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Small and rural communities face severe fiscal constraints. Many factors affect governance in these localities. Because of this, a vital concern are the relationships between “Fiscal Stress” and other factors. Multivariate analysis techniques are utilized to examine these relationships based on data collected from a survey of West Virginia local public officials. The analysis showed that “Public Finance” and “Financial Management” factors affect Fiscal Stress while external factors, such as professionalism, population, and metropolitan status, have little to no impact on Fiscal Stress. Additionally, Public Finance and Financial Management issues are critical to explaining Fiscal Stress in small and rural governments and Fiscal Stress is critical in explaining Public Finance and Financial Management issues. However, the relationships are not of equal strength; Fiscal Stress and Public Finance influence each other more strongly than Financial Management factors.

The prevalence of obesity in secure mental health units is higher than in the general population, having a negative impact on the physical health and mental well-being of people with severe mental health illness (SMI). The purpose of this study was to describe the feasibility of a programme aimed to help people with SMI to eat healthily and be physically active.

A mixed-methods approach was used. A questionnaire administered to patients in both wards measured acceptability, demand, implementation and practicality of the project. Individual semi-structured interviews and focus groups were used to explore staff and patients’ perceptions of the project; as well as the barriers and enablers towards an effective implementation and participation in the project’s activities.

Patients were, overall, satisfied with the activities implemented. Successful activities were easy to implement, had staff actively engaged and did not require logistic or administrative planning beforehand. Barriers included unawareness around funding mechanisms of activities, staff capacity issues or lack of patients’ permission to leave the ward.

Few studies have assessed the feasibility of real-life interventions aimed to improve healthy eating and physical activity in secure mental health units. The results of this study can inform commissioners and providers of mental health services to design and implement new interventions and programmes.

Dementia is found in all races. Within the UK, elders in black and minority ethnic (BME) communities are often unable or unwilling to access services that might help them when they develop dementia. A series of research‐based studies in Wolverhampton have demonstrated that working with community leaders and family carers can identify strengths as well as areas for development in service arrangements. Some areas for development are those shared by all individuals and families with dementia, while others are specific to the cultural group. Areas for action include: the lack of understanding of the normal and pathological features of ageing; fear and stigma associated with mental disorders within BME communities; lack of knowledge of dementia; and insensitivity and inflexibility within some components of services. Knowledge gained from a collaborative review of the situation can be used to plan and deliver iterative improvements. The most effective single initiative is the appointment of a link nurse competent in language, culture and clinical skills. Despite progress over a 10 year period, difficulties remain and there is more to be learned.The research reported here has been conducted over a period of nine years within the city of Wolverhampton. The research has been co‐ordinated from for dementia plus (previously Dementia Plus), which has functioned as the Dementia Development Centre for the West Midlands since 2000.

Since the decline of export agriculture and the loss of trade preferences, most Caribbean countries have shifted their economies towards the provision of tourism services. Barbados, for example, receives more than two‐thirds of its foreign exchange earnings from tourism. The sustainability of tourism in the Caribbean can potentially be affected by climate change. This paper aims to address this issue.

This paper provides an assessment of the likely effects of climate change in the small state of Barbados and suggests some recommended adaptations. Climate change is expected to impact on temperature, rainfall and severe weather, sea levels and sea surface temperatures, biodiversity loss, and lead to erosion and seasonal shifts on the island.

The paper finds that, in relation to tourism demand, as travellers from source markets become more conscious of their carbon footprint and the implementation of green taxes, there might be some alteration in demand for long‐haul destinations such as Barbados. On the supply‐side, increased operating costs, due to higher insurance premiums (particularly for beachfront properties) and greater cooling costs, to name a few could all impact on the profitability of hotels in the island. As climate change impacts on the water table, there is also likely to be some competition for water resources for residential and tourism purposes.

The paper supplies useful information on sustainability of tourism in the Caribbean and the effects of climate change.

This paper aims to discuss the importance of compassion in health care and experiences of Compassion Circles (CCs) in supporting it, placing this into the national policy context of the National Health Service (NHS), whilst focusing on lessons from using the practice in mental health care.

This conceptual paper is a discussion of the context of compassion in health care and a description of model and related concepts of CCs. This paper also discusses lessons from implementation of CCs in mental health care.

CCs were developed from an initial broad concern with the place of compassion and well-being in communities and organisations, particularly in health and social care after a number of scandals about failures of care. Through experience CCs have been refined into a flexible model of supporting staff in mental health care settings. Experience to date suggests they are a valuable method of increasing compassion for self and others, improving relationships between team members and raising issues of organisational support to enable compassionate practice.

This paper is a discussion of CCs and their conceptual underpinnings and of insights and lessons from their adoption to date, and more robust evaluation is required.

