A Balanced Budget with Side Effects—A Case Study of Implementation of a Hospital Cost Savings Program in Sweden

This study examines the implementation of a hospital cost savings program in a Swedish county hospital to understand how and why a downsizing intervention works and what outcomes it produces. Data were gathered from interviews and documents. Substantial differences were found among the healthcare professionals’ perceptions of the downsizing process. These diverse perceptions likely limited the scope of staffs’ participation and innovations of new savings strategies. Our findings stress the need for impact analyses addressing both intended aims and unintended side effects. Full attention should be paid to communication processes required to establish a trustful and committed change climate.     

An expressive voting model of anger,hatred, harm and shame

To consider some political implications of angry voters, we alter the standard expressive model in a fundamental way. One result is that an angry voter with a strong sense of shame at the thought of voting to harm others, may still do so, even when the harm is brutal. Indeed, his willingness to vote for harming others may increase if the proposed harm becomes more severe, even though the angry voter is more “decent” (less willing to harm others) than most of us sometimes are. Several examples are given that are consistent with the most troubling implications of the model. An empirical appendix follows the concluding section which tests the implications of the model indirectly.