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.     

Local workplace organising in the wake of globalisation: Street vendors and autoworkers in Puebla,Mexico

Global changes that seem to limit the intellectual and physical space in which workplace organising takes place, have led many analysts to suggest that labour organisations have become less important politically in recent years. While conceding that global processes have made the workers’ task more difficult, the argument here is that the nature and character of resistance by workers continues to influence political and economic outcomes. When that resistance is ineffective, as is the case to varying degrees with the disparate groups of Pueblan workers compared here, it may appear that global forces are too strong to be challenged. This paper argues, however, that workplace organisations that creatively adapt their structures and strategies to changing circumstances should be able to defend the interests of their constituents, as well as potentially influence political outcomes at local, national and perhaps even international levels.     

Constitutional verbosity and social trust

A common argument in the trust literature is that high-trust cultures allow efficient commercial contracts to be shorter, covering fewer contingencies. We take this idea to the topic of social contracts. Specifically, we ask whether social trust affects the length and detail of constitutions. Cross-country estimates suggest that national trust levels are indeed robustly and negatively associated with the length of countries’ constitutions.     

Forgetting to make votes count: The role of previous democratic experience

This paper argues that wasted votes in founding elections decrease when countries have a previous democratic experience before the current democratic period. This historical-institutionalist argument is tested with national election results in 22 founding elections in third-wave European, Asian, Latin American and African democracies. The results demonstrate that having a democratic past clearly increases coordination and then reduces the percentage of wasted votes in the founding election, controlling for the electoral system.     

Subnational participation in extra-national policy solutions: Kitakyushu City as an intermediate agent in policy coordination

The growing challenges of environment and sustainable development stretch across scales of geographic space and require action at multiple levels of jurisdictions, such as individual level, community level, national level, and global level. Multilevel governance and cross-scale coordination will open up opportunities for a variety of stakeholders to participate in decision-making. While potentially increasing the capacity of governance, the cross-scale and multilevel approaches may face a difficulty in policy coordination created by the plurality of stakeholders and be attended with organizational complexity. This article will examine the potential of subnational participation to make a policy choice, mediated by local governments, to be congruent with global strategies and national mandates in a consistent way. To this end, it will bring a new perspective to Kitakyushu City's experience in Japan as a heuristic test case study. My claim is that subnational actors occupy a strategic position to straddle the division between state and society, between the center and the periphery, and between the domestic and the foreign so they can act as an intermediate agent in reconnecting local action with national policy and turning global strategies into local action for problem solving.     

Historical Circumstances and Theoritical Structures as Sources of Meaning: A Response

The place of theory as providing a context for meaning is furtherelaborated on the presumption that an individuality principleor theorem of fundamental theoretical importance is being advancedby Alexander Hamilton in Federalist 15 and 16. Following ErnstCassirer, the argument is advanced that theoretical definitionsdepend upon a computational logic that enables one to statecausal antecedents that yield a conceptualized effect. Thisis the type of language that is used by artisans to create artifactsincluding those forms of artisanship that are concerned withthe nature and constitution of order in human societies.     

Citizenship and the marginalities of migrants

How should we conceive and address the position of migrants in receiving states? The argument offered here presents an account of this position in terms of civic marginalization, that is, marginalization relative to the norm of the national citizen. Two dimensions of civic marginalization are distinguished. First, marginalization with respect to the status of national citizenship which is addressed in terms of the issue of whether specific kinds of migrants should be entitled to access to national citizenship, and what, if any, conditions governing such access are justifiable. Second, marginalization with respect to the rights and duties of the national citizen, which is addressed in terms of the rights to which specific types of migrant are entitled and the duties which can be demanded of them as well as the duties of the state towards them. Distinguishing these two dimensions also helps to bring into focus their interaction with one another by demonstrating that whether, and under what conditions, a migrant has access to national citizenship is normatively consequential for their rights and duties and the duties of the state towards them. The argument also offers methodological reflections on approaching this topic and draws attention to the strengths and limitations of its own methodological strategy.     

Expressions of Distrust: Third-Party Voting and Cynicism in Government

Voter distrust of the national government is an ongoing theoretical concern for scholars who study voting behavior in the United States. Previous research demonstrates that distrustful voters are less likely to vote for major party candidates than their more trusting counterparts. Using the American National Election Survey, we explore the relationship between citizen distrust and voting for three major third-party challengers (Wallace, Anderson, and Perot) and the use of trust levels as predictors of third- party voting. We find citizen trust levels are significant and strong predictors of third-party voting, independent of other common explanatory variables of vote choice. We also find trust levels are stable over time, and we find little evidence to support the argument that trust levels measure trust of incumbent political figures.     

