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Improving early diagnosis of cancer through system change initiatives is endemic in England’s NHS cancer services. These initiatives, however, often fail to gain traction due to the complexities of health system structures. The purpose of this paper is to explore whether using a change framework grounded in systems thinking could be of help to system leaders.

A portfolio of geographically independent projects, all implementing cancer service changes as part of the Accelerate, Coordinate, Evaluate Programme, was used for the study. Eight projects were purposively selected to give a varied case-mix. Two semi-structured interviews were conducted with each project. Analysis of interviews was carried out using the Framework Method.

Processes working for (growth processes) and against (limiting processes) change were evident in and common across all eight projects. Projects commonly encountered challenges of relevance, time and bounded thinking. Having a network of committed people was vital for both initiating and sustaining change. Furthermore, understanding stakeholders’ emotional responses to change helped mitigate emergent challenges.

Leaders should pay constant attention to the dynamics of change, taking time to anticipate and diffuse challenges whilst simultaneously working to create the conditions that help change flourish. A change framework rooted in complex systems theory can help leaders understand the contradictory and non-linear processes inherent in transformational change.

Few studies seek to understand change dynamics by comparing the experiences of separate change initiatives implemented contemporaneously. The findings offer leaders practical insights on how to implement transformation.

There is clear evidence that prison can be detrimental to mental health and that wider society has tended to assume “out of sight, out of mind” for prisoners in mental distress. The lack of access to effective mental health care in prisons along with increasingly lower numbers of prison officers, or Operational Officers (OOs), has created a negative culture that requires the development of specialist services. With this comes a need to conduct evaluations, and investigations, into the roles of OOs and mental health-care staff. This study aims to report on a commissioned evaluation around the introduction and development of an HMP Mental Health Unit, named the integrated support unit (ISU), in the North of England. This study’s section of the wider evaluation focuses on the early team building, working practice and development of mental health registered nurses, other care staff and OOs within the ISU.

Three focus groups incorporating two professional groups took place on the ISU. The first of six Mental Health Workers (MHW) including Registered Mental Health Nurses and support workers; the second of two sets of two ISU dedicated OOs. The areas addressed within each of the groups concerned why staff wanted to work in the ISU, as well as how they would measure its potential success, and the necessary skills competencies and training they thought were required to prepare them to work in the area.

Overall, the participants expressed an interest or enthusiasm for their work having actively chosen to work in the ISU. There was a strong sense of a wish for the unit to succeed; in fact, success was a motivating drive for all. Both OOs and MHW emphasised the importance of teamworking, autonomy and freedom as well as information sharing. Analysis also revealed many areas of practice that were challenging. The findings are optimistic for the development of such special units as evaluated here. The drivers for different professions along with their measures of success in the field are discussed in detail. The relationship, expectations, hopes and needs of both MHW and prison officers working in a multidisciplinary unit provide useful information to support both policy and practice in the field. The authors make recommendations around training regimes and how they can effectively coordinate the different symbiotic professional roles. The ISU is a new initiative in offender management within prisons and is reviewed as a model of mental health practice in prison settings.

The value in recruiting to the ISU dedicated OOs, with committed interests in mental health. A continued emphasis on the ongoing development of team working, focussing on issues of risk, trust and treatment. The development (by nurses) of a formal/mandatory period of training for new OO’s prior to taking up a role on the ISU. For mental health nurses to embrace team leadership/educator roles in the areas of mental health awareness, team building and conflict resolution. To capture and formulate and develop the specific range of mental health interventions offered within the ISU.

The presented research explores and evaluates the introduction of a new mental health wing (ISU) for 11 patients in a Northern UK prison. It does this through the consideration of group discussions with both MHW and OOs on this wing. This work is part of a larger study.

The purpose of this paper is to describe the development and process evaluation of an educational intervention, designed to help general practitioners (GPs) identify and manage problem alcohol use among problem drug users.

The educational session was developed as part of a complex intervention which was informed by the Medical Research Council framework for complex interventions. A Cochrane review and a modified Delphi-facilitated consensus process formed the theoretical phase of the development. The modelling phase involved qualitative interviews with professionals and patients. The training's learning outcomes included alcohol screening and delivery of brief psychosocial interventions and this was facilitated by demonstration of clinical guidelines, presentation, video, group discussion and/or role play.

Participants (n=17) from three general practices and local medical school participated in four workshops. They perceived the training as most helpful in improving their ability to perform alcohol screening. Most useful components of the session were the presentation, handout and group discussion with participants appreciating the opportunity to share their ideas with peers.

Training primary healthcare professionals in alcohol screening and brief psychosocial interventions among problem drug users appears feasible. Along with the educational workshops, the implementation strategies should utilise multi-level interventions to support these activities among GPs.

The purpose of this study is to investigate how supply chains can become more resilient through innovation initiatives. It examines the expansion and deepening of relationships between buyers and suppliers and the facilitatory role of the government in this process.

This study compares supply chains in the advanced manufacturing and food industries. It is based on qualitative research involving case studies and in-depth interviews with buyers, suppliers and facilitators from government.

The study reveals that innovation is critical in building more resilient supply chains. It uncovers the importance of power distribution, coordination, communication, trust and commitment for innovation within these relationships.

It provides implications about how best to develop effective buyer–supplier relationships through innovation and diversification, for marketing and purchasing managers, CEOs of manufacturing companies and suppliers and government players with responsibility for industry development and innovation.

