Pre-conception care : current practice and methods of provision

This thesis examines the present provisions for pre-conception care and the views of the providers of services. Pre-conception care is seen by some clinicians and health educators as a means of making any necessary changes in life style, corrections to imbalances in the nutritional status of the prospective mother (and father) and the assessment of any medical problems, thus maximizing the likelihood of the normal development of the baby. Pre-conception care may be described as a service to bridge the gap between the family planning clinic and the first ante-natal booking appointment. There were three separate foci for the empirical research - the Foresight organisation (a charity which has pioneered pre-conception care in Britain); the pre-conception care clinic at the West London Hospital, Hammersmith; and the West Midlands Regional Health Authority. The six main sources of data were: twenty five clinicians operating Foresight pre-conception clinics, couples attending pre-conception clinics, committee members of the Foresight organisation, staff of the West London Hospital pre-conception clinic, Hammersmith, District Health Education Officers working in the West Midlands Regional Health Authority and the members of the Ante-Natal Care Action Group, a sub-group of the Regional Health Advisory Group on Health Promotion and Preventive Medicine. A range of research methods were adopted. These were as follows: questionnaires and report forms used in co-operation with the Foresight clinicians, interviews, participant observation discussions and informal meetings and, finally, literature and official documentation. The research findings illustrated that pre-conception care services provided at the predominantly private Foresight clinics were of a rather `ad hoc' nature. The type of provision varied considerably and clearly reflected the views held by its providers. The protocol which had been developed to assist in the standardization of results was not followed by the clinicians. The pre-conception service provided at the West London Hospital shared some similarities in its approach with the Foresight provision; a major difference was that it did not advocate the use of routine hair trace metal analysis. Interviews with District Health Education Officers and with members of the Ante Natal Care Action Group revealed a tentative and cautious approach to pre-conception care generally and to the Foresight approach in particular. The thesis concludes with a consideration of the future of pre-conception care and the prospects for the establishment of a comprehensive pre-conception care service.

An examination of organisational issues in third sector organisations which undertake nonviolent direct action

This thesis is an examination of organisational issues faced by Third Sector organisations which undertake nonviolent direct action. A case study methodology is employed and data gathered from four organisations: Earth First!; genetiX Snowball; Greenpeace; and Trident Ploughshares. The argument commences with a review of the literature which shows that little is known of the organising of nonviolent direct action. Operational definitions of 'organisation' and 'nonviolent direct action' are drawn from the literature. 'Organisation' is conceptualised using new institutionalism. 'Nonviolent direct action' is conceptualised using new social movement theory. These concepts inform the case study methodology in the choice of case, the organisations selected and the data gathering tools. Most data were gathered by semi-structured interview and participant observation. The research findings result from theory-building arising from thick descriptions of the case in the four organisations. The findings suggest that nonviolent direct action is qualitatively different from terrorism or violence. Although there is much diversity in philosophies of nonviolence, the practice of nonviolent direct action has much in common across the four organisations. The argument is that nonviolent direct action is an institution. The findings also suggest that new institutionalism is a fruitful approach to studies of these organisations. Along with nonviolent direct action, three other institutions are identified: 'rules'; consensus decision-making; and 'affinity groups'. An unanticipated finding is how the four organisations are instances of innovation. Tentative theory is developed which brings together the seemingly incompatible concepts of institutions and innovation. The theory suggests preconditions and then stages in the development of new organisational forms in new social movements: innovation. The three pre-conditions are: the existence of an institutional field; an 'institution-broker' with access to different domains; and a shared 'problem' to resolve. The three stages are: unlocking existing knowledge and practice; bridging different domains of practice or different fields to add, develop or translocate those practices; and establishing those practices within their new combinations or novel locations. Participants are able to move into and between these new organisational forms because they consist of familiar and habitual institutional behaviour.

Strategic planning as communicative process

This thesis looks at the construction of a strategic plan within a British university (Unico). After a change in leadership, the well-known strategic planning sequence was adopted to set directions according to Unico’s three Missions, followed by the development of respective goals and measures. The evolving strategic content coincided with the development of Unico’s strategic plan. I was able to follow Unico’s planning efforts over 10 months, from first planning meeting to completion of its strategic plan. The main data source provided non-participant observation (n = 25) and ten versions of Unico’s strategic plan. Additionally, seventy-six interviews were held with participants at various points. In order to examine the strategic plan’s construction, I reconceptualised strategic planning as a communicative process consisting of oral talk and written text. Through this interplay strategic planning activities come in to being. Such reconceptualisation provided a conceptual framework to study the in situ interactions without neglecting contextual characteristics embedding the communicative process. Strategic plans are currently seen as promoting inflexibility and reinforcing the institutional nature of formal strategic planning. Adopting dialogism, as advocated by Bakhtin and Ricoeur, this research provides novel insights into the dialogic of strategy talk and strategy text, such as a strategic plan. Findings illustrated that a strategic plan production cycle provided a meaning making platform for its participants. Through recurrently amending the plan, its content became increasingly specific while at the same time reflecting agreed terminology. This thesis offers an alternative view on strategic planning, elaborates on the strategy-as-practice perspective, focusing on the under-explored area of individuals’ interactions at the micro level, and elaborates on the dialogic of text and agency/conversation, distinguishing between talk and text.