Pathways to impact in local government: the mini-Stern review as evidence in policy making in the Leeds City Region

Although in recent years great emphasis has been placed on global agreements and national commitments on climate change, ultimately action on mitigation and adaptation must take place at the local level. Many local authorities have to face questions of whether they should develop policies on climate change, and if so, on what evidence should policies be designed and delivered. This paper describes how academic research on the economics of low carbon cities (the ‘mini-Stern review’) helped create such an evidence base for the Leeds City Region and its constituent local authorities. We describe how the response to the evidence and the pathways to impact were different in the individual local authorities and what this means for our understanding of evidence in local policy making. In terms of Weiss’ (Social sciences and modern states: national experiences and theoretical crossroads. Advances in political science, Cambridge University Press, Cambridge, 1991) classification, the study was mainly useful as an argument and idea rather than being used instrumentally. We find that the policy and political context in each authority determines to a large extent whether such an academic study is useable as evidence. The contents and timing of the study need to align with existing policy and/or political agendas: is climate change on the agenda at all, with what priority and how is it framed. We find confirmation of a relationship between the policy problem type and the role of evidence as argument, idea or data. The mini-Stern study itself was just one contribution to wide-ranging processes of informing, convincing, pressurising, etc., not just within the different councils but also within the wider communities. Other contextual factors include composition, agenda and activities of local civil society and the local business community. Finally, it depends on the expertise of policy officers in the councils what use is made of evidence. Making policy takes (much) time, translation and negotiation across levels and sectors. Policy work describes how policy officers bring their diverse forms of knowledge to bear on policy questions; how this work is done is something that is learned from practice rather than from the study.     

养老产业政策体系及其协调性--基于政策文本的量化分析

发展养老产业是应对未来深度老龄化的重要国家战略。聚焦养老产业政策体系,构建其协调性分析框架,选取调查2006—2018年中央、陕西省及安康市的资料,分析国家、省、市三级层面现行养老产业政策文本,应用MAXQDA软件对其进行编码,采用文本内容分析、共词分析、社会网络分析与聚类分析方法,对养老产业政策层级、政策发展历程、政策主体、政策效力、政策专项性、政策内容等进行双维协调性定量分析。研究发现:养老产业政策体系内部不同层级之间政策联系紧密,涉及的政策各要素较为完备,但仍然存在纵向、横向维度中的不协调因素。应通过丰富养老产业政策类型与内容、优化体系结构、加强相关部门合作等有效措施,进一步提升养老产业政策体系的协调性,为推动养老产业的健康可持续发展奠定制度基础。     

Experimentalist but not Accountable Governance? The Role of Frontex in Managing the EU's External Borders

In 2005 the European Agency for the Management of Operational Cooperation at the External Borders (Frontex) was founded. Contrary to the widely used principal–agent approaches, it is more promising to analyse Frontex through the lens of experimentalist governance. This paper has two lines of argument. First, it argues that Frontex may only succeed if Frontex has a sufficient degree of organisational independence and enjoys appropriate and steady support by all member states. This is especially virulent when many member states fail to provide significant contributions in terms of material and human resources as well as time, leading to a suboptimal reduction of duration, scope and operational impact of Frontex's missions. The second argument is concerned with the accountability of Frontex. Contrary to the experimental approach, this article takes a sceptical stance, arguing that important (supra-)national actors are sidelined and relevant legal rules are ignored.     

Is Multiculturalism Bad for Social Cohesion and Redistribution?

Multiculturalism as an official policy strategy has recently come in for significant criticism in a number of Western European countries. A key criticism is that multicultural policies undermine redistribution policies, since they would erode the social cohesion upon which redistribution measures are built. However, empirical research does not univocally confirm this critique. This article explains why this is the case. The first argument is called the integration‐recognition paradox. Policies that focus on recognising minority groups may lead to a greater social acceptance of those minorities, and in turn may lead to their feeling more appreciated as participants in society. In a second argument, the authors discuss how multicultural policies could easily be combined with policies that invest in national unity and social cohesion.     

A Not So Technocratic Executive? Everyday Interaction between the European Parliament and the Commission

The European Commission, although generally portrayed as a technocratic, non-majoritarian institution, or as an agent of EU member governments, has become increasingly linked to the European Parliament (EP) through a range of semi-parliamentary measures intended to increase the executive’s legitimacy and accountability. In this article we argue that in addition to several highly visible and often treaty-based control instruments, an almost symbiotic, less visible, routine relationship can be observed between the two institutions. Based on an online survey of EP staff, as well as on minutes from EP committee meetings, this article examines the daily interaction taking place between the Commission and the EP, particularly at the level of officials. Although mutual interdependence in the legislative process may trigger daily interaction, the theoretical argument proposed is that the latter is facilitated and reinforced under two particular conditions: (i) if the two institutions share similar organisational patterns, and (ii) if they share similar behavioural patterns. Three such patterns are emphasised: sectoral, ideological and supranational.     

Coordination between electoral arenas in multilevel countries

This article shows the existence of a coordination dilemma in multilevel countries that hold elections for different parliaments, at different territorial levels and with different electoral rules. With evidence from Spain, the analysis identifies interaction or contamination effects between national and subnational electoral arenas that generate, just as in most mixed-member electoral systems, a centrifugal force that increases the number of electoral parties in national elections. The incentives that solve this coordination dilemma faced by small regional or local parties are theoretically discussed and empirically tested.     

The Ties that Bind? Intra-party Information Exchanges of German MPs in EU Multi-level Politics

As political authority is successively transferred from the national to the EU level, national parliaments are often considered to lose control over the domestic political agenda. Yet recent studies suggest that national parliaments cannot simply be labelled ‘losers’ of European integration. National parliaments have institutionally adapted to the EU in order to better scrutinise and control their governments in EU affairs. While existing research shows how parliaments employ their institutional opportunities to exercise scrutiny in the national arena, this paper suggests that MPs also employ informal strategies to obtain information on EU affairs to control and influence their governments. It argues that MPs primarily act through political parties, which are viewed here as multi-level organisations, and make use of their partisan ties to regional, transnational and supranational party actors to obtain information on EU issues. The article probes this argument by drawing on original data obtained through a survey of German MPs in 2009.     

Does Anthropology Still Exist?

In response to Roger Sandall’s critical analysis, the problematic notion of culture in modern anthropology is examined in terms of cultural resistance to globalization. The example of McDonaldization is taken to be a potent instance of cultural globalization. Three conditions for successful cultural resistance to cultural standardization are proposed. The first is cultural in the shape of a strong aesthetic tradition of (national) resistance. This dimension involves some degree of cultural conservatism. The second condition is political, namely a viable and robust civil society that provides the basis for decisive (cultural) leadership. The third element is the involvement of the state in policies that promote and sustain a national heritage. Without this state involvement, global market conditions will largely shape the erosion of local and national cultures. Without a political response to cultural globalization, global market commodities will in all likelihood oust local goods and services. Those societies that lack both a strong aesthetic and an effective political leadership can offer little effective resistance to negative globalization and their local traditions are quickly destroyed. This argument is then examined in terms of a number of societies especially Turkey, China and Japan where the erosion of national cultures is proceeding rapidly. These critical assertions against global standardization require a strong first-order notion of culture which modern anthropology appears to be unable or unwilling to provide.

Coordination as a Political Problem in Coordinated Market Economies

The purpose of this article is to explore the political dynamics of employer coordination in three well‐known “coordinated market economies.” We examine differences in how employer coordination has been organized in Sweden, Germany, and Japan in the area of industrial relations, and we examine the extent to which such coordination represents a self‐sustaining equilibrium, as some of the most influential treatments suggest. To preview the findings, we argue that precisely the intensification of cooperation between labor and management in some firms and industries (that the “varieties of capitalism” literature correctly emphasizes) has paradoxically had deeply destabilizing collateral effects that have undermined or are undermining these systems as they were traditionally constituted. All three cases are characterized not so much by a full‐blown breakdown of coordination so much as a very significant reconfiguration of the terms and scope of such coordination. Specifically, all three countries feature the emergence of new or intensified forms of dualism—different in each case based on different starting points—in which continued coordination within a smaller core has in some ways been underwritten through the breaking off of other, more peripheral, firms and workers.     

Exploring normative commitment with Nigerian extension workers

This paper explores normative commitment using a sample of 60 agricultural extension workers in a voluntary rural development programme. Organizational commitment is related to participation, standardization, and coordination in order to examine their relative influence on the visit effort of extension agents. Age, education, salary, tenure, position, and participation did not have any influence on normative commitment, whereas standardization negatively influenced it. Commitment, along with red tape, influenced visit efforts. Two major conclusions emerge. The first is that traditional personal and role-related antecedents of commitment may be related to instrumental but not to normative commitment. The second is that normative commitment can predict behaviour outcomes in public organizations.     

Fair-Play Obligations: A Critical Note on Free Riding

McDermott rejects the argument that an individual, in receiving benefits from a political community, thus incurs a 'fair-play obligation' to contribute to the provision of these benefits. While acknowledging that an individual receiving benefits without contributing is 'free riding' and that free riding may be morally wrong, McDermott denies that such moral lapses entail communities having any right to demand support. Not contributing may be morally objectionable, but individuals may still have a right not to contribute. However, both proponents and opponents of the fair-play obligation claim do not sufficiently differentiate between different forms of free riding. Arguments tend to be based on rights that may or may not be invoked when individuals free ride through consuming externalities. However, this form of free riding does not entail any reciprocal obligations. Yet it can plausibly be argued that when free riding occurs in the case of the production of public goods, then communities can demand support from individuals, and can have a right to do so.