Learning with other health professions in the United Kingdom MPharm degree:Multidisciplinary and placement education

This paper reviews the approach to multidisciplinary and placement education in UK schools of pharmacy. The methodology involved triangulation of course documentation, staff interviews and a final year student survey. Staff members were supportive of multidisciplinary learning. The advantages were development of a wider appreciation of the students? future professional role and better understanding of the roles of other professional groups. The barriers were logistics (student numbers; multiple sites; different timetables), the achievement of balanced numbers between disciplines and engagement of students from all participating disciplines. Placement education was offered by all schools, predominantly in hospital settings. Key problems were funding and the lack of staff resources. Currently, multidisciplinary learning within the UK for pharmacy students is inadequate and is coupled with relatively low levels of placement education. In order for things to change, there should be a review of funding and support from government and the private sector employers.

The dynamics of organizational change : an analysis of power, professions and new managerialism in the case of CoastElectric

It is widely accepted that the Thatcher years and their immediate aftermath were associated with substantive social and organizational change. The privatisation programme, 'the rolling back of the State', prosecuted by the successive Conservative Governments from 1979-1997 was a central pillar of Governmental policy. This thesis seeks to engage with privatization through the of CoastElectric, a newly privatised Regional Electricity Company. This thesis contributes to the extant understanding of the dynamics of organizational change in four major ways. Firstly, the study into CoastElectric addresses the senior management decision making within the organization: in particular, it will attempt to make sense of 'why' particular decisions were made. The theoretical backdrop to this concern will draw on the concepts of normalization, cultural capital and corporate fashion. The argument presented in this thesis is that the decision-making broadly corresponded with that which could be considered to be at the vanguard of mangerialist thought. However, a detailed analysis suggested that at different junctures in CoastElectric's history there were differences in the approach to decision making that warranted further analysis. The most notable finding was that the relative levels of new managerialist cultural capital possessed by the decision-making elite had an important bearing upon whether the decision was formulated either endogenously or exogenously, with the assistance of cultural intermediaries such as management consultants. The thesis demonstrates the importance of the broader discourse of new managerialism in terms of shaping what is considered to be a 'commonsensical, rational' strategy. The second concern of this thesis is that of the process of organizational change. The study of CoastElectric attempts to provide a rich account of the dynamics of organizational change. This is realized through, first, examining the pre-existing context of the organization; second, through analyzing the power politics of change interventions. The master concepts utilised in this endeavour are that of: dividing practices, the establishment of violent hierarchies between competing discourses; symbolic violence; critical turning points; recursiveness; creative destruction; legitimation strategies and the reconstitution of subjects in the workplace.

Professions, class and society:solicitors in 19th century Birmingham

The thesis provides an analysis of an occupation in the process of making itself a profession. The solicitors' profession in Birmingham underwent a great many changes during the 19th century against a background of industrialisation and urbanisation. The solicitors' conception of their status and role, in the face of these challenges, had implications for successful strategies of professionalisation. The increased prestige and power of the profession, and especially its elite, are examined in their social context rather than in terms of a technical process, or educational and organisational change. The thesis argues that -the profession's social relationships and broad concerns were significant in establishing solicitors as "professional men". In particular these are related to the profession's efforts to gain control of markets for legal services and increase social status. In the course of achieving these aims a concept of profession and a self-image were articulated by solicitors in order to persuade society and the state of the legitimacy of their claims. The concept of the gentlemanly professional was of critical importance in this instance. The successful creation of a provincial professional "community" by the end of the 19th century rested principally on a social and moral conception of professionalism rather than one which stressed specialised training and knowledge, professional organisations and credentials.

Professionals, discretion and public sector reform in the UK:re-visiting Lipsky

Purpose – Seeks to examine how far Michael Lipsky's theory of discretion as it relates to public sector professionals as “street-level bureaucrats” is still applicable in the light of public sector reform and in particular the introduction of increased managerial control over professionals. Design/methodology/approach – The main thesis in Lipsky's work, Street-Level Bureaucracy, that street-level bureaucrats devise their own rules and procedures to deal with the dilemmas of policy implementation is linked to public sector reform over the past 25 years or so. The article differentiates between three forms of discretion, rule, task and value and assesses the extent to which these different forms of discretion have been compromised by reform. Examples are drawn principally from the literature on school teachers and social workers Findings – The findings suggest that the rule-making (hence bureaucratic) capacity of professionals at street-level is much less influential than before although it is questionable whether or not the greater accountability of professionals to management and clarity of the targets and objectives of organisations delivering public policy has liberated them from the dilemmas of street-level bureaucracy. Research limitations/implications – The work has focussed on the UK and in particular on two professions. However, it may be applied to any country which has undergone public sector reform and in particular where “new public management” processes and procedures have been implemented. There is scope for in-depth studies of a range of occupations, professional and otherwise in the UK and elsewhere. Practical implications – Policy makers and managers should consider how far the positive aspects of facilitating discretion in the workplace by reducing the need for “rule-making” to cope with dilemmas have been outweighed by increased levels of bureaucracy and the “de-skilling” of professionals. Originality/value – Lipsky's much cited and influential work is evaluated in the light of public sector reform some 25 years since it was published. The three forms of discretion identified offer the scope for their systematic application to the workplace.

