Knowledge management and communities of practice in the private sector: lessons for modernizing the National Health Service in England and Wales

The National Health Service (NHS) in England and Wales has embarked upon a radical and far–reaching programme of change and reform. However, to date the results of organizational quality and service improvement initiatives in the public sector have been mixed, if not to say disappointing, with anticipated gains often failing to materialize or to be sustained in the longer term. This paper draws on the authors' recent extensive research into one of the principal methodologies for bringing about the sought after step change in the quality of health care in England and Wales. It explores how private sector knowledge management (KM) concepts and practices might contribute to the further development of public sector quality improvement initiatives in general and to the reform of the NHS in particular. Our analysis suggests there have been a number of problems and challenges in practice, not least a considerable naïvety around the issue of knowledge transfer and 'knowledge into practice' within health care organizations. We suggest four broad areas for possible development which also have important implications for other public sector organizations.     

Close proximity gunshot residues

Intuitively, a hand held in close proximity to a firearm at the instant of discharge will intercept a significant amount of gunshot residue, even though the hand did not actually come into contact with the weapon. There is, however, little information specifically described in the forensic science literature concerning the residue levels which might be encountered in such an instance. The present work confirms that antimony levels consistent with an individual having fired or handled a firearm may be intercepted by a hand held in close proximity.     

Periventricular fatty metamorphosis in neuroglia--a morphologic substrate in SIDS

In 7 of 15 cases of sudden infant death syndrome (SIDS), distinct periventricular fatty metamorphosis of the neuroglia could be demonstrated by a histological staining technique. None of the six children (under 1 year of age) used as a control group whose cause of death was not SIDS showed this morphological change. Thin-layer chromatographic analysis of the lipids accumulated in the glial cells in SIDS established a high amount of esterified cholesterol whereas the content of esterified cholesterol in the control group was low. We presume that fatty metamorphosis of the neuroglia represents the morphological substrate of a metabolic disorder of the sensitive, immature glia of the periventricular white cerebral matter caused by various kinds of damage.     

Policy analysis as discourse

The field of policy analysis encompasses a greater diversity of practices than is commonly appreciated. Many recent revisions agree with the postmodern dictum that analytic studies are socially constructed and propose some form of discourse for formulating policy. This article compares three theoretical perspectives on discourse: analytic discourse, which draws on multiple theories and data sources; critical discourse, which emphasizes critical reflection and links evidence to value discussions; and persuasive discourse, which focuses on the role of ideas and persuasion by policy entrepreneurs. Analytic discourse has had the most impact on the practice of analysis, but the other two literatures have had some influence and address important issues. Critical discourse is sensitive to the structural biases in policy research, and persuasive discourse links the practice of analysis to opportunities in the policy arena. The author seeks to make us more conscious of alternative theories, while emphasizing the role of discourse in all three models and the linkages between policy design and the policy process.