construct ‘red lines’, boundaries to limit bodilyand social intrusion by the purchasers. Theyfunction much like prostitutes, who distancethemselves from certain body parts and acts, and

hold others – like kissing – as too intimate andpersonal to share with clients. It works. People areamazing in the ways that they can make things

work. This book is a powerful description of justthat. It helps that the women are carefully selected– six hours of psychological testing – for ‘mission

focus’ and ‘docility’. Passing the tests makes themfeel like ‘superwomen’ and ‘heroes’ and, yes, (inIsrael) even like soldiers. But like soldiers, they are

chosen and groomed first and foremost forobedience.

Teman’s work raises important questions aboutthe nature and purposes of ethnography and

qualitative work. There are many ethnographiesof people who are deeply constrained. Thoughtfulethnography with battered women, for example,

finds us women who say that he only beats herwhen she really deserves it, he doesn’t mean tohurt her, it’s just the alcohol, he’s a really great

guy and she loves him very much and it won’thappen again. The woman understands it thatway; the ethnographer ⁄ interviewer understandsher; and then the ethnography presents it to the

reader. Are we done?I would not like to stop there. I would like to

understand what is driving her to see it that way. I

would certainly feel obligated to offer a critique ofthe institutional and cultural setting thatmakes ⁄ enables ⁄ encourages ⁄permits her to think

like that. But Teman does want to stop there. Sheis ‘not concerned’, she tells us, ‘with making anargument for or against surrogacy, or entering

into the debate over whether it is right or wrong’.Her goal is to ‘attempt to completely rethink whatwe know about this reproductive practice bytaking the experiences of persons immediately

involved in it at face value and trying tounderstand what surrogacy means to them, intheir own words’ (p.3).

This is an interesting and possibly legitimateway of using ethnography, but for the policyrecommendations at the end. Based on this ‘face

value’ evaluation, she offers this Israeli nightmarebasically as a model for other nations. In sum,Teman offers us fascinating data, on a disturbingsituation, in a deliberately uncritical way.

Barbara Katz RothmanCity University of New York

Gabbay, J., Le May, A., Pope, C., Robert, G.,with Bate, P. and Elston, M. OrganisationalInnovation in Health Services. Bristol: Policy

Press, 2011 viii + 173 pp. ISBN: 978-1-84742-478-5.

On the face of it this is a book about NHSTreatment Centres in England. Dig a little deeperand it is also a book about the way in which

policy is – or perhaps isn’t – put into practice.

There is, the authors say, a tendency for

policymakers at the centre of a large organisationlike the NHS to believe that when a goodinnovation becomes policy it will, given sufficient

incentives and ⁄or funding, be simply taken up andimplemented locally. In contrast to this top-down,‘make it happen’ approach, John Gabbay and

colleagues adopt an interpretive approach,describing findings from an ethnographic study ofeight NHS Treatment Centres (NHSTCs), all ofwhich differed greatly in their approach. What the

authors offer is a well-written account of themessy realities of trying to do somethingdifferently within the NHS, and they draw the

reader immediately into a rich story of thedevelopment and enactment of a high profile andcomplex public sector innovation.

NHS Treatment Centres evolved fromadoption of a US organisational innovation using

‘modern and efficient methods’ based on well-designed care pathways. In England, NHSTCswere seen as a means of fostering new forms of

patient care and delivering reduced waiting timesand waiting lists for common elective procedures.However, the story that the authors tell is not

simply about a single innovation and its impacton services, but about organisational responses toa ‘maelstrom of modernisation’. They present arich and nuanced account of how NHSTCs had

to operate ‘on the hoof’, anxiously searchingaround for new markets and efficiencies tosurvive.

Much of the book is dedicated to explaining thecharacteristics and motivations of sites and their

subsequent fates, as well as changes to patientcare. Perhaps unsurprisingly for the sociologist,one of the key messages is that the context of sites

plays a key role in guiding receptivity toinnovation and shaping the early stages of anNHSTC. Ultimately they show that there is no

single blueprint for an NHSTC and thatinnovation is always reconstituted in a local formaccording to ‘happenstance of local organisational

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� 2012 The AuthorsSociology of Health & Illness � 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

culture, politics, finances, relationships andbuildings’.

