Evaluation of the Heart of Birmingham teaching Primary Care Trust (HoBtPCT): My Choice Weight Management Programme:report commissioned by Heart of Birmingham teaching Primary Care Trust

This report details an evaluation of the My Choice Weight Management Programme undertaken by a research team from the School of Pharmacy at Aston University. The My Choice Weight Management Programme is delivered through community pharmacies and general practitioners (GPs) contracted to provide services by the Heart of Birmingham teaching Primary Care Trust. It is designed to support individuals who are ‘ready to change’ by enabling the individual to work with a trained healthcare worker (for example, a healthcare assistant, practice nurse or pharmacy assistant) to develop a care plan designed to enable the individual to lose 5-10% of their current weight. The Programme aims to reduce adult obesity levels; improve access to overweight and obesity management services in primary care; improve diet and nutrition; promote healthy weight and increased levels of physical activity in overweight or obese patients; and support patients to make lifestyle changes to enable them to lose weight. The Programme is available for obese patients over 18 years old who have a Body Mass Index (BMI) greater than 30 kg/m2 (greater than 25 kg/m2 in Asian patients) or greater than 28 kg/m2 (greater than 23.5 kg/m2 in Asian patients) in patients with co-morbidities (diabetes, high blood pressure, cardiovascular disease). Each participant attends weekly consultations over a twelve session period (the final iteration of these weekly sessions is referred to as ‘session twelve’ in this report). They are then offered up to three follow up appointments for up to six months at two monthly intervals (the final of these follow ups, taking place at approximately nine months post recruitment, is referred to as ‘session fifteen’ in this report). A review of the literature highlights the dearth of published research on the effectiveness of primary care- or community-based weight management interventions. This report may help to address this knowledge deficit. A total of 451 individuals were recruited on to the My Choice Weight Management Programme. More participants were recruited at GP surgeries (n=268) than at community pharmacies (n=183). In total, 204 participants (GP n=102; pharmacy n=102) attended session twelve and 82 participants (GP n=22; pharmacy 60) attended session fifteen. The unique demographic characteristics of My Choice Weight Management Programme participants – participants were recruited from areas with high levels of socioeconomic deprivation and over four-fifths of participants were from Black and Minority Ethnic groups; populations which are traditionally underserved by healthcare interventions – make the achievements of the Programme particularly notable. The mean weight loss at session 12 was 3.8 kg (equivalent to a reduction of 4.0% of initial weight) among GP surgery participants and 2.4 kg (2.8%) among pharmacy participants. At session 15 mean weight loss was 2.3 kg (2.2%) among GP surgery participants and 3.4 kg (4.0%) among pharmacy participants. The My Choice Weight Management Programme improved the general health status of participants between recruitment and session twelve as measured by the validated SF-12 questionnaire. While cost data is presented in this report, it is unclear which provider type delivered the Programme more cost-effectively. Attendance rates on the Programme were consistently better among pharmacy participants than among GP participants. The opinions of programme participants (both those who attended regularly and those who failed to attend as expected) and programme providers were explored via semi-structured interviews and, in the case of the participants, a selfcompletion postal questionnaire. These data suggest that the Programme was almost uniformly popular with both the deliverers of the Programme and participants on the Programme with 83% of questionnaire respondents indicating that they would be happy to recommend the Programme to other people looking to lose weight. Our recommendations, based on the evidence provided in this report, include: a. Any consideration of an extension to the study also giving comparable consideration to an extension of the Programme evaluation. The feasibility of assigning participants to a pharmacy provider or a GP provider via a central allocation system should also be examined. This would address imbalances in participant recruitment levels between provider type and allow for more accurate comparison of the effectiveness in the delivery of the Programme between GP surgeries and community pharmacies by increasing the homogeneity of participants at each type of site and increasing the number of Programme participants overall. b. Widespread dissemination of the findings from this review of the My Choice Weight Management Project should be undertaken through a variety of channels. c. Consideration of the inclusion of the following key aspects of the My Choice Weight Management Project in any extension to the Programme: i. The provision of training to staff in GP surgeries and community pharmacies responsible for delivery of the Programme prior to patient recruitment. ii. Maintaining the level of healthcare staff input to the Programme. iii. The regular schedule of appointments with Programme participants. iv. The provision of an increased variety of printed material. d. A simplification of the data collection method used by the Programme commissioners at the individual Programme delivery sites.

Learning by exporting:lessons from high-technology SMEs

We investigate the learning by exporting hypothesis by examining the effect of exporting on the subsequent innovation performance of a sample of high-technology SMEs based in the UK. We find evidence of learning by exporting, but the pattern of this effect is complex. Exporting helps high-tech SMEs innovate subsequently, but does not make them more innovation intensive. There is evidence that consistent exposure to export markets helps firms overcome the innovation hurdle, but that there is a positive scale effect of exposure to export markets which allows innovative firms to sell more of their new-to-market products on entering export markets. Service sector firms are able to reap the benefits of exposure to export markets at an earlier (entry) stage of the internationalization process than are manufacturing firms. Innovation-intensive firms exhibit a different pattern of entry to and exit from export markets from low-intensity innovators, and this is reflected in different effects of exporting. © 2012 Elsevier Ltd.

