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The purpose of this paper is to present a case study of the World Health Organization’s Global Healthcare Workforce Alliance (GHWA). Based on a commissioned evaluation of GHWA, it applies network theory and key concepts from systems thinking to explore network emergence, effectiveness, and evolution to over a ten-year period. The research was designed to provide high-level strategic guidance for further evolution of global governance in human resources for health (HRH).

Methods included a review of published literature on HRH governance and current practice in the field and an in-depth case study whose main data sources were relevant GHWA background documents and key informant interviews with GHWA leaders, staff, and stakeholders. Sampling was purposive and at a senior level, focusing on board members, executive directors, funders, and academics. Data were analyzed thematically with reference to systems theory and Shiffman’s theory of network development.

Five key lessons emerged: effective management and leadership are critical; networks need to balance “tight” and “loose” approaches to their structure and processes; an active communication strategy is key to create and maintain support; the goals, priorities, and membership must be carefully focused; and the network needs to support shared measurement of progress on agreed-upon goals. Shiffman’s middle-range network theory is a useful tool when guided by the principles of complex systems that illuminate dynamic situations and shifting interests as global alliances evolve.

This study was implemented at the end of the ten-year funding cycle. A more continuous evaluation throughout the term would have provided richer understanding of issues. Experience and perspectives at the country level were not assessed.

Design and management of large, complex networks requires ongoing attention to key issues like leadership, and flexible structures and processes to accommodate the dynamic reality of these networks.

This case study builds on growing interest in the role of networks to foster large-scale change. The particular value rests on the longitudinal perspective on the evolution of a large, complex global network, and the use of theory to guide understanding.

This article explores issues of trust in narratives of interpreted consultations in primary health care.

The paper is based on empirical data from a qualitative study of accounts of interpreted consultations in UK primary care, undertaken in three north London boroughs. In a total of 69 individual interviews and two focus groups, narratives of interpreted consultations were sought from 18 service users, 17 professional interpreters, nine family member interpreters, 13 general practitioners, 15 nurses, eight receptionists, and three practice managers. The study collected and analysed these using a grounded theory approach and taking the story as the main unit of analysis. It applies a theoretical model that draws on three key concepts: Greener's taxonomy of trust based on the different “faces” of power in medical consultations; Weber's notion of bureaucratic vs traditional social roles; and Habermas' distinction between communicative and strategic action.

Trust was a prominent theme in almost all the narratives. The triadic nature of interpreted consultations creates six linked trust relationships (patient‐interpreter, patient‐clinician, interpreter‐patient, interpreter‐clinician, clinician‐patient and clinician‐interpreter). Three different types of trust are evident in these different relationships – voluntary trust (based on either kinship‐like bonds and continuity of the interpersonal relationship over time, or on confidence in the institution and professional role that the individual represents), coercive trust (where one person effectively has no choice but to trust the other, as when a health problem requires expert knowledge that the patient does not have and cannot get) and hegemonic trust (where a person's propensity to trust, and awareness of alternatives, is shaped and constrained by the system so that people trust without knowing there is an alternative). These different types of trust had important implications for the nature of communication in the consultation and on patients' subsequent action.

The methodological and analytic approach, potentially, has wider applications in the study of other trust relationships in health and social care.

Quality in the interpreted consultation cannot be judged purely in terms of accuracy of translation. The critical importance of voluntary trust for open and effective communication, and the dependence of the latter on a positive interpersonal relationship and continuity of care, should be acknowledged in the design and funding of interpreting services and in the training of both clinicians, interpreters and administrative staff.

This is the first study in which interpreted consultations have been analysed from a perspective of critical sociology with a particular focus on trust and power relations.

The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues.

The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts.

Six guiding principles were identified: align vision and action; make incremental changes within a comprehensive transformation strategy; foster distributed leadership; promote staff engagement; create collaborative relationships; and continuously assess and learn from change. These principles interact with contextual elements such as local power distributions, pre-existing values and beliefs and readiness to engage. Mechanisms influencing how these principles sustain cultural change include activation of a shared sense of urgency and fostering flexible levels of engagement.

