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Background: Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods: An inductive modelling approach was used to develop a new evidence‐based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results: Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions: The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution: At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees. [ABSTRACT FROM AUTHOR]

This paper considers what concept of accommodation is necessary to identify and address discrimination, disadvantages and disparities in such a way that the plurality of religious people with their beliefs, values and practices may be justly accommodated in healthcare. It evaluates threats to the possibility of such accommodation pertaining by considering what beliefs and practices might increase the risk of unjust discrimination against and disadvantage for religious people, whether as individuals or as groups; and the risk of disparities between the care provided to religious people. The claim is that there is an important cluster of risks that are political in kind and emergent within philosophical bioethics. While not amounting (yet) to a trend, they are sufficiently threatening to a just civic life for patients and healthcare staff as to warrant scrutiny. After an Introductory Section 1, Section 2 evaluates a criticism of 'accommodation' and the apparently additional health‐related requirements that those of religious faith demand, when compared with other people. It does so by comparing Lori Beaman's idea of agonism with that of a distinct and somewhat complementary approach in Jonathan Chaplin's political philosophy, before examining the role of established religion in setting the conditions for the accommodation of religion and belief in healthcare. Section 3 examines risks to such accommodation by engaging critically with three health‐related instantiations of political philosophy that differ radically from both Beaman and Chaplin. A concluding Section 4 focusses on appropriate modes of communicating about religious and other beliefs in healthcare. [ABSTRACT FROM AUTHOR]

This paper addresses the investor's decision to employ multiple managers for the management of investment funds. Under conditions such that specialization of managers and diversification among managers are not motives for the use of multiple managers, the paper shows that risk sharing considerations may be sufficient. A model is developed in which the decision to use multiple managers is explicitly treated, and conditions are studied such that an increase or decrease in the number of managers would be desirable. Under some conditions, a multiple manager solution is preferred over a single manager solution. [ABSTRACT FROM AUTHOR]

Metaphors are popular in human interaction as a means to make relevant associations, convey complex ideas, and even dramatize reality or introduce humour in conversations. Metaphors, if leveraged effectively, can be a powerful tool for management consultants in their client engagement process. Chosen with a sensitive and empathetic rationale, metaphors can not only help fathom highly complex problem situations, they can also bring in an element of light‐heartedness in consulting conversations that may otherwise be stale and unexciting. Metaphorical associations can enable informality, trust, and long‐term engagement between consultants and their clients. This paper presents a first person narrative of how the author has used metaphors as a tool for creative consulting. A reflection is provided on how the experiences narrated in this paper align with the conceptual lens of holistic flexibility introduced by Rajneesh Chowdhury in his latest book on systems thinking for management consultants in 2019. [ABSTRACT FROM AUTHOR]

Issues of power are often neglected in information systems (IS) studies and under‐theorised in IS research. Systems development methods (SDMs) are commonly used in the IT industry to coordinate the activities between developers and clients. The role of power in the relationship between clients and systems developers remains an important topic of research in information systems development (ISD). Yet, despite the importance of understanding this relationship better, there has only been a limited number of studies exploring the role that an SDM can play in influencing this relationship. What is not widely acknowledged or researched is how different forms of power are inscribed in and enacted through an SDM. The aim of this paper is to advance our understanding of different forms of power—here, obtrusive and unobtrusive power—to show how ISD concepts provide structures during the enactment of an SDM and thereby influence relationships between developers and clients. We present qualitative results from an exploratory case study within an IT division of a large international bank and interpret the results using Clegg's (1989) circuits of power (CoP). Our analysis shows that developers feel disempowered in relation to the client, with developers playing a cooperative but submissive role. Prior SDM enactment studies have either not encountered or not recognised cases where obtrusive and unobtrusive forms of power inscribed within the SDM directly determine the relationship between developers and the client. Our results are presented as a set of propositions explaining how obtrusive and unobtrusive power is inscribed in the SDM and the effect such inscription has on the enactment of the SDM. [ABSTRACT FROM AUTHOR]

Background: Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments. Aim: To describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes. Methods: We conducted a systematic review of qualitative studies evaluating complex health interventions designed for Indigenous communities in high‐income countries. We searched 6 electronic databases (through to January 2020): MEDLINE, PreMEDLINE, Embase, PsycINFO, EconLit and CINAHL and hand‐searched reference lists of relevant articles. Results: From 28 studies involving 677 stakeholders (mostly clinical staff and participants), six main themes were identified: enabling engagement, regaining control of health, improving social health and belonging, preserving community and culture, cultivating hope for a better life, and threats to long‐term programme viability. Conclusion: The prominence of social, emotional and spiritual well‐being as important aspects of the health journey for participants in this review highlights the need to reframe evaluations of health programmes implemented in Indigenous communities away from assessments that focus on commonly used biomedical measures. Evaluators, in consultation with the community, should consistently assess the capacity of health professionals to meet community needs and expectations throughout the life of the programme. Evaluations that include qualitative data on participant and community‐level outcomes can improve decision‐makers' understanding of the impact that health programmes have on communities. Patient or public contribution: This paper is a review of evaluation studies and did not involve patients or the public. [ABSTRACT FROM AUTHOR]

