INTERROGATING INSTITUTIONAL CHANGE: ACTORS' ATTITUDES TO COMPETITION AND COOPERATION IN COMMISSIONING HEALTH SERVICES IN ENGLAND

Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers' understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketization in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.     

PROBLEM-ORIENTED POLICING IN VIOLENT CRIME PLACES: A RANDOMIZED CONTROLLED EXPERIMENT*

Over the past decade, problem-oriented policing has become a central strategy for policing. In a number of studies, problem-oriented policing has been found to be effective in reducing crime and disorder. However, very little is known about the value of problem-oriented interventions in controlling violent street crime. The National Academy of Sciences' Panel on the Understanding and Control of Violent Behavior suggests that sustained research on problem-oriented policing initiatives that modify places, routine activities, and situations that promote violence could contribute much to the understanding and control of violence. This study evaluates the effects of problem-oriented policing interventions on urban violent crime problems in Jersey City, New Jersey. Twenty-four high-activity, violent crime places were matched into 12 pairs and one member of each pair was allocated to treatment conditions in a randomized block field experiment. The results of the impact evaluation support the growing body of research that asserts focused police efforts can reduce crime and disorder at problem places without causing crime problems to displace to surrounding areas.