of private and public sector providers and those working in Commissioning Support Units were not sought.

To lead whole system change the commissioning function needs to be adequately resourced and skilled with better integration across public sector functions and organisations. Greater emphasis needs to be placed on implementing the full commissioning cycle, including the engagement of relevant stakeholders throughout the process and the practical application of outcomes.

This research adds to the limited body of empirical work regarding commissioning in mental health.

This book chapter uses structuration theory and aims to study cross-sectoral collaborations for co-creating public value and their implications in terms of the role and the relationships of the public sector with the private and third sector.

Our research is exploratory and our main research question is: What are the modalities of structuration of cross-sectoral collaborations for co-creating public value? Our analysis is based on a multiple case study analyses conducted in the region of Trentino – South Tyrol (Italy), and it draws on primary and secondary data collected through six extensive semi-structured interviews and documentary analysis on about fifty organizations participating in six cross-sectoral collaborations. We found that the co-creation of public value led public organizations to structure cross-sectoral collaborations involving private and third-sector organizations, but preexistent structures of signification, domination, and legitimation hampered the public sector as a whole to fully democratically meta-govern the modalities of structuration.

The chapter provides insights for practice by highlighting the elements of structuration theory as a useful framework of analysis for decision-making of public managers involved in cross-sectoral collaborations. Research implications deal with using structuration theory and critical approaches at a macrolevel (e.g., the role of the public sector as a whole) within public management studies.

The purpose of this paper is to ask how the UK Government can currently hold such incommensurable positions, explicitly and implicitly, in respect of spatial development priorities within England, and suggest a research agenda that might produce a better understanding of such contradictions.

The paper contrasts evidence on the changing spatial economic geography of the UK with data on recent trends in identifiable regional public expenditure. Current spatial development policy is analysed in detail and contrasted with a range of implicit development decisions made by central government in recent years. The paper considers the adequacy of the literature on metropolitan dominance within UK political and economic life in explaining the discrepancies between what government says and does in terms of spatial development.

Significant discrepancies are found between formal spatial development aspirations as expressed in the Public Service Agreement on Regional Economic Performance and the outcomes of actual spatial development decisions, which are likely to widen rather than reduce the gap between regional growth rates. An important part of the explanation for this divergence is the metropolitan dominance of London but further work is needed on how this might better be conceptualised and measured.

A number of key lines of enquiry for further research on the future of UK metropolitanism and the sustainability of current policy choices are outlined.

This paper makes an original contribution to detailing the disjuncture between formal and implicit spatial development priorities, which will be of value to academics and policy makers.

In exercise of the powers conferred upon him by the Ministry of Food (Continuance) Act, 1920, and of all other powers enabling him in that behalf, the Food Controller hereby orders as follows :—

Large numbers who have received “certificates of attestation” are the better class producers, who, mostly, have always produced clean milk. Many of them are “estate” farms, and some sell no milk at all, but they all enjoy the free services of the nation's servants. I think I am quite right in saying that actually the promoters of the “attestation” scheme (not being the Ministry of Health), are not really concerned with the milk production—as to whether it is clean or not. All the various activities which this memorandum exposes have some good in them, but altogether they make for very little. The experience born of them should be now pooled, and a real compulsory plan proceeded with. An idea which might come to fruition in, say, five years occurs to me, and it is as follows: (1) Frequent inspection of methods and milk sampling at all farms and dairies (both wholesale and retail). (2) Every producer's milk should be tested by animal inoculation for tubercle infection, at least twice per annum. Microscopic examinations of the same samples would disclose certain other infections, such as streptococci. Tests of the same sample for cleanliness (Methylene Blue and Coli) should be applied, with subsequent following inspection of methods to enforce cleanliness. (3) Frequent sampling of milk at various points of transit to consumer for quality. Often milk for delivery to wholesaler or retailer would be sampled on same occasions as visits under item 2. A new regulation should require all receptables containing milk, when placed out of his physical possession, to be sealed, pending collection by the wholesale buyer. The placing of such receptacles exposed to the sun, as is now done in thousands of cases at farm gates, should be prohibited by regulation. It is a common sight to see such receptacles on roads for hours, exposed to the hot sun, awaiting the arrival of the collecting lorry. Often the lids of the churns are raised, with consequent risk of contamination. Some of this milk being the previous afternoon's production, is eighteen to twenty hours old before being collected for transmission to the collecting depot. At such an age, and subjected to such exposure, milk, even of good production, will almost always prove to be of poor keeping quality, indeed it is often on “the turn” on arrival at the depot. (4) The Government should encourage by monetary assistance the renovation of cowsheds and dairies, with emphasis on the provision of a good water supply and means of sterilising utensils. All milk sold to the consumer should be in closed bottles, cartons, or other closed receptacle. (5) Results of tuberculous and other disease‐infected milk discovered by item 2 to be forwarded to the Ministry of Agriculture and Fisheries, Animal Health Division, co‐operative consideration being given on finding extent of disease in any cow as to whether legal proceedings should be instituted for failing to report animal and/or for selling tuberculous milk. (6) Statutory authority should be given providing for the tuberculin test of all cattle, and the sale of reactors should be prohibited. In connection with this, two or three years notice should be given to all cattle keepers (including non‐producers) that a survey tuberculin test would be carried out (the notice being for the purpose of enabling cattle owners to rear sufficient young T.T. stock to replace reactors found on first survey test, and so avert serious reduction in milk yields). The reacting animals would become the property of the State, appropriate compensation being paid to the owner before immediate removal to a district farm establishment adequately segregated, and managed by, say, the Ministry of Agriculture and Fisheries—one such establishment could serve several counties. The best of such animals could be marketed for food, thereby reclaiming a substantial part of the monetary outlay paid in compensation. The reactors would be replaced by the young T.T. stock provided by each owner during the two or three years prior to the first survey. A second test should be made, and any eliminating process necessary via the Ministry's reacting establishments repeated. Afterwards it should be made a serious offence to permit the addition to any herd of any animal which has not passed the tuberculin test. Home‐bred stock should be tested as soon after birth as possible (say 14 days). The test relating to the addition to herds should be the responsibility of the owner, and the cost of tuberculin testing by a private veterinary surgeon should be a fixed, reasonable charge. Certificates showing the result should be furnished to the Animal Health Division office. Thereafter an annual tuberculin test of all herds, with accompanying clinical examination by the Ministry of Agriculture and Fisheries, should be made, when compliance with the regulations respecting animals added since the previous inspection could be checked. If some such scheme as outlined was proceeded with, gone would be the necessity of all the present halfhearted voluntary schemes which are only touching a very small percentage of cattle. As all milk would be clean, tuberculin tested milk, controlled by bacteriological tests, no need would exist for the Milk (Special Designations) Orders: these could be repealed. No more milk need be “pasteurised.” “Approval” of milk for schools, with all its complications, would be redundant, as it would not matter which producer's milk was consumed by the children. The National Milk Testing Scheme would be redundant also.

