Stewardship of quality of care in health systems: Core functions,common pitfalls,and potential solutions

National Ministries of Health in low‐ and middle‐income countries (LMICs) have a key role to play as stewards of the quality agenda in their health systems. This paper uses a previously developed six‐point framework for stewardship (strategy formulation, intersectoral collaboration, governance and accountability, health system design, policy and regulation, and intelligence generation) and identifies specific examples of activities in LMICs in each of these domains, pitfalls to avoid, and possible solutions to these pitfalls. Many LMICs now have quality strategies with clear vision statements. There are good examples of quality agencies and donor collaboration councils to coordinate activities across different sectors. There are multiple options for accountability, including public reporting, community accountability structures, results‐based payment, accreditation, and inspection. To improve health system design, available tools include decision support tools, task‐shifting models, supply chain management, and programs to train quality improvement staff. Policy options include legislation on disclosure of adverse events, and regulations to ensure skills of health care providers. Lastly, health information tools include patient registries, facility surveys, hospital discharge abstracts, standardized population and patient surveys, and dedicated agencies for reporting on quality. Policy‐makers can use this article to identify options for driving the quality agenda and address anticipated implementation barriers.     

Risk and the limits of governance: Exploring varied patterns of risk‐based governance across Europe

Risk‐based approaches to governance are widely promoted as universally applicable foundations for improving the quality, efficiency, and rationality of governance across policy domains. Premised on the idea that governance cannot eliminate all adverse outcomes, these approaches provide a method for establishing priorities and allocating scarce resources, and, in so doing, rationalise the limits of what governance interventions can, and should, achieve. Yet cursory observation suggests that risk‐based approaches have spread unevenly across countries. Based on a comparison of the UK, France, and Germany, this article explores the ways in which, and why, such approaches have “colonised” governance regimes in the UK, but have had much more limited application in France and Germany. We argue that the institutionally patterned adoption of risk‐based governance across these three countries is related to how entrenched governance norms and accountability structures within their national polities handle both the identification and acceptance of adverse governance outcomes.     

Uniformity as response to soft law: Evidence from compliance and non‐compliance with the Dutch corporate governance code

The objective of the paper is to examine how firms have dealt with the trade‐off between flexibility and uncertainty that is characteristic for the decision‐making of firms in coping with self‐regulatory initiatives in general and the comply‐or‐explain principle in corporate governance in particular. Using unique data for 126 listed Dutch firms, we find that firms respond to this self‐regulatory initiative by largely complying with the code recommendation, possibly out of fear that the firm's reputation may be damaged. Furthermore, we find evidence suggesting that firms confine themselves to adopting a specific set of code recommendations and use similar arguments to explain non‐compliance. Our findings indicate uniformity in adopting the standard of good governance which is not in line with the logic of corporate governance codes and casts doubt on the effectiveness of this form of soft law. Overall, the paper's findings indicate that more restrictive (regulatory) instruments may be necessary to make firms conform to the spirit of codes.     

Does the Network Centrality of Government Actors Matter? Examining the Role of Government Organizations in Aquaculture Partnerships

The growth in the use of collaborative governance arrangements has been accompanied by burgeoning scholarship in the field of public affairs that seeks to understand the benefits of engaging diverse stakeholders in common venues. However, few scholars have formally assessed the role of government actors in facilitating outcomes for individual participants in such efforts. Moreover, little work on collaborative governance examines how individual incentives and barriers to collective action are formed within the nested nature of these contexts. We contribute to the study of collaborative governance by formally investigating how the relative centrality of government actors in collaborative policy‐making venues affects individual relationship building and learning for participants therein. We find that government actor centrality is positively associated with relationship building and learning. However, in testing two different conceptualizations of “centrality,” we find that the definition of this construct clearly matters.     

Risk Analysis of Nanomaterials: Exposing Nanotechnology's Naked Emperor

Risk analysis (encompassing risk assessment, management, and communication) is touted internationally as the most appropriate approach for governing nanomaterials. In this article, we survey existing criticisms of risk assessment as a basis for regulatory decision making on emerging technologies, particularly highlighting its exclusion of key societal dimensions, its epistemological underdetermination, and its lack of democratic accountability. We then review the specific case of nanomaterials and identify six major barriers to the effective operation of both risk assessment and risk management. These include a lack of: nano‐specific regulatory requirements, shared definitions, validated and accessible methods for safety testing, available scientific knowledge, reliable information on commercial use, and capacity for exposure mitigation. Finding the knowledge, standards, methods, tools, definitions, capacity, and political commitment all insufficient, we argue that risk analysis is a “naked emperor” for nanomaterial governance. We therefore suggest that additional concepts and approaches are essential for nanomaterials policy and regulation.     

