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Background: Being attached to a primary care (PC) provider is at the core of a strong primary health care system. Centralized waiting lists (CWL) for unattached patients have been implemented in eight provinces of Canada to support the attachment process. In Quebec, the Ministry of Health mandated the implementation of Primary Care Access Points (GAP) across the province to help unattached patients navigate the health system while awaiting attachment through the CWL. Several local health territories developed complementary innovations to the GAP to respond to local population needs. This paper aims to describe five organizational innovations implemented locally. Methods: This multi-case qualitative study was conducted in four local health territories in the province of Quebec. Fifty-two semi-structured interviews with healthcare managers, nurses, physicians, other health professionals and administrative staff were conducted between April 2023 and April 2024. An interview guide was developed based on existing frameworks on the implementation of innovations and the evaluation of the GAP. Thematic analysis was conducted using NVivo software. Inductive and deductive approaches were used to develop relevant codes and themes. Logic models were built to describe the organizational innovations. Results: Five organizational innovations are described. First, a multidisciplinary clinic aimed at responding to patients with mental health issues was implemented. Second, a nurse clinic was implemented to provide temporary care for patients with unstable chronic illnesses. The third innovation is a mobile proximity clinic where unattached GAP patients are first evaluated by a paramedic before receiving care from a nurse. Fourth, a pharmacist trajectory was implemented to increase engagement of community pharmacists to respond to GAP patients. The last innovation is a decentralized GAP offering in-person nursing care to unattached GAP patients. Conclusions: Descriptions of these five innovations are key to inform other territories and provinces on ways to improve access for unattached patients while they are waiting to be attached. The introduction of the GAP and the organizational innovations, suggests a transition where access to PC services does not rely solely on attachment status. [ABSTRACT FROM AUTHOR]

We live in a time of oversaturation with information and data that bombards us and is accessible at every step. This fact applies to all areas of human activity. It is information related to events in our immediate or broader social environment, the range of products and services, market trends, development activities, or something else. In addition to the benefits, such a mass of data and information also brings many problems. One such problem is their verification and, consequently, credibility, which brings a whole range of risks. These problems are not only present in laic environments, where various deceptions and misinformation of different social groups can occur. The problem is also present in professional circles, where such resources, professionally unverified in the broader environment, are used for various research and development needs and expertise, which are then used to guide the development activities of individuals, the economy, and society. This is already a problem that can cause a lot of confusion and deception in the development activities of the economy and society, which leads to the fact that the development efforts do not bring the expected benefits to all stakeholders. Moreover, they often introduce confusion and reduce the success of development efforts. Due to the issues described, we decided to introduce in the first part some views and facts essential to understanding the phenomenon of Industry 4.0 and related issues that are the background for this article, where we are discussing the governance of virtual organizations. [ABSTRACT FROM AUTHOR]

Abstract Background Being attached to a primary care (PC) provider is at the core of a strong primary health care system. Centralized waiting lists (CWL) for unattached patients have been implemented in eight provinces of Canada to support the attachment process. In Quebec, the Ministry of Health mandated the implementation of Primary Care Access Points (GAP) across the province to help unattached patients navigate the health system while awaiting attachment through the CWL. Several local health territories developed complementary innovations to the GAP to respond to local population needs. This paper aims to describe five organizational innovations implemented locally. Methods This multi-case qualitative study was conducted in four local health territories in the province of Quebec. Fifty-two semi-structured interviews with healthcare managers, nurses, physicians, other health professionals and administrative staff were conducted between April 2023 and April 2024. An interview guide was developed based on existing frameworks on the implementation of innovations and the evaluation of the GAP. Thematic analysis was conducted using NVivo software. Inductive and deductive approaches were used to develop relevant codes and themes. Logic models were built to describe the organizational innovations. Results Five organizational innovations are described. First, a multidisciplinary clinic aimed at responding to patients with mental health issues was implemented. Second, a nurse clinic was implemented to provide temporary care for patients with unstable chronic illnesses. The third innovation is a mobile proximity clinic where unattached GAP patients are first evaluated by a paramedic before receiving care from a nurse. Fourth, a pharmacist trajectory was implemented to increase engagement of community pharmacists to respond to GAP patients. The last innovation is a decentralized GAP offering in-person nursing care to unattached GAP patients. Conclusions Descriptions of these five innovations are key to inform other territories and provinces on ways to improve access for unattached patients while they are waiting to be attached. The introduction of the GAP and the organizational innovations, suggests a transition where access to PC services does not rely solely on attachment status.

