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.     

High quality criminal justice education and the role of the community college

Summary We are entering a new era where the demands for quality will include higher expectations of faculty, students, and practitioners. Now is the time for action and decision. Criminal justice education has rapidly matured; rather than being complacent about the progress we’ve made, we should take the lead and become acknowledged as pacesetters for high educational standards. Recommendations for improving the quality of higher education must be considered with sincerity and diligence. The capability for excellence is present in the conscientious faculty residing in each and every criminal justice program. With proper nurturing and support, these faculty would flourish and this excellence come into full bloom. Furthermore, the task of achieving quality education in all fields will not and must not fall to one group for action. We are faced with the necessity of bringing all factions together—teacher, administrator, student, and practitioner—to develop and implement solutions to today’s education problems, not as a last resort, but in recognition of change as a constant reality. The time for change is always now.     

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.     

'Portrait of a profession revisited'

On the walls of my private office hang the photographs of my seven distinguished predecessors as Secretary of the Cabinet. I sometimes find myself staring at them for inspiration, not always successfully I admit. A week or two ago I found myself looking at the great Lord Bridges, Secretary of the Cabinet and War Cabinet from 1938 to 1946. I wondered what he would have made of it if in the space of a week one of his predecessors had published an article in The Spectator advertised as ‘The Descent of the Civil Servant’ and another had appeared on the Frost programme to reassure the world that the Service was still in good shape. Both predecessors, Lords Butler and Armstrong, I hasten to say, were acting in the most supportive spirit and spoke from what for all of us is a deeply shared view of the role of the Civil Service. But, staring at Bridges, I could see a bubble emerging from his mouth enquiring: what precisely is happening on your watch, Sir Richard?     

Presidential mandates and ministerial institutions: Summitry of the Americas, the Organization of American States (OAS) and the Inter-American Development Bank (IDB)

The periodic Summits of the Americas are the highest form of regional multilateralism in the Western Hemisphere, but summits lack their own means to implement their mandates. Hence, Summit Plans of Action assign many initiatives to existing regional institutions, especially the Organization of American States (OAS) and the Inter-American Development Bank (IDB). But a notable difference exists in the character and degree to which these two institutions have responded to their unfunded mandates, in that the OAS has become “nested” under the hierarchy of summitry, while the IDB has eschewed subordination in favor of a “parallel” relationship pursuing largely convergent activities. Relying on extensive interviews and reviews of open source and internal documents, six variables are found to explain this differential response: ministerial authorities, competing mandates, institutional missions, internal structures, membership and leadership. Yet for both regional institutions there remains a wide gap between the directives emanating from the Summits and what the two regional institutions have been—and could be—accomplishing. The study concludes with recommendations to improve institutional design. JEL codes L31 · F42 · F02 · D73 · F1     

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.     

Childhood Sexual Abuse and HIV Risk Among Men Who Have Sex with Men: Initial Test of a Conceptual Model

Childhood sexual abuse has been associated with HIV transmission risk behavior in men who have sex with men. This study examined an adapted model that was originally developed to explain the relationship between childhood sexual abuse and HIV risk behavior among women in a sample of men who have sex with men. Men attending a large gay pride event (n=647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse, symptoms of dissociation, trauma-related anxiety, borderline personality characteristics, hopelessness, substance use, and sexual risk behavior. A latent variable partial least squares analysis was conducted to test the interrelationships between childhood sexual abuse, exchanging sex for money or drugs, emotional disturbances, drug use, substance use in the context of sexual behavior, and sexual risk behavior. The model fit the data well and accounted for 10% of the total variance in sexual risk behavior. History of childhood sexual abuse predicted exchanging sex for money or drugs and this relationship was partly accounted for by active drug use. Substance use proximal to sexual behavior also emerged as a key factor in predicting sexual risk behavior. Findings from this study, therefore, indicate a direct association between history of child sexual abuse and high risk for HIV infection related to engaging in sex trade.     

Industry/University Licensing: Characteristics, Concerns and Issues from the Perspective of the Buyer

The authors previously explored invention licensing from the university's perspective. In this paper we focus on the process from the perspective of firms activity engaged in licensing technology. A survey of industry licensing professionals addresses why some firms license technologies from universities and why others do not. The paper then considers the stage of development of university technologies, the characteristics of their licensing contracts, and sources of information about university technologies, all to better understand how the process works and what advantages and disadvantages it offers to all participants.