The politics of technology adoption : Water metering in Progressive Era Chicago

This paper examines the interactions between knowledge and power in the adoption of technologies central to municipal water supply plans, specifically investigating decisions in Progressive Era Chicago regarding water meters. The invention and introduction into use of the reliable water meter early in the Progressive Era allowed planners and engineers to gauge water use, and enabled communities willing to invest in the new infrastructure to allocate costs for provision of supply to consumers relative to use. In an era where efficiency was so prized and the role of technocratic expertise was increasing, Chicago’s continued failure to adopt metering (despite levels of per capita consumption nearly twice that of comparable cities and acknowledged levels of waste nearing half of system production) may indicate that the underlying characteristics of the city’s political system and its elite stymied the implementation of metering technologies as in Smith’s (1977) comparative study of nineteenth century armories. Perhaps, as with Flyvbjerg’s (1998) study of the city of Aalborg, the powerful know what they want and data will not interfere with their conclusions: if the data point to a solution other than what is desired, then it must be that the data are wrong. Alternatively, perhaps the technocrats failed adequately to communicate their findings in a language which the political elite could understand, with the failure lying in assumptions of scientific or technical literacy rather than with dissatisfaction in outcomes (Benveniste 1972). When examined through a historical institutionalist perspective, the case study of metering adoption lends itself to exploration of larger issues of knowledge and power in the planning process: what governs decisions regarding knowledge acquisition, how knowledge and power interact, whether the potential to improve knowledge leads to changes in action, and, whether the decision to overlook available knowledge has an impact on future decisions.

A comparative analysis of business analysis (BA) and business process management (BPM) capabilities

Many initiatives to improve Business processes are emerging. The essential roles and contributions of Business Analyst (BA) and Business Process Management (BPM) professionals to such initiatives have been recognized in literature and practice. The roles and responsibilities of a BA or BPM practitioner typically require different skill-sets; however these differences are often vague. This vagueness creates much confusion in practice and academia. While both the BA and BPM communities have made attempts to describe their domains through capability defining empirical research and developments of Bodies of knowledge, there has not yet been any attempt to identify the commonality of skills required and points of uniqueness between the two professions. This study aims to address this gap and presents the findings of a detailed content mapping exercise (using NVivo as a qualitative data analysis tool) of the International Institution of Business Analysis (IIBA®) Guide to the Business Analysis Body of Knowledge (BABOK® Guide) against core BPM competency and capability frameworks.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

A sociolinguistic approach to applied epistemology : examining technocratic values in global 'Knowledge' policy

This special issue presents an excellent opportunity to study applied epistemology in public policy. This is an important task because the arena of public policy is the social domain in which macro conditions for ‘knowledge work’ and ‘knowledge industries’ are defined and created. We argue that knowledge-related public policy has become overly concerned with creating the politico-economic parameters for the commodification of knowledge. Our policy scope is broader than that of Fuller (1988), who emphasizes the need for a social epistemology of science policy. We extend our focus to a range of policy documents that include communications, science, education and innovation policy (collectively called knowledge-related public policy in acknowledgement of the fact that there is no defined policy silo called ‘knowledge policy’), all of which are central to policy concerned with the ‘knowledge economy’ (Rooney and Mandeville, 1998). However, what we will show here is that, as Fuller (1995) argues, ‘knowledge societies’ are not industrial societies permeated by knowledge, but that knowledge societies are permeated by industrial values. Our analysis is informed by an autopoietic perspective. Methodologically, we approach it from a sociolinguistic position that acknowledges the centrality of language to human societies (Graham, 2000). Here, what we call ‘knowledge’ is posited as a social and cognitive relationship between persons operating on and within multiple social and non-social (or, crudely, ‘physical’) environments. Moreover, knowing, we argue, is a sociolinguistically constituted process. Further, we emphasize that the evaluative dimension of language is most salient for analysing contemporary policy discourses about the commercialization of epistemology (Graham, in press). Finally, we provide a discourse analysis of a sample of exemplary texts drawn from a 1.3 million-word corpus of knowledge-related public policy documents that we compiled from local, state, national and supranational legislatures throughout the industrialized world. Our analysis exemplifies a propensity in policy for resorting to technocratic, instrumentalist and anti-intellectual views of knowledge in policy. We argue that what underpins these patterns is a commodity-based conceptualization of knowledge, which is underpinned by an axiology of narrowly economic imperatives at odds with the very nature of knowledge. The commodity view of knowledge, therefore, is flawed in its ignorance of the social systemic properties of knowing’.

