The complexity of social practice : understanding inertia and change in maternity care organizations

Beyond the limited efficiency and economy goals of neoliberal health policy lies the promise of genuine health services reform. In maternity care in particular, recent policy developments have sought to make the management of birth more ‘women-centred and family-friendly’. Interprofessional collaboration and greater consumer participation in policy and decision-making are key means to achieve this goal, but changing the entrenched system of medicalised birth remains difficult. Recent social contestation of maternity care has destabilised but not eradicated pervasive medical hegemony. Further reform requires analysis both of institutionalised patterns of power, and attention to the fluidity and situated knowledge shaping organisational and professional practices. Accordingly, this paper outlines a framework with which to explore the multi-layered social processes involved in implementing organisational and cultural change in maternity care. Analysis of social interventions in health systems, we suggest, can be advanced by drawing on strands from critical organization studies, complexity and critical discourse theories and social practice approaches.

Genre theory and language change in a community of practice

Business letters are complex sites of interaction. Discussions of genre theory from different disciplinary perspectives (psychology, applied linguistics, rhetoric) highlight tension between stability and change in writing as a social activity. The research extends the use of ethnographic methodology and Communities of Practice in examining writing and a writing community.

Doing things differently? : technological practice and change in higher education

Explores changes brought about by new technologies. "Technology" is seen to influence, reorder and restructure social and political relations and practices of staff. The study is intended to increase awareness of changing work practices and to encourage an informed and critical view of new technology adoption in education.

Maintaining change programmes for offenders : some suggestions for practice

Despite the widespread acceptance that follow-up or maintenance sessions are an important part of the change process for those who have completed offender rehabilitation programmes, there have been few attempts to articulate the basis upon which such sessions might be developed. This paper reviews the current theoretical and empirical literature relating to maintenance programmes, concluding that whilst there are a number of theories which might be relevant to the design of effective maintenance programmes, there is almost no empirical basis from which to make any assessment of their likely value or effectiveness.

Value-change and self-reflective practice in ecologically sustainable design

Ecologically sustainable design is a transformative design paradigm based on the theory of interdependence. This theory requires that the transformative agenda of design is holistic in practice. In effect, the requirement is for value-change on the part of the designer along with transformation of the built environment. This paper, based on recently completed research into design practice, argues that value-change rests on certainties that are drawn on intuitively while designing, and that this intuitive process is characteristic of design as praxis. It is further argued that design, as praxis, requires a phenomenological approach for inculcating value-change. A phenomenological approach relies on self-reflective practices exemplified by meditation and yoga that can focus on the designer’s ethical know-how. A model for this approach to value-change, the biopsychosocial approach, already exists within clinical medicine. This paper presents findings from interviews with key architects practising self-reflection and/or ecologically sustainable design. These highlight the premium placed by these architects on both certainty and empathy, and how these values influence design as praxis. Formalising techniques for closer scrutiny of these values will highlight design as praxis. Doing so will critically strengthen ecologically sustainable design as holistic, transformative practice.

Desistance from sex offending : motivating change, enriching practice

In this article we draw from desistance research and a strength-based rehabilitation theory, the Good Lives Model (GLM), to present a richer way of intervening with sex offenders. First, we define the concept of desistance and outline some of the major research findings concerning the factors that help offenders to cease offending. Second we briefly describe current best practice sex offender treatment and discuss its efficacy. Third, we explore the relationship between desistance research and the GLM, arguing that the GLM provides a useful conduit for desistance ideas into sex offender treatment programs. Fourth, we briefly consider the treatment implications of an integrated desistance-GLM approach.

Health promotion practice in the context of climate change

Climate change and environmental degradation caused by human activities are having an irrefutable impact on human health. This thesis by publication demonstrates that health promotion practitioners are well placed to use their professional competencies, strategies and principles to facilitate action on climate change and environmental sustainability.

Motivational interviewing techniques : facilitating behaviour change in the general practice setting

Background: One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks.

Objective: To explore current understanding regarding how and why people change, and the potential role of motivational interviewing in facilitating behaviour change in the general practice setting.

Discussion: Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. Motivational interviewing is a counselling method that involves enhancing a patient's motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient's own motivations; Listen with empathy; and Empower the patient. Recent meta-analyses show that motivational interviewing is effective for decreasing alcohol and drug use in adults and adolescents and evidence is accumulating in others areas of health including smoking cessation, reducing sexual risk behaviours, improving adherence to treatment and medication and diabetes management.

Writing groups, change and academic identity: research development as local practice

The development of the research potential of university staff has been given less attention than many other aspects of professional development, particularly teaching development. Yet there is an important need for the development of staff in the research role in the light of growth of higher education and changes to the organisation of the sector in many countries. This article examines one strategy for research development: the use of writing groups. It argues that writing is best seen as a starting point, rather than an endpoint, of the research process and hence that fostering academic writing is a useful place to do research development work. The article provides details of the use of a number of writing groups over three years in a particular faculty and explores the responses of leaders and participants. It identifies factors important in the use of this strategy and focuses on the contextual conditions required for initiatives of this kind to be effectively implemented.

The naming of child homicide offenders in England and Wales: the need for a change in law and practice

Judicial decisions about whether or not to publicly name child homicide offenders have long ani- mated debate in the United Kingdom and internationally. This article draws on case law and in- depth interviews conducted with members of the English criminal justice system to critically analyse the viability of current domestic legislation in the context of the UK’s international human rights obligations. The article identifies ambiguities surrounding the definition of ‘public interest’ in law; the merits of equating the naming of child offenders with open justice, accountability and transpar- ency; and the increasing sabotage of the principle of rehabilitation. By identifying the complexities of this contentious area of judicial discretion, this article highlights the need for a rights-based approach to decisions about publicly naming children in conflict with the law.

School innovation in science : change, culture, complexity

The School Innovation in Science (SIS) initiative has developed and evaluated a model to improve science teaching and learning across a school system. The model involves a framework for describing effective teaching and learning, and a strategy that allows schools flexibility to develop their practice to suit local conditions and to maintain ownership of the change process. SIS has proved successful in improving science teaching and learning in primary and secondary schools. Evidence of variations in the nature and extent of the change is used to argue that the process is essentially cultural in nature, and that change occurs at different levels within a school. Processes supporting change thus need to be flexible and responsive.

Metaphors are good mirrors: reflecting on change for teacher educators

In this paper we discuss the use of metaphor as an educative tool for reflection. In the instance of this paper we use metaphor to reflect on the personal images of change that were used by some women teacher educators to make sense of their professional lives and practices over the last decade. This last decade in teacher education has seen significant institutional and cultural change. The paper discusses the strengths and limitations of the use of metaphor. The different interpretations of these metaphors illustrates how these women have used metaphor for explaining facets of change in their professional lives. The challenge of professional renewal is apparent in the metaphors in the ways that complexity, change, journeys, and movement are indicated. Reflection on change in professional practice needs to be continuous. Use of metaphor in the way described in this paper encourages that ongoing process.