A series of essays treating, among other topics, the definition of orthodox Marxism, the question of legality and illegality, Rosa Luxemburg as a Marxist, the changing function of Historic Marxism, class consciousness, and the ...

Within the context of structural theories this paper examines what health professionals say about their clinical service structures. We firstly trace various conceptual perspectives on clinical service structures, discussing multiple theoretical axes. These theories question whether clinical service structures represent either superficial or more profound changes in hospitals. We secondly explore which view is supported though a content analysis of the free text responses of 111 health professionals (44 doctors, 45 nurses and 22 allied health practitioners) about their clinical service (...) structures in a questionnaire survey in two large hospitals that had implemented clinical service structures three years previously. Commentaries unfavourable toward clinical service structures were made by 47.7% of staff, favourable by 24.3%, mixed (both favourable and unfavourable) by 17.1% and non-evaluative statements were made by 10.8%. The most frequent criticisms were inefficient organisation of change (27%), poor management (24.3%), lack of cooperation between staff (15.9%) and failure to empower health practitioners (13.5%). All professions made more negative than positive evaluations of their clinical service structures but the ratio was highest for doctors and lowest for allied health. Ranking of nurses' and allied health staffs' specific evaluations were similar but both differed significantly from doctors.' Unfavourable or negative comments predominated, and change appears more superficial and less profound than advocates of structural contributions hope. Four types of belief systems about clinical service structures are apparent. Some study participants are disposed toward the status quo; others toward restructuring; yet others are team oriented; and a final group is tribally oriented. The implication of this paper for managers is that more work is needed if clinical service structures are to realise the promise of more multi-disciplinarity and less fragmentation across professional groups. For scholars, the implication is that marrying different theoretical frames with empirical data can serve to produce fresh perspectives and perhaps new insights. (shrink)

In The Construction of Social Reality, John Searle argues that there are two kinds of facts--some that are independent of human observers, and some that require..

As the author explains in this book, the problem of improving performance in health care is due largely to the underlying assumptions on which traditional administration practices have been based. In restructuring health care, he offers a new - and necessary - way of viewing health care, a new paradigm of hospital leadership. The author offers in-depth advice for making the necessary shift from hierarchical, functional organization structures to a patient-focused approach to health care operations. The author describes the concepts (...) of implementing restructuring efforts and explains the theories on which these concepts are based. (shrink)

John Hospers' _Introduction to Philosophical Analysis_ has sold over 150,000 copies since its first publication. This new edition ensures that its success will continue into the twenty-first century. It remains the most accessible and authoritative introduction to philosophy available using the full power of the problem-based approach to the area to ensure that philosophy is not simply taught to students but practised by them. The most significant change to this edition is to respond to criticisms regarding the omission in the (...) third edition of the famous opening chapter. A brand new chapter, Words and the World, replaces this in the fourth edition - which now features a large number of examples and illustrative dialogues. The rest of the text has been thoroughly revised and updated to take account of recent developments in some areas of philosophy. (shrink)

The results of two observational studies of clinical directorates (CDs) are presented. The paper exposes fresh perspectives about the management of hospitals and CDs, and suggests that the most important axis on which hospital decision-making rests continues to be profession rather than the CD, even though CDs are designed at least in part to mitigate professional tribalism and bridge professional divides. In empiricising social structural and cultural theories it seems clear that changes to the prescribed organisational framework, which CDs represent, (...) have had negligible effects on behaviour. This being the case, the paper questions the benefits alleged to have accrued from establishing CDs and calls for more effective, micro-behavioural change strategies than merely altering the structure. (shrink)