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Objectives. To explore the experiences of governance and incentives during organizational change for managers and clinical staff. Study Setting. Three primary care settings in England in 2006-2008. Study Design. Data collection involved three group interviews with 32 service users, individual interviews with 32 managers, and 56 frontline professionals in three sites. The Realistic Evaluation framework was used in analysis to examine the effects of new policies and their implementation. Principal Findings. Integrating new interprofessional teams to work effectively is a slow process, especially if structures in place do not acknowledge the painful feelings involved in change and do not support staff during periods of uncertainty. Conclusions. Eliciting multiple perspectives, often dependent on individual occupational positioning or place in new team configurations, illuminates the need to incorporate the emotional as well as technocratic and system factors when implementing change. Some suggestions are made for facilitating change in health care systems. These are discussed in the context of similar health care reform initiatives in the United States. Key Words. Emotions, chronic illness, relationships, health care, health policy/ policy analysis, In this article we discuss findings from a three-center study in England, which explored the professional experience of evolving organizational and governance structures in primary health and social care, in [...]

In this paper I draw on the findings of an ethnographic study of fertility nursing in a British fertility unit to explore the relevance and importance of ethnography for illuminating the role of emotions in nursing practice. One of the main findings to emerge from the original study was that infertility was an emotional experience for both staff and patients, and that the organisation of the unit ensured that the potentially disruptive emotions of staff and patients were controlled and remained private. These findings have been reported elsewhere (Allan, 2001, 2002). Drawing on these findings, I discuss the role of ethnography in illuminating the role of emotions in the clinic in two ways. First, I will discuss the nature of the data in ethnography and the relationship between participant observation and interviews. Second, I will discuss the experience of researcher reflexivity and ethnographic authority in ethnography.