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The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings.

Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey.

The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system.

The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue.

Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues.

Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

The purpose of this paper is to analyse the clinical outcome data collected as part of an 18-week, abstinence-based residential therapeutic community (TC) programme, Higher Ground Drug Rehabilitation Trust (Higher Ground) in New Zealand. Lessons and implications for routine collection of clinical outcome data are identified.

Higher Ground collects longitudinal data on all consenting clients using a battery of validated psychometric tools, with repeated measures at up to nine points in time from first presentation through to 12-month post-discharge follow up. Data analysis covered clients who entered Higher Ground between 1 July 2012 and 2 June 2015 (n=524).

Clients presented with histories of addiction which often had significant negative associations with their physical and psychological health, their relationships, work, accommodation and criminal behaviour. By the time they exited the programme, clinically and statistically significant improvements were seen across multiple indicators including: substance use and abstinence; symptoms of post-traumatic stress disorder, depression, anxiety and stress; and a range of social indicators.

Attrition in follow-up research is a significant challenge, with people completing the TC programme being more likely to participate than those who do not. This limits generalizability in post-discharge data. There was no control group, making causal attribution a challenge. Identifying suitable benchmarks from the literature is challenging because of the variety of outcome measures and research methodologies used.

Tracking client outcomes longitudinally using psychometric tools is potentially valuable for TCs and their funding bodies, as it provides insights into patterns of client recovery that can inform ongoing service improvements and resource allocation decisions. However, significant challenges remain.

The study demonstrates the value, and practical challenges, of collecting high-quality outcome data in a TC setting.

The purpose of this paper is to get a consumer’s cross-cultural insight on the potential of using social networking sites as short food supply chains.

A qualitative approach, using free listing tasks and sentence completion techniques, was adopted in this research. The research group decided to apply the study in three countries with different cultural backgrounds, namely, Mexico, Spain and Egypt. The final sample consisted of 424 respondents in total, including 209 Spanish, 111 Mexicans and 104 Egyptians, all of them actual users of social networks.

The most significant result that emerges from this study is that a high percentage of consumers within the three countries might be interested in these new short food chains. Also, the study offers food companies the most relevant motivations and barriers of consumers for their engagement to this initiative. Also, the study provides categories of foods that consumers would purchase via these chains in each country.

The multicultural perspective of this study might open new opportunities for food businesses around the world, especially for SMEs, to develop new short food supply chains enabling them to increase sale levels and, therefore, increase profitability and reduce costs.

Identity has emerged as a compelling force in understanding leadership. Situated within the identity approach to leadership, this study explored identity within the context of leadership for both assigned (i.e., positional) and emergent (i.e., nonpositional) student leaders. Findings from this study suggest that a distinct set of a leader’s identities is active in college student leadership and that personal identities are most salient to leaders. By making connections between identity and leadership, educators and practitioners may strengthen their understanding of how their curriculum and workshops may serve as identity workspaces for leaders.

In 1967, Robert N. Bellah famously argued that there existed an “American Civil Religion,” which was distinct from churchly religion and captured the “transcendental” dimension of the American project. In this chapter, I revisit the civil religion concept and reconstruct it along more Weberian lines. Specifically, I argue that the civil religion tradition is one of three competing traditions for thinking about the proper relationship between religion and politics in America; the other two are religious nationalism and liberal secularism. Whereas liberal secularism envisions a complete separation of the religious and political value spheres, and religious nationalism longs for their (re)unification, civil religion aims for a mediating position of partial separation and productive tension. Following Bellah, I argue that the two central strands of the civil religion tradition have been covenant theology and civic republicanism. The body of the chapter sketches out the development of the tradition across a series of national foundings and refoundings, focusing on the writings of leading civil theologians from John Winthrop and John Adams through Abraham Lincoln and John Dewey to Martin King and Barack Obama. The conclusion advances a normative argument for American civil religion – and against liberal secularism and religious nationalism. I contend that liberalism is highly inclusive but insufficiently solidaristic; that religious nationalism is highly solidaristic but insufficiently inclusive; and that only civil religion strikes a proper balance between individual autonomy and the common good.

This chapter considers the place of responsibility in confronting ecological sustainability and social equity problems in the food system. We present two illustrations addressing the following question: In what ways does responsibility present a way to close the metabolic rift in line with the vision of the global food sovereignty movement? First, using the example of Metro-Vancouver in Canada, we consider the ways in which urban people claim responsibility for land protection through the concept of urban agrarianism, defined as an urban ethic of care for foodlands, with an associated responsibility to exercise solidarity with those who cultivate and harvest food. Second, we discuss how deepening relational responsibility in legal and regulatory frameworks might hold the corporate food regime accountable in the Canadian context to address their role in and responsibility for mitigating an increasingly risky world, as evidenced by the COVID-19 pandemic. We argue that the responsibility of urban people to mobilise in solidarity with food movements, and against the corporate food regime in particular, will play a critical role in supporting the transition to sustainable and just food systems. This applies both to finding new ways to claim responsibility for this transition and to hold those actors that have disproportionately benefitted from the corporate food regime responsible. Such a reworking of responsibility is especially necessary as the context for food systems change becomes increasingly urbanised and risky.

The author argues that we must stop and take a look at what our insistence on human labour as the basis of our society is doing to us, and begin to search for possible alternatives. We need the vision and the courage to aim for the highest level of technology attainable for the widest possible use in both industry and services. We need financial arrangements that will encourage people to invent themselves out of work. Our goal, the article argues, must be the reduction of human labour to the greatest extent possible, to free people for more enjoyable, creative, human activities.

Wonders whether companies actually have employees best interests at heart across physical, mental and spiritual spheres. Posits that most organizations ignore their workforce – not even, in many cases, describing workers as assets! Describes many studies to back up this claim in theis work based on the 2002 Employment Research Unit Annual Conference, in Cardiff, Wales.

SEPTEMBER, by a traditional impulse, has always represented to some minds the beginning of the most active period in the library year. This year the month that sees the close of the holiday season, the shortening day and lengthening evening, holds fairer promises and greater difficulties than any in the past six years or perhaps in the past twenty‐five. It sees large programmes in prospect but many fences to be surmounted and, if the physicists are right, the beginning of a new era. It is doubtful if, in so short a space of time as that which has elapsed since we last wrote, so many important events have occurred. The entirely new political alignment may have its effects on our post‐war policy. We hope the library will never again be the protege of a political party because that means that it becomes thereby the target of the opposition—as was the case when in London a change of party in local government brought about the wreck for a generation of at least one library service which had the misfortune to have been initiated by the other party. We have however, no immediate apprehensions about public libraries in present circumstances.