What are tests for? The implications of stuttering steps along the patient pathway

This article explores the implications of how US family physicians make decisions about ordering diagnostic tests for their patients. Data is based on a study of 256 physicians interviewed after viewing a video vignette of a presenting patient. The qualitative analysis of 778 statements relating to trustworthiness of evidence for their decision making, the use of any kind of technology and diagnostic testing suggests a range of internal and external constraints on physician decision making. Test-ordering for family physicians in the United States is significantly influenced by both hidden cognitive processes related to the physician's calculation of patient resources and a health insurance system that requires certain types of evidence in order to permit further tests or particular interventions. The consequence of the need for physicians to meet multiple forms of proof that may not always relate to relevant treatment delays a diagnosis and treatment plan agreed not only by the physician and patient but also the insurance company. This results in a patient journey that is made up of stuttering steps to a confirmed diagnosis and treatment undermining patient-centred practice, compromising patient care, constraining physician autonomy and creating additional expense. © 2014 Elsevier Ltd.

Challenges of product-service systems:a real-life case study

A Product-Service System (PSS) is an integrated product and service offering that delivers value in use. This paper presents a real-life case study of a large company which has moved towards PSS. A research protocol has been created to conduct an extensive series of interviews with key personnel within the case study company. The results of the study and implications for research are explored.

Coping with uncertainty:gender and leadership identities in UK corporate life

Within corporate contexts, senior leaders must construct credible leadership identities if they are to demonstrate effectiveness in achieving business goals. This is a particular challenge for women, who have struggled historically to gain senior leadership positions. This chapter explores the identity struggles experienced by Karen, a woman Human Resources director within a management meeting as she delivers bad news about ‘company restructuring’ to her colleagues. Using Feminist Poststructuralist Discourse Analysis (FPDA), I show how this leader struggles to maintain a professionally competent identity as she negotiates the bad news. The analysis reveals that despite the demands of her role, Karen demonstrates extraordinary linguistic competence in managing her team within a turbulent business world that continues to remain inhospitable to female leaders.