THE LIMITS OF KNOWLEDGE MANAGEMENT FOR UK PUBLIC SERVICES MODERNIZATION: THE CASE OF PATIENT SAFETY AND SERVICE QUALITY

This article assesses the contribution of management of knowledge across organizational and professional boundaries towards improved public services. We empirically investigate the potential for knowledge sharing within the context of the NHS modernization agenda, taking as our focus the current ‘patient safety’ policy agenda. Specifically, we evaluate the introduction of a knowledge management system, namely the National Reporting and Learning System (NRSL) and its impact in the area of operating theatres within a university teaching hospital. We suggest that government policy in this area needs to reflect more upon limits to the management of knowledge and issues of the nature of knowledge, professional cultures and institutional power and politics.     

THE ‘NEW PUBLIC GOVERNANCE’ AND EMPLOYABILITY SERVICES IN AN ERA OF CRISIS: CHALLENGES FOR THIRD SECTOR ORGANIZATIONS IN SCOTLAND

Third sector organizations (TSOs) have emerged as key players in the delivery of public services to assist jobless people to improve their employability and move from welfare to work. Drawing on in‐depth research with employability providers in Scotland, this article explores how TSOs have responded to the challenges of a rapidly changing public services environment. Specifically, we use the concept of the ‘New Public Governance’ to explore TSOs' relationships with UK, devolved and local government stakeholders. TSOs demonstrated a pragmatic approach to shaping their services to reflect the priorities of public funders, and identified some opportunities arising from the new emphasis on ‘localism’. However, the evidence suggests that opportunities for collaboration at times remained constrained by certain forms of ‘contractualism’ and top‐down performance management. Based on the evidence, lessons for future policy and practice are considered.     

HYBRIDS AND PROFESSIONAL COMMUNITIES: COMPARING UK REFORMS IN HEALTHCARE,BROADCASTING AND POSTAL SERVICES

Many countries use state‐owned, for‐profit, and third sector organizations to provide public services, generating ‘hybrid’ organizational forms. This article examines how the hybridization of organizations in the public sector is influenced by interaction between regulatory change and professional communities. It presents qualitative data on three areas of the UK public sector that have undergone marketization: healthcare, broadcasting, and postal services. Implementation of market‐based reform in public sector organizations is shaped by sector‐specific differences in professional communities, as these groups interact with reform processes. Sectoral differences in communities include their power to influence reform, their persistence despite reform, and their alignment with the direction of change or innovation. Equally, the dynamics of professional communities can be affected by reform. Policymakers need to take account of the ways that implementation of hybrid forms interacts with professional communities, including risk of disrupting existing relationships based on communities that contribute to learning.     

‘LEADERISM’: AN EVOLUTION OF MANAGERIALISM IN UK PUBLIC SERVICE REFORM

This paper argues that ‘leaderism’– as an emerging set of beliefs that frames and justifies certain innovatory changes in contemporary organizational and managerial practice – is a development of managerialism that has been utilized and applied within the policy discourse of public service reform in the UK. The paper suggests that ‘leaderism’ is an evolution of entrepreneurial and cultural management ideologies and practices. An analysis of the articulation of leaderism with public service reform in the UK is presented. The paper problematizes the construals of leadership contained within these texts and reflects on their promotion of leadership as a social and organizational technology. ‘Leaderism’ is argued to be a complementary set of discourses, metaphors and practices to those of managerialism, which is being utilized in support of the evolution of NPM and new public governance approaches in the re‐orientation of the public services towards the consumer‐citizen.     

THE ENTERPRISE FORMULA,NEW PUBLIC MANAGEMENT AND THE ITALIAN HEALTH CARE SYSTEM: REMEDY OR CONTAGION?

Health care services represent an extraordinary experimental ground for introducing wider political and institutional transformations of the state. The adoption of entrepreneurialism into European health care systems has strengthened technocratic decision making over traditional mechanisms of political control. In Italy, in the midst of a severe legitimacy crisis affecting the administrative and political systems at the beginning of the 1990s, New Public Management ideas seemed ‘the’ remedy against the pathological politicization of distributive politics. Much hope has been placed since in a new and ascending group of general managers, entrusted with the ambitious mission of running health care services more efficiently and with the unenviable expectation of resuscitating public trust in welfare institutions. By analysing the 1992 Amato government’s landmark health care reform in its substantive changes, this paper explores the last decade’s main reform trajectories of Italian health care reforms that irreversibly transformed its institutional arrangements and organizational structure, namely the enterprise formula and the regionalization of the health care sector. The paper suggests that the political turmoil of 1992–94 served as catalyst for radical policy change and argues that the single most important explanation for the enactment of New Public Management‐type reforms rests in a new executive reinterpretation of its legislative prerogatives and function.     

