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The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS).

To analyse these multi-level dynamics, the authors blend Rogers’ diffusion of innovations theory (DoIT) with Webster’s sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts.

Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application – in particular speed, ease of use, reliability and flexibility and levels of readiness – were highly relevant but their influence was modulated through interaction with complex structural and relational issues.

Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of “co-construction” between designers and end-users.

The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.

In this study, the authors revisit Alberta's public-private partnership (P3) program after 20 years of field level experience by retracing its historical emergence and institutional evolution given its political context. Specifically, the authors adopt a path dependence perspective to reconstruct and reexamine Alberta's P3 program emergence, reflect on the successes achieved, and articulate challenges that must be overcome to institutionalize P3s as part of Alberta's infrastructure delivery environment in the future.

Adopting a constructivist approach and a case-based methodology, the authors (re)analyze the activities of governmental agents, private industry, and other actors as part of a new infrastructure policy introduced in 2002 to transform the provincial institutional landscape to accommodate P3.

The authors find Alberta's P3 emergence was driven by the necessity of its infrastructure deficits, political expediency, and resource scarcity. Furthermore, with well-entrenched conservative political actors as gatekeepers, Alberta's P3 implementation demonstrated stability and incremental change simultaneously, consistent with core elements of path dependency. Following the introduction of P3 in Alberta, the province lacked formal institutional structures that would transition its P3 program from good to great and enable it to become firmly embedded in the public infrastructure delivery landscape. With the subsequent absence of P3-convinced (political) leadership and uncertainty about its P3 policy direction, Alberta was unable or unwilling to consolidate the progress made at the start of the program.

Most recently, the emergence of new political leadership in Alberta has (re)catalyzed policy progress, pointing toward a more methodical program approach, and suggesting a rediscovered confidence in P3s in the province with the establishment of a P3 Office (P3O), including nascent formal rules for unsolicited bids. These recent changes in our view make for a much more anchored policy and could lead to program sustainability and eventual institutionalization. Given the unpredictability of the recent political change, a more robust analysis of the relationship between political party control, leadership, and P3 stability is required to anticipate future policy and organizational obstacles.

How does the human brain absorb information and turn it into skills of its own in psychotherapy? In an attempt to answer this question, the authors will review the intricacies of processing channels in psychotherapy and propose the term transprocessing (as in transduction and processing combined) for the underlying mechanisms. Through transprocessing the brain processes multimodal memories and creates reparative solutions in the course of psychotherapy. Transprocessing is proposed as a stage-sequenced mechanism of deconstruction of engrained patterns of response. Through psychotherapy, emotional-cognitive reintegration and its consolidation is accomplished. This process is mediated by cellular and neural plasticity changes.

The purpose of this paper is to examine the relevance of Cuba’s medical system, its health tourism and related diplomacy in the context of the recent COVID-19 pandemic for the global response to disease outbreaks. In addition to Cuba being a destination for leisure tourists in the Caribbean, the renowned Cuban medical system attracts thousands of health tourists seeking low-cost but high-quality treatment. This paper demonstrates how Cuba’s unique response to the pandemic, which included sending thousands of medical staff abroad, can inform structural and global issues and contribute to a more sustainable future.

The research in this study is primarily drawn from published academic and media sources that address Cuba’s medical system, its health tourism and the government’s response to the recent pandemic. The author, a political scientist and an author of many publications on Cuba, and the PI of a study focused on Cuban tourism, will also draw on her expertise.

This paper addresses the Cuban Government’s ongoing response to the COVID-19 pandemic and places this response in the context of Cuba’s medical system, its health tourism and related diplomacy. It reveals key lessons from Cuba’s response for other tourist destination states and, more broadly, for the worldwide response to global outbreaks and the management of health systems. The findings will further research in diplomacy and tourism as well as inform policy and practice.

This paper explores an ongoing topic and thus further research will be required following the pandemic.

This research note offers important implications for practice including providing accurate, research-based information that challenges misinformation about Cuba’s health system, its medical diplomacy program, health tourism and its response to COVID-19. It offers valuable lessons for public health authorities including the importance of preventative health measures, community medicine and the benefits of working globally to combat outbreaks through the sharing of medical staff and resources.

This research note reveals the health, political and social implications of Cuba’s response in this time of crisis. It shows the benefits of a robust but low-cost community-based medicine program, medical diplomacy and how a state’s response during crisis can moderate the global inequities and injustices such as unequal access to care that often accompany disease outbreaks such as COVID-19.

This research note is an early analysis of a response by an important tourist destination country to the pandemic. The author anticipates that the information provided to the international community via this open access journal will offer practical implications for the ongoing global efforts to manage this crisis and contribute to the research on tourism, diplomacy, justice and health policy.

Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

The effects of the spread of COVID-19 across the world are devastating, both from a health and an economic perspective. However, we also see encouraging examples of collaborative and innovative initiatives, in society and in organizations. The purpose of this paper is to focus on initiatives related to digital business model innovation. The authors explore how organizational characteristics provide a variety of opportunities for digital responses to the COVID-19 pandemic and discuss the potential consequences for the speed of digital transformation in organizations and society.

In this paper, the authors analyze how organizations attempt to mitigate the negative effects of fighting COVID-19 using digital business model responses. The authors draw on a qualitative study where they have collected data from the retail and service industries. They have analyzed the data in relation to theory to better understand this ongoing phenomenon.

The authors have identified four categories of organizations (crisispreneurs, accelerators, endurers and thrivers). Each category faces different challenges and shows a different intensity in their digital transformation. The authors propose that the rapid turn toward digital business models will have enduring effects, as organizations have gained transformational capabilities that will remain, and that the digital trajectory has, as a result, changed forever.

The findings in this paper point toward new challenges for leaders and policymakers in terms of how to support initiatives and meet the needs of different categories of organizations while simultaneously being conscious of the potential societal effects of this rapid digital shift. The authors hope that this paper can be of value for managing this shock and learning how to adapt for the future taking certain aspects of current business models as the departure point.

Change agents are individuals who can successfully transform aspects of how organisations operate. In education, teachers as change agents are increasingly seen as vital to the successful operation of schools and self-improving school systems. To date, however, there has been no systematic investigation of the nature and role of teacher change agents. To address this knowledge gap, we undertook a systematic review into five key areas regarding teachers as change agents. After reviewing 70 outputs we found that current literature predominantly positions teacher change agents as the deliverers of top-down change, with the possibility of bottom-up educational reform currently neglected.

Machine learning (ML) analytical tools are increasingly being considered as an alternative quantitative methodology in management research. This paper proposes a new approach for uncovering the antecedents behind product and product–service innovation (PSI).

The ML approach is novel in the field of innovation antecedents at the country level. A sample of the Equatorian National Survey on Technology and Innovation, consisting of more than 6,000 firms, is used to rank the antecedents of innovation.

The analysis reveals that the antecedents of product and PSI are distinct, yet rooted in the principles of open innovation and competitive priorities.

The analysis is based on a sample of Equatorian firms with the objective of showing how ML techniques are suitable for testing the antecedents of innovation in any other context.

The novel ML approach, in contrast to traditional quantitative analysis of the topic, can consider the full set of antecedent interactions to each of the innovations analyzed.

The purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.

The paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It then considers the healthcare research approaches whose principles and methodologies are more aligned with “slow science” before presenting a description of a “slow science” project in which the authors are currently engaged.

Current approaches to health service research struggle to offer adequate resources for resolving frontline complexity, principally because they set more store by knowledge generalisation, disciplinary continuity and integrity and the consolidation of expertise, than by engaging with frontline complexity on its terms, negotiating issues with frontline staff and patients on their terms and framing findings and solutions in ways that key in to the in situ dynamics and complexities that define health service delivery.

There is a need to engage in a paradigm shift that engages health services as co-researchers, prioritising practical change and local involvement over knowledge production. Economics is a research field where the products are of natural appeal to powerful health service managers. A “slow science” approach adopted by the embedded Economist Program with its emphasis on pre-implementation, knowledge mobilisation and parallel site capacity development sets out how research can be flexibly produced to improve health services.

Human fascination in the unidentified flying objects (UFOs) and alien paranormal phenomenon is rich in history, explored widely in popular culture and many personal beliefs exist across society. The tourism industry offers a range of places where consumers can encounter such a phenomenon. Reports continue to highlight the growth in consumers participating at UFO and alien tourism attractions and locations. Significantly, the purpose of this paper is to shine a light on the relationship between UFOs, aliens and the tourism industry.

This paper takes a pragmatic philosophical approach by embracing a multi-disciplinary analysis. This study examines a range of secondary data information, statistics, reports and research studies.

By identifying the current impotence of the UFO and alien tourism markets and the growing consumer participation in it, this paper presents a theoretical starting point in the form of a model, which maps the current landscape of the industry from supply and demand perspectives. This study should be seen as a stepping stone towards further research into the UFO and alien tourism industry and provide researchers with a theoretical platform and novel ideas through which to explore the subject.

The phenomenon includes an established eclectic mix of attractions and likewise tourist motivations for visiting are wide and diverse. However, the subject lacks academic consideration. Thus, this paper presents original research and timely discussions on the topic.