Barriers and enablers of coordination across healthcare system levels

Coordination across healthcare system levels is a global imperative to ensure efficient resource utilization and provide high-quality care. The substantial body of research on coordination in healthcare mainly concerns coordination across professional and organizational domains. Consequently, there is a dearth of empirical research aimed at delineating the determinants of coordination across healthcare system levels. This paper describes and analyses the barriers and enablers of healthcare coordination across national, regional, and local system levels in a populous Swedish region. Individual interviews and focus group discussions, encompassing a total of 63 individuals, were conducted with managers, administrators, and politicians. The findings of the paper underscore that the barriers identified were most often of a structural or institutional character, whereas the enablers of the studied cross-level coordination were mostly relational. Therefore, we propose that future research should aim to further delineate the prerequisites for personal relationships to emerge, as well as how they may act as enablers of coordination across healthcare system levels.     

Structure and Strategies: Two Faces of Civic Activism in India

Abstract

This paper explains the success of civic actors in achieving their aims by reference to their organizational structure. Based on a comparison of a religious nationalist movement and a women's movement in South Asia, I argue that organizational structure is closely linked to the success of a social movement. The lack of coordination and collaboration among women's groups in terms of mission and strategy has led to a perception of the overall movement as weak and marginal. The superior coordination of strategy and mission within the religious nationalist movement have allowed it to effectively use its resources to cause great changes in Indian society.     

The Fourth Level of Government: on the Standardization of Public Policy within International Regions*

Both in the literature and in public documents one usually operates with three levels of government: local, regional, and national. This may be partly due to a common perception of coordination and standardization as something that takes place only through hierarchical forms of organization. However, if we realize that coordination and standardization may also take place through other organizational forms, as for instance bargaining, consultation, and autonomous adjustment, we can add A fourth level of government. At the same time, hierarchy seems considerably modified at the national levels. Thus, a central argument is that 'national' policies cannot be adequately explained by 'national' politics alone. Some data from the Norwegian context are used to illustrate this argument.     

Spanning “Bleeding” Boundaries: Humanitarianism,NGOs, and the Civilian‐Military Nexus in the Post–Cold War Era

How do nongovernmental (NGO), international (IO), and military organizations cope with their dependencies and address their perceptual and real differences in order to coordinate their field operations? This question is addressed through the creation of a matrix grouping civilian (NGOs and IOs) and military operations into four general types: peacekeeping; disaster relief; complex humanitarian emergencies/warfare; and stabilization and reconstruction. Second, using Galbraith's information processing approach to organizational design, a range of formal coordination mechanisms that organizations use at the strategic and operational levels to help them cope with their dependencies in different field operations is identified. Third, the author underscores how communities of practice are emerging as informal mechanisms of coordination among civilian and military organizations. And finally, a framework of organizational forms that views communities of practice as an alternative to hierarchy and markets is offered. Believing communities of practice hold the most promise for coordination in the human security domain when hierarchies are politically untenable and markets lack accountability, the author concludes with implications for interorganization coordination research and practice.     

The institutional structuring of innovation policy coordination: theory and evidence from East Asia

This article suggests that variations in the dominant pattern of innovation policy coordination can be analysed and understood effectively by dividing innovation and other complementary socio-economic policies into low-complexity and high-complexity tasks. The effective implementation of these two sets of policy tasks that differ in the extent, nature and intractability of collective action problems confronting the coordination process hinges on the strength of two sociopolitical institutions: bureaucratic organizational structures and interactive governing arrangements. While bureaucratic organizational structures are better suited to delivering low-complexity tasks, interactive governing arrangements are more effective in resolving high-complexity policy problems. They interact differently across political economies to structure the management of coordination challenges and thus give rise to divergent patterns of innovation policy-making. The comparative analysis of innovation policy coordination between Hong Kong and Singapore over the past two decades lends strong support to the central theoretical propositions of the article.

