The struggle to implement teaching-hospital mergers

Abstract: This paper presents some initial results from a longitudinal study of two major hospital mergers (involving three large institutions each). After examining the context of the two mergers and the cultures that must be integrated, we describe the processes of pre-merger negotiation, leadership development, strategic framing and operationalization. Despite very different processes that seem on the surface smoother in one organization than in the other, both organizations have experienced difficulties in achieving successful operationalization. We conclude that the context of limited resources, diffuse power and divergent cultures are largely responsible for the difficulties experienced. Sommaire: Cet article présente quelques résultats préliminaires tirés d'une étude longitudinale de deux grandes fusions d'hôpitaux (impliquant trois gros établissements chacune). Après avoir examiné le contexte des deux fusions et les cultures à intégrer, nous décrivons les processus de négociation précédant la fusion, de développement du leadership, d'encadrement stratégique et d'opérationnalisation. Malgré des processus trés différents, dont l'un semble à prime abord plus harmonieux que l'autre, les dew organisations ont éprouvé des difficultés à atteindre une opérationnalisation réussie. Now en concluons que le contexte de ressources limitées, de pouvoir diffus et de cultures divergentes est largement à l'origine des difficultés éprouvées.     

Social capital and support for the welfare state in Russia

Few tasks are more important in a post-communist setting than rebuilding the welfare state. We study individual preferences for increasing social welfare spending to reduce inequality. Using two surveys of about 34,000 and 37,000 Russians, we show the great importance of the “bridging” type of social capital for redistribution preferences in Russia, as it precludes possibilities of cheating and free-riding on the welfare state. Instrumenting social capital with education, climate, and distance from Moscow, we deal with endogeneity concerns and also contribute to our understanding of the deep roots of social capital in Russia. We claim that social capital in post-socialist countries could help mobilize public support for redistribution even where institutions are weak.