The article outlines the changes to the EU’s Common Agricultural Policy for 2023-2027 with a particular focus on a new type of direct payment, i.e. ecoschemes. The aim of the article is also to present the interest of farmers in this tool for obtaining funds in the initial period of its operation, i.e. in the first half of 2023. The level and spatial differentiation of interest of Polish farmers in this new type of direct payments was analyzed. It was indicated that the number of applications submitted is influenced by the production specialization of individual provinces. The results of the study further confirm that carbon farming is the most popular of the five types of ecoschemes, with practices such as mixing straw into the soil (61.2%), using winter intercrops/intercrops (35.0%) and mixing manure on arable land within 12 hours of application (23.8%). This state of affairs was influenced by the previous experience of farmers related to the improvement of soil structure.

This paper analyses the role of gender of the chief executive officer (CEO) on the propensity to introduce innovations using a sample of 1405 Spanish small- and medium-sized enterprises (SMEs). We examine whether there are significant differences between female- and male-led businesses in terms of their propensity to innovate, and whether these differences may be explained by factors related to the attributes of the CEO concerning risk tolerance, self-confidence, education level and cooperative behaviour. In particular, this study tests if the linkages between these managerial attributes and the propensity to innovate are influenced by the gender of the CEO. Using a multivariate probit model (triprobit), we further investigate the role of gender on the CEO decision to simultaneously introduce product, process and organisational innovations. Our main results indicate that there are not significant differences in the propensity to introduce innovations between male- and female-run businesses when considering innovation at an aggregated level, that is, innovating in any of the three types of innovations considered. However, we obtain a higher propensity of male CEOs to introduce process innovations, as compared to their female counterparts. No significant differences by gender are found for product and organisational innovations. Additionally, results of the multivariate probit model indicate that the three innovation decisions are interdependent and should be jointly analysed. This study contributes to the scant literature regarding gender impact on firm's innovativeness with novel empirical evidence for SMEs. [ABSTRACT FROM AUTHOR]

A combination of business-to-business car sharing and electric cars—shared electric cars (SECs)—has the potential to significantly reduce emissions from local travels during work time in organisations. In this paper, we analyse the uptake of SECs in two communities of mobile workers in Norway based on a combination of community of practice and affordances theories. The term community-based affordance is coined to describe how new mobility technologies are enacted and made sense of in the community, leading to transformations in work and mobility practices. Five community-based affordances are located for the SEC-system as follows: replacements of private cars, customised use of vehicles, rapid reimbursement, co-riding to meetings and commuting mode reconfigurations. Together, these affordances indicate how an SEC- system can contribute to the development of sustainable mobility practices in enterprises with many mobile workers. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused the whole educational system to collapse during the lockdown period. Hence, higher education institutions (HEI) led the change of learning delivery mode phases for effective and efficient academic services. This study describes the extent of manifestation on critical success factors (CSF) observed in one state university and determines the degree of organizational innovation practices in terms of technology-enhanced instructions. It also investigates the dimensions of CSFs that singly or in combination predict organizational innovations. The study purposively chose 251 faculty members from Laguna State Polytechnic University-San Pablo City, Philippines as respondents. Multiple regression analysis was used to determine significant predictors of Organizational Innovations. The findings reveal that five (5) constructs of CSFs were highly manifested (IUQDDI, ILT, IFCE, ISC & ITQ) among respondents and organizational innovations concerning technology-enhanced instructions viewed as highly practiced. Likewise, moderate to a strong association was seen between CSFs and organizational innovations. Furthermore, ISC, ILT, IUQDDI, and IFCE as the CSF construct were deemed significant predictors of organizational innovations. The results served as basis for organizations’ future planning on the effective implementation of the learning delivery mode.

The use of available digital tools, the entrepreneur’s personal human capital, and the formation and filling of niche markets are seen as the main factors of enterprises’ prosperity. Thus, the study aims to identify the impact of business research on the dynamics of operational and commercial efficiency of small and medium-sized enterprises (SME). The online survey and regression analysis methods based on the data obtained were used. The study revealed that SMEs constantly need to perform data analysis, but despite the need for business intelligence, enterprises rarely use Big Data (cloud technologies). Most small businesses that conduct business research use digital tools, which poses acute problems of staff development and building an effective model for outsourcing research agents. Currently, the economic efficiency of business research is not clearly visible, which is due to the influence of strong external factors, as well as a low level of innovation and research activity of economic agents.

