IMPLEMENTING PERFORMANCE‐BASED FUNDING FOR HEALTH RESEARCH: WHEN GOVERNANCE AND PROCEDURAL FAIRNESS MATTER

The article examines the implementation by the Italian Ministry of Health of performance‐based funding to allocate resources for research to IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico) hospitals. The analysis provides evidence that ten years from its introduction the performance‐based funding system has persisted, but it has been implemented rather differently from what had been imagined by its proponents. By drawing on the theoretical frameworks of policy implementation, agency, and relational contracting, the study establishes that the overall design of the system has contributed to this final outcome only to a limited extent. Rather, the lack of procedural fairness, as well as of political leadership in linking the system to national research priorities, has undermined the basis for trust between hospitals and the Ministry of Health. The article discusses how, in this, the governance of performance‐based funding and its strong ownership by the ministerial bureaucracy has been determinant.     

STREET‐LEVEL BUREAUCRACY AND PUBLIC ACCOUNTABILITY

The concept of ‘street‐level bureaucracy’ was coined by Michael Lipsky (1980) as the common denominator for what would become a scholarly theme. Since then his stress on the relative autonomy of professionals has been complemented by the insight that they are working in a micro‐network of relations, in varying contexts. The conception of ‘governance’ adds a particular aspect to this: the multi‐dimensional character of a policy system as a nested sequence of decisions. Combining these views casts a different perspective on the ways street‐level bureaucrats are held accountable. In this article some axiomatic assumptions are drawn from the existing literature on the theme of street‐level bureaucracy and on the conception of governance. Acknowledging variety, and arguing for contextualized research, this results in a rethinking of the issue of accountability at the street level.     

INFORMATION‐SHARING AND CONFIDENTIALITY IN SOCIAL POLICY: REGULATING MULTI‐AGENCY WORKING

In recent years, there has been growing concern in the UK that local services aimed at risky or vulnerable people are ineffective, because of agencies’ persistent failure to share information about their clients. Despite considerable national policy effort to encourage better information‐sharing, previous research indicates that there are many cases where information is still not shared when it should be, or where it is shared when it should not be, with potentially devastating results. This article uses data from the largest empirical study of local information‐sharing yet undertaken to examine four policy sectors where multi‐agency working has come to the fore. It shows that variations in their information‐sharing and confidentiality practices can be explained by neo‐Durkheimian institutional theory and uses insights from this theory to argue that current policy tools, which emphasize formal regulation, are unlikely to lead to consistent and acceptable outcomes, not least because of unresolved conflicts in values and aims.     

SCALE AND POLICY IMPACT IN PARTICIPATORY‐DELIBERATIVE DEMOCRACY: LESSONS FROM A MULTI‐LEVEL PROCESS

This article addresses two interrelated critiques of participatory‐deliberative democratic institutions: that they are beset by problems of scale and that they achieve weak policy impact. This article tests these criticisms through the case of the UK Sustainable Communities Act (SCA), a multi‐level process that is relatively strongly institutionalized. The evidence lends qualified support to these critiques. The article differentiates between contextual factors, related to the attempt to institutionalize participatory‐deliberative processes within existing socioeconomic and political structures, and design factors to do with institutional and process design. The case of the SCA calls for caution about the claim that multi‐level participatory‐deliberative processes can overcome problems of scale and policy impact, but the question remains open. The article ends by suggesting that expectations of direct policy impact might be too high. Rather than determinants of policy, multi‐level participatory‐deliberative processes might function best as agenda‐setters.     

THE IMPACT OF PUBLIC SERVICE MOTIVES ON WORK OUTCOMES IN AUSTRALIA: A COMPARATIVE MULTI‐DIMENSIONAL ANALYSIS

There is a general consensus that individuals who are driven to serve the public interest can possess a mix of public service motives for engaging in altruistic actions. This article proposes that when analysed simultaneously, some public service motives may play a more important role than others in influencing work outcomes. The pressing questions are which ones and how? Through a survey of a group of Australian public sector employees, this article explores the relationship between the various dimensions of public service motivation (PSM) and the common work outcomes: organizational commitment, job satisfaction and job motivation. The combinations of PSM dimensions that had a greater impact on these work outcomes are also found to vary with different outcomes.     

