The organizational context and use of routine data for cancer service management

The authors studied the use of routinely available data by four cancer networks in England. Data use was not well developed, but beneficial structures included commitment by a full-time information officer, enthusiasm of a clinician with professed interest in multiple sources of information, and good links with external networks and clinical service groups. Policy-makers should support organizations where data are valued and integrated into performance.     

Independence and the regulatory state—Telecommunications in Scotland and the rest of the United Kingdom

In the autumn of 2014 the residents of Scotland, but not other parts of the UK, will vote on whether to leave the UK and to become a separate state, with a positive vote leading to an independent parliament expected to be elected in 2016. It would remain within the EU and in compliance with its acquis communitaire. This paper identifies issues that would have to be addressed in preparing for and creating a new system of governance for telecommunications markets on that tight timescale.     

Resisting hybridisation between modes of clinical risk management: Contradiction,contest, and the production of intractable conflict

This article explores and explains escalating contradictions between two modes of clinical risk management which resisted hybridisation. Drawing on a Foucauldian perspective, these two modes – ethics-orientated and rules-based – are firstly characterised in an original heuristic we develop to analyse clinical risk management systems. Some recent sociologically orientated accounting literature is introduced, exploring interactions between accountability and risk management regimes in corporate and organisational settings; much of this literature suggests these systems are complementary or may easily form hybrids. This theoretical literature is then moved into the related domain of clinical risk management systems, which has been under-explored from this analytic perspective. We note the rise of rules-based clinical risk management in UK mental health services as a distinct logic from ethics-orientated clinical self-regulation. Longitudinal case study data is presented, showing contradiction and escalating contest between ethics-orientated and rules-based systems in a high-commitment mental health setting, triggering a crisis and organisational closure. We explore theoretically why perverse contradictions emerged, rather than complementarity and hybridisation suggested by existing literature. Interactions between local conditions of strong ideological loading, high emotional and personal involvement, and rising rules-based risk management are seen as producing this contest and its dynamics of escalating and intractable conflict. The article contributes to the general literature on interactions between different risk management regimes, and reveals specific aspects arising in clinically based forms of risk management. It concludes by considering some strengths and weaknesses of this Foucauldian framing.