The principles identified in this review, along with the contexts and mechanisms that influence their effectiveness, are useful domains for policy and practice leaders to explore when grappling with cultural change. These principles are sufficiently broad to allow local flexibilities in adoption and application.

This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.

This chapter considers the usefulness and validity of public inquiries as a source of data and preliminary interpretation for case study research. Using two contrasting examples – the Bristol Inquiry into excess deaths in a children’s cardiac surgery unit and the Woolf Inquiry into a breakdown of governance at the London School of Economics (LSE) – I show how academics can draw fruitfully on, and develop further analysis from, the raw datasets, published summaries and formal judgements of public inquiries.

Academic analysis of public inquiries can take two broad forms, corresponding to the two main approaches to individual case study defined by Stake: instrumental (selecting the public inquiry on the basis of pre-defined theoretical features and using the material to develop and test theoretical propositions) and intrinsic (selecting the public inquiry on the basis of the particular topic addressed and using the material to explore questions about what was going on and why).

The advantages of a public inquiry as a data source for case study research typically include a clear and uncontested focus of inquiry; the breadth and richness of the dataset collected; the exceptional level of support available for the tasks of transcribing, indexing, collating, summarising and so on; and the expert interpretations and insights of the inquiry’s chair (with which the researcher may or may not agree). A significant disadvantage is that whilst the dataset collected for a public inquiry is typically ‘rich’, it has usually been collected under far from ideal research conditions. Hence, while public inquiries provide a potentially rich resource for researchers, those who seek to use public inquiry data for research must justify their choice on both ethical and scientific grounds.

The study aims to analyze the previous literature on government initiatives to implement health information systems (HISs).

Proknow-C (Knowledge Development Process-Constructivist) was used in the selection of the literature and in the bibliometric and systematic analysis.

The research identified a portfolio composed of 33 articles aligned with the research theme and with scientific recognition, as well as periodicals, authors, papers and keywords that stood out the most. Amongst the government initiatives in the 24 identified countries, England has been the most studied nation, and there is a certain prominence of research arising from developed countries. Electronic health records (EHRs) have been the most explored technology. Efficiency and safety of health care delivery, integration of information and among health organizations, cost reduction and economicity are the most expected benefits from government programs. The difficulties found are related to the broader context in which the system is inserted, to the management of the program, to technology itself and to individuals. The most emphasized difficulties identified in most countries were previous context marked by a lack of standardization/interoperability, acceptance of providers and users and project financing. The findings of the present article provide a theoretical framework for future studies, in addition to yielding a replicable process for future use.

This research may be considered original as it analyzes – through a constructivism-structured process (Proknow-C) – the phenomenon under investigation by gathering bibliometric and systematic review data concomitantly. The countries and technologies reported emerge from the process itself.

How is medical knowledge produced and what are the implications of that knowledge production for medical practice? Using theoretical ideas on evidence-based medicine, standardization in medical research and practice, and biopower, I examine the relationship between medical knowledge and medical practice through the case of pelvic pain care in the US.

Data from ethnographic observations at two medical conferences as well as interviews with healthcare providers inform a critical analysis of the medical discourse.

The analysis reveals how evidence-based medicine is practiced in the context of medical conditions that lack objective evidence, as well as the unintended consequences of such practices. I provide an alternative approach to medical practice for conditions lacking traditional evidence through presenting outlier cases in the data.

In doing so, I make the broad theoretical argument that biomedical paradigms must emerge through the critical process of negative dialectics in order to reach past the limits of standardized medical care.

In sociologically analyzing the case of pelvic pain care, I reveal dire limits in the evidence-based approach to medical care for conditions and symptoms that may be deemed medical anomalies, demanding an alternative approach to care for such conditions.