Learning by exporting:lesson from high-technology SMEs

Theory points to the existence of a learning by exporting effect, in which exposure to export markets enhances performance through exposure to the knowledge stocks of trading partners. We investigate the learning by exporting hypothesis by examining the effect of exporting on the subsequent innovation performance of UK high-tech SMEs. We find evidence of learning by exporting, but the pattern of this effect is relatively complex. Exporting helps high-tech SMEs innovate subsequently, but does not make them more innovation intensive. There is also evidence that it is consistent exposure to export markets that helps firms overcome the innovation hurdle, but that there is a positive scale effect of exposure to export markets which allows innovative firms to sell more of their new-to-market products on entering export markets. Service sector firms are able to reap the benefits of exposure to export markets at an earlier (entry) stage of the internationalization process than are manufacturing firms. Firms producing a rapidly changing portfolio of innovative products exhibit higher churn in terms of entry to and exit from export markets than low-intensity innovators, and this is reflected in the effects of entry and exit into and out of such markets.

Network learning:an empirically-derived conceptual model of learning by groups of organizations

Building on a previous conceptual article, we present an empirically derived model of network learning - learning by a group of organizations as a group. Based on a qualitative, longitudinal, multiple-method empirical investigation, five episodes of network learning were identified. Treating each episode as a discrete analytic case, through cross-case comparison, a model of network learning is developed which reflects the common, critical features of the episodes. The model comprises three conceptual themes relating to learning outcomes, and three conceptual themes of learning process. Although closely related to conceptualizations that emphasize the social and political character of organizational learning, the model of network learning is derived from, and specifically for, more extensive networks in which relations among numerous actors may be arms-length or collaborative, and may be expected to change over time.

Network learning:Exploring learning by interorganizational networks

The importance of interorganizational networks in supporting or hindering the achievement of organizational objectives is now widely acknowledged. Network research is directed at understanding network processes and structures, and their impact upon performance. A key process is learning. The concepts of individual, group and organizational learning are long established. This article argues that learning might also usefully be regarded as occurring at a fourth system level, the interorganizational network. The concept of network learning - learning by a group of organizations as a group - is presented, and differentiated from other types of learning, notably interorganizational learning (learning in interorganizational contexts). Four cases of network learning are identified and analysed to provide insights into network learning processes and outcomes. It is proposed that 'network learning episode' offers a suitable unit of analysis for the empirical research needed to develop our understanding of this potentially important concept.

Learning in ultrametric committee machines

The problem of learning by examples in ultrametric committee machines (UCMs) is studied within the framework of statistical mechanics. Using the replica formalism we calculate the average generalization error in UCMs with L hidden layers and for a large enough number of units. In most of the regimes studied we find that the generalization error, as a function of the number of examples presented, develops a discontinuous drop at a critical value of the load parameter. We also find that when L>1 a number of teacher networks with the same number of hidden layers and different overlaps induce learning processes with the same critical points.

Social software in Higher Education:the diversity of applications and their contributions to students' learning experiences

Higher education institutions are increasingly using social software tools to support teaching and learning. Despite the fact that social software is often used in a social context, these applications can significantly contribute to the educational experience of a student. However, as the social software domain comprises a considerable diversity of tools, the respective tools can be expected to differ in the way they can contribute to teaching and learning. In this review on the educational use of social software, we systematically analyze and compare the diverse social software tools and identify their contributions to teaching and learning. By integrating established learning theory and the extant literature on the individual social software applications we seek to contribute to a theoretical foundation for social software use and the choice of tools. Case vignettes from several UK higher education institutions are used to illustrate the different applications of social software tools in teaching and learning.

Exploring the relationships between network change and network learning

This paper relates the concept of network learning - learning by a group of organizations as a group - to change and notions of change management. Derived initially from a review of literature on organizational learning (OL) and interorganizational networks, and secondary cases of network learning, the concept was evaluated and developed through empirical investigation of five network learning episodes in the group of organizations that comprises the English prosthetics service. We argue that the notion of network learning enables a richer understanding of developments in networks over extended periods of time than can be afforded through more established concepts of change and change management alone.