The digital Dark Ages : a retro-speculative history of possible futures

The Dark Ages are generally held to be a time of technological and intellectual stagnation in western development. But that is not necessarily the case. Indeed, from a certain perspective, nothing could be further from the truth. In this paper we draw historical comparisons, focusing especially on the thirteenth and fourteenth centuries, between the technological and intellectual ruptures in Europe during the Dark Ages, and those of our current period. Our analysis is framed in part by Harold Innis’s2 notion of "knowledge monopolies". We give an overview of how these were affected by new media, new power struggles, and new intellectual debates that emerged in thirteenth and fourteenth century Europe. The historical salience of our focus may seem elusive. Our world has changed so much, and history seems to be an increasingly far-from-favoured method for understanding our own period and its future potentials. Yet our seemingly distant historical focus provides some surprising insights into the social dynamics that are at work today: the fracturing of established knowledge and power bases; the democratisation of certain "sacred" forms of communication and knowledge, and, conversely, the "sacrosanct" appropriation of certain vernacular forms; challenges and innovations in social and scientific method and thought; the emergence of social world-shattering media practices; struggles over control of vast networks of media and knowledge monopolies; and the enclosure of public discursive and social spaces for singular, manipulative purposes. The period between the eleventh and fourteenth centuries in Europe prefigured what we now call the Enlightenment, perhaps moreso than any other period before or after; it shaped what the Enlightenment was to become. We claim no knowledge of the future here. But in the "post-everything" society, where history is as much up for sale as it is for argument, we argue that our historical perspective provides a useful analogy for grasping the wider trends in the political economy of media, and for recognising clear and actual threats to the future of the public sphere in supposedly democratic societies.

The digital Dark Ages : a retro-speculative history of possible futures

The Dark Ages are generally held to be a time of technological and intellectual stagnation in western development. But that is not necessarily the case. Indeed, from a certain perspective, nothing could be further from the truth. In this paper we draw historical comparisons, focusing especially on the thirteenth and fourteenth centuries, between the technological and intellectual ruptures in Europe during the Dark Ages, and those of our current period. Our analysis is framed in part by Harold Innis’s2 notion of "knowledge monopolies". We give an overview of how these were affected by new media, new power struggles, and new intellectual debates that emerged in thirteenth and fourteenth century Europe. The historical salience of our focus may seem elusive. Our world has changed so much, and history seems to be an increasingly far-from-favoured method for understanding our own period and its future potentials. Yet our seemingly distant historical focus provides some surprising insights into the social dynamics that are at work today: the fracturing of established knowledge and power bases; the democratisation of certain "sacred" forms of communication and knowledge, and, conversely, the "sacrosanct" appropriation of certain vernacular forms; challenges and innovations in social and scientific method and thought; the emergence of social world-shattering media practices; struggles over control of vast networks of media and knowledge monopolies; and the enclosure of public discursive and social spaces for singular, manipulative purposes. The period between the eleventh and fourteenth centuries in Europe prefigured what we now call the Enlightenment, perhaps moreso than any other period before or after; it shaped what the Enlightenment was to become. We claim no knowledge of the future here. But in the "post-everything" society, where history is as much up for sale as it is for argument, we argue that our historical perspective provides a useful analogy for grasping the wider trends in the political economy of media, and for recognising clear and actual threats to the future of the public sphere in supposedly democratic societies.

Ceremony and cybrary : Digital libraries and the dialectic of place and space

This article examines social, cultural and technological change in the systems and economies of educational information management. Since the Sumerians first collected, organized and supervised administrative and religious records some six millennia ago, libraries have been key physical depositories and cultural signifiers in the production and mediation of social capital and power through education. To date, the textual, archival and discursive practices perpetuating libraries have remained exempt from inquiry. My aim here is to remedy this hiatus by making the library itself the terrain and object of critical analysis and investigation. The paper argues that in the three dominant communications eras—namely, oral, print and digital cultures—society’s centres of knowledge and learning have resided in the ceremony, the library and the cybrary respectively. In a broad-brush historical grid, each of these key educational institutions—the ceremony in oral culture, the library in print culture and the cybrary in digital culture—are mapped against social, cultural and technological orders pertaining to their era. Following a description of these shifts in society’s collective cultural memory, the paper then examines the question of what the development of global information systems and economies mean for schools and libraries of today, and for teachers and learners as knowledge consumers and producers?