TRANSACTIONS COSTS IN RURAL DECISION‐MAKING: THE CASES OF FUNDING AND MONITORING IN RURAL DEVELOPMENT IN ENGLAND

Public domain decisions in rural England have become more complex as the number of stakeholders having a say in them has increased. Transactions costs can be used to explore this increasing complexity. The size and distribution of these costs are higher in rural areas. Grouping transactions costs into four – organizations, belief systems, knowledge and information, and institutions – two of the latter are evaluated empirically: growth in the bid culture, and monitoring and evaluation. Amongst 65 Agents of Rural Governance (ARGs) in Gloucestershire, both were found to be increasing over time, but those relating to finance were a greater burden than those of monitoring: the latter can improve ARG performance. Increasing transactions costs in rural decision‐making appears to be at variance with ambitions of achieving ‘smaller government' through, for example, the Big Society. Smaller government is likely to be shifting the incidence of these costs, rather than reducing them.     

MANAGERIAL GOALS IN A PERFORMANCE‐DRIVEN SYSTEM: THEORY AND EMPIRICAL TESTS IN HIGHER EDUCATION

Factors influencing managerial goals and decision‐making processes have been debated for decades among public administration scholars. Previous literature has explained goal setting through theories of performance gaps, bureaucratic control, and isomorphic rationality. However, there exists no direct empirical test of these theories to determine which theoretical expectation may have more or less weight with managers when setting organizational goals. Using an original survey of university presidents, this study tests how public managers prioritize competing performance goals. Findings suggest that the goal setting decisions of these public managers is primarily driven by political control mechanisms.     

POLITICAL ACCOUNTABILITY AND PERFORMANCE AUDIT: THE CASE OF THE AUDITOR GENERAL IN NORWAY

Performance audit is widely used in public administration, but, at present, little empirical evidence exists on its usefulness and contribution to accountability. Based on survey data from 353 civil servants in Norway, this article analyzes the auditees' perceptions of the audit. Performance audit was seen as useful by a majority of the auditees. If auditees agreed to audit criteria and assessments, were allowed to influence the process, had favourable opinions of the reports, and believed that the State Audit Institution contributed to accountability and improvement, then they regarded it as useful. Reports used for accountability purposes were not perceived as less useful. The auditees' administrative level, the use of the report to further interests, and attention from politicians, the media, and the Parliament impacted on the accountability dimension. These results indicate that performance audit can influence civil servants, but the influence is contingent on how the audited civil servants perceive the performance audit.     

EVIDENCE‐BASED MANAGEMENT: THE VERY IDEA

This essay critically evaluates the recent phenomenon of ‘evidence‐based management’ in public services that is especially prominent in health care. We suggest that the current approach, broadly informed by evidence‐based health care, is misguided given the deeply contested nature of ‘evidence’ within the discipline of management studies. We argue that its growing popularity in spite of the theoretical problems it faces can be understood primarily as a function of the interests served by the universalization of certain forms of managerialist ‘evidence’ rather than any contribution to organizational effectiveness. Indeed, in a reading informed by the work of French geographer Henri Lefebvre, we suggest that in the long term the project is likely to inhibit rather than encourage a fuller understanding of the nature of public services. We conclude with a call for forms of organizational research that the current preoccupations of the evidence‐based project marginalize if not write out altogether.     

DEMOCRATIC ACCOUNTABILITY IN PUBLIC–PRIVATE PARTNERSHIPS: THE CURIOUS CASE OF FLEMISH SCHOOL INFRASTRUCTURE

This article questions the negative outlook on the democratic accountability in public–private partnerships (PPPs). It challenges this widely held perception in the literature with the empirical findings of a case study of Flemish school infrastructure (Belgium). A large design, build, finance, and maintenance (DBFM) programme is compared with the regular subsidizing system through the public agency AGIOn (Agency for School Infrastructure). This case study demonstrates that more accountability forums and actors can be active in the PPP, that they can behave more actively in the PPP, and that they get results in terms of accountability. It provides a critical example of having more accountability in the PPP variant of school infrastructure than in direct public provision, and there are reasons to argue that this also means improved accountability, because internal and latent processes of accountability become external and actual ones.     

