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The drive towards clinical effectiveness and cost‐effective care within the NHS is becoming increasingly apparent. Consequently, there is a need to change clinical practice, and a set of activities with which to implement the necessary and desirable changes is required. Resistance to accepting change at an individual and organisational level is common and it is postulated that the solution lies in adopting an eclectic approach where the range of factors affecting the implementation of change is considered. A possible framework for identifying suitable behaviour change strategies is proposed. Factors included are the context of change, the relevant theoretical and empirical literature and the implementation and maintenance of change. With practical application in mind, the framework is intended as a tool to assist health care professionals analyse the change process in a structured manner and develop potential strategies for achieving desirable behaviour changes within their own and others’ practice.

This paper describes the implementation of a clinical guideline across three acute Trusts. A Clinical Effectiveness Steering Group identified prevention of venous thromboembolism as a health priority. A local guideline development group adapted the recommendations of an existing review and produced a local guideline. Then, a multidisciplinary implementation group developed the practical aspects of implementing guidelines into routine daily practice. They identified appropriate staff to carry out risk assessment and to administer appropriate prophylaxis, as necessary. They also produced a “guideline pack” containing a training resource manual and implementation aids. Following this a multiple strategy implementation programme was used to introduce the guidelines, and an evaluation was carried out eight to ten months after the introduction of the guidelines. The evaluation identified a number of areas for improving current practice. Guideline implementation is a complex, time‐consuming process.

This paper describes the implementation of a clinical guideline across three acute Trusts. A Clinical Effectiveness Steering Group identified prevention of venous thromboembolism as a health priority. A local guideline development group adapted the recommendations of an existing review and produced a local guideline. Then, a multidisciplinary implementation group developed the practical aspects of implementing guidelines into routine daily practice. They identified appropriate staff to carry out risk assessment and to administer appropriate prophylaxis, as necessary. They also produced a “guideline pack” containing a training resource manual and implementation aids. Following this a multiple strategy implementation programme was used to introduce the guidelines, and an evaluation was carried out eight to ten months after the introduction of the guidelines. The evaluation identified a number of areas for improving current practice. Guideline implementation is a complex, time‐consuming process.

Effective management of costly facilities is of prime importance to all concerned with the delivery of health care. Outpatient services, always a major source of demand on hospital facilities, are increasing in importance as the swing towards day cases, pre‐admission investigations and day care gathers momentum. Outpatient records, an essential tool of clinical management and patient care, can also be the means of acquiring knowledge of the use of hospital facilities by outpatient services.

The trend is towards a gradual increase in emphasis on manpower control, and a high commitment to employee relations. The ideal of the 1970s, that of developing and maintaining agreeable working relationships, is still professed by many personnel managers. Research arising from detailed questionnaires distributed to 350 establishments as part of a Leverhulme Trust/IPM‐funded project has identified six broad tendencies in personnel departments. These cover the enabling function (action as a service to managers and department); the “odds and ends” function (being given “bits” of responsibility); the attenuated function (having rank and responsibility but little professional support); the symbolic function (developing a symbiosis between personnel departments and consultants); the futuristic function (moving towards adopting information technology); and the professional function (being technically skilful, using consultants sparingly but effectively).

The information on which this article is based comes from a major piece of research on the changing nature of personnel management, which is being conducted by the authors and Lesley Mackay at UMIST. The work is being funded by the Leverhulme Trust in collaboration with the IPM. The first phase of the research was the completion of extensive and detailed questionnaires about personnel practice in 350 different establishments during the Spring and early Summer of 1984. That data are still being analysed, but the second stage of the research began at the end of 1984. This is a series of interviews with questionnaire respondents. Conclusions from the research will be published progressively until the end of 1986.

Previous research shows that identity and academic learning are interdependent, so affecting one can affect the other. The purpose of this case study was to explore preservice English teachers’ reading identities and their perceptions of reading identity development in the context of English classrooms.

This study used qualitative collective case design. Data sources included analogy exercise about participants’ reading identities, participant-generated observations of reading identity instruction, questionnaire on reading identity, class discussions about reading identity and final written reflection.

Data showed examples of participants’ reading identities as taking a variety of forms, but when discussing what shaped their reading identities, the strongest codes related to positive interactions with people and texts. The data showed that participants related positive reading identities to both reading to learn and reading for pleasure. More participants’ perceived their professional identity as that of a literature teacher than a reading teacher.

Future research is needed on how to support preservice teachers’ positive reading identities in English education courses.

Our data suggest that learning about reading identity may help preservice English teachers think of reading as something that is developing in themselves as well as their students over a lifetime. By providing space in English methods programs to attend to preservice teachers’ reading lives, we can help them rekindle or find their love of reading.

This research is needed because helping preservice teachers construct and enact positive reading identities in turn aids guidance of their future students’ reading identities, and having a positive reading identity is in turn linked to positive student outcomes.

Lauren Tate began a new career at a new organization. Based on information she learned in a recent MBA Leadership course, Lauren approached her new workplace with the goal of being more strategic in her interpersonal interactions. She focussed on identifying and building sources of power in this new career and proactively managed her evolving relationships. At some levels, she was very successful and effective but some relationships were characterized by stress. The case asks students to analyze Lauren's actions to determine which were effective and how her actions could have been even more effective.

Deciding the best course of treatment for a drug or alcohol user can be a complex one. Continuing our look at harm reduction and abstinence, we ask what the best plans are for Nigella, a young woman with mental health problems who uses heroin to prevent recurring self‐harm. In a refreshing and challenging critique Lesley Don explores the decision‐making process towards that treatment. Should Nigella stop her heroin use? If she does, will she self‐harm? Which harm is more desirable? And why, as professionals, do we seek one solution over another?