Governance reforms and public acceptance of regulatory decisions: Cross-national evidence from linked survey experiments on pesticides authorization in the European Union

Do governance reforms affect public acceptance of regulatory decisions, and if so, how? We tackled this critical but under-studied question through a pair of linked survey experiments on public attitudes toward the reform of European Union (EU) pesticides regulation among a representative sample of the adult population in six EU member states. We tested the expectation that citizens are more likely to accept a regulatory decision that runs counter to their prior policy preferences if it is taken under a procedure they support. We first conducted a conjoint experiment to study whether the specific design of decision-making procedures impacts public support for EU pesticide regulation. In a second linked experiment, we asked respondents whether farmers should be allowed to use glyphosate, the best known and most controversial pesticide. We then asked respondents if they would accept an authorization decision on glyphosate contrary to their prior expressed preference if it were taken under a decision-making procedure they supported. The results demonstrate that a regulatory decision-making procedure respondents support increases their willingness to accept a hypothetical authorization decision contrary to their prior expressed preference. Contrary to the findings of previous research, our study thus provides strong evidence that governance reforms supported by citizens can enhance acceptance of controversial regulatory decisions, even on politicized issues such as pesticides authorization.     

Local Governance Versus Centralization: Connecticut Wetlands Governance as a Model

Scholars disagree whether local decision making is inherently more democratic and sustainable than centralized governance structures. While some maintain it is, due to the incorporation of local knowledge, citizen decision makers' closeness to the issues, and the benefits of participatory democracy, others find it as susceptible to issues of corruption and poor implementation as any other scale. We argue that with wetlands, a natural resource with critical local benefits, it is imperative to incorporate local governance, using the U.S. state of Connecticut as an example. Despite the American policy of No Net Loss, the local benefits of wetland resources cannot be aggregated on a national scale. Each local ecosystem needs wetland resources to ensure local ecological benefits such as flood control and pollution remission, as well as the substantial economic benefits of recreation. We illustrate the benefits of local control of wetlands with data from the American state of Connecticut, which consistently surpasses the federal wetland goal of No Net Loss due, we argue, to the governance structure of town‐level wetlands commissions. A national policy such as No Net Loss, where wetlands are saved or created in designated areas and destroyed in others, is insufficient when it ignores critical benefits for localities. The Connecticut system using local volunteers and unpaid appointees is a successful method for governing common‐pool wetland systems. In the case of Connecticut, we find that local decision making is not a “trap,” but instead an effective model of sustainable, democratic local governance.     

‘New spaces’ for change?: Diamond governance reforms and the micro‐politics of participation in post‐war Sierra Leone

While the majority of research carried out on diamonds and development in Sierra Leone has focused on debates concerning the role that diamonds played in the country's civil war of the 1990s, little attention has been directed towards understanding how the emergence and consequences of ‘new spaces’ for citizen engagement in diamond governance are shaping relationships between mining and political economic change in the post‐war period. Recent fieldwork carried out in two communities in Kono District illustrates how the emergence of such spaces—although much celebrated by government, donors and development practitioners—may not necessarily be creating the ‘room for manoeuvre’ necessary to open up meaningful public engagement in resource governance. The analysis focuses on one recent governance initiative in the diamond sector—the Diamond Area Community Development Fund (DACDF)—which aims to strengthen citizen participation in decision‐making within the industry, but has frequently been at the centre of controversy. In framing and articulating socio‐environmental struggles over resource access and control in Sierra Leone's post‐war period of transition, the article highlights how the emerging geographies of participation continue to be shaped by unequal power relationships, in turn having an impact on livelihood options, decision‐making abilities and development outcomes in the country's diamondiferous communities. Copyright © 2010 John Wiley & Sons, Ltd.     

Digital diasporas and governance in semi‐authoritarian states: the case of the Egyptian Copts

This article explores the potential role of diasporas and information technology (IT) in fostering good governance in semi‐authoritarian states. Following a review of the literature on good governance and information technology, the case of the Egyptian Copt community and its diaspora is explored, focusing on the activities of the U.S. Copt Association. It is argued that, whether or not it is an explicit objective, the U.S. Copt Association is supporting improved and more democratic governance in Egypt. The case confirms that heterogeneous networks of communication and people can promote good governance, even for the socially excluded and disempowered in a weakly penetrated state. Copyright © 2005 John Wiley & Sons, Ltd.     

