Session outline

1753: I took twelve patients in the scurvy, on board the Salisbury at sea. Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of their knees. They lay together in one place, being a proper apartment for the sick in the forehold; and had one diet common to them all. Two of these were ordered a quart of cider a day. Two others took twenty-five gutts of vitriol three times a day, on an empty stomach. Two others took two spoonfuls of vinegar three times a day, upon an empty stomach; having their gruels and their other food well acidulated with it, and also the gargle for their mouth Two of the worst patients, with the tendons in the ham rigid, (a symptom none of the rest had), were put under a course of sea-water. Of this, they drank half a pint every day, and sometimes more or less as it operated, by way of gentle psychic. Two others had each two oranges and one lemon given them every day. These they ate with greediness, at different times upon an empty stomach. They continued but six days under this course, having the quantity that could be spared. The two remaining patients, took binges of a nutmeg three times a day, of an electuary recommended by a hospital surgeon. The consequence was, that the most sudden and visible good effects were perceived from the use of oranges and lemons; one of those who had taken them, being at end of six days fit for duty. ... The other was the best recovered of any in his condition; and being now deemed pretty well, was appointed nurse to the rest o the sick....’

1794: Senior officers insists the captain issues lemon juice onboard the Suffolk. No outbreak of scurvy on a twenty-three week, non-stop voyage to India. This ‘astonishing’ event resulted in a widespread demand within the Navy for lemon juice, backed by the ‘Sick and Hurt’ Board 1795: The Admiralty accepts its own recommendation that lemon juice should be issued routinely to the whole fleet. >1800: Admiral Lord St Vincent insists vitamin C be issued generally.[

“...it is in the power of others to execute...” James Lind (1716 – 1794)

The ‘saviour of mothers’, Ignaz Semmelweis (1818-65)

1847: Publishes ‘Etiology, concept and prophylaxis of childbed fever’ 1865: Admitted to an asylum; beaten to death 2008: Motif for the Austrian commemorative coin; also a university, medical history museum and hospitals

“. I have been impressed with the urgency of doing “...I have been impressed with the urgency of doing. Knowing is not enough; we must apply. Being willing is not enough; we must do!” Leonardo da Vinci (1452-1519) and Johann Wolfgang von Goethe (1749-1832)

“...The [world] will not evolve past its current state of crisis by using the same thinking that created the situation” Albert Einstein (1879 –1955)

The NPT Framework: How to make successful change your new ‘normal’

Vision Problem Normalization 1 Rejection Positive 2 Negative Making the change / Work required Development Implementation Integration Embedding Normalization What is the result of the change? Normalization 1 Why do you need to change? Rejection Vision Problem What is the change? Positive 2 Negative

Inappropriate Internal External Unknown

The NPT Framework Coherence Cognitive participation Collective action Reflexive monitoring   15

Non-medical example

Coherence Sense-making work https://www.youtube.com/watch?v=dcNrh8FL3vE

Differentiation

Communal specification

Individual specification

Internalization

Cognitive Participation The work of engaging the right people https://www.youtube.com/watch?v=NRy3fCCR0Yg

Initiation

Enrolment

Activation

Legitimation

Collective Action The work of enacting the change Lucy’s famous chocolate scene https://www.youtube.com/watch?v=8NPzLBSBzPI

Interactional workability

Relational integration

Skill-set workability

Contextual integration

Reflexive Monitoring Appraisal work https://www.youtube.com/watch?v=dtSAn6Gxp4g

Systematization

Individual and communal appraisal

Reconfiguration

Cognitive Participation Reflexive Monitoring Cognitive Participation Coherence Collective Action NPT Framework

Normalization Embedding Integration Implementation Development

Take home points http://www.normalizationprocess.org/