A case study of how primary school teachers in Papua New Guinea understand outcomes-based education

This case study explored how a group of primary school teachers in Papua New Guinea (PNG) understood Outcomes-based Education (OBE). OBE measures students. learning against specific outcomes. These outcomes are derived from a country.s vision of the kind of citizen that the education system should produce. While countries such as Australia, South Africa, New Zealand and the United States have abandoned OBE, others such as PNG have adopted it in various ways. How teachers understand OBE in PNG is important because such understandings are likely to influence how they implement the OBE curriculum. There has been no research to date which has investigated PNG primary school teachers. understandings and experiences with OBE. This study used a single exploratory case study design to investigate how twenty primary school teachers from the National Capital District (NCD) in PNG understood OBE. The study, underpinned by an intepretivist paradigm, explored the research question: How do primary school teachers understand outcomes-based education in PNG? The data comprised surveys, in-depth interviews and documents. Data were analysed thematically and using explanation building techniques. The findings revealed that OBE is viewed by teachers as a way to equip them with additional strategies for planning and programming, teaching and learning, and assessment. Teachers also described how OBE enabled both students and teachers to become more engaged and develop positive attitudes towards teaching and learning. There was also a perception that OBE enhanced students. future life skills through increased local community support. While some teachers commented on how the OBE reforms provided them with increased professional development opportunities, the greatest impediment to implementing OBE was perceived to be a lack of sufficient teaching and learning resources. The process of planning and programming classroom activities was also regarded as onerous. Some teachers indicated that they had been required to implement OBE without adequate in-service training support. The social constructivist theory of knowledge which underpins OBE.s student-centred pedagogy can cause tensions within PNG.s cultural contexts of teaching and learning. Teachers need to be aware of these tensions when conducting peer or group learning under OBE in PNG. By exploring how these PNG primary teachers understood OBE, the study highlighted how teachers engaged with OBE concepts when interpreting syllabus documents and how they applied these concepts to curriculum. Identifying differences in teacher understanding of OBE provides guidance for both the design of materials to support the implementation of OBE and for the design of in-service training. Thus, the outcomes of this study will inform educators about the implementation of OBE in PNG. In addition, the outcomes will provide much needed insight into how a mandated curriculum and pedagogical reform impacts teachers‟ practices in PNG.

Managing knowledge for enterprise systems in indian organizations: Case study insights

Many Enterprise Systems (ES) projects have reported nil or detrimental impacts despite the substantial investment in the system. Having expected positive outcomes for the organization and its functions through the weighty spend, the effective management of ES-related knowledge has been suggested as a critical success factor for these ES projects in ES implementations. This paper suggests theoretical views purporting the importance of understanding on knowledge management for ES success. To explain the complex, dynamic and multifaceted of knowledge management, we adopt the concepts in Learning Network Theory. We then conceptualized the impact of knowledge management on ES by analyzing five case studies in several industries in India, based on the Knowledge-based Theory of the Firm that captures the performance of the system.

Designing university, government and industry community engagement to build informed and effective interventions in the area of road safety

Individuals, community organisations and industry have always been involved to varying degrees in efforts to address the Queensland road toll. Traditionally, road crash prevention efforts have been led by state and local government organisations. While community and industry groups have sometimes become involved (e.g. Driver Reviver campaign), their efforts have largely been uncoordinated and under-resourced. A common strength of these initiatives lies in the energy, enthusiasm and persistence of community-based efforts. Conversely, a weakness has sometimes been the lack of knowledge, awareness or prioritisation of evidence-based interventions or their capacity to build on collaborative efforts. In 2000, the Queensland University of Technology’s Centre for Accident Research and Road Safety – Queensland (CARRS-Q) identified this issue as an opportunity to bridge practice and research and began acknowledging a selection of these initiatives, in partnership with the RACQ, through the Queensland Road Safety Awards program. After nine years it became apparent there was need to strengthen this connection, with the Centre establishing a Community Engagement Workshop in 2009 as part of the overall Awards program. With an aim of providing community participants opportunities to see, hear and discuss the experiences of others, this event was further developed in 2010, and with the collaboration of the Queensland Department of Transport and Main Roads, the RACQ, Queensland Police Service and Leighton Contractors Pty Ltd, a stand-alone Queensland Road Safety Awards Community Engagement Workshop was held in 2010. Each collaborating organisation recognised a need to mobilise the community through effective information and knowledge sharing, and recognised that learning and discussion can influence lasting behaviour change and action in this often emotive, yet not always evidence-based, area. This free event featured a number of speakers representing successful projects from around Australia and overseas. Attendees were encouraged to interact with the speakers, to ask questions, and most importantly, build connections with other attendees to build a ‘community road safety army’ all working throughout Australia on projects underpinned by evaluated research. The workshop facilitated the integration of research, policy and grass-roots action enhancing the success of community road safety initiatives. For collaboration partners, the event enabled them to transfer their knowledge in an engaged approach, working within a more personal communication process. An analysis of the success factors for this event identified openness to community groups and individuals, relevance of content to local initiatives, generous support with the provision of online materials and ongoing communication with key staff members as critical and supports the view that the university can directly provide both the leadership and the research needed for effective and credible community-based initiatives to address injury and death on the roads.