RENEWING POLICY TO SUPPORT EVIDENCE‐BASED HEALTH CARE

Health systems internationally have developed policies to support evidence‐based health care (EBHC) for over a decade. As this article shows, the time is ripe to review current policy frameworks in an evidence‐based manner. We summarize key themes deriving from qualitative research on the UK EBHC implementation and draw out implications for policy renewal. Our diagnosis is different from current UK NHS (National Health Service) policy since we stress local capacity building rather than top‐down frameworks, standardized tools and guidelines. As other jurisdictions demonstrate alternative EBHC policy frameworks, more international comparison and mutual learning is needed.     

GOVERNMENT FUNDING,EMPLOYMENT CONDITIONS,AND WORK ORGANIZATION IN NON‐PROFIT COMMUNITY SERVICES: A COMPARATIVE STUDY

The article provides a comparative exploration of New Public Management (NPM) funding models on the non‐profit sectors in the UK and Australia, and the implications for services, employment conditions, and worker commitment. A degree of convergence exists around the principles of NPM in the two case studies, creating employment regimes of low pay, casualization, and work intensification. Enhanced vulnerability to pay cuts in the UK, and insecurity in Australia are explained by national differences in exposure to recession, industrial relations institutions, and competition, leading to diminishing worker commitment and raising important concerns for policy‐makers as benefits gained from outsourcing to non‐profits are eroded.     

‘RENEWING DEFRA’: EXPLORING THE EMERGENCE OF RISK‐BASED POLICYMAKING IN UK CENTRAL GOVERNMENT

Risk‐based policymaking is a form of reflexive policymaking that uses risk analysis to address both the primary objects of policy interventions and their secondary adverse consequences. As such, it has become central to debates about efficiency, control and accountability in UK government. To better understand the factors shaping its emergence, this article studies the UK Department for Environment, Food and Rural Affairs' (Defra) adoption of risk‐based policymaking. In‐depth interviews with Defra staff suggest that risk‐based policymaking serves conflicting objectives and struggles to perform its ostensive functions. The article concludes, first, that risk understandings can be organizationally filtered in ways that reinforce rather than challenge entrenched policy practices. Second, that using risk‐based policymaking for audit purposes can undermine policymaking reflexivity. Third, that the value of risk ideas in reconciling competing accountability and blame‐avoidance pressures leads to risk ‘colonizing’ increasing dimensions of policymaking.     

COLLABORATIVE CAPACITY AND STRATEGIES IN AREA‐BASED INITIATIVES

Despite considerable evaluator investment in examining partnership activity in UK public policy initiatives, little attention has been paid to the role of strategy in supporting the generation and harnessing of the resources necessary to collaborate effectively. This paper focuses on one of the first New Labour initiatives – Health Action Zones (HAZ) – and draws on national evaluation findings to delineate local strategies, assess their application in practice and reflect on their contribution to collaborative action. The paper argues that even within nationally constrained policy initiatives there is sufficient flexibility for local actors to select strategies to steer collaborative effort, but these strategies are informed by their operating context and are liable to change in response to experience and changes in context. In addition, the evaluation findings suggest that effective strategies are those which harness collaborative capacity across a range of dimensions. The paper concludes by identifying implications for theory, policy and evaluation.     

THE ROLE OF BOUNDARY‐SPANNING MANAGERS IN THE ESTABLISHMENT OF PUBLIC‐PRIVATE PARTNERSHIPS

This article presents the findings of a study examining the roles and behaviours of boundary‐spanning managers during the establishment of voluntary public‐private partnerships (PPPs). It responds to recent calls in the literature to pursue research that incorporates the pivotal contribution of individual actors in the collaborative process, and to set this research within the stage specific context of partnerships. The analysis is located within the theoretical framework of organizational sensemaking. Using a grounded methodology of data collection, coding and analysis within ten Australian and UK PPPs, the study demarcates a four‐stage evolutionary establishment process of PPPs. Within each stage there exists a specific managerial focus in conjunction with one or two main managerial challenges. Boundary‐spanning managers employ various strategies to overcome such challenges within each specific stage, thus ensuring the progressive evolution of the PPP. These foci, challenges and strategies are identified and analysed in the article.