IMPACT OF DECENTRALIZATION REFORMS IN PAKISTAN ON SERVICE DELIVERY—AN EMPIRICAL STUDY

By bringing decision making closer to people, decentralization is expected to improve governance and service delivery outcomes. Yet, the empirical evidence on the impact of decentralization on macroeconomic performance and public sector size presents a mixed picture. However, the findings of cross‐country studies in the literature are sensitive to the way decentralization is defined, and how its extent and impact are measured. This article avoids the unwanted effects of incomparability and aggregation in cross‐country analysis. We use a unique panel data set from 183 villages in Pakistan to analyze the impact of decentralization reforms implemented in 2001 on the provision of services—street paving, construction of water canals, sanitation sewer lines, and school facilities. Our results show that the magnitude of provision of all services increased significantly following decentralization reforms. We further show that the four services are impacted differently and service delivery improvement is not uniform, but not in ways that conform to the hypotheses of patronage theory. Copyright © 2011 John Wiley & Sons, Ltd.     

Outcome‐focussed planning in Australian local government: How council plans and cultural development plans measure up

Contemporary public policy increasingly emphasises a focus on outcomes, the difference that occurs in the lives of citizens from policy and activity of government. Other contemporary imperatives for effective planning include: recognition of the values of the community whom plans serve, direction towards goals and objectives, utilisation of evidence, articulation of theories of change that underpin planning and responsiveness to evaluation. This article reports a desk‐based research project to assess how local government planning documents meet these imperatives. Two documents are examined for 67 councils across Australia: the major strategic document, council plan or other‐named document and the cultural development plan (CDP) or other‐named document that directs staff and investment aimed at cultural enrichment of the LGA. Findings indicate that the majority of councils’ documents appeared only concordant with one or two of these planning imperatives. No plan addressed more than three. Overall, council plans and cultural development plans did not clearly indicate their responsiveness to values of their communities, nor include objectives that formed measurable steps towards goals or formally refer to the use of evidence in decision‐making. No plans included theories of change to underpin decision‐making. This analysis indicates clear areas of improvement for planning for local governance.     

The limits and variety of risk‐based governance: The case of flood management in Germany and England

Risk‐based governance is argued by many to hold the promise of a more rational and efficient state, by making explicit the limitations of state interventions and focusing finite resources on those targets where probable damage is greatest. This paper challenges the assumption that risk‐based governance has the potential for universal and uniform application, by comparing contemporary flood management in Germany and England. On first inspection, flooding appears to be a paradigmatic case of risk colonizing European policy discourses, with the traditional notion of flood defense giving way to flood risk management in the context of climate change, increasingly frequent flood disasters, political and cost pressures on flood protection, and publicly available European‐wide flood assessments. Drawing on in‐depth empirical research, this paper shows how the role, and even the definition, of “risk” is institutionally shaped, and how the respective institutional environments of German and English flood management practices impede and promote risk colonization. In particular, the use and conceptualizations of risk in governance are variously promoted, filtered, or constrained by the administrative procedures, structures, and political expectations embedded within flood management and wider polities of each country. The findings of this research are important for the design and implementation of supranational policies and regulations that endorse risk‐based approaches, such as the recent EU Flood Directive, as well as scholarly debate as to how to legitimately define the limits of governance in the face of uncertainty and accountability pressures.     

Achilles' heels of governance: Critical capacity deficits and their role in governance failures

This article assesses the usefulness of conceptions of policy capacity for understanding policy and governance outcomes. In order to shed light on this issue, it revisits the concept of governance, derives a model of basic governance types and discusses their capacity pre‐requisites. A model of capacity is developed combining competences over three levels of activities with analysis of resource capabilities at each level. This analysis is then applied to the common modes of governance. While each mode requires all types of capacity if it is to match its theoretically optimal potential, most on‐the‐ground modes do not attain their highest potential. Moreover, each mode has a critical type of capacity which serves as its principle vulnerability; its “Achilles' heel.” Without high levels of the requisite capacity, the governance mode is unlikely to perform as expected. While some hybrid modes can serve to supplement or reinforce each other and bridge capacity gaps, other mixed forms may aggravate single mode issues. Switching between modes or adopting hybrid modes is, therefore, a non‐trivial issue in which considerations of capacity issues in general and Achilles' heel capacities in particular should be a central concern.     

Contextual Factors Influencing Collaboration Levels and Outcomes in National Forest Stewardship Contracting

The number of policies promoting collaborative processes in national forest management has increased considerably over the past decade but do mandates alone increase the levels of collaboration in national forest management? Collaborative governance literature identifies the importance of the situational context for the emergence and performance of collaboration but does not identify the role of specific attributes and processes. This article presents a comparative case‐study analysis of factors influencing levels of collaboration in USDA Forest Service stewardship contracting processes. Incorporating concepts from the collaborative governance literature and Institutional Analysis and Development framework we found policy and administrative guidance alone will not increase the use of collaborative processes associated with stewardship contracts. A combination of existing agency‐community planning efforts, leadership, and agency support were essential for collaboration to materialize. Top‐down policy direction meant to increase the use of collaboration to achieve natural resource management objectives must incorporate opportunities to establish these conditions.     