The paper aims to recognize whether family firms that introduce the creative ideas of their employees are more innovative than the other family firms, i.e. if they introduce more products, processes, marketing, and organizational innovations. Moreover, it explores the relationship between the innovation of family businesses and their involvement in activities that stimulate innovative thinking by building a trusting workplace climate, driving employees’ development, and supporting team integration. The study is based on the primary research which was conducted in Poland on a sample of 353 family firms. The statistical analysis of the research results shows that family firms that implement the creative solutions of their employees introduce significantly more product innovations than other family businesses. However, there are no differences between these two groups of family firms regarding organizational, process, and marketing innovations. Our analysis also revealed that: (i) supporting employee development is an independent factor influencing the product, process and organizational innovation of family businesses; and that (ii) building team integration by the company is an independent factor that impacts process innovation.

To enhance milk quantity and quality which have continued to decrease in Kenya, various stakeholders have intervened through promotion of technical dairy innovations at the farm level including improved cow feeding, health management, promotion of exotic breeds, and milking hygiene. At the milkshed level, stakeholders’ focus has been on organizational innovations, specifically milk sale by farmers through groups. This study sought to characterize dairy innovations that have been adopted by farmers in the milkshed of three milk processors including New Kenya Co-operative Creameries Sotik (NKCC Sotik), Happy Cow Limited (HCL), and Mukurweini Wakulima Dairy Limited (MWDL), representing one state, private, and farmer-owned processor, respectively. Data were collected using a structured questionnaire from a sample of 1146 farmers (410, 382, and 354 in MWDL, HCL, and NKCC Sotik, respectively). A categorical principal components analysis was used to reduce 32 variables into four sets of uncorrelated components. Four categories were identified including principal component (PC) 1 (technical capacity), PC 2 (animal health management), PC 3 (organizational capacity), and PC 4 (milk hygiene). More farmers in the milkshed of MWDL adopted technical and organizational dairy innovations such as use of artificial insemination and milk sale through groups, respectively, than farmers in milkshed of NKCC and HCL. The county governments in the milkshed of HCL and NKCC Sotik need to strengthen cooperative societies to boost adoption of artificial insemination through arrangement in which milk is sold and payment of services offered on credit is settled from milk sale and ensure milk market availability throughout the year. [ABSTRACT FROM AUTHOR]

Management in education is growing in importance because of the major changes in the education system that requires efficiency and effectiveness of running. Organizational innovations are an important tool for making changes in the entire education management system. It was assumed that the organizational innovation in education consists mainly in introducing changes to the education system or an educational institution and relates to its structure, processes or pedagogical procedures. The aim of the article is to assess the implemented organizational innovations at the central, regional and local levels and to identify key areas contributing to their effective management. The work uses a critical literature review focused on innovation management and analysis of randomly selected educational programs, as well as a case description; conclusions were formulated as well. The conclusion of the analysis is the dependence between the management of organizational innovations and the scope of their implementation. Educational innovations implemented at the central level can be an example and model for local initiatives. The innovative methodology used by central institutions will guarantee greater effectiveness in achieving success.

The main aim of the article is to present certain aspects of technological and organisational innovations on the basis of literature and the results of the authors’ survey carried out among 99 representatives of catering businesses. The research was carried out in 2014-2016 and focused on technological innovations. Its results indicate that improvements in the production process are contingent on the financial status of the firm and the scope of its activity. Low-calorie, organic and regional dishes were novelties introduced by companies from the sector. When it comes to the organisational innovations, respondents tended to indicate the following: cheaper sources of supplies, new operation strategies, reorganisation of organisational structures and new marketing methods.