Performance Management,Evaluation and Learning in ‘Modern’ Local Government

Public sector reforms throughout OECD member states are producing a new model of ‘public governance’ embodying a more modest role for the state and a strong emphasis on performance management. In the UK, the development of performance management in the context of the ‘new public management’ has been primarily ‘top‐down’ with a dominant concern for enhancing control and ‘upwards account‐ability’ rather than promoting learning and improvement. The development of performance management and evaluation in local government in the UK has been conditioned by external pressures, especially reforms imposed by central government, which have encouraged an ‘instrumental–managerial’ focus on performance measurement. The new Labour government's programme of ‘modernizing local government’ places considerable emphasis on performance review and evaluation as a driver of continuous improvement in promoting Best Value. However, recent research has indicated that the capacity for evaluation in local government is uneven and many obstacles to evaluation exist in organizational cultures. Local authorities need to go beyond the development of review systems and processes to ensure that the capacity for evaluation and learning is embedded as an attribute of ‘culture’ in order to achieve the purpose of Best Value.     

ETHICAL CLIMATE AND RULE BENDING: HOW ORGANIZATIONAL NORMS CONTRIBUTE TO UNINTENDED RULE CONSEQUENCES

Rules help ensure consistent employee behaviour, yet rule bending occurs in public organizations every day. Previous research indicates that rule bending is influenced by organizational structure and personal characteristics (DeHart‐Davis 2007). This present study considers the influence of organizational norms on rule bending by exploring the impact of ethical climate, which signals to employees the best course of action when faced with situations that are ethical in nature (Victor and Cullen 1987, 1988). To investigate this relationship, survey data from employees of a large American local government are analysed. Results from a structural equation model show that three ethical climates – ‘organization interest’, ‘team interest’, and ‘rules/SOP’ – significantly influence rule bending. Findings suggest that organizational norms play a critical role for employee behaviour and public managers can consider rule bending and ethical climate as impetuses for organizational change.     

The Impact of Institutional Forces Upon Knowledge Sharing in the UK NHS: The Triumph of Professional Power and the Inconsistency of Policy

Academics, policy‐makers and practitioners are increasingly interested in the contribution that effective management of knowledge across organizational and professional boundaries can make to improved public services. Examining knowledge sharing within the context of the UK NHS, we ground our investigation in neo‐institutional organizational sociology. We highlight the influence of regulatory, normative and cultural‐cognitive aspects of institutions operating in the health care field on the boundaries that impede knowledge sharing. We illustrate how institutional isomorphic processes facilitate convergence within groups of organizations and occupations subject to the same institutional pressures, but, by the same token, inhibit convergence across different organizational and occupational groupings. In short, the development of a learning organization, where knowledge is shared freely across boundaries, will be difficult to realize.     

Public participation

’Evidence‐based practice’ is a term used in Britain's National Health Service to describe the use of research evidence in policy, management and practice decisions. This article develops this idea and explores its use in local government decision making, using case studies of social care and education. It argues that the absence of a funding stream to support local authorities’ own research reinforces a view of local authorities as essentially administrative arms of the state, supervised through service‐by‐service performance measurement, rather than ‘intelligent’ agents using local research to develop evidence‐based policies.     

Archetype Transition in the German Health Service? The Attempted Modernization of Hospitals in a North German State

In this paper, we argue that, rather than aiming at universal contingency relationships, archetype theory needs to go down a path where 'local variants' can be discovered and understood by relating them to their organizational and institutional context(s). The case study of a public sector hospital group in a North German state (Hamburg) is drawn on here to elaborate the argument. We found evidence for a change from a Public Sector hospital archetype to a Public Hospital Corporation archetype. Drawing on this model permits us to explore the impact of the introduction of new forms of public management organization and the implications the managerial ideology underpinning this may have for the professional organization. The study explores the consequences of the innovations for professional/managerial relations. We also suggest that the 'archetype' approach may be particularly useful for the comparative study of organizations. This is particularly pertinent given the different – corporatist – organization of the German health care system and its different approach to public sector reform to that of the Anglo-American and Scandinavian systems where the 'archetypal' approach has so far been applied.     

