Question order bias revisited: A split‐ballot experiment on satisfaction with public services among experienced and professional users

Public decision‐makers increasingly rely on satisfaction surveys to inform budget and policy decisions. Yet, our knowledge of whether, and under what conditions, this input from public service users provides valid performance information remains incomplete. Using a preregistered split‐ballot experiment among government grant recipients in Denmark, this article shows that the ordering of survey questions can bias satisfaction measures even for highly experienced and professional respondents. We find that asking about overall satisfaction before any specific service ratings lowers overall user satisfaction, compared to the reverse order, while the correlations between specific ratings and overall satisfaction are relatively stable. Also, the question order effect outweighs that of a large‐scale embezzlement scandal, which unexpectedly hit the investigated government agency during the data collection. Our results support rising concerns that subjective performance indicators are susceptible to bias. We discuss how practitioners should approach satisfaction surveys to account for the risk of question order bias.     

Tackling the Performance Regime Paradox: A Problem-Solving Approach Engages Professional Goal-Based Learning

Public performance regimes are bedeviled by a paradox: they must engage the specialized knowledge of professionals who often perceive those very regimes as a threat to their autonomy. The authors use a mixed-method analysis of performance management in Danish hospitals, with separate data for managers and frontline professionals, to offer two insights into this challenge. First, the study shows that managerial behavior—in the form of performance information use—matters to the way frontline professionals engage in goal-based learning. Second, it shows that the way managers use performance data matters. When managers use data in ways that reinforce the perception of performance management as an externally imposed tool of control, professionals withdraw effort. However, when managers use data in ways that solve organizational problems, professionals engage in goal-based learning. The threat to professional values that performance regimes pose can therefore be mitigated by managers using data in ways that complements those values.     

Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy‐based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.     

Revisiting DDR in Liberia: exploring the power,agency and interests of local and international actors in the ‘making’ and ‘unmaking’ of combatants

The understanding that disarmament, demobilisation and reintegration (DDR) programmes are essential in helping to prevent war recurrence in post-conflict situations is at the heart of current international aid practice and the academic literature on peacekeeping and stabilisation. However DDR programmes are often launched on the basis of untested assumptions. This article considers the DDR programme in Liberia and analyses the complex relationship between the programmatic efforts to disarm and reintegrate combatants and the programme's actual effects. If we are to understand how DDR works as a tool of post-conflict governance, it is essential to explore the mechanisms of authority and power at stake. The focus is therefore not on whether combatants were successfully disarmed and reintegrated, but rather on exploring unfolding processes and the field of forces within which DDR programmes are implemented. It critically assesses the ideas of disarmament and reintegration and the basic assumptions behind current DDR policy through an analysis of the Liberian case, emphasising the agency and interests of local and international actors in the ‘making’ and ‘unmaking’ of combatants.     

The Effects of New Public Management: Activity‐based Reimbursement and Efficiency in the Scandinavian Hospital Sectors

Activity‐based reimbursement (ABR) is a key element in the New Public Management reform programme. In recent decades ABR has replaced or supplemented frame‐based reimbursement (FRB) in the Scandinavian hospital sectors, and political decision makers have widely believed that ABR would improve efficiency. This article systematically describes and compares 12 studies and their results to determine whether research supports this belief. The article has two main conclusions. First, existing research provides a much more blurry picture than envisaged by decision makers. Studies with positive and non‐positive results are approximately equal in number, even when the quality of research designs is taken into account. Second, it is quite likely that the blurry picture is caused mainly by the low credibility of the new ABR schemes, which has undermined the incentives for greater efficiency that the new schemes should provide. The issue of credibility is not tested in existing research and is thus a particularly promising avenue for future research into the effects of economic steering tools like ABR.     

DOES OWNERSHIP MATTER FOR THE PROVISION OF PROFESSIONALIZED SERVICES? HIP OPERATIONS AT PUBLICLY AND PRIVATELY OWNED CLINICS IN DENMARK

In terms of clinical procedures (to take the example used in this article, hip operations), both public and private organizations provide highly professionalized services. For this service type, our knowledge about ownership differences is sparse. To begin to fill this gap, we investigate how the ownership of hip clinics affects professional behaviour, treatment quality and patient satisfaction. The comparison of private and public hip clinics is based on data from the Danish Hip Arthroplasty Register and the Danish Central Patient Register combined with 20 semi-structured interviews. We find that private clinics employ stronger individual financial incentives and try harder to increase the income/costs ratio than do public clinics. Private clinics optimize non-clinical factors such as waiting time much more than public clinics and have fewer complication-prone patients than public clinics. However, the clinical procedures are very similar in the two types of clinics. Private clinics do not achieve better clinical results, but patient satisfaction is nevertheless higher with private clinics. The implication is that ownership matters for highly professionalized services, but professionalism neutralizes some – but not all – ownership differences.     

Game Changing – Tracing the Positions,Strategies and Interaction Modes of the German Länder towards the (Ever Expanding?) European Union

This article investigates how the positions, strategies and modes of interaction of the German Länder have changed over time in response to the process of Europeanization. By applying the method of process tracing within a theoretical framework of rational choice institutionalism, the article concentrates on the Länder's responses to (1) the transfer of policy competences to the European level and (2) the enlargement of the European polity. Thereby, the article sheds new light on the Europeanization of the German federal system. It is shown that the transfer of policy competences to the European level have had the greatest impact on the Länder, which have reacted increasingly strategically by successfully demanding more power in the national coordination mechanism. However, the European Union enlargements have also had an effect as together with the transfer of policy competences they have resulted in a more sceptical attitude of the Länder towards (the perceived ever expanding) European Union.     

The ESDP and Civilian Rapid Reaction: Adding Value is Harder than Expected

Abstract

This article takes issue with the prevailing view that the ESDP capacity building process is easier and has been more successful in the civilian than in the military field. It argues that civilian capacity building is harder than military capacity building, demonstrates that the European Union's (EU's) civilian rapid reaction capacity is considerably smaller and less integrated than is generally assumed and that the capacity goals set for 2008 are unattainable. Yet another major EU expectations–capability gap has been created and there is now a real danger that this gap will seriously damage the EU's reputation as the global leader in civilian rapid reaction crisis management.     

Forensic medical examination of refugees who claim to have been tortured

The United Nations Convention against torture prohibits repatriation of refugees if there is reason to believe they will be tortured on return to their country. A history of torture is therefore an important factor in making a case for asylum. In this study, the results of the medical examinations of 59 torture victims investigated at the Department of Forensic Medicine, University of Aarhus, Denmark, 1996-2002, are presented and discussed. Variables including age, sex, education, health, torture methods, condition of confinement, torture aftereffects, and findings at the forensic examination were registered in a database (Paradox) and analyzed. In 70%, aftereffects of torture could be documented. These included scars after fixation, burns, incisions, or flogging. Symptoms and signs from joints, muscles, and nerves were common in victims who had been suspended. Many of the victims of phalanga had painful feet and signs of walking impairment. A majority of the victims suffered from posttraumatic stress syndrome. An independent medical report offers an opportunity to evaluate and elaborate the story told by the victim and should be used in disputed cases. We have a duty to protect refugees against torture.