As an emergent area of practice CCs have been seen to present a powerful and practical approach to supporting individual members of staff and teams. Organisations and individuals might wish to join the community of practice that exists around CCs to consider the potential of this intervention in their workplaces and add to the growing body of learning about it. It is worth further investigation to examine the impact of CCs on current concerns with maintaining staff well-being and engagement, and, hence, on stress, absence and the sustainability of work environments over time.

CCs present a promising means of developing a culture and practice of more compassion in mental health care and other care contexts.

CCs have become supported in national NHS guidance and more support to adopt, evaluate and learn from this model is warranted. This paper is a contribution to developing a better understanding of the CCs model, implementation lessons and early insights into impact.

Describes how the National Health Service management has responded to pressure for change as a “critical case site” for investigation of the importance of innovativeness. What factors help or hinder innovation? What distinguishes highly innovative teams? How does the process of innovation develop over time? What practical recommendations can be made to facilitate innovation? Identifies four significant factors: vision, participative safety, a climate for excellence, and support for innovation. Describes a programme of recommended practical interventions.

The purpose of this paper is to examine the challenges that health care organizations face in nurturing and sustaining cultures that ensure the delivery of continually improving, high quality and compassionate care for patients and other service users.

Based on an extensive review of the literature, the authors examine the current and very challenging context of health care and highlight the core cultural elements needed to enable health care organizations to respond effectively to the challenges identified.

The role of leadership is found to be critical for nurturing high-quality care cultures. In particular, the authors focus on the construct of collective leadership and examine how this type of leadership style ensures that all staff take responsibility for ensuring high-quality care for patients.

Climates for quality and safety can be accomplished by the development of strategies that ensure leaders, leadership skills and leadership cultures are appropriate to meet the challenges health care organizations face in delivering continually improving, high quality, safe and compassionate patient care.

This paper provides a comprehensive integration of research findings on how to foster quality and safety climates in healthcare organizations, synthesizing insights from academic literature, practitioner reports and policy documents to propose clear, timely and much needed practical guidelines for healthcare organizations both nationally and internationally.

A growing body of research has identified many barriers (such as education, identification of appropriate technologies, research and development in the indigenous environments and, perhaps most importantly, public policy) to the implementation of renewable energy (RE) programmes in small island developing states (SIDS). This paper seeks to examine the proposition that lack of an integrated RE policy, necessary non‐technical infrastructure and insufficient investment continues to limit the development and commercialization of RE technologies.

The study surveyed literature, focusing on policies for supporting RE and the issues of competition and regulation. Caribbean policies for supporting RE were compared with those in selected countries.

The findings indicate that while undertaking a series of policy, economic, market and research and development (R&D) measures will advance the RE technologies and their deployment, it is also the case that regulatory mandates and financial incentives can lead to the same result.

The study represents a starting‐point for further research into the complicated interplay between competition and regulations in the development and commercialization of renewable technologies.

As we face fundamental issues of alternative energy use across the Caribbean region, the lack of an integrated RE policy, necessary non‐technical infrastructure and insufficient investment continues to limit the development and commercialization of RE technologies. Deeper understandings of this may help governments build a compelling case.

There is a need for individual‐level research into innovation, which departs from the traditions of mainstream creativity research. A working definition is given which enables innovation to be distinguished from creativity, and a qualitative study, examining individual experiences of innovation, is described. Unstructured interviews were carried out with 27 people in managerial or professional jobs, eliciting descriptive accounts of individual experiences of innovation at work. Transcripts of these interviews were content‐analysed, and the findings are discussed here under three headings: facilitators and inhibitors of innovation, reactions to innovations, and strategies for the management of innovation. Implications are drawn for future research in this area.

The ubiquity and value of teams in healthcare are well acknowledged. However, in practice, healthcare teams vary dramatically in their structures and effectiveness in ways that can damage team processes and patient outcomes. The aim of this paper is to highlight these characteristics and to extrapolate several important aspects of teamwork that have a powerful impact on team effectiveness across healthcare contexts.

The paper draws upon the literature from health services management and organisational behaviour to provide an overview of the current science of healthcare teams.

Underpinned by the input‐process‐output framework of team effectiveness, team composition, team task, and organisational support are viewed as critical inputs that influence key team processes including team objectives, leadership and reflexivity, which in turn impact staff and patient outcomes. Team training interventions and care pathways can facilitate more effective interdisciplinary teamwork.

The paper argues that the prevalence of the term “team” in healthcare makes the synthesis and advancement of the scientific understanding of healthcare teams a challenge. Future research therefore needs to better define the fundamental characteristics of teams in studies in order to ensure that findings based on real teams, rather than pseudo‐like groups, are accumulated.