Market-driven strategies and the design of flexible production systems: evidence from the electronics industry

Links the concept of market-driven business strategies with the design of production systems. It draws upon the case of a firm which, during the last decade, changed its strategy from being “technology led” to “market driven”. The research, based on interdisciplinary fieldwork involving long-term participant observation, investigated the factors which contribute to the successful design and implementation of flexible production systems in electronics assembly. These investigations were conducted in collaboration with a major computer manufacturer, with other electronics firms being studied for comparison. The research identified a number of strategies and actions seen as crucial to the development of efficient flexible production systems, namely: effective integration of subsystems, development of appropriate controls and performance measures, compatibility between production system design and organization structure, and the development of a climate conducive to organizational change. Overall, the analysis suggests that in the electronics industry there exists an extremely high degree of environmental complexity and turbulence. This serves to shape the strategic, technical and social structures that are developed to match this complexity, examples of which are niche marketing, flexible manufacturing and employee harmonization.

Dancing for women:subverting heteronormativity in a lesbian erotic dance space?

This article utilises participant observation, interview and collaborative visual data, collected with women erotic dancers, management and customers, to ascertain how far heteronormativity is subverted in a UK lesbian leisure space, Lippy (the name is a pseudonym), which provides erotic dance for women customers. The potential for a female 'gaze', the 'normativity' of gendered and sexualised bodies, and the notion of a 'women's space' are taken as areas for analysis. Women's engagement with erotic dance is complex, and this article examines the connections between sexual agency and gendered power relations, questioning how far women can exercise autonomous sexual expression in commercial sexual encounters. © The Author(s) 2012.

A KM perspective on implementing an electronic patient record within an NHS hospital

The Electronic Patient Record (EPR) is being developed by many hospitals in the UK and across the globe. We class an EPR system as a type of Knowledge Management System (KMS), in that it is a technological tool developed to support the process of knowledge management (KM). Healthcare organisations aim to use these systems to provide a vehicle for more informed and improved clinical decision making thereby delivering reduced errors and risks, enhanced quality and consequently offering enhanced patient safety. Finding an effective way for a healthcare organisation to practically implement these systems is essential. In this study we use the concept of the business process approach to KM as a theoretical lens to analyse and explore how a large NHS teaching hospital developed, executed and practically implemented an EPR system. This theory advocates the importance of taking into account all organizational activities - the business processes - in considering any KM initiatives. Approaching KM through business processes allows for a more holistic view of the requirements across a process: emphasis is placed on how particular activities are performed, how they are structured and what knowledge demanded and not just supplied across each process. This falls in line with the increased emphasis in healthcare on patient-centred approaches to care delivery. We have found in previous research that hospitals are happy with the delivery of patient care being referred to as their 'business'. A qualitative study was conducted over a two and half year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non- participant observation of meetings and documentary data. We believe that the inclusion of patients within the study may well be the first time this has been done in examining the implementation of a KMS. The theoretical propositions strategy was used as the overarching approach for data analysis. Here Initial theoretical research themes and propositions were used to help shape and organise the case study analysis. This paper will present preliminary findings about the hospital's business strategy and its links to the KMS strategy and process.

Latin Americans in London:language, integration and ethnic identity

This thesis studies the links between language, migration and integration in the context of the 'new migrant' group of Latin Americans in London. It reviews the many ways in which language impacts the integration processes of migrants by influencing people's access to jobs, services, social contacts and information. By focusing on migrants' experiences this research also investigates the ways in which language and identity articulate, as well as the affective variables that are at play in the acquisition of the local language. With a large sector trapped in a cycle of poor command of English and labour market disadvantage, many Latin Americans experience exclusion and poverty. In reaction to this, a sector of the community is campaigning for ethnic minority recognition. This work reviews the debates for recognition and the strategy of organising around ethnicity, paying special attention to the role language plays in the process. The study is based on over two and half years of qualitative research, which included interviews, surveys, and long-term participant observation within a community organisation and a recognition campaign. Its interdisciplinary perspective allows the recognition of both the intimate links between language and identity, as well as the social and structural forces that influence migrants' linguistic integration. It unveils the practical and symbolic value that the mother tongue has for Latin American migrants and provides a broader account of their experiences. This research calls attention to the need for a more comprehensive approach to the study of language and migration in order to acknowledge the affective and social factors involved in the linguistic practices of migrants. By studying the community's struggles for recognition, this work evidences both the importance of visibility for minority groups in London and the intrinsic methodological limitations of monitoring through ethnic categorisation.

Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods.

(Re)inventing the past: the politics of 'national' history in the Ukrainian classroom

This article examines how the Ukrainian state has used, and continues to use, history to forge collective identities in Ukraine. It assesses how history textbooks are utilised by the state as ‘tools’ to introduce schoolchildren to key historical episodes around which a modern Ukrainian national identity can be shaped. Attempts to ‘historicise’ Ukrainian national identity must answer fundamental questions such as: Who are we? Where have we come from? Where are we going? Who are we not? The final question is vital in understanding ‘who we are’ in comparison to the ‘other’. Thus, emphasis is placed on how the Ukrainian state is attempting to form an all-encompassing Ukrainian identity by distancing itself from Russia. The article argues that while a ‘national’ history is being espoused, a ‘regional politics of the textbook’ is subtly being allowed by the state to develop. This stands at odds with state attempts to create one universal, all-encompassing Ukrainian history.

Contestation and negotiation: regionalism and the politics of school textbooks in Ukraine's eastern borderlands

This paper aims to explore the (re)construction of identities in three regions adjacent to the Russian–Ukrainian border. The article analyses the areas' historical and political development and argues that placing such areas within a mega-region term such as ‘eastern Ukraine’ fails to recognise important differences between them. Content analysis of regional history textbooks reveals that the ‘official’ state historical narrative found in school history textbooks is heavily negotiated, with regional elites in each area ‘picking and choosing’ which parts of the ‘official’ state narrative to accept and which parts to reject. In this way, the article demonstrates how the notions of ‘inclusion’ and ‘exclusion’ are highly debated topics in the Ukrainian classroom as the central and local state elites are both part of the dynamic process of (re)definition of national identities.

Nation, region and history in post-communist transitions:identity politics in Ukraine, 1991-2006

Since independence in 1991, issues of nation and identity have become highly debated topics in Ukraine. This monograph explores not only how national identity is being (re)constructed by the Ukrainian state, but also the processes by which it is negotiated through society. The central argument of this work is that too much attention, concerning identity in Ukraine, has focused on markers of ethnicity and language. Instead, the author advocates a regional approach, engaging with the issue of how Ukraine's regional differences affect nation-building processes. Following the tumultuous events of the 'Orange Revolution', the view of Ukraine as a country inherently 'divided' between 'East' and 'West' has (re)emerged to become a popular explanation for political events. The study outlines the necessity for academics, policymakers and indeed politicians to veer away from this simplistic 'West versus East' divide. The book advocates an analysis of Ukraine's unique brand of regionalism not in terms of divisions, but in terms of regional differences and diversity. The author deconstructs the concept of 'Eastern Ukraine' by focusing on three Ukrainian localities, all adjacent to the Ukrainian-Russian border. The study examines how individuals provide 'their' own understanding of the place of their region within the wider processes of nation building across Ukraine. In doing so, the book develops a 'regional' approach to the study of identity politics in Ukraine.

Orthodox Christianity and Nationalism in Nineteenth-Century Southeastern Europe

Nation-building processes in the Orthodox commonwealth brought together political institutions and religious communities in their shared aims of achieving national sovereignty. Chronicling how the churches of Greece, Romania, Bulgaria, and Serbia acquired independence from the Patriarchate of Constantinople in the wake of the Ottoman Empire’s decline, Orthodox Christianity and Nationalism in Nineteenth-Century Southeastern Europe examines the role of Orthodox churches in the construction of national identities. Drawing on archival material available after the fall of communism in southeastern Europe and Russia, as well as material published in Greek, Serbian, Bulgarian, Romanian, and Russian, Orthodox Christianity and Nationalism in Nineteenth-Century Southeastern Europe analyzes the challenges posed by nationalism to the Ecumenical Patriarchate and the ways in which Orthodox churches engaged in the nationalist ideology.