The effect of ward design on the well-being of post-operative patients

Changes in the design of hospital wards have usually been determined by architects and members of the nursing and medical professions; the views and preferences of patients have seldom been sought directly. The Hospital Anxiety and Depression scale and the Disturbance Due to Hospital Noise questionnaire were administered to 64 female patients on bay and Nightingale wards together with a questionnaire designed for this study. Perceptions of social and physical factors of ward design were examined, and their relationship to psychological well-being and sleep patterns. The results show that the bay ward seemed to offer a more favourable environment for patients but some of the disadvantages of bay wards are balanced by better staffing levels and better and more modern facilities. Visibility to nurses was lower on the bay ward. The Nightingale ward was perceived as significantly noisier than the bay ward and noise levels were significantly correlated to anxiety scores. Paradoxically the increase in noise levels appeared to improve the perceived level of privacy on the Nightingale ward. Seventy-five per cent of patients were found to prefer the bay ward design, and since neither design appears to have major disadvantages their continued introduction should be encouraged. However, recommendations are made concerning the optimizing of patients' well-being within the bay ward setting.

Information systems design for the community health services

This system is concerned with the design and implementation of a community health information system which fulfils some of the local needs of fourteen nursing and para-medical professions in a district health authority, whilst satisfying the statutory requirements of the NHS Korner steering group for those professions. A national survey of community health computer applications, documented in the form of an applications register, shows the need for such a system. A series of general requirements for an informations systems design methodology are identified, together with specific requirements for this problem situation. A number of existing methodologies are reviewed, but none of these were appropriate for this application. Some existing approaches, tools and techniques are used to define a more suitable methodology. It is unreasonable to rely on one single general methodology for all types of application development. There is a need for pragmatism, adaptation and flexibility. In this research, participation in the development stages by those who will eventually use the system was thought desirable. This was achieved by forming a representative design group. Results would seem to show a highly favourable response from users to this participation which contributed to the overall success of the system implemented. A prototype was developed for the chiropody and school nursing staff groups of Darlington health authority, and evaluations show that a significant number of the problems and objectives of those groups have been successfully addressed; the value of community health information has been increased; and information has been successfully fed back to staff and better utilised.

An institutional perspective on management accounting change in the public sector : a case study from Canada

This thesis reports on a four-year field study conducted at the Saskatchewan regional office of the Department of Indian Affairs and Northern Development, a large department of the Government of Canada. Over the course of the study, a sweeping government-wide accounting reform took place entitled the Financial Information Strategy. An ethnographic study was conducted that documented the management accounting processes in place at the regional office prior to the Financial Information Strategy reform, the organization’s adoption of the new accounting system associated with this initiative, and the state of the organization’s management accounting system once the implementation was complete. This research, therefore, captures in detail a management accounting change process in a public sector organization. This study employs an interpretive perspective and draws on institution theory as a theoretical framework. The concept of loose coupling and insights from the literature on professions were also employed in the explanation-building process for the case. This research contributes to institution theory and the study of management accounting change by recognizing conflicting institutional forces at the organizational level. An existing Old Institutional Economics-based conceptual framework for management accounting change is advanced and improved upon through the development of a new conceptual framework that incorporates the influence of wider institutional forces, the concepts of open and closed organizational systems and loose coupling, and the recognition of varying rates of change and institutionalization of organizational activity sets. Our understanding of loose coupling is enhanced by the interpretation of institutional influences developed in this study as is the role of professionalization as a normative influence in public sector organizations.

Professionalisation and ophthalmic optics

This thesis is a sociological study of the ophthalmic optical profession in Britain. It includes a survey of the development of ophthalmic optics as an occupation and three questionnaire, surveys, one each of first and final year ophthalmic optics students, and one of practising opticians. The developmental survey showed that four themes have been important in the occupation's process of professionalisation - the actions of the opticians' leaders, the gradual unification of the bodies, representing segments of the profession, the struggle with medicine and the involvement of ophthalmic opticians in state-organised optical welfare schemes. The student surveys showed that the profession is now recruiting largely from middle class, state educated groups, and increasingly from women, who hold significantly different attitudes to income, independence and career commitment. In general, both first and final year students considered service to be rather more important than furthering knowledge. Practising opticians have been recruited increasingly, from middle class backgrounds, mostly from state selective secondary schools, but with a large minority from non-state schools. The self-recruitment rate of the profession (18.9%) is very similar to that for British medical students. Significant differences in concepts of professionalism were found among ophthalmic opticians of different ages, sexes and types of practice but few among those in different areas of practice. In general, ophthalmic opticians seemed to stress service more·than furthering knowledge. It is suggested that the leaders of the profession have 'negotiated' considerable autonomy for its members and that the possibilities for commercialism within the ophthalmic optician's professional role are intrinsically no greater than those in more 'established' professions.

