Regulation and innovation: Rethinking 'inclusive' housing design

The Lifetime Homes (LTH) concept initiated in 1989 by the Helen Hamlyn Trust, and subsequently promoted by the Joseph Rowntree Foundation, emerged at a point when there was growing awareness of the decline of both private and public sector housing quality, especially in relation to floorspace standards (Karn & Sheridan, 1994). LTH were intended to offset the concerns of first, the house buying public of the appearance and affordability of homes suitable for successive generations, second, the private house building industry of the cost and marketability of incorporating 'inclusive' design features, and third, Registered Social Landlords (RSLs), who had to balance cost constraints with addressing the needs of a growing number of households with older and/or disabled people. Approved Document Part M of the building regulations was extended in 1999, from public buildings to private dwellings, and currently requires that all new housing meet minimal 'visitability' criteria. Indeed, although the signs are that Part M will be incrementally extended to comprise LTH principles, the paper argues that in their existing form they are insufficient to act as a key component of the government's 'new agenda for British housing'. This paper therefore explores how they might usefully be expanded from an approach, largely based on compromise, to one that inspires innovative, flexible and inclusive house forms, which also challenge design conventions.

Reaching for the skies: Time and turbulence in digital technologies and practices

This research examines dynamics associated with new representational technologies in complex organizations through a study of the use of a Single Model Environment, prototyping and simulation tools in the mega-project to construct Terminal 5 at Heathrow Airport, London. The ambition of the client, BAA. was to change industrial practices reducing project costs and time to delivery through new contractual arrangements and new digitally-enabled collaborative ways of working. The research highlights changes over time and addresses two areas of 'turbulence' in the use of: 1) technologies, where there is a dynamic tension between desires to constantly improve, change and update digital technologies and the need to standardise practices, maintaining and defending the overall integrity of the system; and 2) representations, where dynamics result from the responsibilities and liabilities associated with sharing of digital representations and a lack of trust in the validity of data from other firms. These dynamics are tracked across three stages of this well-managed and innovative project and indicate the generic need to treat digital infrastructure as an ongoing strategic issue.

Visual practices and the objects of design

Recent interest in material objects - the things of everyday interaction - has led to articulations of their role in the literature on organizational knowledge and learning. What is missing is a sense of how the use of these 'things' is patterned across both industrial settings and time. This research addresses this gap with a particular emphasis on visual materials. Practices are analysed in two contrasting design settings: a capital goods manufacturer and an architectural firm. Materials are observed to be treated both as frozen, and hence unavailable for change; and as fluid, open and dynamic. In each setting temporal patterns of unfreezing and refreezing are associated with the different types of materials used. The research suggests that these differing patterns or rhythms of visual practice are important in the evolution of knowledge and in structuring social relations for delivery. Hence, to improve their performance practitioners should not only consider the types of media they use, but also reflect on the pace and style of their interactions.

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.