The authors capture the enormous effort thatgoes into driving innovation within the NHS:obtaining clinical support, developing a

participative management style, using formalmethods such as ‘process mapping’ all had a role.But what did sites achieve in terms of changingpractice? All eight sites had some degree of success

in helping their trusts to meet the politicallyimportant reduction in waiting times as a result ofchanges in booking systems, pre-operative

assessment, admissions procedures, new patientpathways and improved discharge. But ultimatelythe impact on patient outcomes remains hidden:

as the authors rightly point out, this reflects thelack of political will to build objectivebenchmarking and evaluation into such

programmes (the political emphasis being onquickly developing TCs and their market-share).And perhaps this is immaterial, as only one of theNHSTCs emerges as what policymakers might

consider a ‘success story’ that Gabbay et al.describe as having ‘weathered the storm’.

There remains much to be learned about why itis that the featured sites did not turn out as policyhad planned. The answer, the authors suggest, lies

largely in what one respondent neatly sums up as:‘nobody ever really understood where the activitywas going to come from’. They hold back from

challenging current NHS reforms, but anunderlying theme here is how increasingmarketisation can potentially stifle public sector

innovation, with successive policies (e.g. PatientChoice) severely limiting the ability of sites toensure sufficient levels of activity and raising

concerns about unchecked competition andchoice.

The book offers a nuanced – if at timesrepetitive – account of the practical lessons alliedto policy enactment and diffusion of innovation.

However, there is nothing radically new here.Rather, it reinforces what we already know aboutorganisational innovation and its contingencies,NHS change management and the significance of

local context. The authors attempt to add to thisby providing a bewildering array of practicalrecommendations in their concluding chapter,

which arguably risk stopping the innovators intheir tracks. What we do not know – and theauthors do not touch upon – is why policymakers

and managers persist in their desire to implementuniform solutions to health service problems and,

in doing so, ignore the growing body of evidence(to which this book adds) that innovation doesnot unfold in predictable uniform ways.

Readers looking for a theoretically-groundedaccount would do well to turn to the penultimate

chapter in which the authors usefully reflect onthe evidence from their study in the light of widerliterature. They draw on previous work in the fieldof organisational studies and diffusion of

innovations (e.g. Greenhalgh, Van de Ven) todescribe the twists and turns of ‘the innovationjourney’ which so many of their own sites

experienced. Like others, they emphasise howinnovation does not happen in an orderlysequence. Rather it is characterised, as in the

NHSTCs, by complexity, diversity and disorder.The authors neatly capture this complexity and,with one eye on a more generic audience of

policymakers and managers, they manage to doso in an easily accessible and readable book.

Sara ShawQueen Mary, University of London

Washer, P. Emerging Infectious Diseases and

Society. Basingstoke: Palgrave Macmillan,Houndmills, 2010 £52.00 (hbk) 191 pp. ISBN:978-0230221321

In 2009, the world experienced its first infuenzapandemic since 1968, caused by the swine flu virus

H1N1. The virus first made its appearance inMexico on 28 March 2009 and spread quicklythrough Mexico and across the world, arriving in

the UK on 28 April 2009. On 11 June 2009 theWorld Health Organisation declared the outbreaka pandemic at threat level 6 (the highest level) and

on 14 June the first person died of the virus in theUK. The swine flu virus presented a confusingpicture to public health officials, contradicted

expectations about emerging infectious diseasesand posed new challenges to science and societies.

The swine flu pandemic is not covered in PeterWasher’s book Emerging Infectious Diseases andSociety, which was published in 2010 and

probably written just when swine flu emerged as anew infectious disease. This outbreak reminds us,however, of how important it is to understandemerging infectious diseases (EIDs) better, in

terms both of basic science and modern society.Washer’s book provides a fundamental groundingfor such an understanding. It not only offers a

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� 2012 The AuthorsSociology of Health & Illness � 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd