'Designing Better Health Care in the South': A Case Study of Unsuccessful Transformational Change in Public Sector Health Service Reform

This article presents a case study of a project known as 'Designing Better Health Care in the South' that attempted to transform four separately incorporated health services in southern Adelaide into a single regional health service. The project's efforts are examined using Kotter's (1996) model of the preconditions for transformational change in organisations and the areas in which it met or failed to meet these preconditions are analysed, using results from an evaluation that was commenced during the course of the attempted reform. The article provides valuable insights into an attempted major change by four public sector health organisations and the facilitators and barriers to such change. It also examines the way in which forces beyond the control of individual public sector agencies can significantly impact on attempts to implement organisational change in response to an identified need. This case study offers a rare glimpse into the micro detail of health care reform processes that are so widespread in contemporary health services but which are rarely systematically evaluated.     

From Cash to Accrual Budgeting and Accounting in the Public Sector: The Dutch Experience

Traditionally, governments used to deploy input‐based budgeting systems and cash‐based accounting systems. However, these systems do not provide the information that is necessary for a government to operate efficiently and effectively. Therefore, a growing number of countries have already shifted or are planning to shift from cash‐based to some form of accrual accounting in the public sector. Usually, the implementation of some accrual‐based system is linked to wider financial management reforms including performance management requiring information on cost. This paper focuses on the Dutch experience with the shift from cash‐based accounting and budgeting systems to an accrual‐based system.     

A Multi-mediation Model on the Relations of Bullying,Victimization, Identity,and Family with Adolescent Depressive Symptoms

This study investigated a multi-mediation model of the relationship between bullying behavior, peer victimization, personal identity, and family characteristics to adolescent depressive symptoms in 194 high school students, 12–18 years of age. In the first model, peer victimization mediated the relation between bullying behavior and depressive symptoms. In the second model, personal identity mediated the relation between peer victimization and depressive symptoms. In the final model, the two mediation models were combined. The relative influence of family characteristics on all variables in the two mediation models was studied using structural equation modeling. The results supported both mediation models and confirmed the influence of family characteristics on all variables in the mediation models. This study indicates that victimization by one’s peers has consequences for adolescents’ psychological health when their personal identity is affected. In addition, the study was able to model several processes in which family characteristics were related to adolescent depressive symptoms. Moreover, the final combined model (in which the two mediation models and the influence of family characteristics on all variables were confirmed) explained half of the variance in adolescent depressive symptoms.

Globalization forces and social policy choices: Glass half‐full or half‐empty?

Globalization, Europeanization and the End of Scandinavian Social Democracy?Edited by robert geyer, christine ingebritsen and jonathon w. moses. London: Macmillan. 2000. Changing Politics of Canadian Social Policy. By james j. rice and michael j. prince. Toronto: University of Toronto Press. 2000. Four Strong Winds: Understanding the Growing Challenges to Health Care. By michael b. decter Toronto: Stoddard. 2000. Now resident on Vancouver Island, the author was until recently a faculty member in the Department of political science at the University of Windsor.     

The histopathological spectrum of myocardial inflammation in relation to circumstance of death: a retrospective cohort study in clinical and forensic autopsies

Interpreting a myocardial inflammation as causal, contributory or as of no significance at all in the cause of death can be challenging, especially in cases where other pathologic and/or medico-legal findings are also present. To further evaluate the significance of myocardial inflammation as a cause of death we performed a retrospective cohort study of forensic and clinical autopsy cases. We revised the spectrum of histological inflammatory parameters in the myocardium of 79 adult autopsy cases and related these to the reported cause of death. Myocardial slides were reviewed for the distribution and intensity of inflammatory cell infiltrations, the predominant inflammatory cell type, and the presence of inflammation-associated myocyte injury, fibrosis, edema and hemorrhage. Next, the cases were divided over three groups, based on the reported cause of death. Group 1 (n = 27) consisted of all individuals with an obvious unnatural cause of death. Group 2 (n = 29) included all individuals in which myocarditis was interpreted to be one out of more possible causes of death. Group 3 (n = 23) consisted of all individuals in which myocarditis was reported to be the only significant finding at autopsy, and no other cause of death was found. Systematic application of our histological parameters showed that only a diffuse increase of inflammatory cells could discriminate between an incidental presence of inflammation (Group 1) or a potentially significant one (Groups 2 and 3). No other histological parameter showed significant differences between the groups. Our results suggest that generally used histological parameters are often insufficient to differentiate an incidental myocarditis from a (potentially) significant one.     

EU issue voting and the 2014 European Parliament elections: a dynamic perspective

EU issue voting in European Parliament elections has been shown to be highly conditional upon levels of EU politicization. The present study analyzes this conditionality over time, hypothesizing that the effect of EU attitudes on EP vote preferences is catalyzed as EP elections draw closer. In contrast to extant cross-sectional post-election studies, we use a four-wave panel study covering the six months leading up to the Dutch EP elections of 2014, differentiating between party groups (pro, anti, mixed) and five EU attitude dimensions. We find that EU issue voting occurs for both anti- and pro-EU parties, but only increases for the latter. For mixed parties we find no effect of EU attitudes, yet their support base shifts in the anti-EU direction as the elections draw closer. The overarching image, however, is one of surprising stability: EU attitudes form a consistent part of EP voting motivations even outside EP election times.     

Evaluating Others If They Stand Up for Their Moral Convictions,and Evaluating Ourselves If We Don't Stand Up

Social Justice Research - Acting on one’s moral principles is not always easy. Upholding one’s moral beliefs may run counter to one’s social environment or situational demands. It...