Learning and change in interorganizational networks:the case for network learning and network change

The ALBA 2002 Call for Papers asks the question ‘How do organizational learning and knowledge management contribute to organizational innovation and change?’. Intuitively, we would argue, the answer should be relatively straightforward as links between learning and change, and knowledge management and innovation, have long been commonly assumed to exist. On the basis of this assumption, theories of learning tend to focus ‘within organizations’, and assume a transfer of learning from individual to organization which in turn leads to change. However, empirically, we find these links are more difficult to articulate. Organizations exist in complex embedded economic, political, social and institutional systems, hence organizational change (or innovation) may be influenced by learning in this wider context. Based on our research in this wider interorganizational setting, we first make the case for the notion of network learning that we then explore to develop our appreciation of change in interorganizational networks, and how it may be facilitated. The paper begins with a brief review of lite rature on learning in the organizational and interorganizational context which locates our stance on organizational learning versus the learning organization, and social, distributed versus technical, centred views of organizational learning and knowledge. Developing from the view that organizational learning is “a normal, if problematic, process in every organization” (Easterby-Smith, 1997: 1109), we introduce the notion of network learning: learning by a group of organizations as a group. We argue this is also a normal, if problematic, process in organizational relationships (as distinct from interorganizational learning), which has particular implications for network change. Part two of the paper develops our analysis, drawing on empirical data from two studies of learning. The first study addresses the issue of learning to collaborate between industrial customers and suppliers, leading to the case for network learning. The second, larger scale study goes on to develop this theme, examining learning around several major change issues in a healthcare service provider network. The learning processes and outcomes around the introduction of a particularly controversial and expensive technology are described, providing a rich and contrasting case with the first study. In part three, we then discuss the implications of this work for change, and for facilitating change. Conclusions from the first study identify potential interventions designed to facilitate individual and organizational learning within the customer organization to develop individual and organizational ‘capacity to collaborate’. Translated to the network example, we observe that network change entails learning at all levels – network, organization, group and individual. However, presenting findings in terms of interventions is less meaningful in an interorganizational network setting given: the differences in authority structures; the less formalised nature of the network setting; and the importance of evaluating performance at the network rather than organizational level. Academics challenge both the idea of managing change and of managing networks. Nevertheless practitioners are faced with the issue of understanding and in fluencing change in the network setting. Thus we conclude that a network learning perspective is an important development in our understanding of organizational learning, capability and change, locating this in the wider context in which organizations are embedded. This in turn helps to develop our appreciation of facilitating change in interorganizational networks, both in terms of change issues (such as introducing a new technology), and change orientation and capability.

Organisational learning, climate change and the tragedy of the commons in China

This paper ends with a brief discussion of climate change and suggests that a practical solution would be to transfer much of the current air, sea and long-haul trucking of intercontinental freight between China and Europe (and the USA) to maglev systems. First we review the potential of Asian knowledge management and organisational learning and contrast this against Western precepts finding that there seems to be little incentive to 'look after one's fellows' in China (and perhaps across Asia) outside of tight personal guanxi networks. This is likely to be the case in the intense production regions of China where little time is allowed for 'organisational learning' by the staff and there is little incentive to initiate 'knowledge management' by senior managers. Thus the 'tragedy of the commons' will be enacted by individuals, township, and provincial leaders upwards to top ministers - no one will care for the climate or pollution, only for their own group and their wealth creation prospects. Copyright © 2011 Inderscience Enterprises Ltd.

Foreign direct investment, technology sourcing and reverse spillovers

Recent theoretical work points to the possibility of foreign direct investment motivated not by 'ownership' advantages which may be exploited by a multinational enterprise but by the desire to access the superior technology of a host nation through direct investment. To be successful, technology sourcing foreign direct investment hinges crucially on the existence of domestic-to-foreign technological externalities within the host country. We test empirically for the existence of such 'reverse spillover' effects for a panel of UK manufacturing industries. The results demonstrate that technology generated by the domestic sector spills over to foreign multinational enterprises, but that this effect is restricted to relatively research and development intensive sectors. There is also evidence that these spillover effects are affected by the spatial concentration of industry, and that learning-by-doing effects are restricted to sectors in which technology sourcing is unlikely to be a motivating influence.

Exporting and productivity in business services:evidence from the United States

Does exporting make firms more productive, or do more productive firms choose to become exporters? Given the amount of resources devoted by governments to supporting exporters, this is an important question. There are reasons to expect exporting to boost productivity, both through the exposure to foreign competition which exporting brings, and through ‘learning by exporting’. However, the broad thrust of previous research is that more productive firms self-select into export markets, with relatively little evidence that exporting leads to higher productivity thereafter. This paper considers the link between exporting and productivity for a sample of firms in US business services. We find that larger, more productive firms are more likely to become exporters, but that these factors do not necessarily influence the extent of exporting. This conforms with previous literature that there is a self-selection effect into exporting. We then test for the effect of exporting on productivity levels after allowing for this selection effect. We model both the relationship between exporting and productivity, and a simultaneous relationship between export intensity and productivity after allowing for selection bias. In both cases we find a clear association, indicating that productivity is positively linked both to exporting and to increased exposure to international markets.