'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.     

Trajectories in public administration reforms in European Continental countries

The aim of this article is to study key New Public Management (NPM) transformations undertaken at central level in the European Union public administrations of Germanic, Nordic and Southern European countries. Our study shows that there is no global tendency towards the same NPM model, although, within public administration models, there are strong similarities. Although some NPM initiatives have been taken as steps towards implementing these reforms, in other contexts they could have been adopted in order to ward off deeper reforms.     

The risky business of public–private partnerships

Public–private partnerships (PPPs) are now a common strand of third way government policy, with better efficiency promised from the private funding of public infrastructure through the transfer of risks to private parties. This paper aims to investigate, on an empirical basis, the realities of risk transfers in PPPs and compare this experience against both the rhetoric of project proponents and the formal contract conditions. The paper outlines some conceptual frameworks underpinning PPPs and establishes the notions of risk shifting and risk sharing. The range of typical risks encountered in infrastructure projects is specially considered, and differences to traditional project delivery arrangements are articulated. Some empirical experience on the transfer of risks under PPPs is then outlined through a case study. This analysis shows the extent to which risks were shifted to the private parties as planned, or whether risks remained with government. It is argued that while commercial risks were largely well managed, governance risks were not. It is critical to understand better the nature of risk transfers in PPPs in view of the large financial implications of these deals along with long contract terms.     

试析美国奥巴马政府的核不扩散政策

奥巴马政府上台后,美国核不扩散政策出现了重要转变。这一转变既是奥巴马政府对布什政府核不扩散政策进行反思的结果,又是修复美国国际形象和维护其世界领导地位的战略需要,更是美国对朝鲜和伊朗的核开发问题施加压力的一种手段。奥巴马政府对美国核不扩散政策的调整,有利于国际核军控工作走上正轨;将对中国产生多重影响;对地区核问题的解决所产生的效果具有不确定性。     

Ned Cobb's children: A new look at white supremacy in the rural southern US

Many scholars regard segregation in the US South as part of urbanization and modernization. Yet few have examined race relations in the countryside. The Rural Face of White Supremacy shows that absolute separation based on race proved poorly adapted to rural life. Inspired by the sociological studies of the rural South done in the 1930s and the 1940s, this book uses oral history to show that interracial social life in mid-twentieth century rural Georgia was ‘marked by intimacy as well as white supremacy.’ Race relations reflected the paternalism and dependence of an agrarian labour system that reduced black workers to the status of a peasantry.