Transformational Change Research Articles

10.A. Round table: Transforming public health systems at large scale: no pain, no gain

Abstract The COVID-19 pandemic, acceleration of climate change, and geopolitical turmoil have triggered discussions about how public health systems in Europe need to transform to be adequately equipped for the so-called “permacrisis”. The challenges to policy makers, health institutions and health services have become so multifaceted, that single solutions from the health sector alone no longer work. Yet, despite the complexity, countries seek to get its own house in order whilst building on inter-sectoral and European approaches in parallel. Germany, Ireland, and Ukraine have all embarked upon ambitious public health services and institutional reforms, leading to transformative change in public health systems. WHO has been accompanying these reforms. The workshop will provide a platform to draw insights and lessons on transforming public health systems from all three countries, although their population size, their socioeconomic and political situation and their public health system design is so different. As the smallest of the three countries in population, Ireland created coherence and is aligning public health actors within “Healthy Ireland” and the Sláintecaire and the Crowe Horwath public health reforms. Germany’s “Pact for the Public Health Services” has been one of the greatest public health investment programs in Europe that was initiated following lessons from the COVID-19 pandemic. And Ukraine has undertaken important legal steps to adopt a Public Health System Law, in the middle of a war of aggression on its territory. The workshop will exhibit the process of large-scale public health system transformation in each of the three countries. The purpose is to identify the enablers that make large scale system transformation possible and addressing some of the pains and gains. The workshop will have three parts. Part one consists of three presentations on large scale system reforms from each of the participating countries. Part two consists of a moderated Q&A session. Part three will focus on the synthesis of enablers for large scale public health system reforms through interaction with the workshop participants, using a digital white board. Key messages • Disruptive times can create enabling conditions for large scale public health system transformation. • Designing and implementing large scale public health system reforms is complex, requiring passion, resilience, and collaborative leadership.

Maximizing energy efficiency in HetNets through centralized and distributed sleep strategies under QoS constraint

This research addresses the critical need to optimize the Energy Efficiency (EE) for Ultra-Dense HetNets amid the ever-increasing demands for high-speed data networks. The rapid increase in high-speed devices highlights the urgent necessity for a transformative change in upcoming 5G cellular networks. According to Ericsson's 2022 report, mobile data traffic volume is expected to double by 2027, with mobile video traffic anticipated to rise by nearly 30% each year. In response to these challenges, researchers have identified essential technologies that facilitate 5G networks, including massive Multiple-input-Multiple-output (m-MIMO) systems and HetNets. Although both promise enhanced coverage and throughput, HetNets emerges as a cost-effective solution, surpassing m-MIMO in implementation cost and coverage. However, achieving maximum EE in HetNets necessitates careful consideration of various constraints, including delay, coverage probability, and Signal-to-Interference-plus-Noise Ratio (SINR) thresholds. This research marks a significant milestone in adopting the Distributed Dynamic Opportunistic Sleep Strategy (D-DOSS) approach. The D-DOSS method organizes small clusters throughout the network and evaluates key Quality of Service (QoS) parameters including Energy Utilization Efficiency (EUE), Coverage Probability, Data Throughput, and Success Probability using Monte Carlo simulations. This research analyzes Distributed Sleep (DS) and Centralized Schemes (CS) concerning given QoS parameters. While DS methodologies often exhibit performance trade-offs compared to CS, they provide significant advantages in terms of ease of implementation and management. CS, though representing the most commonly used method in ultra-dense HetNets involves high computational costs that complicate its management. By integrating the D-DOSS and addressing various constraints, this research not only advances HetNet technologies but also makes a significant contribution to optimizing EE while preserving network performance and QoS. The innovative D-DOSS approach offers a promising solution to the challenges of energy efficiency in wireless communication networks and paves the way for future advancements in HetNet deployments. The results and analysis show that D-DOSS effectively addresses the limitations of DS and outperforms existing CS techniques.