Conclusion: Is competency management a passing fad?

Is competency management a passing fad; is it a catch‐all term to cover diverse national patterns of development or a symptom of wider changes within bureaucracies? As the papers published here suggest, it is more likely to be a passing fad in Europe than the USA. Competency management addresses rather different agendas in different countries and while it does not embrace as diverse a collection of activities as ‘new public management’, there is substantial range in the issues it does address. European experience suggests competency is more likely to be ephemeral and concerned with repackaging rather than bringing something substantially new to personnel management in the upper reaches of civil services. Without taking too rosy a view of US experience, there may be a stronger case for arguing that contemporary competency management approaches there have brought something new to a longer standing debate in public and private management.     

Facing the challenges of research‐informed knowledge mobilization: ‘Practising what we preach’?

The political imperative to make public services more evidence based has contributed to the growth in the past two decades of both research and practice in the field of knowledge mobilization: the range of approaches to encourage the creation, sharing and use of research‐informed knowledge alongside other forms of knowledge. Paradoxically the growth of the field has made the challenge of encouraging research use much more complex and uncertain, and the roles of knowledge mobilizers much more diverse and demanding. This in‐depth interview study of knowledge mobilization in 51 agencies concerned with knowledge for public services breaks new ground in exploring a paradox at the heart of knowledge mobilization practice: the challenges that research agencies face in practising in research‐informed ways themselves.     

COMPARING BUSH–CHENEY AND CLINTON–GORE PERFORMANCE MANAGEMENT STRATEGIES: ARE THEY MORE ALIKE THAN DIFFERENT?

Successful performance management strategies are intrinsically linked to the political environment in which public policy‐making occurs. Since the mid‐1990s, many governments have re‐examined how to simultaneously reduce costs, increase performance and achieve results. Public agencies are experimenting with performance measurement and management systems designed to meet public policy goals and respond to citizen demands. Various reform models have been proposed and public administrators now expend considerable time, effort and resources exchanging ‘best practices’, finding ‘best value’, and ‘rethinking’ government operations. Although equally important, less effort has been devoted to performance management (PM) within increasingly complex, ideologically charged and politicized decision‐making environments. Despite significant increases in productivity, more theoretical and empirical research is needed to assist public managers in applying private market‐based alternatives to public service delivery structures. This article compares the PM initiatives of the Clinton–Gore Administration in the United States, known as the National Performance Review (NPR), with President Bush‘s Presidential Management Agenda (PMA). Following the comparison, a theory‐based research agenda is proposed to determine which of many approaches best ‘fits’ the varied and often contradictory systems for delivering public services in a decentralized governance system.     

THE DIFFICULT TRANSFORMATION OF STATE AND PUBLIC ADMINISTRATION IN PORTUGAL. EUROPEANIZATION AND THE PERSISTENCE OF NEO‐PATRIMONIALISM

Portugal has been characterized by a late discontinuous democratization process. This contribution discusses the case of state and public administration reform in Portugal by using approaches from democratization, modernization and Europeanization theories. In order to understand the Portuguese case, the concept of ‘neo‐patrimonialism’ is used. We characterize Portuguese public administration as still having ‘neo‐patrimonial’ features, and therefore is still in transition from old closed‐minded practices such as particularistic decision making or clientelistic relationships to new open‐minded ones. The ‘new’ governance agenda combines new public management instruments and a growing flexibilization of public administration towards networks with non‐statal actors and has certainly led to some improvement in the quality of the services associated with public administration. Although is still too early to assess, top‐down and horizontal Europeanization processes, particularly since the late 1990s, may have contributed to a more reflexive approach in moving towards a more endogenous strategic vision based on the needs of the Portuguese state and public administration.     

PUBLICS,PATIENTS, CITIZENS,CONSUMERS? POWER AND DECISION MAKING IN PRIMARY HEALTH CARE

This article uses theoretical approaches to the discussion of power in order to consider the role of public and patient participation in primary health care organizations in the UK. There is considerable evidence to suggest that, despite major national initiatives to extend participation in health services, the role of participation in decision making remains underdeveloped. The primary purpose of this article is to understand how and why this should be the case. Using findings from qualitative research that explored approaches taken by the dominant professional groups on primary care groups (PCGs) to involving patients and the public, we consider how these approaches reflect the exercise of different forms and levels of power. The explanation combines Lukes’ categorization of three forms of power with Bourdieu’s dynamic conceptualization of the relations of habitus and field. It is argued that the models observed represent different opportunities for the operation of power with implications for the role that participation can play.     