[Review of] Ivo Mijnssen, The Quest for an Ideal Youth in Putin’s Russia I. Back to Our Future! History, Modernity and Patriotism According to Nashi, 2005–2012. Soviet and Post-Soviet Politics and Society, Stuttgart: Ibidem Verlag, 2012, 202pp., e 34.90 p/b

THE YOUTH MOVEMENT NASHI (OURS) WAS FOUNDED IN THE SPRING of 2005 against the backdrop of Ukraine’s ‘Orange Revolution’. Its aim was to stabilise Russia’s political system and take back the streets from opposition demonstrators. Personally loyal to Putin and taking its ideological orientation from Surkov’s concept of ‘sovereign democracy’, Nashi has sought to turn the tide on ‘defeatism’ and develop Russian youth into a patriotic new elite that ‘believes in the future of Russia’ (p. 15). Combining a wealth of empirical detail and the application of insights from discourse theory, Ivo Mijnssen analyses the organisation’s development between 2005 and 2012. His analysis focuses on three key moments—the organisation’s foundation, the apogee of its mobilisation around the Bronze Soldier dispute with Estonia, and the 2010 Seliger youth camp—to help understand Nashi’s organisation, purpose and ideational outlook as well as the limitations and challenges it faces. As such,the book is insightful both for those with an interest in post-Soviet Russian youth culture, and for scholars seeking a rounded understanding of the Kremlin’s initiatives to return a sense of identity and purpose to Russian national life.The first chapter, ‘Background and Context’, outlines the conceptual toolkit provided by Ernesto Laclau and Chantal Mouffe to help make sense of developments on the terrain of identity politics. In their terms, since the collapse of the Soviet Union, Russia has experienced acute dislocation of its identity. With the tangible loss of great power status, Russian realities have become unfixed from a discourse enabling national life to be constructed, albeit inherently contingently, as meaningful. The lack of a Gramscian hegemonic discourse to provide a unifying national idea was securitised as an existential threat demanding special measures. Accordingly, the identification of those who are ‘notUs’ has been a recurrent theme of Nashi’s discourse and activity. With the victory in World War II held up as a foundational moment, a constitutive other is found in the notion of ‘unusual fascists’. This notion includes not just neo-Nazis, but reflects a chain of equivalence that expands to include a range of perceived enemies of Putin’s consolidation project such as oligarchs and pro-Western liberals.The empirical background is provided by the second chapter, ‘Russia’s Youth, the Orange Revolution, and Nashi’, which traces the emergence of Nashi amid the climate of political instability of 2004 and 2005. A particularly note-worthy aspect of Mijnssen’s work is the inclusion of citations from his interviews with Nashicommissars; the youth movement’s cadres. Although relatively few in number, such insider conversations provide insight into the ethos of Nashi’s organisation and the outlook of those who have pledged their involvement. Besides the discussion of Nashi’s manifesto, the reader thus gains insight into the motivations of some participants and behind-the-scenes details of Nashi’s activities in response to the perceived threat of anti-government protests. The third chapter, ‘Nashi’s Bronze Soldier’, charts Nashi’s role in elevating the removal of a World War II monument from downtown Tallinn into an international dispute over the interpretation of history. The events subsequent to this securitisation of memory are charted in detail, concluding that Nashi’s activities were ultimately unsuccessful as their demands received little official support.The fourth chapter, ‘Seliger: The Foundry of Modernisation’, presents a distinctive feature of Mijnssen’s study, namely his ethnographic account as a participant observer in the Youth International Forum at Seliger. In the early years of the camp (2005–2007), Russian participants received extensive training, including master classes in ‘methods of forestalling mass unrest’ (p. 131), and the camp served to foster a sense of group identity and purpose among activists. After 2009 the event was no longer officially run as a Nashi camp, and its role became that of a forum for the exchange of ideas about innovation, although camp spirit remained a central feature. In 2010 the camp welcomed international attendees for the first time. As one of about 700 international participants in that year the author provides a fascinating account based on fieldwork diaries.Despite the polemical nature of the topic, Mijnssen’s analysis remains even-handed, exemplified in his balanced assessment of the Seliger experience. While he details the frustrations and disappointments of the international participants with regard to the unaccustomed strict camp discipline, organisational and communication failures, and the controlled format of many discussions,he does not neglect to note the camp’s successes in generating a gratifying collective dynamic between the participants, even among the international attendees who spent only a week there.In addition to the useful bibliography, the book is back-ended by two appendices, which provide the reader with important Russian-language primary source materials. The first is Nashi’s ‘Unusual Fascism’ (Neobyknovennyi fashizm) brochure, and the second is the booklet entitled ‘Some Uncomfortable Questions to the Russian Authorities’ (Neskol’ko neudobnykh voprosov rossiiskoivlasti) which was provided to the Seliger 2010 instructors to guide them in responding to probing questions from foreign participants. Given that these are not readily publicly available even now, they constitute a useful resource from the historical perspective.