Patients' Voices, Rights and Responsibilities: On Implementing Social Audit in Primary Health Care

This paper reports on an interpretive research project which examines the feasibility of implementing social audit within the general medical practice setting. The study aims to communicate patients' voices to aid evaluation of the potential contribution of social audit to the public health sector and also addresses particular conceptual problems which arise when attempting to implement social audit within this environment. The fieldwork focuses on one general health practice in Lanarkshire (in southern central Scotland). Consultative focus group discussions and individual interviews were carried out with a sample of twenty two patients. Patients were most concerned with health service organisational and delivery issues. Overall, the results suggest patients are enthusiastic about the ideas and process of the social audit. Patients were able to demonstrate a capacity for grasping accountability issues and balanced reasoning. There was an acute awareness of the constraints which exist in the public services. Patients addressed the broad rights and responsibilities issues, and highlighted the possible pitfalls of relying on a representational mechanism for ensuring their voices were heard. The study concludes that an involved and negotiative dialogue process of implementing social audit could provide beneficial understanding and ideas to the organisation which may be further researched.     

Power, Mastery And Organizational Learning

The topic of power has not featured strongly in debates about organizational learning, a point that is illustrated in a discussion of influential studies of teamworking. Despite the insights that such studies have provided into the nature of expertise and collaboration they have tended not to explore the relevance of issues of hierarchy, politics and institutionalized power relations. The paper addresses the problem by exploring the links between power, expertise and organizational learning. Power is analysed both as the medium for, and the product of, collective activity. The approach emphasizes how skills and imaginations are intertwined with social, technical and institutional structures. While studies of teamworking have concentrated on situations where imaginations and structures are tightly linked, unexpected developments may occur when these relations are loosened. Such situations occur when the needs of the moment overshadow normal routines and relationships and there is no single overview or centre of control. It is suggested that organizational learning can be conceptualized as the movement between familiar and emergent activities and between established and emergent social relations. Events in a two-year action research project are used to illustrate the approach and explore episodes of decentred collaboration.     

A regional analysis of black male-white male wage differences

This research indicates that labor market outcomes for black males in terms of hourly wages differed markedly from region to region over the 1976 to 1984 period. And although black males faced a substantial amount of discriminatory treatment in all regions, the amounts varied significantly by region.     

The declining relative economic status of black families

Data are presented on black family income and wealth that run counter to the claims that blacks have made substantial economic progress in recent years. The evidence reveals that not only has there been little in the way of real, sustained advances but that what few gains have been made are starting to erode.     

Transnational Organizing: A Case Study of Contract Workers in the Colombian Mining Industry

This article examines recent organizing successes in the Carbones del Cerrejón coal mine, reversing the organizational crisis of the Colombian mining union, Sintracarbon. Using Wever's concept of ‘field‐enlarging strategies’, we argue that these events were facilitated by the dissemination of organizing experiences between affiliates of a Global Union Federation, International Federation of Chemical, Energy, Mine and General Workers' Unions (ICEM), which recently merged to form IndustriALL. Additionally, we argue that this articulation between international and national unions, based on the principle of subsidiarity, was facilitated through sustained ICEM educational project activity, providing multiple entry points for Sintracarbon to operationalize its strategy and re‐establish bargaining with multinational employers.     

Towards an understanding of health care purchasing: The purchasing behaviour of general practice fundholders 1

In the last few years there have been considerable changes in the National Health Service. Perhaps the most significant of these has been the introduction of competition into health care, that is the split of the health service into purchasers and providers of care. Central to this development has been the introduction of general practice fundholding, whereby practices are able to purchase health care for their patients directly from competing suppliers. Those pradices which have become fundholders have faced considerable challenges in developing their purchasing function. At the same time, provider units in areas where fundholding has become established face an increasingly fragmented purchasing base.

Building on existing theoretical work into the nature of organizational purchasing behaviour and current knowledge of the health care market in Britain, this paper attempts to develop an understanding of the dynamics of GP fundholder purchasing behaviour.     

Comparing sustainable consumption patterns across product sectors

In this paper, we present findings from two qualitative studies where we explored sustainable consumption practices through examining consumers' information search and decision-making processes for recent purchases of five categories of goods/services: fast moving consumer goods (such as foodstuffs and household products), white goods (such as fridges and washing machines), small electrical products (such as TVs and computers), green energy tariffs (such as electricity from renewable sources) and tourism (such as flights). This research has provided us with a set of rich data which explores the nature and extent of sustainable consumption practices across different product sectors. A comparative analysis has allowed us to draw out patterns of consumer behaviour for different product and service types. Our findings suggest that even the same green consumer will not use the same information sources or decision-making criteria, consider the same options or focus on the same industry actors, for products in different sectors. However, we have identified some degree of consistency in purchases within sectors. We present these sector-specific patterns of consumer behaviour and highlight differences in the criteria utilized and the research norms in each sector.