Achieving supply chain sustainability : the role of relationship management, culture and procurement form

In this research we examined, by means of case studies, the mechanisms by which relationships can be managed and by which communication and cooperation can be enhanced in developing sustainable supply chains. The research was predicated on the contention that the development of a sustainable supply chain depends, in part, on the transfer of knowledge and capabilities from the larger players in the supply chain. A sustainable supply chain requires proactive relationship management and the development of an appropriate organisational culture, and trust. By legitimising individuals’ expectations of the type of culture which is appropriate to their company and empowering employees to address mismatches that may occur, a situation can be created whereby the collaborating organisations develop their competences symbiotically and so facilitate a sustainable supply chain. Effective supply chain management enhances organisation performance and competitiveness through the management of operations across organisational boundaries. Relational contracting approaches facilitate the exchange of information and knowledge and build capacity in the supply chain, thus enhancing its sustainability. Relationship management also provides the conditions necessary for the development of collaborative and cooperative relationships However, often subcontractors and suppliers are not empowered to attend project meetings or to have direct communication with project based staff. With this being a common phenomenon in the construction industry, one might ask: what are the barriers to implementation of relationship management through the supply chain? In other words, the problem addressed in this research is the engagement of the supply chain through relationship management.

Managing the project learning paradox : a set-theoretic approach toward project knowledge transfer

Managing project-based learning is becoming an increasingly important part of project management. This article presents a comparative case study of 12 cases of knowledge transfer between temporary inter-organizational projects and permanent parent organizations. Our set-theoretic analysis of these data yields two major findings. First, a high level of absorptive capacity of the project owner is a necessary condition for successful project knowledge transfer, which implies that the responsibility for knowledge transfer seems to in the first place lie with the project parent organization, not with the project manager. Second, none of the factors are sufficient by themselves. This implies that successful project knowledge transfer is a complex process always involving configurations of multiple factors. We link these implications with the view of projects as complex temporary organizational forms in which successful project managers need to cope with complexity by simultaneously paying attention to both relational and organizational processes.

Perceptions of online learning in an Australian university : Malaysian students' perspectives