Status and professional association councils. Available in 4 volumes.

This thesis examines the predictive value of a conceptual distinction between status-seeking associations and status-maintaining associations for enhancing understanding of ten selected professional associations and of the attitudes, values, behaviour and policies of their governing organs. Thirty four specific hypotheses have been tested by such research methods as questionnaires administered to individuals and associations, participant observation and an examination of association minutes and publications. Certain hypotheses have been found to be valid for particular matched pairs and/or groups of associations. The findings of the study suggest that the present conceptualisation of profession, the individual professional, professionalism, professionalisation, professional status and that relating to the role of the professions in society needs to be refined and modified in varying degrees in application to accounting associations, business graduate associations and management associations. The concept of the `ideal type' profession is shown to be of limited value in understanding certain aspects of the activities of business graduate and management associations. The findings of the study suggest that in future the professional associations examined may attach less importance to their qualifying role and lay more stress upon their representational role. The professional association faces a managerial challenge to adjust and adapt to a range of `external' pressures and `internal' demands from members and may increasingly need to be regarded as an organisation that possesses certain combinations or sets of characteristics rather than as a type of organisation that possesses a particular or relatively exclusive set. With a blurring of the distinction between the professional and state sector vocational education, and a growing customer/market orientation associated with the changing nature of work, membership of a professional association may, in future, come to be associated rather more with securing access to a relevant range of services and less with qualification for a particular career.

The development of chemical exposure limits for the workplace

The thesis examines and explains the development of occupational exposure limits (OELs) as a means of preventing work related disease and ill health. The research focuses on the USA and UK and sets the work within a certain historical and social context. A subsidiary aim of the thesis is to identify any short comings in OELs and the methods by which they are set and suggest alternatives. The research framework uses Thomas Kuhn's idea of science progressing by means of paradigms which he describes at one point, `lq ... universally recognised scientific achievements that for a time provide model problems and solutions to a community of practitioners. KUHN (1970). Once learned individuals in the community, `lq ... are committed to the same rules and standards for scientific practice. Ibid. Kuhn's ideas are adapted by combining them with a view of industrial hygiene as an applied science-based profession having many of the qualities of non-scientific professions. The great advantage of this approach to OELs is that it keeps the analysis grounded in the behaviour and priorities of the groups which have forged, propounded, used, benefited from, and defended, them. The development and use of OELs on a larger scale is shown to be connected to the growth of a new profession in the USA; industrial hygiene, with the assistance of another new profession; industrial toxicology. The origins of these professions, particularly industrial hygiene, are traced. By examining the growth of the professions and the writings of key individuals it is possible to show how technical, economic and social factors became embedded in the OEL paradigm which industrial hygienists and toxicologists forged. The origin, mission and needs of these professions and their clients made such influences almost inevitable. The use of the OEL paradigm in practice is examined by an analysis of the process of the American Conference of Governmental Industrial Hygienists, Threshold Limit Value (ACGIH, TLV) Committee via the Minutes from 1962-1984. A similar approach is taken with the development of OELs in the UK. Although the form and definition of TLVs has encouraged the belief that they are health-based OELs the conclusion is that they, and most other OELs, are, and always have been, reasonably practicable limits: the degree of risk posed by a substance is weighed against the feasibility and cost of controlling exposure to that substance. The confusion over the status of TLVs and other OELs is seen to be a confusion at the heart of the OEL paradigm and the historical perspective explains why this should be. The paradigm has prevented the creation of truly health-based and, conversely, truly reasonably practicable OELs. In the final part of the thesis the analysis of the development of OELs is set in a contemporary context and a proposal for a two-stage, two-committee procedure for producing sets of OELs is put forward. This approach is set within an alternative OEL paradigm. The advantages, benefits and likely obstacles to these proposals are discussed.

Mothering and intellectual disability:partnership rhetoric?

This paper is about mothering an intellectually disabled child identified with special educational needs. It specifically looks at the parent partnership rhetoric that has dominated UK government policy and directives for nearly three decades and yet research suggests parents and more often mothers have to battle to be recognised as legitimate experts. This paper engages with sociological analysis as it highlights via qualitative narratives that mothers are weighed down by the sheer number of professionals involved in their day-to-day life. Moreover, mothers whose children are not identified in the early years are often blamed in the first instance for playing a part in their child’s difficult behaviour. This research ultimately suggests that partnership work is important and necessary for practice within health, education and social work professions, not least of all because the emotional roller-coaster that mothers experience during the assessment and statementing process is disabling.