     

The Influence of Political Parties on Policy Coordination

Despite an increasing interest in party‐state relations, the functions political parties as organizations fulfill in the government apparatus are rarely theorized or empirically examined. Instead of focusing on citizen demands toward parties, this article focuses on the demands of government. It argues that party organizational linkages help integrate an increasingly complex government apparatus. To substantiate this claim, it analyzes the impact of party linkages on policy coordination within and across subnational governments in the United States, Canada, and Switzerland. The analysis shows that: (1) the extent to which processes within different policy fields are connected—policy integration—is shaped by the relative strength of party organizational linkages rather than being a mere reflection of institutional divisions and (2) depending on the party configurations predominantly governing at the subnational level, policy integration within subnational governments either facilitates intergovernmental policy coordination or accelerates cross‐jurisdictional conflict between them.     

Organizational turnaround: moving beyond one-size-fits-all solutions

Abstract

Literature on organizational turnaround has frequently suggested, but rarely investigated, the possibility that turnaround strategies for failing organizations must be matched to the specific needs of the organization. Building on work related to causes of decline in private sector literature, this study offers a framework for matching strategic interventions to the current state of an organization’s functioning in terms of resources (material and human), coordination (horizontal and vertical), and the environment. Using a panel dataset of New York City schools, we find that two understandings of turnaround that often appear mutually exclusive—that an organization can improve performance by shoring up weaknesses and that an organization should play to its current strengths—can complement each other and may both appropriately describe different types of organizational challenges.     

Extra‐Network Organizational Reputation and Blame Avoidance in Networks: The Hurricane Katrina Example

Research on public service networks has identified a variety of mechanisms to foster coordination, including trust and reciprocity norms. This article argues that network actors are also driven by a desire to avoid blame. Network membership is often a political responsibility rather than a voluntary act, and members may be at least as attuned to their extra‐network organizational reputation as to their intra‐network reputation, creating an incentive to utilize blame avoidance strategies when failure occurs. Blame avoidance strategies undermine intra‐network trust and coordination, representing a significant threat to the implementation of public policy. To illustrate the potential of the concept for network theory, blame avoidance strategies are identified under the conditions of high political risk and task salience, as represented by the crisis response network in the U.S. disaster of Hurricane Katrina.     

Informelle transgouvernementale Koordinationsnetzwerke der Ministerialbürokratie der EU-Mitgliedstaaten bei einer Regierungskonferenz

We investigate the informal bilateral transgovernmental relations between equivalent ministries of EU member states during the preparation of the Intergovernmental Conference 1996. Starting point of this analysis is the hypothesis of a growing importance of transnational and transgovernmental relations as a cause and a result of European integration. Whereas these proclaimed tendencies have been extensively researched with regard to economic interdependencies and transnational relations of societal actors, networks of the administrative and bureaucratic elites have been rather neglected. Applying diverse concepts of network analysis, we identify the hitherto latent informal network structures of the governments. The overall configuration can be described as a mixture of a centre-periphery structure and cohesive blocks. The gradual center-periphery structure consists of a “triumvirate” of the powerful member states (Germany — France — Great Britain) and smaller states, and is characterized by a clear north-south dimension. The costs of informal coordination are mainly borne by the large member states as well as by “brokers” (Austria, BeNeLux, Finland, Sweden).     

Entwicklungslinien der Politischen Theorie in Deutschland seit 1945

In this article we map out the development of German political theory since 1945 and locate it within the international context. For this purpose we track concepts which were central in shaping the scholarly controversies within the field. We distinguish between organizational concepts (democracy, state, power, system, institution), normative ideas (justice, common welfare, recognition) and new themes (gender, discourse, globalization). The resulting picture of the development of political theory replaces the common idea of three phases with a decisive break at the beginning of the 1980s.     

Rural development management in Nepal,Part I: Coordination in the Rasuwa-Nuwakot Integrated Rural Development Programme

Rural development management in Nepal has been criticized for more than a decade now on the grounds of the country's weak aid-absorbing capacity, administrative slowness and poor project management. Though several reforms of the rural development planning and management systems have been staged, at present coordination in integrated rural development projects remains weak. The paper reports on the empirical findings of research on mechanisms, procedures, organizational arrangements and problems of coordination. Although the country's environment, and its socioeconomic and cultural constraints, may negatively influence smooth operations in implementing integrated programmes, several policy considerations for improvement may be formulated. Among these, organizational reform with decentralization and reduction of the number of offices involved, strengthening the resource management system, especially budget release and personnel motivation, and a more integrated method of policy, programme and project formulation are the issues considered most important by the government officers themselves. Part II will appear in vol. 7, no. 3 of this journal, and examines the implementation and management of rural development in the Karnali and Bheri districts of the Mid-Western Development Region of Nepal.     