The unstable core of global finance: Contingent valuation and governance of international accounting standards

Accounting standards are the foundations of the financial regulatory edifice, and global financial governance is no more stable than the asset valuations that feed it. Yet for two decades and up to this day, no international accounting rule for financial instruments – the bulk of banks' balance sheets – has emerged that was more than a temporary fix, to be succeeded by further reforms. We show how banking regulators have been central to this dynamic and how their support for applying fair value accounting to financial instruments, the cornerstone of regulatory debate, has oscillated throughout the whole period. The two common international political economy approaches to global financial governance, which analyze it either as interest‐based bargaining or as ideas‐driven expert governance, fail to account for this pattern. In contrast, we show how the contingency of financial valuations itself has made it impossible for regulators to embrace or reject a stable set of accounting rules.     

Regulatory reform and governance: A survey of selected developing and transition economies

Regulation is now considered an integral instrument in developing policy toolkit to support market‐led, pro‐poor growth in developing and transition economies. Institutional environment in general and regulatory governance in particular have increasingly been viewed as a factor of competitiveness. In search for better governance, regulatory reform is critical. This article assesses regulatory reform in selected developing and transition economies by reporting the results of a survey on the application of regulatory governance policies, tools and institutions. It is found that in these countries regulatory reform has not shifted in approaches and objectives to taking a systematic view of regulatory governance and the means of promoting and enhancing it. It is suggested that, in order to improve regulatory governance, focus should be put on each of the three elements: regulatory policies, tools and institutions, and that centralised and concerted efforts are needed to integrate the elements. Copyright © 2009 John Wiley & Sons, Ltd.     

Coming to grips with corporate governance in local government

Local government, the tier of government closest to the people, provides services and infrastructure which impact daily on the well‐being of local communities. Despite the Australian state‐based regulatory framework, governance dysfunction regularly results in dismissal of councils. This paper seeks to gain an insight into what is understood by corporate governance at the local government level, an area not addressed in previous research. The methodology was a case study of one local municipality in Tasmania using explanatory sequential mixed methods. Findings revealed a narrow compliance‐based understanding, with effective accountability strategies not included in that understanding. Diverse information sources, such as previous employment experience and industry‐based training, led to embedded beliefs about the meaning of corporate governance which were not necessarily shared by all. This study has implications for state governments seeking to find long‐term solutions for dysfunctional councils, and to bring about positive change.     

Public Financial Management Systems and Countries' Governance: A Cross‐Country Study

The objective of this study is to explore whether a relationship exists between public financial management (PFM) systems and expert perceptions of countries' governance in an international cross‐country study. We examine the extent to which variations in accounting, budgeting and auditing practices are associated with governance in a sample of 97 countries that represent different levels of development, analysing the differences between countries classified into factor, efficiency and innovation‐driven economies. Our concept of governance perception includes three dimensions: accountability, government effectiveness and corruption. We find that countries with a higher level of economic development show, on average, more sophisticated PFM systems characterized by the presentation of accrual‐based financial statements, the application of value for money audits and higher budget transparency. When analysing the sub‐samples of countries according to the level of economic development, we find that countries with similar governance perception scores show different patterns of PFM practices, suggesting that there is no one‐size‐fits‐all approach. Copyright © 2015 John Wiley & Sons, Ltd.     

Collaborative Approaches to Regional Governance – Lessons from Victoria

Victoria's Regional Management Forums were established in 2005 to facilitate collaboration between Victorian Government departments and local government in each of Victoria's eight administrative regions. At the time they were established, Regional Management Forums were a pioneering experiment in collaborative governance. Seven years after their establishment, this paper examines the Regional Management Forums to consider how they have evolved, what role they now serve, and what lessons can be learned. This paper finds that Victoria's Regional Management Forums have been able to adapt to an evolving policy and governance context. While not without their challenges, Regional Management Forums have given rise to regional‐scale thinking and collaborative relationships.     

Advanced Metering Infrastructure Deployment in the United States: The Impact of Polycentric Governance and Contextual Changes

Advanced metering infrastructure provides the first building block in smart grids by empowering customers and utilities with real‐time information regarding energy use. It is a key element in the U.S. government's push for electric grid modernization. Using a panel dataset for 50 U.S. states and the District of Columbia over the years 2007–2012, we evaluate the impacts of a polycentric governance system and socioeconomic contexts on states' performance in smart metering deployment. We find that the advanced metering technological change in the United States has been exclusively created by the interdependencies and interactions between different layers of government. High‐tech industry is the only socioeconomic factor that has a negative impact on smart meter deployment, whereas other factors, such as pressures from energy consumers and environmental groups, and electric grid conditions, have negligible impacts.