This paper explores the firm-level relationship between product, process, organizational and marketing innovation activities and firm productivity. We propose a structural model that relates R&D decisions, innovation activities, and productivity by using a version of the model developed by [Crépon, B., E. Duguet, and J. Mairesse. (1998). "Research, Innovation and Productivity: An Econometric Analysis at the Firm Level." Economics of Innovation and New Technology7: 115–158] and empirically analyze the drivers of firms' innovation strategies as well as which combination has effects on firm's economic productivity. Results show that R&D expenditures are an important predictor of all types of innovation as well as an important indirect driver of firm productivity through innovation activities. Both process and product innovation have positive effects on firm's economic productivity, especially when they are jointly conducted. Organizational activities are beneficial also for other types of innovation and especially for process innovation. The introduction of a new product on the market may raise productivity if complemented by marketing innovations. Results are driven by firms that have invested the most in new equipment and machinery. [ABSTRACT FROM AUTHOR]

In article on the basis of official data of state statistics analyzes results of the surveys, which were conducted in Europe, in order to investigate the innovation activity of companies. Focuses on organizational innovations. Discusses the definitions of organizational innovations and evolution of innovations.

The topicality of this research is determined by a low innovative activity of complex economic entities. Due to the implementation of a new version of the international standard ISO 9001:2015, it is required to both adjust documentation and make new strategic decisions regarding the changes in internal and external environment. The majority of Russian organizations underestimates the role of organizational innovations in the development of an economic entity. The authors view a quality management system (QMS) of an economic entity not only to form the environment for the effective innovative development of a parent company and its separate business units but also to be an organizational innovation capable of accelerating the diffusion of organizational changes and launching the organizational expansion. The analysis of the interdependence between QMS and organizational innovations proved the lack of the integrative concept for creating the QMS of a complex economic entity as a direction of innovative development.

The subject of research is theoretical and practical questions of using of innovative systems of quality management of system the services sector. The purpose of the article – to analyze the innovative system of quality management system service sector and it role in activization of development tourism. Methods of the research. Methods of theoretical generalization and comparison, system analysis are used in the article. The results of the research. Activization of tourist services sector determines of necessity the development and implementation of quality management system as compulsory component of the development strategy as tourism as a whole and at the level of the individual companies. The most real method to achieve this purpose is the formation of mechanism of state regulation and quality management of tourist services, should directed to the full using of measures, systems and methods of management. System of services sector of quality management in the implementation and improvement interacts with other social systems and industrial enterprises of the tourism industry. The first is the management of development of the tourism product, production planning, technological preparation, material and financial resources, quality of work, preparation of personnel. Together, these systems cover all spheres of activity the labour collective of tourist enterprise, industrial, economical, social, technological. Achieving of effectiveness system of the management quality of services sector on enterprises of the tourism industry can’t achieved without the using of various innovative forms and active influence of services sector and management personnel on improve of the quality of tourist services, tourist agents. Field of using results. The results providing create of a theoretical basis for activization of innovation activity in the national quality management system of services sector. Conclusions. Quality of services sector affects on the structure and consumer demand is an important factor in competition on the tourism market in the modern economic conditions. Tourists of the services sector at hotels, restaurants, travel agencies, travel agencies, active advocates are satisfied. On quality of services sector is influenced of such factor as the directing on services and products, their orientation to a specific consumer.

Background: Many organizations struggle to efficiently and effectively spread improvement activities. This article presents findings from a model developed to standardize the sharing of innovative ideas within nursing at an academic medical center. Problem: Quality improvement activities were occurring in many nursing units but often did not spread beyond the originating unit. Challenges included variability in operationalizing initiatives, inconsistent understanding of project goals, and the lack of a dissemination process. Approach: The Spread of Innovations Model was developed to ensure structure and resources are in place to spread successful initiatives. The model uses Lean problem-solving and engages frontline nurses with senior leadership when spreading internally developed best practices. Outcomes: The model was piloted by spreading a catheter-associated urinary tract infection (CAUTI) prevention project throughout nursing. Using the model led to significantly decreased CAUTIs. Conclusions: Improvement efforts without a process for spreading can lead to inefficiencies and variable outcomes. [ABSTRACT FROM AUTHOR]

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This paper investigates two sets of hypotheses related to the relationship between the investment in the knowledge-based economy (KBE) and innovation performance in a developing country. The first set supposes that investment in information and communication technologies (ICT), organizational innovations, and human capital, the main three pillars of KBE, has a direct effect on innovation performance of Tunisian firms. The second set tests the hypothesis of complementary effect of these pillars such that their combination constitutes a significant production system affecting the innovation performance. Using recent firm-level data, we find evidence of direct effect of investment in the KBE on firm's innovation performance. The second set of hypotheses is partly supported. We find evidence of complementarity between ICT and human capital as well as between ICT and organizational innovations, but we do not find evidence of complementarity between human capital and organizational innovations. Moreover, we find that full complementarity between ICT, organizational innovations, and human capital does not apply to Tunisian firms. [ABSTRACT FROM AUTHOR]