Institutional entrepreneurship:a literature review and analysis of the maturing consulting field

With few exceptions (e.g. Fincham & Clark, 2002; Lounsbury, 2002, 2007; Montgomery & Oliver, 2007), we know little about how emerging professions, such as management consulting, professionalize and establish their services as a taken-for-granted element of social life. This is surprising given that professionals have long been recognized as “institutional agents” (DiMaggio & Powell, 1983; Scott, 2008) (see Chapter 17) and professionalization projects have been closely associated with institutionalization (DiMaggio, 1991). Therefore, in this chapter we take a closer look at a specific type of entrepreneurship in PSFs; drawing on the concept of “institutional entrepreneurship” (DiMaggio, 1988; Garud, Hardy, & Maguire, 2007; Hardy & Maguire, 2008) we describe some generic strategies by which proto-professions can enhance their “institutional capital” (Oliver, 1997), that is, their capacity to extract institutionally contingent resources such as legitimacy, reputation, or client relationships from their environment.

Adaptation to flood risk:the case of businesses in the UK

Despite Government investment in flood defence schemes, many properties remain at high risk of flooding. A substantial portion of these properties are business establishments. Flooding can create serious consequences for businesses, including damage to property and stocks, being out of business for a considerable period and ultimately business failure. Recent flood events such as those in 2007 and 2009 that affected many parts of the UK have helped to establish the true costs of flooding to businesses. This greater understanding of the risks to businesses has heightened the need for business owners to adapt their businesses to the threat of future flooding. Government policy has now shifted away from investment in engineered flood defences, towards encouraging the uptake of property level flood resistance and resilience measures by businesses. However, implementing such adaptation strategies remains a challenge due a range of reasons. A review of the current state of property level flood risk adaptation of UK businesses is presented, drawing from extant literature. Barriers that may hinder the uptake of property level adaptation by businesses are revealed and drivers that may enhance uptake and effectively overcome these barriers are also discussed. It is concluded that the professions from the construction sector have the potential to contribute towards the adaptation of business properties and thereby the flood resilience of businesses at risk of flooding.

Eye alignment:a novel approach

This thesis describes the design and development of an eye alignment/tracking system which allows self alignment of the eye’s optical axis with a measurement axis. Eye alignment is an area of research largely over-looked, yet it is a fundamental requirement in the acquisition of clinical data from the eye. New trends in the ophthalmic market, desiring portable hand-held apparatus, and the application of ophthalmic measurements in areas other than vision care have brought eye alignment under new scrutiny. Ophthalmic measurements taken in hand-held devices with out an clinician present requires alignment in an entirely new set of circumstances, requiring a novel solution. In order to solve this problem, the research has drawn upon eye tracking technology to monitor the eye, and a principle of self alignment to perform alignment correction. A handheld device naturally lends itself to the patient performing alignment, thus a technique has been designed to communicate raw eye tracking data to the user in a manner which allows the user to make the necessary corrections. The proposed technique is a novel methodology in which misalignment to the eye’s optical axis can be quantified, corrected and evaluated. The technique uses Purkinje Image tracking to monitor the eye’s movement as well as the orientation of the optical axis. The use of two sets of Purkinje Images allows quantification of the eye’s physical parameters needed for accurate Purkinje Image tracking, negating the need for prior anatomical data. An instrument employing the methodology was subsequently prototyped and validated, allowing a sample group to achieve self alignment of their optical axis with an imaging axis within 16.5-40.8 s, and with a rotational precision of 0.03-0.043°(95% confidence intervals). By encompassing all these factors the technique facilitates self alignment from an unaligned position on the visual axis to an aligned position on the optical axis. The consequence of this is that ophthalmic measurements, specifically pachymetric measurements, can be made in the absence of an optician, allowing the use of ophthalmic instrumentation and measurements in health professions other than vision care.

Tracking habitus across a transnational professional field

The sociology of the professions has shied away from cross-national comparative work. Yet research in different professional jurisdictions emphasizes the transnational nature of professional fields. Further work is therefore needed that explores the extent to which transnational professional fields are characterized by unity or heterogeneity. To that end, this article presents the results of a qualitative interrogation of the habitus of partners in ‘Big 4’ professional service firms across, primarily, five countries (Bangladesh, Canada, France, Spain and the UK). Marked differences are observed between the partner habitus in Bangladesh and the other countries studied in terms of entrepreneurial and public service dispositions. In turn, these findings highlight the methodological relevance of habitus for both the sociology of the professions and comparative capitalism literatures: for the former, habitus aids in mapping the dynamics of transnational professional fields; for the latter, habitus can elucidate the informal norms and conventions of national business systems.