Organizational and Spatial Determinants of Fiscal Stress: An analysis of Norwegian Municipalities

Two types of factors are thought to lead to fiscal stress of municipalities in Norway: municipal organization and spatial characteristics. Organizational and political factors include the rationality of the agency of government, the ability of the resource coordinator to achieve a balance, and the coordination of governmental policies. Spatial factors include industrial presence and north-south regional differences. Only the two spatial variables are significantly correlated with the budget difficulties. Case studies, though, show organizational factors and the interplay between organizational and spatial factors can be important determinants for fiscal stress.     

Two Political Worlds? Multi-level Campaign Integration in Canadian Constituencies

The purpose of this article is twofold. First, using survey data from Canadian constituency associations, the article explores the extent to which federal and provincial parties engage in cross-jurisdictional coordination. In doing so, this study builds on and empirically tests findings that have been derived from earlier case studies (i.e. Koop, 2011). Far from inhabiting ‘two political worlds’ the data reveal that parties are much more connected than previously thought. Second, the article seeks to uncover why some parties and associations are more integrated than others. Examining organizational design, the article concludes that vertical party integration is not simply an organizational phenomenon, as organizationally truncated parties still engage in modest levels of informal integration. In addition, constituency level factors are also considered. The results of a multinomial logistic regression demonstrate that parties are significantly more integrated in districts where they are electorally viable compared to those where they are weak.     

WHAT IS A “GOOD” SOCIAL NETWORK FOR POLICY IMPLEMENTATION? THE FLOW OF KNOW‐HOW FOR ORGANIZATIONAL CHANGE

This study concerns how intraorganizational networks affect the implementation of policies and practices in organizations. In particular, we attend to the role of the informal subgroup or clique in cultivating and distributing locally adapted and integrated knowledge, or know‐how. We develop two hypotheses based on the importance of intraorganizational coordination for an organization's capacity for change. The first emphasizes the importance of distributing know‐how evenly to potential recipient subgroups. The second emphasizes the importance of restricting know‐how to flow from high know‐how subgroups. We test our hypotheses with longitudinal network data in 21 schools, finding stronger support for the second hypothesis than the first. Our findings can help managers cultivate know‐how flows to contribute to organizational change.     

Coercive Leadership

We develop a model of leadership in which an informed leader has some degree of coercive influence over her followers (agents). Agents benefit from coordination but face two distinct challenges: dispersed information and heterogeneous preferences. The leader's coercive power facilitates coordination by weakening the effect presented by both of these challenges through “binding” agents to a strategically chosen policy. The leader's policy choice becomes more informative to the agents about the leader's privately held information as her coercive capacity increases. By adjusting her policy choice in response to available private and public information, the coercive leader achieves her preferred average of agents' actions, and in so doing, neutralizes the possibly deleterious coordinating influence of public information. We develop implications of our analysis for understanding autocratic leadership in different political and organizational contexts.     

Reorganizing for National Security and Homeland Security

This article considers the post–September 11 challenges faced by the U.S. national security machinery and analyzes the relationship between the new threat environment, the United States's role in the world, and decision–making structure. Homeland security is defined as a subset of national security. The threat of foreign terrorist organizations acting on U.S. soil should be seen in the political context of the pursuit of U.S. national interests in an often anarchic world. Two models for homeland security organizational structures are considered: a departmental model and an interagency model. The interagency model, embodied in the Homeland Security Council, is a better fit given the nature of the threat, the crucial need for coordination, and the realities of governmental decision making. The organizational challenges that may complicate the government's preparations, decisions, and implementation of a major homeland defense mission stem from three rivalries: executive–legislative, cabinet–staff, and Homeland Security Council–National Security Council.     

