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AimThe aim of this paper is to explore knowledge work in situ, in order to develop a grounded understanding of both the production of midwifery knowledge in a practice setting, decision-making interactions and the potential of information technologies to support knowledge work in health systems. BackgroundGlobally the demand for quality led and innovative service delivery requires that nurses and midwives must shift from "information workers", passive receivers of managerial and organisational decisions, to become "knowledge workers", able to create, lead and communicate service innovation and practice development. New communication technologies may offer a means for health care professionals to interact as knowledge workers and develop supportive communities of practice. MethodsAn online discussion forum was designed and implemented as a low-cost technological intervention, deploying existing hardware and a standard hospital intranet. The setting was a non-teaching, acute National Health Service Hospital in the United Kingdom. The evaluation of the forum was constructed as case-study organizational research. The totality of the online communication, both traffic and content, was analysed over a three-month period (193 messages downloaded 2003/04), and 15 in-depth interviews were undertaken with forum users. 2 FindingsThe findings show that given simple, facilitative, innovative technology, supported by a positive working culture and guided by effective leadership, midwives can function as "knowledge workers", critically reflecting upon their practice and translating knowledge into action designed to achieve change in practice. Participation occurred across all grades, and midwives were predominantly supportive and facilitative towards the contributions made by colleagues. ConclusionsMidwives may be ideally located to exemplify the "ideal" characteristics of the knowledge worker being demanded of modern health care professionals. The deployment of online interactive technologies as part of strategic vision to enhance knowledge work among health care professionals should be given attention within health systems.  There is research on knowledge work in business and management, but very little research on the application of knowledge work theory to health care workers particularly in relation to knowledge creation, capture and use. What this paper adds This paper shows that knowledge work theory is of relevance to the work of midwives. Online software tools such as interactive discussion forums can enhance midwifery practice. It appears that midwives can function as "knowledge workers" with a significant element of the midwifery communication being "supportive" of the knowledge work of others".

Recent changes in policy and culture require health workers to incorporate "knowledge work" as a routine component of professional practice. Innovative computer-mediated communication technologies provide the opportunity to evaluate the nature of "knowledge work" within nursing and midwifery. This study embedded an online discussion system into an acute NHS Trust to support interaction within communities of practice. The complete record of online communications was analysed. Nurses were found to predominantly engage in information work with knowledge work restricted to senior-to-senior level exchanges. In contrast, midwives were observed to employ the technology to support knowledge work between all grades. The study indicates that technology can support knowledge work, including conveying tacit knowledge effectively.

Employment in UK retail banking has begun to decline as all the major institutions shed workers. Technological, organizational and market-driven reasons for the job losses in the major clearing banks are discussed. Irrevocable long-term changes in employers' industrial relations and human resource strategies are identified as necessary accompaniments to pushing the current retrenchment through in the context of a developing general crisis in employment relations.The 1990s seem set to be a watershed decade of far-reaching staffing changes for the banking industry, and particularly for the big clearing banks that are its main employers. In this article we attempt to make sense of some of these changes [l]. Firstly, we review the changing pattern of employment in terms of the differing fortunes of various categories of employees and of what we argue to be the beginnings of a long-term process of decline in numbers employed, most obviously in the big High Street clearing institutions. We isolate five reasons for the job losses, some of which are of short-term and contemporary significance and others that will be of more long-term concern in restructuring employment in the clearing banks. Following on from this, we consider the implications for banking employees and 0 Peter Cressey is Lecturer in Sociology in the School of Social Sciences, University of Bath. Peter Scott is a Research Officer in the School of Social Sciences, University of Bath. management of the current period of manpower reductions in two key areas. These are the effects of staff reductions on the career structure, traditionally one of the main cornerstones of the stable internal labour market in banking; and the industrial relations developments and their accompanying impacts on the corporate culture of banks.Our primary data derives from a study of industrial relations and innovation in two banks: one of the 'Big Four' English clearing banks and one of the Scottish banks of issue. As one part of this, various industrial relations practitioners from company and recognised trade unions were interviewed. It became quite clear from the case-study of the English bank in particular in late 1990iearly 1991 that considerable innovations in employment and industrial relations practices were in train, but also that all the main clearing banks were treading the same path. In this article we have added statistical data and secondary sources providing information on the wider rationalisation Employment, technology and industrial relations in UK clearing banks 83

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