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This paper provides managers and clinicians with an analysis of routine data collected by seven speech and language therapy services in the UK. Managers in seven districts in the UK of varying size and location were asked to provide information on referrals, waiting times and attendances during the six month period, and to give a breakdown of the types of intervention offered and type of clients seen. These data were aggregated and comparisons were made with existing data on speech and language therapy services. The results revealed considerable variations in prevalence, staffing ratios and client management practices. The implications for service planning are discussed.

In the last five years more and more scholars have drawn on insights from the complexity sciences as a way of understanding the process of managing and organising in the NHS differently. This paper aims to describe working methods derived from the theory of complex responsive processes, a more radical interpretation of these insights, used by a consultancy team in one NHS setting.

The authors were invited to undertake this intervention over a two year period to bring about service improvement. The paper sets out a critique of systems theory, which underpins most management literature, as well as offering a critique of some of the ways that complexity theory gets taken up in the health literature. As an alternative it explores the theoretical underpinnings of complex responsive processes and gives practical examples of methods that the authors believe are more suitable for understanding the complex environment NHS staff work within.

Working with ideas of ambiguity, paradox and complexity are not easy for staff educated in a Western tradition of linear cause and effect. However, as a result of this intervention managers and staff pointed to a much greater confidence and skill in dealing with the complex daily process of organising, which they attribute to the methods used. Although the authors make no claim that service improvement arose as a direct consequence of the methods employed, significant, observable improvements in service provision did occur during and after the consultancy intervention.

The description of working methods based on reflective and reflexive group processes, alongside more empirical data‐gathering methods, is offered as a radical alternative to more orthodox ways of understanding, and attempting to work with change in the NHS.

The purpose of this paper is to find the determinants of participation and targeting efficiency of the following safety net programs in West Bengal: Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA), self-targeted program; National Rural Livelihood Mission (NRLM), subsidy based livelihood program; Indira Awaas Yojona (IAY), targeted cash transfer program and Public Distribution System (PDS), targeted in kind transfer program.

The study is based on a household survey comprising 900 households across three Districts: Murshidabad, Nadia and Burdwan.

Benefits from MNREGA and PDS are not substantial, whereas financial benefits are substantial from NRLM and IAY. This paper shows that poor people have higher likelihood of participation in MNREGA and PDS. But, non poor get disproportionate benefits from IAY and NRLM both have been designed for the poor. Therefore, targeting cannot remove elite capture altogether. Socially down trodden section have higher participation in MNREGA and PDS, whereas people who are at upper tier of social hierarchy enjoy the benefits of IAY and NRLM. However, it cannot be said that these programs miss their target completely.

The study suffers from the usual limitations of sampling.

Programs targeted for the poor are being appropriated by the non poor. If there is better targeting money will be channelized to the desired beneficiaries and welfare will be enhanced.

The study has unearthed the underlying reasons behind why some safety net programs have better targeting and some safety net programs have poor targeting.

Fiction has the potential to dispel myths and helps improve public understanding and knowledge of the experiences of under-represented groups. Representing the diversity of the population allows individuals to feel included, connected with and understood by society. Whether women and girls with autism spectrum disorder (ASD) are adequately and accurately represented in fictional media is currently unknown. The paper aims to discuss this issue.

Internet and library searches were conducted to identify female characters with ASD in works of fiction. Examples of such works were selected for further discussion based on their accessibility, perceived historical and cultural significance and additional characteristics that made the work particularly meaningful.

The search highlighted a number of female characters with ASD across a range of media, including books, television, film, theatre and video games. Many were written by authors who had a diagnosis of the condition themselves, or other personal experience. Pieces largely portrayed characters with traits that are highly recognised within the academic literature. However, some also appeared to endorse outdated myths and stereotypes. Existing works appear to preferentially portray high functioning autistic women, with limited representation of those whom also have intellectual disability.

This is the first exploration of the depiction of ASD in females within fiction. There is a need for more works of fiction responsibly depicting females with ASD, as this can help reduce stigma, develop public awareness and recognition and increase representation.

The purpose of this paper is to describe research that examined physician leadership development using complexity science principles.

Intensive interviewing of 21 participants and document review provided data regarding physician leadership development in health-care organizations using five principles of complexity science (connectivity, interdependence, feedback, exploration-of-the-space-of-possibilities and co-evolution), which were grouped in three areas of inquiry (relationships between agents, patterns of behaviour and enabling functions).

Physician leaders are viewed as critical in the transformation of healthcare and in improving patient outcomes, and yet significant challenges exist that limit their development. Leadership in health care continues to be associated with traditional, linear models, which are incongruent with the behaviour of a complex system, such as health care. Physician leadership development remains a low priority for most health-care organizations, although physicians admit to being limited in their capacity to lead. This research was based on five principles of complexity science and used grounded theory methodology to understand how the behaviours of a complex system can provide data regarding leadership development for physicians. The study demonstrated that there is a strong association between physician leadership and patient outcomes and that organizations play a primary role in supporting the development of physician leaders. Findings indicate that a physician’s relationship with their patient and their capacity for innovation can be extended as catalytic behaviours in a complex system. The findings also identified limiting factors that impact physicians who choose to lead, such as reimbursement models that do not place value on leadership and medical education that provides minimal opportunity for leadership skill development.

This research provides practical applications for physician leadership development and emphasizes that it is incumbent upon physicians and organizations to focus attention on this to achieve improved patient and organizational outcomes.

This study pairing complexity science and physician leadership represents a unique way to view the development of physician leaders within the context of the complex system that is health care.