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This thesis outlines a study into institutional change analysing how certain senior individuals, called opinion leaders, were able to achieve change within the strongly institutionalized environment of medical education. It is situated in the complex and contested context of the English National Health Service, which for more than 60 years has seen numerous managerial, organizational, political and professional changes, which have impacted upon the roles and relationships of medical professionals, managers and government. Adopting a retrospective case study approach, the research centres on the specific case of the Enhancing Engagement in Medical Leadership (EEML) project, which had national-level sponsorship and status, directly involving a multitude of senior NHS bodies, representatives and individuals, to embed leadership and management training into medical curricula. Medical curricula are a mediated result of cultural, social, political and economic forces (Kuper and D’Eon, 2011) rooted in the construction of professional identity and transformation from lay person to professional. Prior to this project, there had been limited attempts to engage the medical profession in leadership and management conspicuously through the curriculum, because of the difficulty of including new content into already crowded specialty curricula, given the constraints of time and resources for medical training. Using conceptual insights into agency in institutional theory, such as institutional work (Lawrence and Suddaby, 2006) and institutional entrepreneurship (DiMaggio, 1988); practice theory (Feldman and Orlikowski, 2011; Nicolini, 2012); social position (Battilana, 2011) and capital (Lockett et al., 2014; Bourdieu, 1986), this study explores how project members enacted change within medical education. It analyses the processes involved in their actions and practices and establishes how this case furthers understanding of strongly institutionalized environments. Interviews were conducted with members of the EEML project team and steering group, many of whom had positions of influence and status in other relevant organizations in this field. In addition, a review of documentary data encompassing published and non-published project materials was undertaken. An open coding and thematic analysis approach was taken to gain deeper insight into the interview data, whilst the documentary evidence was used to confirm and support the interview analysis. This case study research reveals that contextual and environmental conditions, as well as exogenous shocks and endogenous motivation led to this change initiative occurring. Routine and recognised ‘practices’ resulted in significant change through embedding the Medical Leadership Competency Framework (MLCF) into contested medical curricula space. Opinion leaders were able, with other project members, to adopt an approach to change, understanding the prevailing conditions, identifying the project’s purpose and committing to an emerging form of practice known as ‘mirroring’. Moreover, this study explores how opinion leaders achieved change through making use of theirs’ and others’ capital resources to form a cross-field collective capital, known as system capital. Using this, they adopted a disposition in their practice beyond professions known as system centrism.

Current SME performance models suffer from a number of disadvantages. The models use intensively a business ratio approach, they look at SMEs as a homogenous group, they consider firms to be closed systems, they do not directly incorporate the impact of an enterprise’s innovation activities, and finally they are complex and rely on sophisticated statistical refining methods making them unpractical to use by SME managers. There are four major challenges when one tries to build SME performance models that lack these deficiencies. The first challenge is that the desired performance evaluation model must optimally incorporate both quantitative and qualitative input. The second challenge is that the model must incorporate non-financial input parameters, such as firm size and age (among others), in the performance evaluation models. The third is that the model must consider the variety of SMEs as concerns their business sectors, nationalities, sizes, and ages. The final challenge is that the model must be able to utilize existing limited information available from the SMEs bookkeeping practices in an optimal way. The thesis addresses three questions related to constructing a better SMEperformance model, namely (1) What are the advantages and disadvantages of the existing models used in evaluating SME performance? (2) What characterizes a comprehensive model for measuring SME performance with acknowledgement of the firm’s innovation activities? (3) How can a firm’s innovation activities be enhanced in relation to the firm’s external environment? To construct a model that copes with these challenges, I used a literature-based selection of parameters as well as a theory-based selection. I used both a conceptual approach and an empirical approach to discuss and propose a model, the Survival Index Value (or SIV) model, as an alternative to the existing performance models for SMEs. The major contributions of this thesis to the field of SME performance can be summarized in three outcomes: the SIV model as a new model of SME performance evaluation, the ASPEM as a new tool for strategic utilization of SME performance models, and a new approach to account for innovation in relation to the external environment of the firm using the IBAM tool. The work adds to the theory of the firm, as it presents a new way of evaluating firm performance. It also contributes to bridging the theory of the firm to organizational theory, by elevating the significance of networking and its impact on SME efficiency.

Made available in DSpace on 2015-05-14T13:24:10Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1513036 bytes, checksum: cd16c91ace53ccf66204a7ee76f1c188 (MD5) Previous issue date: 2009-11-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Sucking on a slice of the surplus labor in the form of public funds, which provides the Modern State in his hands for administration of the "social evils" through social assistance is a constitutive feature in the capital system. But with the onset of another crisis in the capital in mid-1970 and its bearing to the days progress, the social assistance has been recruited as the policy of the Brazilian social protection for "confrontation" and to "eradicate" the ills. This data is supported, especially when viewed as a process of that budget policy. In this sense, the objective of our work is to consider what both sides of that excess spotlight on social welfare policy, which has relied primarily on the riddle of the personifications of capital worldwide. To this end, we chose a critical-bibliographic and documentary that favored a cut of between three years (2005-2007) and socio-territorial space of Paraíba, specifically, the state management. From the theoretical and methodological nature of critical-dialectic, and the contribution of technical and operational physical and digital documents, especially, the Comptroller General of the State (CGE) and Court of the State (ECA), on public finances, mentioned that the back of high budget social assistance via "security income and nutritional security", is the cornerstone to increased degree of human barbarity that we sociometabólico this model of production, given its uninterrupted movement of accumulation and expansion in any compliance. / A sucção de uma fatia do trabalho excedente, sob forma de fundos públicos, os quais o Estado Moderno disponibiliza em suas mãos para administração dos ―males sociais‖ através da assistência social é um traço constitutivo no sistema do capital. Porém, com o desencadeamento de mais uma crise do capital, em meados da década de 1970 e seu rolamento até os dias em curso, a assistência social vem sendo recrutada como a política da proteção social brasileira para enfrentamento e até erradicação dos ―males sociais‖. Esse é um dado corroborado, sobretudo, quando analisada a processualidade orçamentária da referida política. Neste sentido, o objetivo precípuo do trabalho é analisar qual o verso desse excesso de holofotes na política de assistência social, que vem contando, sobretudo, com o crivo das personificações mundiais do capital. Para tanto, optamos por uma pesquisa critíco-bibliográfica e documental, que privilegiou um recorte temporal de três anos (2005-2007) e o espaço socioterritorial da Paraíba, de modo específico, a gestão estadual. A partir do referencial teórico-metodológico de cariz crítico-dialético, e do aporte técnico operativo de documentos físico-digitais, sobretudo, da Controladoria Geral do Estado (CGE) e Tribunal de Contas do Estado (TCE), sobre as finanças públicas, assinalamos que o verso da elevação orçamentária da assistência social, via ―segurança renda e segurança nutricional‖, tem como pedra angular a intensificação do grau de barbárie humana a que chegamos nesse modelo sociometabólico de produção, face seu movimento ininterrupto de acumulação e expansão sob qualquer condicionalidade.