Objective: To synthesize the qualitative literature on adults' experiences of psychological therapy assessments. The review was led by people with experience of undergoing assessments, with high levels of client involvement throughout. Search strategy: A comprehensive search of electronic databases was undertaken, with additional search strategies employed to locate further literature. Inclusion criteria: Studies were included that qualitatively explored the experiences of people aged 16+ who had been assessed for psychological therapy services. Assessments could be structured or unstructured. Qualitative was defined as any analysed account of people's experiences, including qualitative survey data. Data extraction and synthesis: Literature quality was appraised using the Critical Appraisal Skills Program checklist, modified to include client involvement and intersectionalities. Following data extraction, thematic synthesis was used to synthesize findings across studies. Results: Of 12 743 titles were screened, with 13 studies relevant to the review. Themes and subthemes were identified at three stages of the assessment process: the journey to the assessment, at the assessment, and after the assessment. Findings highlighted the emotional impact of assessments, collaboration, intersectionalities, rights, pathologization, socioeconomic restrictions, and information and support needs. Implications and limitations were indicated. Discussion and conclusions: Findings were situated within the trauma‐informed (TIA) literature. Trauma‐informed assessment principles, including collaborative assessments, may be fruitful means of improving people's experiences. Whilst the benefits of collaboration appear self‐evident, explicitly collaborative approaches were not the norm, nor were studies conducted independently. Further service user research is needed. A greater understanding of the experience of minority groups is also needed. [ABSTRACT FROM AUTHOR]

This article addresses ethical and legal issues arising from the increasing use of e-mail and other forms of instant written communication in the conduct of business. E-mail communications are often casual and informal. Yet e-mail is a written record that can be more permanent and widely accessible than a paper communication. This article focuses on the implications of this fact, including (1) how individuals compromise their own privacy by the voluntary use of e-mail; (2) how e-mail has complicated the duty of confidentiality of employees to employers, and professionals to clients; (3) whether the use of e-mail affects ethical deliberation and choice; and (4) the use of e-mail as evidence of corporate conduct and intent in civil and criminal litigation. The article suggests that e-mail users think “forensically” about their e-mail—i.e., consider its potential as evidence in the context of other emails and underlying events— before pressing the “send” button. [ABSTRACT FROM AUTHOR]

Traditionally, the literature assumed that solo practitice best exemplifies the ideal professional work arrangement and that when professionals become salaried employees their professionalism is seriously threatened. The primary goal of this paper is to examine lawyers' sense of professionalism across two work contexts: solo practitioner offices and law firm settings. We also examine status distinctions within law firms, between associates and partners, and compare both to independent practitioners. Solo practitioners and law firm partners are similar on most key dimensions of professionalism, whereas the greatest contrasts occur between partners and associates within law firms. Partners and solo practitioners share similar experiences of autonomy and service as owner-managers, whereas partners and associates share greater collegiality among professionals, perhaps fostered through law firm cultures. All three groups report comparable amounts of variety in their work and are equally committed to the practice of law. The key factors that account for gaps in professionalism reflect the nature of law practices, primarily through time spent with corporate clients and pressure to generate profits. We conclude that different versions of lawyers' professionalism are influenced by the everyday aspects of their work and one version is not necessarily more professional than the other. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study defines an aspect of consultant knowledge that provides credibility without claiming unrealistic status for a field like consulting. Our focus is the “sector knowledge” that consultants accumulate which derives from repeated assignments in the industrial sector in which the client organization resides. This has been under-researched partly because of an emphasis on knowledge as technique and method. But knowledge configured around the sector enables consultants to play the role of the outside expert and draw on a language and experiences held in common with the client. The paper explores the role of consultants as sector intermediaries through a case study of contemporary management consulting in a UK local authority. We see “the sector” as an alternative type of knowledge formation salient for a client-centered occupation like consulting. We also explore sector knowledge as a negotiated setting and dispel overly simple notions of know-how being “brought to” the client. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents a discussion on marriage counseling involving a passive husband and an aggressive wife. It is the purpose of this paper to indicate by the technique of a case presentation how one professional marriage counselor was of assistance to a couple in achieving more adequate marital relationships and some of the basic principles involved. It is important that the counselor have a philosophy and theory of counseling which orients and directs his procedure in the handling of cases. There are certain basic principles that are important regardless of whether one's theory is psychoanalytic, behavioristic, symbolic interactional, or of some other school. The counselor must be able to accept his client regardless of his actions or attitudes. In his acceptance he must strive for objectivity in the sense of being nonjudgmental and nonmoralistic, which requires a great amount of flexibility, insight and self control, as well as open-mindedness on the part of the counselor. The ability to listen and to allow the client to talk is extremely important, for when the counselor does most of the talking, advising and planning, the client takes the passive role and his progress is severely retarded.

This empirical study of business-to-business service firms examines the determinants and effects of control rights to intellectual assets in a property rights theoretic framework. Regression analyses using survey data suggest that service suppliers that retain control over their intellectual output are more innovative. In long-term relationships, service firms' clients may thus be better off balancing their need to control outsourced activities with the suppliers' incentives to invest in learning and innovation. Additionally, and aligned with property rights theoretic predictions, service suppliers' bargaining power and their indispensability in service projects are positively associated with their ability to retain control rights. In contrast, innovation capabilities are not very significant in determining control rights allocation between service suppliers and their clients. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The use of problem structuring method (PSM) interventions leads to outcomes unique to the circumstances of the problem context. Given the singular nature of these outcomes, a consultant attempting to sell a PSM intervention will struggle to articulate value to clients in terms that are commercially meaningful prior to the intervention being enacted. Thus, in order to win a contract to deliver a PSM intervention, the consultant must first resolve this puzzle. We explore this question by (i) reviewing how the value of PSMs has been assessed previously, (ii) setting out a suitable theoretical position to explore the problem and (iii) presenting empirical data from a commercial organization to build our theoretical position. This starts with agreement with Checkland and Scholes that attempting to sell the (financial) value of a PSM intervention a priori is unlikely to ever succeed. Our theoretical development through analysis of empirical data leads to the recognition that the process of selling a PSM intervention is bound to the interposition of the processes of problematization and interessement and the issue of trust. The recognition of a distinction between these and the actual enactment of a PSM intervention leads us to conclude that the process of selling the consulting engagement is entirely associated with the temporal ordering between them. We thus avoid the bind of the original puzzle only by articulating a paradox. To resolve the paradox, we shift analytical focus to the pre‐contractual phase of the relationship between a consultant and client and discuss implications of this paradox for soft OR practice. © 2018 The authors. Systems Research and Behavioral Science published by International Federation for Systems Research and John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare patients' and dietitians' perceptions of patient‐centred care (PCC) in dietetic practice. Methods: Participants were as follows: (a) adult patients who had attended ≥1 individual dietetic consultation with an Accredited Practicing Dietitian (APD) working in primary care; and (b) APDs with experience working in primary care. A cross‐sectional survey was undertaken using a patient‐ and dietitian‐reported inventory to measure PCC in dietetic practice. The inventory comprised of five previously validated scales: The Communication Assessment Tool; the 9‐item Shared Decision‐Making Questionnaire; the Patient‐Doctor Depth of Relationship Scale; the Schmidt Perception of Nursing Care Scale‐Seeing the Individual Patient sub‐scale; and the Person‐Centred Practice Inventory—Staff ‐Providing Holistic Care sub‐scale. Descriptive statistics were used to analyse participant characteristics and to compute total scores for the five scales. The Mann‐Whitney U test was used to compare median scores between patients and dietitians. Results: One‐hundred and thirty‐three patients and 180 dietitians completed the survey. Patients reported significantly higher scores compared to dietitians for "shared decision‐making" (P = 0.004), but significantly lower scores for "providing holistic and individualized care" (P = 0.005), "knowing the patient/dietitian" (P = 0.001) and "caring patient‐dietitian relationships" (P =0.009). Conclusion: This study highlighted potentially important differences between patients' and dietitians' perceptions of PCC and identified key aspects of dietetic care requiring practice improvements. Strategies are needed to bridge gaps between dietitians' and patients' perceptions and enhance PCC in dietetic practice. These findings suggest that dietitians should focus on individualizing nutrition care, gaining a holistic understanding of their patients and knowing/understanding each patient. [ABSTRACT FROM AUTHOR]