Several researchers have reported that cultural and language differences can affect online interactions and communications between students from different cultural backgrounds. Other researchers have asserted that online learning is a tool that can improve teaching and learning skills, but, its effectiveness depends on how the tool is used. Therefore, this study aims to investigate the kinds of challenges encountered by the international students and how they actually cope with online learning. To date little research exists on the perceptions of online learning environments by international Asian students, in particular Malaysian students who study in Australian Universities; hence this study aims to fill this gap. A mixed-method approach was used to collect quantitative and qualitative data using a modified Online Learning Environment Survey (OLES) instrument and focus group interviews. The sample comprised 76 international students from a university in Brisbane. Thirty-five domestic Australian students were included for comparison. Contrary to assumptions from previous research, the findings revealed that there were few differences between the international Asian students from Malaysia and Australian students with regard to their perceptions of online learning. Another cogent finding that emerged was that online learning was most effective when included within blended learning environments. The students clearly indicated that when learning in a blended environment, it was imperative that appropriate features are blended in and customised to suit the particular needs of international students. The study results indicated that the university could improve the quality of the blended online learning environment by: 1) establishing and maintaining a sense of learning community; 2) enhancing the self motivation of students; and 3) professional development of lecturers/tutors, unit coordinators and learning support personnel. Feedback from focus group interviews, highlighted the students‘ frustration with a lack of cooperative learning, strategies and skills which were expected of them by their lecturers/tutors in order to work productively in groups. They indicated a strong desire for lecturers/tutors to provide them prior training in these strategies and skills. The students identified four ways to optimise learning opportunities in cross-cultural spaces. These were: 1) providing preparatory and ongoing workshops focusing on the dispositions and roles of students within student-centred online learning environments; 2) providing preparatory and ongoing workshops on collaborative group learning strategies and skills; 3) providing workshops familiarising students with Australian culture and language; and 4) providing workshops on strategies for addressing technical problems. Students also indicated a strong desire for professional development of lecturers/tutors focused on: 1) teacher attributes, 2) ways to culturally sensitive curricula, and 3) collaborative learning and cooperative working strategies and skills, and 4) designing flexible program structures. Recommendations from this study will be useful to Australian universities where Asian international students from Malaysia study in blended learning environments. An induction program (online skills, collaborative and teamwork skills, study expectations plus familiarisation with Australian culture) for overseas students at the commencement of their studies; a cultural awareness program for lecturers (cultural sensitivity, ways to communicate and a better understanding of Asian educational systems), upskilling of lecturers‘ ability to structure their teaching online and to apply strong theoretical underpinnings when designing learning activities such as discussion forums, and consistency with regards to how content is located and displayed in a learning management system like Blackboard. Through addressing the research questions in this study, the researcher hopes to contribute to and advance the domain of knowledge related to online learning, and to better understand how international Malaysian students‘ perceive online learning environments. These findings have theoretical and pragmatic significance.

Under the carpet : the politics and trauma of patient harm

Few studies have investigated iatrogenic outcomes from the viewpoint of patient experience. To address this anomaly, the broad aim of this research is to explore the lived experience of patient harm. Patient harm is defined as major harm to the patient, either psychosocial or physical in nature, resulting from any aspect of health care. Utilising the method of Consensual Qualitative Research (CQR), in-depth interviews are conducted with twenty-four volunteer research participants who self-report having been severely harmed by an invasive medical procedure. A standardised measure of emotional distress, the Impact of Event Scale (IES), is additionally employed for purposes of triangulation. Thematic analysis of transcript data indicate numerous findings including: (i) difficulties regarding patients‘ prior understanding of risks involved with their medical procedure; (ii) the problematic response of the health system post-procedure; (iii) multiple adverse effects upon life functioning; (iv) limited recourse options for patients; and (v) the approach desired in terms of how patient harm should be systemically handled. In addition, IES results indicate a clinically significant level of distress in the sample as a whole. To discuss findings, a cross-disciplinary approach is adopted that draws upon sociology, medicine, medical anthropology, psychology, philosophy, history, ethics, law, and political theory. Furthermore, an overall explanatory framework is proposed in terms of the master themes of power and trauma. In terms of the theme of power, a postmodernist analysis explores the politics of patient harm, particularly the dynamics surrounding the politics of knowledge (e.g., notions of subjective versus objective knowledge, informed consent, and open disclosure). This analysis suggests that patient care is not the prime function of the health system, which appears more focussed upon serving the interests of those in the upper levels of its hierarchy. In terms of the master theme of trauma, current understandings of posttraumatic stress disorder (PTSD) are critiqued, and based on data from this research as well as the international literature, a new model of trauma is proposed. This model is based upon the principle of homeostasis observed in biology, whereby within every cell or organism a state of equilibrium is sought and maintained. The proposed model identifies several bio-psychosocial markers of trauma across its three main phases. These trauma markers include: (i) a profound sense of loss; (ii) a lack of perceived control; (iii) passive trauma processing responses; (iv) an identity crisis; (v) a quest to fully understand the trauma event; (vi) a need for social validation of the traumatic experience; and (vii) posttraumatic adaption with the possibility of positive change. To further explore the master themes of power and trauma, a natural group interview is carried out at a meeting of a patient support group for arachnoiditis. Observations at this meeting and members‘ stories in general support the homeostatic model of trauma, particularly the quest to find answers in the face of distressing experience, as well as the need for social recognition of that experience. In addition, the sociopolitical response to arachnoiditis highlights how public domains of knowledge are largely constructed and controlled by vested interests. Implications of the data overall are discussed in terms of a cultural revolution being needed in health care to position core values around a prime focus upon patients as human beings.