Defining ordinary or 'zero-level' capabilities as those that permit a firm to 'make a living' in the short term, one can define dynamic capabilities as those that operate to extend, modify or create ordinary capabilities. Logically, one can then proceed to elaborate a hierarchy of higher-order capabilities. However, it is argued here that the strategic substance of capabilities involves patterning of activity, and that costly investments are typically required to create and sustain such patterning—for example, in product development. Firms can accomplish change without reliance on dynamic capability, by means here termed 'ad hoc problem solving.' Whether higherorder capabilities are created or not depends on the costs and benefits of the investments relative to ad hoc problem solving, and so does the 'level of the game' at which strategic competition effectively occurs

Continuing professional development (CPD) is costly in terms of both organizational resources and personal time and effort. It forms an important part of the strategy for modernizing the health service and is an expectation of qualified nurses. There is little evidence to demonstrate the impact of CPD in terms of improved patient care and services. A small pilot study was undertaken. A group of intensive therapy unit (ITU) managers developed a goal attainment scale (GAS) to evaluate the impact of an ITU course. Results suggest that the ITU course did make a difference to the development of ITU nurses, but the nurses who did not take the course also developed. This has implications for service providers and educationalists in terms of expectations, timing and content of courses. The GAS was a useful tool as an approach to evaluating the impact of CPD but requires more rigorous testing before it can be described as reliable and valid.