Drawing on interviews conducted at five Hungarian high-growth firms (HGFs), this paper discusses how dynamic capabilities shape the outcome of HGFs’ efforts to meet the managerial challenges posed by rapid growth. HGFs are investigated in the context of a relatively under-researched country: Hungary. The research demonstrates that dynamic capabilities have strong explanatory power for the surveyed companies’ achievements, in a similar manner to what is established in the literature on HGFs in advanced economies.

The topicality of this research is determined by a low innovative activity of complex economic entities. Due to the implementation of a new version of the international standard ISO 9001:2015, it is required to both adjust documentation and make new strategic decisions regarding the changes in internal and external environment. The majority of Russian organizations underestimates the role of organizational innovations in the development of an economic entity. The authors view a quality management system (QMS) of an economic entity not only to form the environment for the effective innovative development of a parent company and its separate business units but also to be an organizational innovation capable of accelerating the diffusion of organizational changes and launching the organizational expansion. The analysis of the interdependence between QMS and organizational innovations proved the lack of the integrative concept for creating the QMS of a complex economic entity as a direction of innovative development. [ABSTRACT FROM AUTHOR]

This paper analyzes various innovation strategies of firms. Using five waves of the Community Innovation Survey in Sweden, we have traced the innovative behavior of firms over a 10-year period, i.e. between 2002 and 2012. We distinguish between sixteen innovation strategies, which compose of Schumpeterian four types of innovations (process, product, marketing, and organizational) plus various combinations of these four types. First, we find that firms are not homogenous in choosing innovation strategies, instead, they have a wide range of preferences when it comes to innovation strategy and some of the innovation strategies are 'commonly' used among firms. Second, using Transition Probability Matrix, we found that firms also persist to have such a diverse innovation strategy preferences. Finally, using Multinomial Logit model, we explained the determinant of each and every innovation strategies, while we gave special attention to the commonly used innovation strategies among firms. [ABSTRACT FROM AUTHOR]

The aim of the article. The aim of the article is to define the most promising types of innovation activity in domestic conditions (general, crisis or post-crisis). The authors consider them as a type of innovation that involves creation of new consumer value by means of removing the unnecessary functions and properties. It allows to reduce the cost of the novelty while preserving uniqueness through proper innovation positioning and highlighting.The results of the analysis. The authors proposed to complement the existing approaches to the classification of innovations adding orientation of the development process. According to this approaches innovation may be divided into two groups: focused on complications and directed on simplification.The authors suggested methodical approach to the substantiation of simplifying innovations creation. It has to be based on the principles of functional analysis. The sequence of procedures of simplifying innovations creation and implementation were proposed.The developed approach was introduced in activities of Municipal Institution of the Sumy Regional Council Sumy Regional Centre of Recreation, Recovery, Tourism and military-patriotic education (hereinafter Center). The implementation of those changes has provided a new impetus to the Centers development in conditions of limited funding. The main idea of innovative project is to organize recreation for children and youth in camping instead of rest in stationary camps. Camping have to be located in beautiful, eco-friendly areas,.Development and implementation of an innovative project directed on the Centers development has brought a number of effects, the main ones are:economic benefit for consumers as cost recovery is 30-40% off than in stationary camps;economic benefit for the Center as camps are organized on a pulsating principle. So they are created when there is a need and dismissed when it is not. It allows to save money on their maintenance and spend them on other social activities;public and social effects are in the number of children and young people which are able to have a rest in such camps; for privileged families the tour is absolutely free, besides campsites popularize active forms of recreation and healthy lifestyles;environmental advantage and the effect of energy savings (campgrounds do not use dirty energy sources that pollute environment). Campers also acquire skills of deference attitude to the natural environment. It will perspectival solve the problem of pollution, preserving and restoring of natural assets of the country;pedagogical effect is that the variability and mobility of approaches and forms of work with children in tent camps are wider.Conclusions and directions of further researches. The results confirm the effectiveness of authors ideas to create and implement the simplifying innovations. It is one of the promising directions of innovative development of enterprises and institutions in Ukraine.

