2. Session outline

4. 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....’

5. 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.[

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

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

8. 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

9. “. 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 ( ) and Johann Wolfgang von Goethe ( )

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

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

12. 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

14. Inappropriate
Internal
External
Unknown

15. The NPT Framework Coherence Cognitive participation Collective action
Reflexive monitoring 15

16. Non-medical example

17. Coherence Sense-making work

18. Differentiation

19. Communal specification

20. Individual specification

21. Internalization

22. Cognitive Participation The work of engaging the right people

23. Initiation

24. Enrolment

25. Activation

26. Legitimation

27. Collective Action The work of enacting the change
Lucy’s famous chocolate scene

28. Interactional workability

29. Relational integration

30. Skill-set workability

31. Contextual integration

32. Reflexive Monitoring Appraisal work

33. Systematization

34. Individual and communal appraisal

35. Reconfiguration

36. Cognitive Participation
Reflexive Monitoring
Cognitive Participation
Coherence
Collective Action
NPT
Framework

37. Normalization
Embedding
Integration
Implementation
Development

38. Take home points