'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.     

Do school accountability systems make it more difficult for low‐performing schools to attract and retain high‐quality teachers?

Administrative data from North Carolina are used to explore the extent to which that state's relatively sophisticated school‐based accountability system has exacerbated the challenges that schools serving low‐performing students face in retaining and attracting high‐quality teachers. Most clear are the adverse effects on retention rates, and hence on teacher turnover, in such schools. Less clear is the extent to which that higher turnover has translated into a decline in the average qualifications of the teachers in the low‐performing schools. Other states with more primitive accountability systems can expect even greater adverse effects on teacher turnover in low‐performing schools. © 2004 by the Association for Public Policy Analysis and Management.