“Every patient teaches you something new”: experiences of physiotherapists delivering cognitive functional therapy for chronic, disabling low back pain in a randomised controlled trial

Purpose Cognitive functional therapy (CFT) is an individualised person-centred biopsychosocial intervention that demonstrated large and sustained clinically important improvements in people with chronic, disabling low back pain (LBP) in the RESTORE randomised controlled trial. This study aimed to explore physiotherapists’ experiences of delivering CFT in the RESTORE trial. Materials and methods Cross-sectional qualitative design using reflexive thematic analysis with interviews of 15 treating physiotherapists (3–25 years experience) across Perth and Sydney. Results The overarching theme was “Driving on P(probationary)-plates.” The probationary driver analogy encompassed feelings of being newly competent, gaining experience, and refining competencies. Four themes were developed: “Sharing the journey of transformational change,” “Refining new competencies,” “Navigating patient complexity,” and “Balancing patient care with trial-related processes.” Physiotherapists described the life-changing improvements and re-engagement with valued activities of their patients under the theme of “Sharing the journey of transformational change.” “Refining new competencies” described the continued enhancement of physiotherapists’ new competencies towards an individualised and collaborative approach. Conclusions: The experiences of physiotherapists trained to deliver individualised, person-centred biopsychosocial care within an RCT can be likened to being a probationary driver. Experiential learning, ongoing support, and opportunities to navigate challenges with complex patients were important aspects of the journey towards mastery.

Instantaneous Tiltmeter Triggered by Dynamic Wetting Behavior.

A novel instantaneous tiltmeter with dynamic and static monitoring functions is reported that is based on liquid metal dynamic wetting behavior in a bio-fabricated anisotropic microchannel. The proposed system achieves instantaneous tiltmeter functionality, offering a broad detection range (-90°-90°) with high precision (0.05°), a rapid reaction time (0.11 s), and enhanced durability. Moreover, a seamless integration has enabled water wave detection, language programming, and human limb monitoring. Especially, the integration of tiltmeter and a t3D motion platform results in a surface structure scanning system capable of effectively performing large area (>200 cm2) and height difference scanning functions. This innovative approach holds great potential for transformative changes in the fields of advanced manufacturing, flexible robotics, and the flexible sensing, further facilitating widespread adoption.

Call for equitable hearing healthcare provision: an exploration of Māori adults’ perspectives and lived experiences of ear and hearing healthcare services in Te Waipounamu

ABSTRACT Māori adults are over-represented in self-reported hearing loss statistics in Aotearoa, yet they are currently underserved in hearing healthcare services that were designed using one-size-fits-all Eurocentric ideologies and models of health and disability. Unassisted hearing loss has been linked to increased rates of depression, social isolation, communication issues, early retirement, and cognitive decline, as well as a decreased ability to engage with cultural practices. An area that requires further research is the exploration of Māori adults’ perspectives and experiences of hearing healthcare. This article uses a Kaupapa Māori lens to bring forward Māori narratives and expands on previous research of a te reo Māori hearing screening test. The article shares findings from interviews with Māori adults, exploring both their perspectives and lived experiences of ear and hearing healthcare and te reo hearing assessments. It highlights the barriers that exist for Māori when accessing hearing healthcare in Te Waipounamu (The South Island of Aotearoa) and the desire to see transformative change in the hearing healthcare landscape.

Microsoft applications of 6G in V2X

Abstract. With the rapid advancement of intelligent transportation systems and autonomous driving technologies, 6G networks, as a key technology for future communications, are set to bring trans-formative changes to V2X (Vehicle-to-Everything) communication. This paper explores the application prospects of 6G in V2X, with a focus on the critical technological support 6G provides to vehicular networks. The high transmission rates and ultra-low latency of 6G will significantly enhance real-time interactions between vehicles and between vehicles and infrastructure, improving traffic safety and efficiency. Additionally, 6G's broad connectivity and flexible network architecture will support a greater number of simultaneous device connections, facilitating the widespread adoption of intelligent transportation systems. However, 6G faces challenges in V2X applications, including security issues, privacy protection, and internet power supply concerns. The paper analyzes these challenges, proposes corresponding solutions, and envisions the future development of 6G technology in the V2X domain.

Partnering in construction re-visited: gauging progress in industry practice and prospects for advances in academic research

Despite the ubiquity of partnering and alliancing in industry discourse and academic research, questions remain about the extent of transformational change within the sector towards more collaborative working. Revisiting earlier work that highlighted issues, problems and dilemmas of partnering related to definitional ambiguities, conflicting (commercial) orientations and cultural reach and readiness, this paper highlights continuing problems of definition, formalization, translation and performance. Attention is directed towards the lack of external validation and institutionalization, as well as the need for more comparative analysis, situated understanding, awareness of organizational pluralism and recognition of relational dynamics. From this critical review, a framework is presented that embraces the variety and indeterminacy in the many definitions, pathways to collaboration, realizations in practice and evaluative recipes used. Partnering is presented instead as being constituted through complex and interacting bundles of practices that cut across levels of interaction, and which reflect competing (and contested) institutional influences, situated practices, outcomes/effects and performance evaluations. This practice-based approach is more attuned to the diversity and fluidity of the institutional contexts, organizational processes, and project/programme settings wherein partnering is situated and through which it is instantiated, and thus affords new avenues of research into its nature and effects.