Marketing innovation is essential for small industries to transform products into profit; therefore, understanding its nature and determinants is of utmost importance. This study aimed at understanding marketing innovation and its determinants in the 60 small food industries in the rural areas of Tehran province, Iran. Using a census sampling method, 111 managers of these firms were interviewed. Results showed that the firms’ performance in marketing innovation is generally weak, and a higher level of radical innovation in marketing is perceived compared to the incremental innovation. Also, a cause-and-effect relationship exists between both product and organizational innovations and marketing innovation. Furthermore, while incremental marketing innovation was negatively influenced by formal R&D unit, product diversification, and the manager’s years of experience, radical marketing innovation was affected by the capacity of production, product diversification, and managers’ age and education. The study concluded that in order to boost marketing innovation, innovation should be made also in products and organization. In addition, in order to facilitate the process of marketing innovation, practical and updated training for managers encouraging incremental innovation in marketing, product diversification, and improving R&D activities in the studied firms should be regarded. [ABSTRACT FROM PUBLISHER]

This paper investigates two set of hypotheses related to the relationship between the investment in the knowledge based economy (KBE) and innovation performance in a developing country. The first set supposes that investment in information and communication technologies (ICT), organizational innovations and human capital, the main three pillars of KBE, has a direct effect on innovation performance of Tunisian firms. The second set test the hypothesis of complementary effect of these pillars such that their combination constitutes a significant production system affecting the innovation performance. Using recently firm-level data, we find evidence of direct effect of investment in the KBE on firm's innovation performance. The second set of hypotheses is partly supported. We find evidence of complementarity between ICT and human capital as well as between ICT and organizational innovations, but do not find evidence of complementarity between human capital and organizational innovations. Moreover, we find that full complementarity among ICT, organizational innovations and human capital does not apply to Tunisian firms. [ABSTRACT FROM AUTHOR]

The host of statistical data on labour organization from the 2004 Encuesta de Calidad de Vida en el Trabajo (2005) will be used as a basis for using factorial analysis to identify the factors that determine how ‘modern’ companies organize their work according to business management literature. Workers' identification with their company seems to be the essence of a good part of business managers' objectives. The results of the research point to a continuity in a worker profile that largely corresponds to the Fordist model, with a few significant changes: the domain of some non-conflictive industrial relations which is settled on the value that is given to the good relationships with mates and managers and the flexible work-class positive assessment that allows to harmonize other life aspects. [ABSTRACT FROM PUBLISHER]

The purpose of this study is to ascertain whether there is any correlation between the implementation of quality-management systems (QMSs) in manufacturing firms and the use of certain organizational innovations in those firms. A conceptual model of the relationships among the constructs of 'organizational innovations' and 'level of quality management' is proposed and tested. The study finds a correlation between the level of quality management in an organization and the implementation of procedural organizational innovations. Because the study is pioneering and exploratory in nature, the analysis is confined to the use of a limited number of organizational innovations in Spanish manufacturing firms. The findings will assist managers to make appropriate strategic decisions when implementing QMSs. © 2010 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The article focuses on the measures and strategies in the pursuance of Institute of Medicine (IOM) quality aims in the U.S. It discusses the relationships between IOM quality aims and the organization technologies. It also offers illustrations on the interplay of organizational technologies and IOM aims across an array of organizational innovations with transformative potential to ambulatory care.

Objective To report the process of introduction, development and sustenance of a curriculum for a department of general practice in the context of changing curricula required by the General Medical Council. Setting and context Tayside Centre for General Practice, the Department of General Practice within Dundee University Medical School. Methods Use of action research methodology common in educational and sociological research. Action research utilizes a range of data collection techniques which allow the participants in the research full opportunities to reflect on the data as it emerges and make developments accordingly. Analysis This took place as part of the process of the 5-year project. The analysis used as its starting point the sociological theory of the social construction of power within institutions. It offers the thesis that marginality seems to be a prerequisite in confronting institutional conservatism. Conclusions Use of an action research model facilitated more effective change by providing a supportive atmosphere in which to tackle changes. The marginal status of the general practice group in relation to the medical school allowed creative negotiation of alliances within the medical school. Other groups within the medical school who are introducing new curricula can learn from this report. [ABSTRACT FROM AUTHOR]