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In the changing environment of the National Health Service (NHS) medical ward rounds have become increasingly complex. With complexity comes the inevitable risk that things will go wrong. Serious failures in care can have important consequences for individual patients, their families, cause distress to health care staff and undermine public confidence in the NHS. The paper's aim is to introduce the concept of a medical ward round considerative checklist to improve ward round processes, effectiveness, reliability and efficiency, aid team working and foster better communication.

The checklist includes aspects of ward round preparation, the consultation, progress assessment, discharge planning and handover. It is a “considerative checklist” as it not simply checking if an essential component has been done but rather that it has been considered, discussed, action identified and communicated effectively and involves an “at the point of care check and correct” process.

The introduction of the checklist has provided a systemic approach to medical ward rounds, provided reassurance that quality care is given, aided active participation from all health care professionals and reignited team work. It has streamlined handover, improved patient and professional communication, improved medical documentation and provided an audit tool for ongoing improvement.

The diversity of general medicine makes standard measures of quality of care such as length of stay, morbidity and mortality outcomes hard to measure; however, qualitative data can be obtained.

The authors have developed a systemic ward round approach which ensures attention to quality and safety at the point of care, encourages team working and improvements can be documented.

The purpose of this paper is to stimulate thinking about the relative importance of leaders and leadership or teamworking and teamsmanship in promoting progressive improvements in health care provision. The author argues that much more emphasis should be placed on the purpose and functioning of health care teams than on developing traditional heroic leaders. The attributes that the author has come to see as important in leaders within healthcare teams have been described. Some of these are far from glamorous and include good organisation, hard work and self-discipline.

Over the past five years, the author has read widely on leadership, as well as on “lean” philosophies of working. During that time the author has tried to introduce changes to improve the working practices of their inpatient care team. The essay was written on the basis of reflection and discussion. This is a free-form article, in the old style of essay writing. This format is ideal for stimulating high-level thinking in readers’ minds.

There should be far more emphasis on training in and development of teams, team-working and teamsmanship than on individual leaders and leadership skills in health care.

The author hopes this essay is original, stimulating thinking, expressed in a readable format, and that it will prove valuable to those responsible for making improvements in health care provision at both the macro-and microlevels.

Our approach is largely historical, argument by example. We leave it to the theoreticians and empiricists to take the argument in a more technical direction.¹ Throughout, we suppose that germs are self-interested and they have a research question, for example, how might our species improve the chances of survival, the answer to which might potentially benefit germs (or, harm them by less).

Ritual female genital practices, widespread throughout Africa, are essential to gender identification and often are a pre-requisite for marriage. More severe forms of the practice, which are common in parts of Northeastern Africa, are also believed to enhance a woman’s childbearing capacity. Here, we critically review the gender- and class-based theories that explain the origins and persistence of female genital practices and the factors that precipitate social change. We also critically review evidence of the association of certain forms of the practice with various health, demographic, and social consequences. Our review exposes several methodological limitations of existing research that preclude population-based inferences about the medical and social implications of these practices and suggest that existing policies targeting such practices draw more on concerns over human rights than on scientific evidence about their sequelae. This review nevertheless exposes a potential contradiction between local justifications for and consequences of certain forms of the practice. Namely, despite an intended function of female genital practices to enhance a woman’s marital capital, certain forms may ironically lead to marital instability and dissolution through their negative effects on the health and reproductive capacity of women. We conclude with recommendations for research to examine the salience and implications of this potential paradox for women in Northeastern Africa.

This chapter provides first insights into identities and communities of educational staff in one of the largest, multi-campus universities in Italy. This group of managers refers to those supporting teaching and learning in the light of emerging demands from the European strategy for universities which is positioning education at the frontline in today’s higher education institutions (HEIs).

These insights are compared with common issues surveyed among research managers and administrators (RMAs) working in the same as well as in other international HEIs using Evans’ ‘restricted’ and ‘extended’ models of professionalism.

Among findings, educational managers (EM) show awareness of their identity only as ‘professionals’ while RMAs may feel like ‘hybrid’ profiles. Unlike RMAs, EM report not having a strong sense of belonging to one community but feeling like they belong to a plethora of groups. In conclusion, there are no dominant ‘extended’ or ‘restricted’ traits for any of the two groups and they have both these attitudes to a certain extent as the results of this chapter will further explain.

The purpose of this paper is to identify, describe and evaluate the different ways in which formal collective change agency is structured in specialist units inside 25 diverse organisations. As such it is oriented towards a range of practitioners operating in HR, project management or with responsibility for delivering change in public and private sectors.

Using a qualitative design, exploratory interview and case study research was conducted in organisations across the UK public and private sectors to explore how different change agency units operate within organisational structures.

Four dominant types of internal change agency unit are identified, varying in terms of their change impact scope and degree of structural embeddedness in the organisation. These units are described as transformers, enforcers, specialists and independents and share key concerns with securing client credibility and added value, effective relationship management and the use of consulting tools. Their roles and the tensions they experience are outlined along with hybrid forms and dynamic shifts from one type to another.

The study could be extended outside of the UK and conducted longitudinally to help identify outcomes more precisely in relation to context.

Each of the four types of change agency unit identified is shown to be suited to certain conditions and to present particular challenges for collective change agency and for specialist management occupations engaged in such work. The analysis could usefully inform organisation design decisions around internal change agency.

The authors extend debates around the nature of internal change agency which has typically focussed on comparisons with external change agents at the level of the individual. Developing the work of Caldwell (2003), the authors reveal how emergent, team-based or collective approaches to change agency can be formalised, rather than informal, and that structural considerations of change need to be considered along with traditional concerns with change management.

The purpose of this paper is to assess the usefulness of nutrition labels in Thailand during nutrition transition from traditional to modern diets that increase salt, sugar, and calorie intake and to note socio-demographic interactions and associations with consumption of transitional processed foods.

The authors studied 42,750 distance learning Open University adults aged 23-96 years in 2013 residing nationwide and participating in an ongoing community-based prospective cohort study. The authors used multivariable logistic regression to relate nutrition label experiences (“read”, “good understand”, “frequent use”), socio-demographic factors, and consumption of four transitional foods. These foods included “unhealthy” instant foods, carbonated soft drinks, and sweet drinks, or “healthy” milk.

Overall, two-thirds reported good understanding and frequent use of nutrition labels. Unhealthy transition-indicator processed foods were frequently consumed: instant foods (7 per cent), (carbonated) soft drinks (15 per cent), and sweet drinks (41 per cent). Frequent users of nutrition labels (e.g. females, older persons, professionals) were less likely to consume unhealthy indicator foods. Those with the most positive overall nutrition label experience (“read” + “good understanding” + “frequent use”) had the best indicator food profiles: instant foods (odds ratio (OR) 0.63; 95%CI, 0.56-0.70); soft drinks (OR 0.56; 95%CI, 0.52-0.61); sweet drinks (OR 0.79; 95%CI, 0.74-0.85); milk (OR 1.87; 95%CI, 1.74-2.00).

Knowledge protected – those with most nutrition label experience were least likely to consume unhealthy foods. Results support government regulated nutrition labels, expanding to include sweet drinks. The study is remarkable for its large size and nationwide footprint. Study subjects were educated, represent Thais of the future, and show high awareness of transition-indicator foods.