Balancing continuity and change through forms of organising

Faced with increasing environmental complexity and uncertainty, organisations have been urged to replace traditional bureaucratic structures with more flexible, responsive forms of organising. However, the emerging paradox is that exploration and experimentation, features of new forms of organising, benefit from the planning, coordinating and direction-setting mechanisms that underpin traditional forms of organising. It is therefore important to recognise the distinctive and complementary features of traditional and new forms of organising. This demands a dualities-sensitive perspective which encourages, rather than tries to resolve, a constructive tension between seemingly contradictory organising forms such as flexibility and efficiency, autonomy and control, hierarchy and networks, focus and diversification. Managing continuity and change through forms of organising becomes central to building healthy organisations.

Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement

Aim. The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement.
Background. Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis.
Method. A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005.
Findings. Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study.
Conclusion. Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.

The role of dualities in arbitrating continuity and change in forms of organizing

A substantial body of literature on new forms of organizing has forecast the end of bureaucracy. More recent empirical studies, however, indicate that high-performing organizations are adopting dual forms of organizing in which the controllability advantages associated with traditional forms work to complement and support the responsiveness attributes of new forms of organizing. The paradox is that, if organizations discard the key planning, co-ordinating and direction-setting mechanisms of traditional forms of organizing, they also remove the stabilizing dimensions of organizational form that are essential in periods of uncertainty and change. The challenge for organizations lies in learning how to manage the tensions or dualities between traditional and new forms of organizing, a process demanding the arbitration of continuity and change. This paper explores the concept of dualities and its salience in the management of organizing forms. First, the nature of dualities is explained; secondly, a set of characteristics is developed to describe the behaviour of dualities; and thirdly, suggestions are presented for arbitrating the tensions that exist in organizing form dualities. These three contributions are relevant because they signal the route to the effective creation and management of organizing form dualities, the benefit of which is the constructive combination of dynamic capabilities (underpinning innovation and responsiveness, the hallmarks of new forms of organizing) and operational capabilities (underpinning stability and efficiency, the hallmarks of traditional forms of organizing).

China's defence industries : change and continuity

Asia looks and feels very different now compared to the days of the Cold War. The sense that Asia now works differently can be traced to a single source – the re-emergence of China. China was the dominant power in greater Asia for most of recorded history. This historical norm was interrupted from the early 19th century, too far into the past to be recognisable and readily accommodated by the actors in today’s international arena. A powerful China feels new and unfamiliar.

Arriving peacefully at mutually acceptable relationships of power and influence that are very different from those that have prevailed for the past half century will be a demanding process. The world’s track record on challenges of this kind is not terrific. It will call for statesmanship of a consistently high order from all the major players, and building the strongest possible confidence among these players that there are no hidden agendas.

Contestation and continuity in educational reform : a critical study of innovations in environmental education

This study explores the notion of contestation in environmental education. Contestation is a process in which self-interested individuals and groups in a social organisation cooperate, compete and negotiate in a complex interaction aimed at solving social problems. A "framework for critique" is developed, comprising technicist, liberal

Continuity and change at C.B.C. : an ethnography of a Catholic Brothers School in Australian society

This thesis is an ethnographic investigation of a Catholic Brothers school, Christian Brothers College (C.B.C.), in the provincial city of Newburyport, Australia* The study explores the traditions and historical purposes of education at the independent, religious school, and examines the manner in which these have changed or are changing. All names, including the name of the school and the city, have been altered to preserve anonymity. The opening section discusses the emergence of the theoretical problem of the dialectic of change and continuity in the ongoing activity of C.B.C. actors. This is followed by an argument that an understanding of such activity requires an ethnographic perspective. Such a perspective, however, must not overlook the organisational and structural constraints within which participants operate. Hence, a critical ethnography, which takes account of both the agency of human actors and the structures which influence their activity, is advocated as the most suitable approach for understanding continuity and change within a complex organisation in its social context. This argument is followed by an ethnographic account of Christian Brothers College, which focuses on the perceptions and activities of teachers and administrators, Individual chapters deal with the Christian Brothers Order and its educational mission at C.B.C.; the nature of religious education at the school; the administration of the school; approaches to control and discipline; the curriculum and evaluation of pupils; and the relationship between C.B.C. and the wider Newburyport community. The concluding section integrates an analysis of continuity and change at C.B.C. with a discussion of theoretical perspectives on reproduction and transformation. The thesis concludes that, although change has occurred in many ways, an institutionalised image of C.B.C. as 'Brothers’ school'persists and impedes the formation of more democratic authority relations, curriculum, and evaluation. The potential for such change, however, is seen most strongly in the ongoing reform of religious education.

Continuity of midwifery care and gestational weight gain in obese women : a randomised controlled trial

Background: The increased prevalence of obesity in pregnant women in Australia and other developed countries is a significant public health concern. Obese women are at increased risk of serious perinatal complications and guidelines recommend weight gain restriction and additional care. There is limited evidence to support the effectiveness of dietary and physical activity lifestyle interventions in preventing adverse perinatal outcomes and new strategies need to be evaluated. The primary aim of this project is to evaluate the effect of continuity of midwifery care on restricting gestational weight gain in obese women to the recommended range. The secondary aims of the study are to assess the impact of continuity of midwifery care on: women’s experience of pregnancy care; women’s satisfaction with care and a range of psychological factors.
Methods/Design: A two arm randomised controlled trial (RCT) will be conducted with primigravid women recruited from maternity services in Victoria, Australia. Participants will be primigravid women, with a BMI≥30 who are less than 17 weeks gestation. Women allocated to the intervention arm will be cared for in a midwifery continuity of care model and receive an informational leaflet on managing weight gain in pregnancy. Women allocated to the control group will receive routine care in addition to the same informational leaflet. Weight gain during pregnancy, standards of care, medical and obstetric information will be extracted from medical records. Data collected at recruitment (self administered survey) and at 36 weeks by postal survey will include sociodemographic information and the use of validated scales to measure secondary outcomes.
Discussion: Continuity of midwifery care models are well aligned with current Victorian, Australian and many international government policies on maternity care. Increasingly, midwifery continuity models of care are being introduced in low risk maternity care, and information on their application in high risk populations is required. There is an identified need to trial alternative antenatal interventions to reduce perinatal risk factors for women who are obese and the findings from this project may have application in other maternity services. In addition this study will inform a larger trial that will focus on birth and postnatal outcomes.

Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk : the COSMOS randomised controlled trial

Objective  To determine whether primary midwife care (caseload midwifery) decreases the caesarean section rate compared with standard maternity care.

Design  Randomised controlled trial.

Setting  Tertiary-care women’s hospital in Melbourne, Australia.

Population  A total of 2314 low-risk pregnant women.

Methods  Women randomised to caseload received antenatal, intrapartum and postpartum care from a primary midwife with some care by ‘back-up’ midwives. Women randomised to standard care received either midwifery or obstetric-trainee care with varying levels of continuity, or community-based general practitioner care.

Main outcome measures  Primary outcome: caesarean birth. Secondary outcomes included instrumental vaginal births, analgesia, perineal trauma, induction of labour, infant admission to special/neonatal intensive care, gestational age, Apgar scores and birthweight.

Results  In total 2314 women were randomised–1156 to caseload and 1158 to standard care. Women allocated to caseload were less likely to have a caesarean section (19.4% versus 24.9%; risk ratio [RR] 0.78; 95% CI 0.67–0.91; P = 0.001); more likely to have a spontaneous vaginal birth (63.0% versus 55.7%; RR 1.13; 95% CI 1.06–1.21; P < 0.001); less likely to have epidural analgesia (30.5% versus 34.6%; RR 0.88; 95% CI 0.79–0.996; P = 0.04) and less likely to have an episiotomy (23.1% versus 29.4%; RR 0.79; 95% CI 0.67–0.92; P = 0.003). Infants of women allocated to caseload were less likely to be admitted to special or neonatal intensive care (4.0% versus 6.4%; RR 0.63; 95% CI 0.44–0.90; P = 0.01). No infant outcomes favoured standard care.

Conclusion  In settings with a relatively high baseline caesarean section rate, caseload midwifery for women at low obstetric risk in early pregnancy shows promise for reducing caesarean births.

Continuous plankton records stand the test of time: evaluation of flow rates, clogging and the continuity of the CPR time-series

The Continuous Plankton Recorder (CPR) survey is one of the most extensive biological time-series in existence and has been in operation over major regions of the North Atlantic since 1932. However, there is little information about the volume of water filtered through each sample, but rather a general assumption has persisted that each sample represents 3 m3. Data from electromagnetic flowmeters, deployed on CPRs between 1995 and 1998, was examined. The mean volume filtered through samples was 3.11 m3 and the effect of clogging on filtration efficiencies was not great. Consequently, even when the likely variations in flow due to clogging are taken into account, previously identified links between zooplankton abundance and climatic signals remain strong.

The intergenerational continuity of breastfeeding intention, initiation, and duration: a systematic review.

In studies investigating predictors of breastfeeding behaviors, it is not uncommon for researchers to adjust for participants' having been breastfed as an infant. This assumes an intergenerational effect of breastfeeding continuity. Our aim was to investigate the veracity of that assumption. Specifically, we sought to summarize and evaluate evidence of associations between breastfeeding in one generation and breastfeeding intentions and behaviors in the second generation.

The Nazis’ use of ‘Sieg Heil’: a point of continuity with the Völkisch movement

This historical note briefly considers the history of the phrase ‘Sieg Heil,’ using excerpts from original sources. It argues that this phrase, and the swastika, marked points of continuity with the earlier völkisch movement.

Autobiographical memory and depression: identity-continuity and problem-solving functions indirectly predict symptoms over time through psychological well-being

The aim of this study was to assess the longitudinal associations between adaptive autobiographical memory functions and depressive symptoms. Consistent with the proposed mechanisms of change underpinning cognitive-reminiscence therapy (CRT), it was hypothesised that more frequent adaptive reminiscence would lead to increases in psychological resources over time and indirectly affect depressive symptoms through this pathway. A sample of 171 young adults (mean age=25.9years, SD=3.5) completed measures of how frequently they utilised autobiographical memory for identity-continuity and problem-solving purposes, depressive symptoms and personal resources (self-esteem, self-efficacy, meaning in life and optimism) at two time-points. The results of structural equation modelling supported the model of indirect influence between reminiscence functions and depression through these psychological resources. These findings clarify the effects of adaptive autobiographical memory on depressive symptoms in young adults and indicate potential benefits of interventions such as CRT.

We're offering true play-based learning: teacher perspectives on educational dis/continuity in the early years

Educational continuity is a well-documented challenge facing the early childhood field. This research project investigated preschool and primary teachers' perspectives of educational dis/continuity, as they have been under-represented in the literature to date. The inclusion of dual-qualified educators in the sample group provided the counter-perspective of those who have trained and taught in both settings. It was found that teacher perceptions of how preschool and primary school differentiate have historical roots, and are orientated in the belief that the two settings apply incongruent approaches to teaching and learning. It was argued that gaining knowledge and experience in both settings could open up teachers' perceptions and assist them to find opportunities for improving continuity.