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This chapter examines and accounts for skillful coping and its complexity in a way that linear and staged models cannot. The authors propose a morphogenetic approach of enskilment that surmounts the limitations of such stepwise progressions from novice to expert. Based on rich empirical data that follow forwards the process of one author’s craft apprenticeship over time, the chapter shows that becoming enskilled is an ongoing process that unfolds against the background of practice. This reveals a recursive, multidirectional pattern of movement that is specific to each practitioner, depending upon his or her prior experiences and circumstances. Thus the pattern of enskilment may be shared by a range of skillful copers, but is given its specificity by each practitioner’s particular background practice(s).

In Chapter 4, Mork et al. explore the intrinsically contested, negotiated and contradictory nature of collective work through the case of Transcatheter Aortic Valve Implantation (TAVI). TAVI represents one of a range of new therapies replacing traditional surgery, thus producing tensions between old and new ways of practising. The authors draw upon Cultural Historical Activity Theory (CHAT), which views such tensions as potential generators of new forms of practice. The authors suggest that this dialectical view offers a useful counterpoint to approaches to practice where collective activities unfold harmoniously around a common telos, and where learning occurs unproblematically. By exploring the way multiple actors, mediators and activity systems involved in the process converge at some points and diverge at others, contradictions can be considered as signs of development.

We contribute to the literature on the production of knowledge through engaged management and organisational research. We explore how relational practices in management and organisational research may interpenetrate and change one another, thereby potentially producing new knowledge. We demonstrate the importance of the disruptive qualities of arresting moments in this process. We present data from within ongoing engaged management and organisational research at an arts festival involving related music, management and research practices, during which two arresting moments arose: one in our own core research practice, the other in related music and management practices. We found arresting moments were preceded by increasingly intense divisions between practices, when practitioners experienced increasingly entrenched views and heightened emotions. Arresting moments sometimes followed, producing an empathetic connection between practitioners, so that they could suddenly see situations from a new perspective. In this way, arresting moments could produce opportunities for (self-) reflexivity and the possibility of reconstructing knowing in relational practices.

Summary This paper explores identity work in the creative setting of an opera company. We focus on how people account for who they are and what they do as they go through the process of preparing to perform an opera. Identity work can occur as a response to internal tensions and we inquire into the kinds of tension that occur for our research participants. We go on to analyse a dramatic event as a form of re-narration and we consider how the re-narration can occur. As a result we seek to make two related contributions to the literature on identity work in the creative industries. First, we elucidate three kinds of internal tension that can elicit on-going identity work by people in creative organisations. Second, we explicate re-narration as an aspect of the process of identity work. In re-narration, the characters of others become reformed so as to fit with a narrative that holds sway in the social context, and as a result the relationship between self and other is affected.

In the U.K., approaches to policy implementation, service improvement and quality assurance treat policy, management and clinical care as separate, hierarchical domains. They are often based on the central knowledge transfer (KT) theory idea that best practice solutions to complex problems can be identified and 'rolled out' across organisations. When the designated 'best practice' is not implemented, this is interpreted as local--particularly management--failure. Remedial actions include reiterating policy aims and tightening performance management of solution implementation, frequently to no avail. We propose activity theory (AT) as an alternative approach to identifying and understanding the challenges of addressing complex healthcare problems across diverse settings. AT challenges the KT conceptual separations between levels of policy, management and clinical care. It does not regard knowledge and practice as separable, and does not understand them in the commodified way that has typified some versions of KT theory. Instead, AT focuses on "objects of activity" which can be contested. It sees new practice as emerging from contradiction and understands knowledge and practice as fundamentally entwined, not separate. From an AT perspective, there can be no single best practice. The contributions of AT are that it enables us to understand the dynamics of knowledge-practice in activities rather than between levels. It shows how efforts to reduce variation from best practice may paradoxically remove a key source of practice improvement. After explaining the principles of AT we illustrate its explanatory potential through an ethnographic study of primary healthcare teams responding to a policy aim of reducing inappropriate hospital admissions of older people by the 'best practice' of rapid response teams.

Background There is an increasing literature on learning organisations as a way of fostering communication, teamwork, collaboration and collective learning, thereby promoting quality improvement and enhancing patient safety. An increasing number of instruments are being developed in an attempt to measure learning organisation characteristics. However, the majority of these tools are created for a business setting, have not been scientifically tested and have not been applied in healthcare. Objective To evaluate elements of the validity and reliability of an instrument (ie, learning practice inventory (LPI)) for diagnosing learning practice characteristics in primary healthcare. Method Content validity was evaluated using a modified nominal group technique and a content validity rating scale. Construct validity and reliability evaluation was undertaken with 10 staff members from 10 general practices in the west of Scotland. Staff completed the inventory twice, 4–6 weeks apart. Applying generalisability theory, a variance component analysis was performed. Results The main findings present evidence that the inventory has acceptable reliability and content validity. The results also demonstrate that the inventory can reflect the consistent and uniquely different perspectives of particular designations of staff within a practice. It is possible to compare practices' overall learning environments and to identify specific areas of practice strength as well as areas for development. Conclusion This study demonstrates the psychometric properties of a learning practice diagnostic inventory. It highlights the consistently different perspectives that individual staff groups have on the function of their practice, suggesting that the success of quality improvement initiatives may be compromised without the involvement and true engagement of each staff group.

Expertly written by leading scholars from a range of different starting points, this compendium presents a synthesis of recent work relating to institutionally-informed accounts from transitional and emerging markets, as well as from mature economies. It specifically focuses on the linkage between institutions and what goes on inside firms, and the relationship between setting, strategic choice and systemic outcomes.