P2P Lending and Mobile Payments: Disrupting Traditional Banking Systems and Expanding Financial Inclusion

Technological development in the field of finance (FinTech) has sprouted and scaled up rapidly, disrupting the traditional banking system. The rise of new platforms allowing P2P lending and mobile payments has changed the way where and how people receive financial services by replacing professionally-managed financial intermediaries aka banks. This paper explores how P2P lending has enabled decentralised financing by providing flexible loans to borrowers, higher returns to lenders, and alternative credit-scoring methods to assess borrowers credibility. The subsequent development and recent widespread use of mobile payments have brought about transformative changes in finance where users can make payments without using physical cash or relying on banking infrastructure altogether. The combination of these technologies is providing inclusive finance by allowing unbanked and underbanked populations access to necessary financial services. This paper further delves into the challenges emerging from both these innovations, such as assessment of risks, security issues and regulatory uncertainty. The paper concludes by emphasising that new technology-based lending and payments have the potential to foster inclusive economic growth in rural, remote and low-income regions of the world, and by highlighting the challenges that needs to be tackled for FinTech to succeed.

Temporal Range Dynamics of the Lataste's Viper (Vipera latastei Boscá, 1878) in Doñana (Spain): Insights into Anthropogenically Driven Factors.

Doñana (southern Spain), a region of notable biodiversity richness, is highly threatened by ongoing landscape transformation and climate change. We investigated the local effect of these anthropogenic factors on the temporal range dynamics of Lataste's viper (Vipera latastei), an Iberian endemic Mediterranean reptile that has apparently become rare over the years in Doñana. Using ecological niche-based models, based on climatic and remote sensing variables, we analyzed historical (1959-1999) and contemporary (2000-2022) records of the species to assess range shifts and identify environmental factors that may influence them. Our results show that V. latastei is mostly restricted to the coastal region of Doñana and that one temperature variable is the most important factor explaining this distribution pattern in both periods. Additional climatic and vegetation variables play a role in its historical distribution, but they become less important in contemporary times, suggesting a niche simplification over time. We found 30.5% of reduction in the species suitable area from historical to contemporary conditions, a reduction that would be even greater (83.37%) in the absence of niche shift. These findings underscore the species' heightened vulnerability to ongoing environmental changes and highlight the urgent need for targeted conservation strategies.

Transformative Experiences During Short-Term Immersion Trips Abroad: An Examination of MSW Students in Panama and Italy

ABSTRACT Although several studies highlight the benefit of short-term immersion programs abroad among social work students, few studies have examined their transformative nature. In response, this study aimed to describe the transformative change experienced by MSW students from the Southwest USA who participated in a short-term, immersion program in either Panama or Italy. The structure of the program consisted of two components: a 10-week hybrid classroom during the semester and a 12–13 day, short-term immersion program during the summer. Content analysis was utilized to examine student reflections on the impact of the short-term study abroad experience in areas such as cultural awareness and humility, professional and personal growth, and the most impactful and transformative experiences. The results included the following themes: (1) Community, (2) Adaptation, (3) Empowerment/Inspiration/Transformation, &; (4) Culture. Implications for future research in this area are identified along with considerations for educators regarding planning, teaching, and/or leading the in-country experience to best support student transformation in short-term immersion programs abroad.

Training for transformation: examining food systems courses at US land-grant universities

Higher education institutions can play an essential role in preparing students to participate in movements for just and sustainable food systems change. For the past two decades, many United States land-grant universities (LGUs) have developed food systems education (FSE) courses. This study examined the extent to which FSE courses employ four capacities deemed crucial by the FSE literature: multidimensional approaches, interdisciplinarity, centering equity, and training students to take action in food systems. The syllabi of 171 undergraduate courses at 20 LGUs were obtained by contacting instructors, and their course descriptions and learning outcomes were analyzed. This subset of LGUs were identified from the membership list of the Menus of Change University Research Collaborative (MCURC), a nationwide network of colleges using campus dining halls and classrooms as living laboratories for food systems change. Most course descriptions and learning outcomes exhibited multidimensional approaches and interdisciplinarity. However, many failed to incorporate teaching content and practices that help students critically examine equity and social justice issues in food systems, or engage in transformative change. LGUs have both the resources and urgent responsibility to empower students to be part of movements to transform unjust, unsustainable food systems. The findings of this study, and an accompanying open-access syllabus website, aim to accelerate the development of FSE curricula that prepare students to change food systems.

