Asthma management : implementation of short-acting beta agonist guidelines in Western Australia:a unique collaboration

Background: The Respiratory Health Network in Western Australia developed the Asthma Model of Care in 2010 which incorporates best practice guidelines. At the same time short-acting beta agonist guidelines (SABA) were developed by stakeholder consensus at University of Western Australia (UWA) and incorporated the use of an Asthma Action Plan Card. Objective: To report on the implementation of a key component of the WA Asthma Model of Care, the SABA guidelines that incorporate the Asthma Action Plan card. Methods: Implementation strategies included lectures, direct pharmacy detailing, media releases, and information packs (postal and electronic). Groups targeted included pharmacists, consumers and medical practitioners. Results: State-based (n=18) and national (n=6) professional organisations were informed about the launch of the guidelines into practice in WA. In the four-month implementation period more than 47,000 Asthma Action Plan Cards were distributed, primarily to community pharmacies. More than 500 pharmacies were provided with information packs or individual detailing. More than 10,000 consumers were provided with information about the guidelines. Conclusions and implications: The collaboration of stakeholders in this project allowed for widespread access to various portals which, in turn, resulted in a multifaceted approach in disseminating information. Ongoing maintenance programs are required to sustain and build on the momentum of the implementation program and to ultimately address patient outcomes and practice change, which would be the longer-term goals of such a project. Future research will seek to ascertain the impact of the card on patient outcomes in WA.

Reinsurance trading in Lloyd’s of London:balancing conflicting-yet-complementary logics in practice

Drawing on a year-long ethnographic study of reinsurance trading in Lloyd’s of London, this paper makes three contributions to current discussions of institutional complexity. First, we shift focus from purposeful organizational responses to institutional complexity to the everyday practices by which individuals collectively address competing demands on their work. Based on our findings, we develop a model of how individuals can balance conflicting institutional demands through a set of four interrelated practices, labeled segmenting, switching, bridging, and demarcating. Second, moving beyond the dominant focus on contradiction between logics, we show how these practices comprise a system of conflicting-yet-complementary logics, through which actors are able to both work within contradictions, whilst also exploiting the benefits of interdependent logics. Third, in contrast to most studies of newly formed hybrids and/or novel complexity, our focus on a long-standing context of institutional complexity, shows how balancing logics can become a matter of settled complexity, enacted routinely within everyday practice.

Reinsurance trading in Lloyd's of London:balancing conflicting-yet-complementary logics in practice

Drawing on a year-long ethnographic study of reinsurance trading in Lloyd’s of London, this paper makes three contributions to current discussions of institutional complexity. First, we shift focus away from structural and relatively static organizational responses to institutional complexity and identify three balancing mechanisms - segmenting, bridging, and demarcating - which allow individuals to manage competing logics and their shifting salience within their everyday work. Second, we integrate these mechanisms in a theoretical model that explains how individuals can continually keep coexisting logics, and their tendencies to either blend or disconnect, in a state of dynamic tension which makes them conflicting-yet-complementary logics. Our model shows how actors are able to dynamically balance coexisting logics, maintaining the distinction between them, whilst also exploiting the benefits of their interdependence. Third, in contrast to most studies of newly formed hybrids and/or novel complexity our focus on a long-standing context of institutional complexity shows how institutional complexity can itself become institutionalized and routinely enacted within everyday practice.

Charting new territory for organizational ethnography:insights from a team-based video ethnography of reinsurance trading in Lloyd’s of London

An increasing interest in “bringing actors back in” and gaining a nuanced understanding of their actions and interactions across a variety of strands in the management literature, has recently helped ethnography to unknown prominence in the field of organizational studies. Yet, calls remain that ethnography should “play a much more central role in the organization and management studies repertoire than it currently does” (Watson, 2011: 202). Ironically, those organizational realities that ethnographers are called to examine have at the same time become less and less amenable to ethnographic study. In this paper, we respond to these calls for innovative ethnographic methods in two ways. First, we report on the practices and ethnographic experiences of conducting a year-long team-based video ethnography of reinsurance trading in Lloyd’s of London. Second, drawing on these experiences, we propose an initial framework for systematizing new approaches to organizational ethnography and visualizing the ways in which they are ‘expanding’ ethnography as it was traditionally practiced.