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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.

Unicorn and STILAS are multiuser client/server systems developed in and for the Unix environment to automate all aspects of information management, from cataloging and authority control to intelligent access of non‐SIRSI databases. In keeping with the client/server concept, SIRSI has introduced a graphical user interface (GUI) to Unicorn and STILAS. The SIRSI system provides a path to information both inside and outside the library. SIRSI provides a standard interface, an “Intelligent Interface” client to diverse database systems and other vendors' library automation systems. SIRSI's Reference Database Managers provide an intelligent connection to locally mounted reference databases. SIRSI's VIZION, a stand‐alone desktop client, provides an automatic graphical user interface to hundreds of online sources of information and services available through the Internet and via modem. Furthermore, SIRSI has recently introduced WebCat, which facilitates mounting and access to the complete catalogs and other services of libraries over the Internet's World Wide Web.

Consumer confusion is an often discussed, but seldom investigated, construct central to marketing. This study aims to conceptualize consumer confusion as an intellectual emotion with cognitive and emotional components, and examine it in the context of qualified health claims and conflicting marketplace information.

A between-subjects experimental design is used to test the hypotheses.

Structural equation modeling suggests that weak science discussions and conflicting information on dietary supplements evoke consumer confusion. Confusion, in turn, impacts scientific certainty perceptions, product quality and firm credibility. Incorporating confusion measures in theoretical models significantly increases the amount of variance explained in consumer perceptions. Implications are offered for businesses, consumer behaviorists and public policymakers.

It is hard to think about many of marketing’s focal issues (e.g. trademark theory, disclosures and warnings, advertising deception, search and shopping behavior) without using the term confusion. While confusion is central to discussions of these domains, it has evaded focused attention and study. Indeed, no previous research in marketing has directly addressed the experience of consumer confusion per se. The current research fills a gap in the marketing literature by explicitly defining the construct of confusion and offering a measurement approach that is easily adapted to many business/consumer interactions. Furthermore, the authors demonstrate the role of confusion in the context of qualified health claims by showing how conflicting information between health claims, qualifiers and external information can create confusion, and in turn, lead to negative consumer perceptions.

This case is best taught in a first-year MBA finance course and with a series of cases based on cash flow analysis. Its primary objective is to portray the major differences in project analysis for nonprofit organizations compared to for-profit companies and to highlight the unique issues relevant in a health care environment. Students must decide, based on cash flow analysis and nonfinancial factors, whether or not to propose a long-term acute care hospital (LTAC) project to the board of directors of the U. Va. Health System. Students must use the assumptions outlined in the case to create a cash flow analysis and then compute a net present value (NPV) calculation and internal rate of return (IRR) for the project. After assessing the base-case results and sensitivity analysis of the assumptions driving those results, students must decide if the project should be taken to the board of directors.

The study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of cancer care pathways; to highlight any interrelating factors; to find gaps in the literature concerning areas of research; to summarise the strategies and recommendations implemented in the studies.

The study used a qualitative approach and developed a causal loop diagram to summarise the current literature on cancer care pathways, from screening and diagnosis to treatment. A total of 46 papers was finally included in the analysis, which highlights the recurring themes in the literature.

The study highlights the myriad areas of research applied to cancer care pathways. Factors influencing the delivery of cancer care pathways were classified into different albeit interrelated themes. These include access barriers to care, hospital emergency admissions, fast track diagnostics, delay in diagnosis, waiting time to treatment and strategies to increase system efficiency.

As far as the authors know, this is the first study to present a visual representation of the complex relationship between factors influencing the delivery of cancer care pathways.

The purpose of this paper is to provide insights into cross‐cultural conflicts and their management in ecclesiastical organizations in Tanzania. It aims at increasing the understanding of these complexities from an emic perspective of employees with a Christian background, thereby providing in‐depth information on the topic. These new insights provide fresh ideas for further research on this topic in the Tanzanian context.