Just Sustainability Transitions: Politics, Power, and Prefiguration in Transformative Change Toward Justice and Sustainability

Facing the world's ecological, economic, and social challenges requires us to connect the concepts of justice, sustainability, and transitions. Bridging and discussing heterogeneous fields, we argue that these concepts need to complement each other, and we present just sustainability transitions (JUSTRAs) to do so. To define JUSTRAs, we review the state-of-the-art literature, focusing on the understanding of these three concepts and their pairings in various disciplinary fields and empirical settings (e.g., environmental justice, just transitions, sustainability transitions, energy justice, food justice, urban justice). We center marginalized voices to highlight the processes of radical transformative change that JUSTRAs seek. We offer three analytical lenses that further the understanding of JUSTRAs: politics, power, and prefiguration. We argue that these complementary lenses are necessary to remake the world in both critical and pragmatic ways. Finally, we present a research agenda on JUSTRAs, foregrounding three complementary modes of inquiry: analyzing, critiquing, designing.

Relational visioning and the emerging future: Transforming towards a sustainable local society

The Earth is currently facing unprecedented anthropogenic impacts. In this context of widespread environmental degradation and climate anxiety, there is an urgent need to reimagine our approaches to sustainability. This paper explores how a relational framing of sustainability can be applied to visioning exercises to foster transformative actions in local governance. While relational approaches are increasingly recognized as important to spark transformative change, their benefits and practical applicability to visioning are still under-explored. Drawing on findings from a multi-stakeholder workshop in a Norwegian municipality, we make two main contributions to the existing literature. First, we demonstrate how a relational visioning process can be carried out, identifying three key elements for establishing a relational foundation that can catalyse effective sustainability transformations: 1) the act of listening deeply, 2) integrating values, and 3) defining direction. Second, we contribute with new insights concerning the benefits and practical application in local sustainability governance contexts, highlighting the need for facilitating incremental (yet radical) changes in existing governance frameworks that are sensitive to available bureaucratic resources.

Land struggles, livelihoods, and trajectories of agrarian change in the Polochic valley, Guatemala

ABSTRACT This article assesses the impact of political contestation on trajectories of agrarian change in the Polochic valley, Guatemala. Livelihood surveys were carried out in four Indigenous Maya-Q’eqchi’ agrarian communities, two of which obtained access to land as a direct outcome of grassroots resistance to land grabbing. By situating livelihood strategies within the broader political economy, I argue that political contestation has inadvertently reproduced a functionally dualist agrarian structure that sustains the agroexport plantation economy while leaving little potential for expanded reproduction among campesino households. Agrarian social movements must look beyond land access alone to achieve the transformative change they seek.

Cross-cultural learning as a foundation for reimagining ocean governance

ABSTRACT Research is a key tool that can contribute to the transformation of governance systems and help uncover solutions to our planetary crises. In recognition of the need for research itself to be transformed, researchers and research institutions are increasingly being challenged to move away from unidirectional approaches to partnership building, to decolonise science, and to be aware of individual and institutional positionality and established power relations. Yet the ways and means of doing so are poorly articulated and often extremely challenging. This paper seeks to explore the practical realities of engaging with a reflexive approach to research, through three distinct case studies which examine the critical role that cross-cultural interactions can play in triggering social learning and transformative change. Across all three case studies, we found that engaging across diverse, cross-cultural and knowledge interfaces has profoundly influenced the projects and partnerships in which we are involved, by shifting perceptions, challenging established norms and triggering reorientation and redirection in institutional rules and behaviours. Yet we also highlight the many challenges and mistakes we made along the way. As such, we offer suggestions on how the reflexivity might be better supported and nurtured within institutional research structures.

When “symbolic” policy is anything but: Policy design and feedbacks from California's human right to water law

AbstractDespite the reality that advocates frequently expend significant resources to pass symbolic policies, this policy design has often been neglected by policy studies scholarship. We combine policy design and policy feedback theory to examine this oft overlooked policy design in practice using the case of California's human right to water law (Assembly Bill 685, or AB 685). Through semi‐structured interviews, archival research, and document analysis, we reveal how grassroots advocates deliberately and effectively pursued AB 685 to build power across the water justice movement and catalyze narrative change about drinking water access, while also building state responsiveness on the topic. These interpretive policy feedback effects then accelerated the policy's resource effects through formal policy changes in funding allocations, administrative structures, and regulatory systems. Collectively, feedbacks from AB 685 have transformed the sociopolitics of drinking water access. Contrary to prevailing wisdom, the policy's ambiguity proved key to building the broad coalition necessary to accomplish these changes, and it facilitated work across policy venues and governance scales through time, which is critical to enacting transformational change. Based on these findings, we argue that symbolic policies merit attention as a potentially advantageous policy design for social movements seeking social change and transformation.