How Organizational Identity Affects Hospital Performance: Comparing Predictive Power of Mission Statements and Sector Affiliation

Abstract

Organizational identity is an important concept in organizational theory, as it can contextualize the behavior of organizations and members. The literature presents divergent perspectives on organizational identity: some studies have characterized organizational identity as constrained by institutional forces, whereas others have contended it is socially constructed by organizational members. Studies have largely focused on the former perspective, measuring organizational identity by sector affiliation; the latter approach has rarely been empirically tested. Therefore, in addition to sector affiliation, this article proposes a different approach to operationalizing organizational identity by examining hospitals’ mission statements. The study also examines which of these dual forces have more predictive power regarding organizational performance. Together with hospitals’ sector affiliation, we test how the presence and frequency of mission statement language regarding access, cost, quality, or unique organizational values affect hospitals’ various performance metrics. Regression analyses with 172 acute hospitals in Florida reveal significant relationships between types of mission statement content, sectors, and performance indicators.     

IMPLEMENTATION OF EVIDENCE‐BASED PRACTICE IN HUMAN SERVICE ORGANIZATIONS: IMPLICATIONS FROM AGENT‐BASED MODELS

Much of the impact of a policy depends on how it is implemented, especially as mediated by organizations such as schools or hospitals. Here, we focus on how implementation of evidence‐based practices in human service organizations (e.g., schools, hospitals) is affected by intraorganizational network dynamics. In particular, we hypothesize intraorganizational behavioral divergence and network polarization are likely to occur when actors strongly identify with their organizations. Using agent‐based models, we find that when organizational identification is high, external change agents who attempt to direct organizations by introducing policy aligned messages (e.g., professional development emphasizing specific teaching practices) may unintentionally contribute to divergence in practice and polarization in networks, inhibiting full implementation of the desired practices as well as reducing organizational capacity to absorb new practices. Thus, the external change agent should consider the interaction between the type of message and the intraorganizational network dynamics driven by organizational identification.     

Measuring multi‐level regulatory governance: Organizational proliferation,coordination, and concentration of influence

As regulation increasingly results from the interplay of a wide array of different actors operating at different levels, it has become crucial to focus on how these constellations of regulatory actors operate. Although this research field presents huge potential for theoretical development, we still lack the measurement techniques to allow systematic comparative research. We contribute to filling this gap with four indices measuring crucial characteristics of multi‐actor regulatory arrangements: (i) the scope of organizational proliferation; (ii) the extent of coordination between regulatory actors; (iii) the amount of influence that each individual regulatory actor has on the sector regulation; and (iv) the extent to which the regulatory influence is concentrated in the hands of one or a few actors. We argue that our indices are sufficiently systematic, reliable, and flexible to be applied in a variety of research contexts relating to multi‐level and multi‐actor regulatory governance.     

Multiple Institutional Embeddedness in Europe: The Case of Danish, Norwegian, and Swedish Government Officials

The questions posed in the current study are (1) whether, and (2) how, participation within Commission expert committees and Council working parties of the European Union (EU) affects the coordination behaviour of the participants. Based on organizational theory arguments, the coordination role of the Ministry of Foreign Affairs is arguably weakened by institutional dynamics existing within Commission expert committees. The opposite is argued to be the case within Council working parties. Empirically, this study is based on 160 questionnaires and 47 face-to-face interviews with Danish, Norwegian, and Swedish domestic government officials attending EU committees. Secondly, this study also includes answers from 49 officials at the permanent representation to the EU of these three Scandinavian countries. Being excluded from attending Council working parties, Norwegian civil servants participating within Commission expert committees are shown to coordinate considerably less with the foreign ministry than their Danish and Swedish counterparts. Notwithstanding these observations, this study also reveals how the coordination behaviour evoked by national civil servants reflects their domestic institutional affiliations. In addition to showing how EU committees affect coordination behaviour among the participants, the current analysis also shows how responses to integration requirements are filtered – and even conditioned – by a prior state of affairs at the domestic level of governance.