Qualitative data were selected from a more comprehensive case study carried out in multiple governmental, educational, ecclesiastical and economic organizations in Tanzania. The case study was based on phenomenological and interpretative paradigms and hermeneutical interpretations using qualitative methodology including in‐depth interviews and observation during field stays, as well as documentary and secondary analysis.

The findings show that senior management staff of ecclesiastical organizations function as mediators for conflicting parties to regain harmony and peace through third‐party intervention and spiritual self‐development. Mediation in ecclesiastical organizations is mainly used in relationship conflicts, employment conflicts and church re‐structuring processes. It supports the resolution of value conflicts between the conflict parties and the environment and at the same time re‐constructs religious and Christian values and concepts, such as the concept of “Shalom” and “creating lobe” and thereby re‐enforces spiritual integrity and the reality of the church.

The findings are not generalizable and are limited to this specific research context. Findings should be verified by follow‐up studies which expand the content, the context and the methodological approach of this study. These findings should be viewed as exploratory research findings and as highly contextual and sample‐bound.

The paper describes the practical implications for further research relating to future research topics for researchers interested in the field of cross‐cultural conflict management in ecclesiastical organizations in Tanzania.

The authors present original data and provide new insights into managing conflicts in Tanzanian ecclesiastical organizations through mediation.

The role of implicit provider bias in mental health care is an important issue that continues to be of concern in the twenty-first century for the Black/African American community. Access to mental health and quality care remains elusive as members of this social group lack access to mental health screening, diagnosis, and attention due to institutional and cultural barriers. Supporting the position that implicit and explicit provider bias exists in the mental health profession, this chapter will explore how implicit provider bias is an intractable institutional barrier that prevents Black/African Americans from accessing mental health and quality care. A review of the implications related to mental health outcomes with Black/African American clients will also be explored.

A brief overview of the Black/African American cultural responses to implicit provider bias will be discussed later in this chapter. There will be an exploration of the ways to help identify, address, and eliminate implicit provider bias using evidence-based personal and community engagement strategies that promote mental health wellness within the Black/African American community. Implications for best practices in Black/African American mental health will also be addressed to eradicate the risk of unethical or medical malpractice with Black/African American clients, reduce the mental health disparity experienced by Blacks/African Americans, and create mental health equity for this population.

This chapter explores a common, but typically overlooked urban practice: smoking outside the workplace. This activity is analysed as an attempt to create marginal spaces of brief retreat from the acceleration and agitation of the workplace. By talking to smokers about what drives them into the street, and capturing smokers photographically, we discover that these people are seeking moments of breakaway from the dominating involvement of the commercial city. The practices we observe in this chapter are typical of what Erving Goffman refers to as ‘away’ activities: strategies for briefly escaping from the absorption of all-consuming social situations. We conclude by asking whether these urban pauses could be stretched to a point where they challenge the compulsion of the overwrought rhythmic order of the capitalist city.

The purpose of this paper is to call for strong medical co-leadership in transforming the Australian health system. The paper discusses how Health LEADS Australia, the Australian health leadership framework, offers an opportunity to engage medical clinicians and doctors in the leadership of health services.

The paper first discusses the nature of medical leadership and its associated challenges. The paper argues that medical leaders have a key role in the design, implementation and evaluation of healthcare reforms, and in translating these reforms for their colleagues. Second, this paper describes the origins and nature of Health LEADS Australia. Third, this paper discusses the importance of the goal of Health LEADS Australia and suggests the evidence-base underpinning the five foci in shaping medical leadership education and professional development. This paper concludes with suggestions on how Health LEADS Australia might be evaluated.

For the well-being of the Australian health system, doctors need to play an important role in the kind of leadership that makes measurable differences in the retention of clinical professions; improves organisational cultures; enhances the engagement of consumers and their careers; is associated with better patient and public health outcomes; effectively addresses health inequalities; balances cost effectiveness with improved quality and safety; and is sustainable.

This is the first article addressing Health LEADS Australia and medical leadership. Australia is actively engaging in a national approach to health leadership. Discussions about the mechanisms and intentions of this are valuable in both national and global health leadership discourses.