The LTAR Cropland Common Experiment at the Kellogg Biological Station.

The Kellogg Biological Station Long-term Agroecosystem Research site (KBS LTAR) joined the national LTAR Network in 2015 to represent a northeast portion of the North Central Region, extending across 76,000 km2 of southern Michigan and northern Indiana. Regional cropping systems are dominated by corn (Zea mays)-soybean (Glycine max) rotations managed with conventional tillage, industry-average rates of fertilizer and pesticide inputs uniformly applied, few cover crops, and little animal integration. In 2020, KBS LTAR initiated the Aspirational Cropping System Experiment as part of the LTAR Common Experiment, a co-production model wherein stakeholders and researchers collaborate to advance transformative change in agriculture. The Aspirational (ASP) cropping system treatment, designed by a team of agronomists, farmers, scientists, and other stakeholders, is a five-crop rotation of corn, soybean, winter wheat (Triticum aestivum), winter canola (Brassicus napus), and a diverse forage mix. All phases are managed with continuous no-till, variable rate fertilizer inputs, and integrated pest management to provide benefits related to economic returns, water quality, greenhouse gas mitigation, soil health, biodiversity, and social well-being. Cover crops follow corn and winter wheat, with fall-planted crops in the rotation providing winter cover in other years. The experiment is replicated with all rotation phases at both the plot and field scales and with perennial prairie strips in consistently low-producing areas of ASP fields. The prevailing practice (or Business as usual [BAU]) treatment mirrors regional prevailing practices as revealed by farmer surveys. Stakeholders and researchers evaluate the success of the ASP and BAU systems annually and implement management changes on a 5-year cycle.

Agency, Structure, and Organization: School-Wide Approaches to Dismantling Injustice

Schools and districts have long grappled with race- and disability-based exclusionary discipline inequities. Research on the topic has uncovered a variety of systems that maintain such disparities, including school policies and practices that exacerbate the problem. Researchers and practitioners have increasingly considered school context and practices as mediators of both special education and exclusionary discipline risk. Although educational leaders are often required to review policies, practices, and procedures that contribute to inequities, few tools exist for practical translation toward school-wide solutions. This case is designed to help school and district leaders translate theory and research into practical actions for transformational change. The case provides considerations for designing and implementing culturally responsive Multi-Tiered Systems and Supports within a given school context, including climate and programming.

Towards Regenerative Material Design and Innovation: Overcoming Multi-Level Barriers

The ecological impacts of industrial products are often locked in at the material design stage, requiring transformative changes to practices, mindsets and systems from the beginning of the innovation journey. This paper critically explores how such transformative shifts are being shaped by the application of regenerative principles to material design and innovation practices in the realm of entrepreneurship. It is based on a qualitative interview study with 12 material innovation companies. The study aims to understand the novel innovation practices they are fostering to catalyse regenerative and/or circular approaches that can address global plastic pollution – a major contributor to global GHG emissions. The analysis identifies seven perceived innovation barriers that complicate the full adoption of regenerative principles, including advocating for new product categories, educating B2B customers about novel materials and inventing appropriate scaling approaches. Overcoming these barriers requires mindset-related and systemic transformations, linking this research to broader innovation management, sustainability transitions and regeneration debates. The article concludes by articulating key insights and managerial implications for innovation leaders who are keen to further regenerative transitions through material innovations within (and beyond) their own organisations.

INNOVATING IN URBAN DISTRIBUTION OF GOODS, SMALL CHANGES, BIG RESULTS FOR THE CITY

The conceptual article invites us to reflect on how innovation doesn’t always require huge investments or technological revolutions. Sometimes the most transformative changes come from simple ideas. It is in simplicity that we often find the greatest potential for change. Implementations such as optimizing routes, reorganizing delivery schedules or using electric bicycles. They show that accessible solutions can transform urban logistics. These small but modest steps, bring great benefits and contribute to sustainability. Likewise, the ability to reimagine our processes, reusing the strategic value of the resources we already have, is to see the familiar with new eyes, reusing the known to create something extraordinary. True innovation cannot flourish in isolation. This is where public-private collaboration becomes important. While companies can lead these efforts, support from the public sector is the direct way to create new opportunities. When we join forces, we generate an ecosystem of change that allows us to integrate these small advances. We believe that innovation is not just for the few, we all have the power to generate great results from small changes.