It advances the industrial buyer–supplier literature by extending the predominantly business-to-business supply chain perspective to include the role of government in supply chains and their innovation.

This article aims to examine tensions between hybrid clinician managers' professional values and health care organisations' management objectives.

Data are from interviews conducted with, and observation of, 14 managerial participants in a Cancer Therapy Unit set in a large teaching hospital in New South Wales, Australia, who participated in a Clinical Leadership Development Program.

The data indicate that there are tensions experienced by members of the health care organisation when a hybrid clinician manager appears to abandon the managerial role for the clinical role. The data also indicate that when a hybrid clinician manager takes on a managerial role other members of the health care organisation are required concomitantly to increase their clinical roles.

Although the research was represented by a small sample and was limited to one department of a health care organisation, it is possible that other members of health care organisations experience similar situations when they work with hybrid clinician managers. Other research supports the findings. Also, this paper reports on data that emerged from a research project that was evaluating a Clinical Leadership Development Program. The research was not specifically focused on organisational professional conflict in health care organisations.

This paper shows that the role of the hybrid clinician manager may not bring with it the organisational effectiveness that the role was perceived to have. Hybrid clinician managers abandoning their managerial role for their clinical role may mean that some managerial work is not done. Increasing the workload of other clinical members of the health care organisation may not be optimal for the health care organisation.

Organisational professional conflict, as a result of hybridity and divergent managerial and clinical objectives, can cause conflict which affects other organisational members and this conflict may have implications for the efficiency of the health care organisation. The extension or duality of organisational professional conflict that causes interpersonal or group conflict in other members of the organisation, to the authors' knowledge, has not yet been researched.

This essay addresses the topic of research lifeworlds and personal lifeworlds and what we gain and lose as researchers, and as people, from their overlaps and collisions. The essay analyses six narrative accounts of the authors lived experience of a unique collision between research and personal lifeworlds when the researcher-mother presented with her sick daughter to the hospital emergency department that served as the field site for her own research. This analysis revealed the following themes through which a researcher’s personhood animates the research process: feeling exposed but empowered; gaining conceptual clarity while opening up ethical ambiguity; and becoming liminal because of identity shifts and coping through self-reflexivity. The essay contributes to our collective understanding and shared learning of the ways a researcher’s personhood shapes, and is shaped by, the research process and (re)production of knowledge.

Let me begin this essay with some propositions found in the preface to this study. “(A) dynamic of contradiction…stands at the heart of Marxist theory” (p. 8). And (quoting Engels) while “men make their own history…in that each person follows his own consciously desired end, and it is precisely the result of these many wills operating in different directions and of their manifold effect upon the world outside that constitute history.” “What driving forces in turn stand behind these motives? What are the historical causes which transform themselves into these motives in the minds of actors?” (p. 9). Hunt's study demonstrates that Engels was certainly a most contradictory figure, alternating and sometimes conjoining a life of womanizing and carousing to one of the serious and dedicated political work to one of the capitalist manager. As to the second issue, while Hunt shows the various influences that prompted Engels to move toward, indeed, facilitate the development of what is termed Marxism, the question of motivation that caused him to honor those influences is left unanswered. That is, while many were subject to the same influences, the same historical forces, why did Engels “allow” these forces to pull him in a particular direction?

Physical appearances constitute a criterion of discrimination recognised by the French law. This topic is often raised in the field of media and advertising, but the consequences of stereotypes and prejudices about appearances at work are not taken into account as much. However, this criterion is subject to a multitude of normative injunctions, located in time and space, and significantly affects all spheres of life. Voluntary or involuntary transgression of these norms leads to processes of segregation, discrimination and harassment. These processes are all the more insidious because their legitimacy is less questioned than when it concerns a criterion shared by a collective such as race or gender. Appearances are, in fact, perceived as individual characteristics; moreover, some of them are perceived as controllable, which justifies the unfavourable treatment of people who do not fit the norm.

At work, recruitment is the most obvious step in which appearances play a role because first impressions are largely based on them. But remuneration or daily life at the office is also affected by beliefs and expectations about appearances. After presenting testimonies from focus groups on this issue, we offer some advices for organisations concerned by the topic.

Both high reliability theory (HRT) and “new school” supply chain resilience (SCR) promote a multi-layered, adaptable, transformational, and holistic perspective on organizing and managing. The authors explore whether, and if so how, HRT offer fresh perspectives on the SCR challenges experienced during COVID-19 and on organizing for future resilience.

Addressing SCR at the interorganizational network level, and blending theory synthesis and case study research, the authors assess if and how HRN constructs and practices can guide analysis of SCR in dynamic, complex networks, and help shape development pathways towards organizing for resilience. Findings draw on thick description and iterative coding of data (58 interviews and 200+ documents) on the buyer network responsible for managing the supply of critical medical products in the Netherlands.

HRT highlights the interconnectedness of challenges encountered during COVID-19 and helps design future resilience through three lessons. Organizing for SCR requires (1) both anticipation and containment strategies, (2) stable working relationships characterized by trust, and (3) a clear basis of command underpinned by experience-based legitimacy.

Distinctive from SCR, which views crises as “black swans”, HRT organizes around everyday consideration of the risk of failure. Taking a buyer network perspective, the authors move beyond the buyer-supplier network focus in SCR. The authors contend that emphasis on measures such as supplier base management, stockpiling, and domestic production are essential but not sufficient. Rather, HRT implies that deep structural and social ties within the buyer network should also be emphasized.