This article presents evidence suggesting that the relationship that existed between the partnership of J. P. Morgan and its client firms partially resolved the latter's external financing problems by diminishing the principal-agent and asymmetric information problems. I estimate and compare investment regression equations for a sample of Morgan-affiliated companies and a control group of nonaffiliated companies. The econometric results seem to indicate that companies not affiliated to the House of Morgan were liquidity constrained. [ABSTRACT FROM AUTHOR]

Context Co-creation-collaborative knowledge generation by academics working alongside other stakeholders-reflects a 'Mode 2' relationship (knowledge production rather than knowledge translation) between universities and society. Co-creation is widely believed to increase research impact. Methods We undertook a narrative review of different models of co-creation relevant to community-based health services. We contrasted their diverse disciplinary roots and highlighted their common philosophical assumptions, principles of success, and explanations for failures. We applied these to an empirical case study of a community-based research-service partnership led by the Centre of Research Excellence in Quality and Safety in Integrated Primary-Secondary Care at the University of Queensland, Australia. Findings Co-creation emerged independently in several fields, including business studies ('value co-creation'), design science ('experience-based co-design'), computer science ('technology co-design'), and community development ('participatory research'). These diverse models share some common features, which were also evident in the case study. Key success principles included (1) a systems perspective (assuming emergence, local adaptation, and nonlinearity); (2) the framing of research as a creative enterprise with human experience at its core; and (3) an emphasis on process (the framing of the program, the nature of relationships, and governance and facilitation arrangements, especially the style of leadership and how conflict is managed). In both the literature review and the case study, co-creation 'failures' could often be tracked back to abandoning (or never adopting) these principles. All co-creation models made strong claims for significant and sustainable societal impacts as a result of the adaptive and developmental research process; these were illustrated in the case study. Conclusions Co-creation models have high potential for societal impact but depend critically on key success principles. To capture the nonlinear chains of causation in the co-creation pathway, impact metrics must reflect the dynamic nature and complex interdependencies of health research systems and address processes as well as outcomes. [ABSTRACT FROM AUTHOR]

There is now a body of research evaluating breastfeeding interventions and exploring mothers' and health professionals' views on effective and ineffective breastfeeding support. However, this literature leaves relatively unexplored a number of questions about how breastfeeding women experience and make sense of their relationships with those trained to provide breastfeeding support. The present study collected qualitative data from 22 breastfeeding first‐time mothers in the United Kingdom on their experiences of, and orientation towards, relationships with maternity care professionals and other breastfeeding advisors. The data were obtained from interviews and audio‐diaries at two time points during the first 5 weeks post‐partum. We discuss a key theme within the data of ‘Making use of expertise’ and three subthemes that capture the way in which the women's orientation towards those assumed to have breastfeeding expertise varied according to whether the women (1) adopted a position of consulting experts vs. one of deferring to feeding authorities; (2) experienced difficulty interpreting their own and their baby's bodies; and (3) experienced the expertise of health workers as empowering or disempowering. Although sometimes mothers felt empowered by aligning themselves with the scientific approach and ‘normalising gaze’ of health care professionals, at other times this gaze could be experienced as objectifying and diminishing. The merits and limitations of a person‐centred approach to breastfeeding support are discussed in relation to using breastfeeding expertise in an empowering rather than disempowering way. [ABSTRACT FROM AUTHOR]

Background There is a growing body of evidence that safe outcomes and quality care are important to patients. For the patient, evaluations of safety and quality are made on the basis of the interpersonal interactions that they have with health professionals as well as the technical aspects of their care. Objective In this study, we investigated the extent to which outcome of care (harm or not) and relationship (good or bad) with the care provider impact on the judgements of responsibility and blame as well as decisions about likelihood of making a complaint. Method Ninety-eight mothers made seven ratings of responsibility, blame and action in response to four hypothetical vignettes in a questionnaire. The vignettes described poor quality ante-natal care in which outcome and relationship with the health-care provider were systematically manipulated across different versions of the questionnaire. Results Multivariate analyses showed that participants made significantly more negative ratings in response to vignettes describing a bad outcome and those that described a poor relationship with the health professional. However, whilst ratings of seriousness and likelihood of making a complaint were most influenced by the manipulation of outcome in the vignettes, judgements of blame and responsibility were most effected by the depiction of relationship with the health professional as good or bad. Moreover, for three of the four vignettes, relationship rather than outcome most strongly influenced overall ratings of care. Discussion These findings are discussed in the context of theory and policy developments. [ABSTRACT FROM AUTHOR]

This article examines whether the independent agents provide better service to their customers than sole representatives of direct writers. Results of a survey of a sample of both types of insurance agents indicate that even though the former apparently excel on some service dimensions, the latter perform as well as or even better than the independent agents on other dimensions. [ABSTRACT FROM AUTHOR]