In a contemporary business environment where change is often regarded as continuous, the ability of people or organizations to be able to successfully adapt and respond to change is key. Change often involves not only the learning of new behaviours, ideas, or practices but also giving up or abandoning some established ones. Despite both these elements generally being important to change, academic focus on processes of abandoning or giving up established knowledge and practices, that is, unlearning, is lacking. This conceptual article draws on a range of literature to suggest that the process of individual unlearning may have particular features. The review defines the concept of unlearning, differentiates between two different types of individual unlearning, and suggests that each type of individual unlearning may have its own distinctive features and dynamics. This article builds from this insight through developing a typology, which distinguishes between four types of individual unlearning. It concludes with an agenda for future empirical research to examine and validate the concepts presented.

In 1964, Smith et al described a syndrome of microcephaly, growth and mental retardation, unusual facial appearance, syndactyly of toes 2 and 3, and genital abnormalities. Major structural malformations and early death have been uncommon in the many subsequent literature reports. We report on 19 infants with a phenotype we propose to call Smith-Lemli-Opitz syndrome (SLOS)-Type II, in which major structural abnormalities, male pseudohermaphroditism, and early lethality are common. Of these 19 patients, 18 had postaxial hexadactyly, 16 had congenital heart defect, 13 had cleft palate, and 10 had cataracts. Unusual findings seen in these patients at autopsy included Hirschsprung "disease" in five patients, unilobated lungs in six, large adrenals in four, and pancreatic islet cell hyperplasia in three. Comparison of our cases to 19 similar literature cases suggests the existence of a distinct phenotype that may be separate from SLOS as originally described. It is also inherited as an autosomal recessive, as documented by occurrence in one pair of sibs in this study and recurrence in three reported families.

Eighty cases of Potter sequence due to a renal or urologic abnormality were studied retrospectively. The abnormal renal findings were bilateral renal agenesis in 21.25%; cystic dysplasia in 47.5%; obstructive uropathy in 25%; and others in 5.25%. Fifteen patients had multiple congenital anomalies; of these three had aneuploidy, four had autosomal recessive syndromes, and eight were of unknown cause. Results of chromosome analysis in 41 patients and 21 sets of parents were abnormal in three patients, one of whom had a balanced translocation carrier parent; two additional patients and three parents had apparently balanced translocations. There was one recurrence within the study (the first child had bilateral renal agenesis and the second cystic dysplasia). The ultrasound prenatal diagnosis of the renal abnormality was made in eight cases between 18 and 34 weeks. Family histories were suggestive of an autosomal dominant gene disorder with incomplete penetrance in four of 45 families with nonsyndromic bilateral renal agenesis and cystic dysplasia. The evaluation of patients with the Potter sequence should include an examination for nonrenal defects, autopsy, chromosome analysis, and renal ultrasound or urologic evaluation of parents. Ultrasonographic prenatal monitoring of subsequent pregnancies in such families is strongly warranted because of a definite but unknown degree of recurrence risk.

BackgroundThe ability of health-care managers or organisations to adapt and respond to change is vital if they are to succeed in the contemporary health-care environment. Change involves the learning of new behaviours and giving up, or abandoning, some established ones – more formally defined as unlearning. However, research on unlearning is lacking. This original exploratory study investigates UK NHS health-care managers' engagement with behavioural unlearning and cognitive unlearning, and also considers the related concept of fading. The study also investigates the impact of individual unlearning on participating health-care managers' decision-making.Research questions(1) To what extent do health-care managers engage with the process of unlearning and what impact does the engagement with this process have on health-care managers' decision-making? (2) What are the barriers and enablers that influence the engagement of health-care managers with the process of unlearning? (3) To what extent does the health-care setting affect the level of engagement with the process of unlearning by health-care managers?MethodsThe study investigated these questions through an examination of the academic literature. Several management (Business Source Complete, Emerald), psychological (PsycINFO), health (MEDLINE) and education [Education Resources Information Center (ERIC)] electronic databases were searched for English-language articles that were published between January 2000 and March 2012. The literature provided the basis for original exploratory research that investigated local health-care managers' experiences of unlearning. A case study approach was adopted for empirical data collection, using qualitative interviews to investigate experiences of unlearning in two secondary care NHS trusts (an acute trust and a mental health trust). A total of 85 episodes of unlearning were identified from a purposive sample of 29 health-care managers. The sample participants varied in terms of clinical/non-clinical background, type of department/unit and length of time as a manager.ResultsThe findings show that the health-care managers who participated in this study engaged with unlearning and fading. The engagement is triggered through either an individual experience or a change event. There was little evidence to indicate that health-care setting or professional background had a strong influence over health-care managers' engagement with unlearning, although this finding is limited by the exploratory nature of the study, sample size and range of settings examined. Participants identified a variety of barriers to individual unlearning including personal behaviour and staff resistance to change. Enablers such as personal skills, attitudes and relationships were more commonly cited than organisational enablers such as policies, procedures and work circumstances. The findings also suggest that unlearning does influence the decision-making of health-care managers, encouraging a more discovery-orientated approach.LimitationsThis study has a number of limitations. It is an exploratory study involving a small number of participants drawn from two NHS trusts, which limits the depth of insight that it can provide regarding specific aspects of unlearning processes. Further, because of the relatively low numbers of participants in our study, the findings provide limited insights regarding theextentto which managers engage with processes of unlearning across different health-care settings and theimpacton their decision-making. Finally, the study is able to provide only a limited interpretation of the nature of fading, although the empirical data do provide evidence that fading should not be conceptualised as a type of individual unlearning.ConclusionsThe study has enhanced the theory of individual unlearning by reconceptualising existing unlearning models and developing a new typology that distinguishes between four separate types of individual unlearning. The findings demonstrate that health-care managers who participated in this study engaged with unlearning processes and that this engagement impacted on their decision-making processes. After engaging with individual unlearning, several managers moved away from idea imposition approaches to decision-making in favour of more discovery-focused approaches, which have been reported in academic literature to be more successful. Future work that investigates a greater number of health-care managers' experiences of unlearning in a wider range of settings is necessary to establish the significance of health-care setting to individual unlearning experiences and provide greater generalisability to the findings of this study.FundingThe National Institute for Health Services and Delivery Research programme.

This study shows the value of evaluating antimicrobial use through a pharmacy database. Although vancomycin use decreased during the study period, large amounts of vancomycin are still being prescribed primarily on subspecialty service patients. Interventions to reduce vancomycin use should focus on these groups.