PUBLIC POLICY NETWORKS AND ‘WICKED PROBLEMS’: A NASCENT SOLUTION?

The last two decades have seen a shift in public services organizations from hierarchies to networks. Network forms are seen as particularly suited to handling ‘wicked problems'. We make an assessment of the nature and impact of this shift. Using recent evidence from the United Kingdom (UK) National Health Service (NHS), we explore the nature and functioning of eight different public policy networks. We are also interested in whether there has been a radical transition – or not – from hierarchical to network forms.     

The joint demand for health care,leisure, and commodities: Implications for health care finance and access in Vietnam

This paper explores linkages between the demand for health care providers and the consumption of food, non-food goods, and leisure in Vietnam, using a mixed continuous/discrete dependent variable model. Cross-price elasticities calculated from the model suggest there are strong substitution effects between health care, leisure, and certain commodities. The model allows us to explore the implications of replacing user fees with alternative forms of health care finance, such as commodity taxes. In particular, the results suggest financing public health care services with a non-food sales tax rather than user fees would be more progressive and would improve access to care.     

THE QUASI-MARKET,THE ENTREPRENEUR AND THE EFFECTIVENESS OF THE NHS BUSINESS MANAGER

The recent changes in the UK National Health Service were heralded by the publication of the Griffiths report in 1983 which highlighted the need for a business-like’approach to management. The policy makers’generic strategy of the late 1980s and early 1990s centred around the concept of‘quasi-markets’. These were artificial internal markets encompassing the purchasers and providers of public services. Little research has been undertaken into this new phenomenon of the‘quasi-market’but entrepreneurship economic theory would suggest that for markets to be efficient would require a supply of alert and aware entrepreneurs. Within the restructured NHS, the mantle for entrepreneurial management seems to have been placed firmly on the shoulders of the newly created‘business managers’. A 1993 survey amongst NHS business managers in first and second wave trust hospitals in the Trent Regional Health Authority indicated that whilst business managers were knowledgable of what entrepreneurial activity is, they currently feel constrained in their new roles for a variety of reasons. The authors suggest that rational economic analysis is insufficient to explain this lack of innovatory endeavour. Instead policy makers’attention should be devoted to liberating health managers from their current constraints to encourage their entrepreneurial development.     

Developing New Forms of Partnership With the ‘Market’ in the Procurement of Public Services

This article provides a conceptual framework for understanding the key differences between newly emerging ‘market’ relationships and more traditional forms of procurement by public sector organizations. It highlights how multiple relationships between service clients in the public sector and other stakeholders mean that service clients may often co‐produce welfare changes in their communities in ways which professional and commercial providers cannot easily control and may not fully understand. It highlights the very different nature of collaborations which affect single commissioners and contractors (relational contracting), multiple commissioning bodies with a unified procurement policy (partnership procurement) and multiple commissioning bodies with diverse procurement policies empowered by a single purchasing body (distributed commissioning). The article suggests that traditional conceptions of the ‘market’ and of ‘market management’ are now outdated and need to be revised to take into account the potential of collaborative relationships between multiple stakeholders in the public domain.     

ENTREPRENEURIAL EXIT RESPONSE TO DISSATISFACTION WITH PUBLIC SERVICES

Following Hirschman's seminal Exit, Voice and Loyalty, an exit response to dissatisfaction with public services is often portrayed as a replacement of one service provider with another, depending on the availability of alternatives. This article enriches Hirschman's typology by conceptualising an ‘entrepreneurial exit' response referring to citizens who exit proactively by creating a viable alternative themselves. The practical aspects of entrepreneurial exit are analysed based on five manifestations: planned homebirth, homeschooling, urban self‐defence groups, children with disabilities, and claim clubs in the American West. Whereas citizens' roles within the public service sphere are referred to as ‘participators’, ‘customers’, and ‘co‐producers', entrepreneurial exit indicates the entrepreneurial role citizens may play. Similar to the additional forms of exit, entrepreneurial exit becomes meaningful if the newly introduced form of service gains social acceptance, especially when it reflects policy non‐compliance within which laymen are transformed into providers of professional services.