This paper is an initial attempt to discuss the American institutionalist movement as it changed and developed after 1945. Institutionalism in the inter-war period was a relatively coherent movement held together by a set of general methodological, theoretical, and ideological commitments (Rutherford, 2011). Although institutionalism always had its critics, it came under increased attack in the 1940s, and faced challenges from Keynesian economics, a revived neoclassicism, econometrics, and from new methodological approaches derived from various versions of positivism. The institutionalist response to these criticisms, and particularly the criticism that institutionalism “lacked theory,” is to be found in a variety of attempts to redefine institutionalism in new theoretical or methodological terms. Perhaps the most important of these is to be found in Clarence Ayres’ The Theory of Economic Progress (1944), although there were many others. These developments were accompanied by a significant amount of debate, disagreement, and uncertainty over future directions. Some of this is reflected in the early history of The Association for Evolutionary Economics.

“We live at a hinge time in history, a threshold time when societies and cultures are being recomposed. We are learning that the way life used to work—or the way we thought it should— doesn’t work any longer” (Parks, 2009, p. xv). This article is about learning, culture change, practice and leadership. Many wise minds have articulated the leadership mindset we need for the future, and what remains stubbornly elusive is how we get there. We believe the difficult challenge of developing a new mindset--a new view of the world--to address the complexity and dynamic nature of the 21^st century is of central importance to leadership education today. As Einstein famously conveyed, we cannot address the problems of today with the same mindset that created those problems. Our inquiry explores the following questions: “How do we develop the skills, capacities and consciousness necessary for bringing creativity, innovation and a new mindset to our most strategic and pressing organizational challenges? How do we practice our way into a new paradigm of leadership?” We invite you to join us in this inquiry into leadership

PRACTICALLY everyone engaged in work study concentrates on new methods and the measurement of work. We pause to wonder whether enough attention is paid to the unmeasurable factors because these outweigh those which can be observed. The unseen factors of boredom, social maladjustment, and other emotional facets create fatigue and stress—especially in female workers. Why are there not more female work study practitioners to operate in factories where female labour predominates? Such women, after being properly trained in time and motion study, should receive psychological training and, as a result, female operatives would rise to a greater level of co‐operation and ultimate working efficiency. The notion that only men should work study female operatives is a myth which should be exploded. Let there be more female work study practitioners. And the sooner the better.

Legislation designed to promote and maintain high food standards and the hygienic handling and manufacture of food must recognise the existence of two problems. First, how to prevent deliberate adulteration, and, second, how to persuade the people concerned in its handling and manufacture that ignorance and carelessness, or a combination of both, can and do result in the contamination of the product, rendering it as dangerous for human consumption as any substance on the poisons register. In bygone days the adulteration of food proved a remunerative pastime. Millers and bakers were particularly unscrupulous, adding alum and other matter to their flour. Grocers, not to be outdone, mixed lime with sugar and starch with cocoa. A commission set up by the editor of the Lancet in 1851 revealed that tea had been treated with blacklead, indigo and mica, while every sample of milk was diluted with water and every loaf sophisticated with alum! Fortunately, measures taken to prevent this knavery and to protect the consumer in other ways, such as the Food and Drugs Adulteration Act of 1928 (now replaced by the Food and Drugs Act, 1938) have proved largely successful; but the problem of how to ensure clean and uncontaminated supplies of food still remains, and, in recent years, has engaged the attention of the experts to an ever increasing degree. Recent widespread cases of food poisoning in various forms, some of them fatal, have rightly caused general public concern, but the real danger seldom lay in the food itself. The evidence in these cases seems to indicate that in the first place the food was perfectly wholesome but that infection had been transmitted to it by human contact. In June, 1948, over ninety people suffered agonies from food poisoning attributed to eating cream buns at a party in Lambeth. It was found that the substance used for filling these buns had been infected by a person who had prepared them, a “carrier” of the germ which caused the poisoning. In another case, 171 people were taken ill after four separate wedding parties catered for by the same restaurant proprietor. Their illness was traced to one of the girls who prepared the trifle for each party. There have, of course, been a few cases in which the outbreak has been due to the activities of unscrupulous traders who have used ingredients unfit for human consumption in the manufacture of cooked meats, meat pies, etc. Nevertheless, in any attempt to eliminate the dangers of food poisoning, emphasis must be laid on personal hygiene and the cleanliness of the premises and utensils rather than on the condition of the food itself.