Contracting for management: Assessing management capacity under alternative service delivery arrangements

Contracting critics suggest that when governments outsource, they reduce their capacity to produce services and manage service delivery. In this paper, we decompose the service delivery decision into service production and service management components. When governments contract for service production, they may also choose to contract for a portion of service delivery management. Studies that only compare the management activities of contracting and direct service delivery governments, without examining the management activities contracted to vendors, are likely to be incomplete and biased. Drawing on a unique survey of governmental refuse collection service directors, matched with a survey of refuse collection vendors operating under municipal contracts, we show that the vendors' management activities offset the decline in management capacity that occurs when governments contract for service delivery for this particular service. Governments can “buy” management activities when contracting for service production. © 2006 by the Association for Public Policy Analysis and Management     

Adjusting to New Ways of Working: Experiments with Service Delivery in the Public Sector

In response to the perceived failure of both the state and market models of service delivery, governments have embarked on a reform program that draws on the community sector to expand the suite of available policy and service delivery arrangements. This paper explores and identifies the nature of changed relationships between government and the community sector. It uses a case study that examines the operation of a new type of community organisation, and analyses the affectivity and outcomes from the experience of a community based networked arrangement. Although there is evidence of a shift to more relationship‐ oriented models of operation because of either mandate or preference both community and government sectors have found it difficult to make the necessary adjustments to these new ways of working. Community has begun the shift to this new relational approach but finds it difficult to sustain the momentum and tends to revert to more independent and competitive modes. Governments find it difficult to make the necessary adjustments to power‐sharing and resource allocation and continue to operate as ‘business as usual’ through the traditional bureaucratic authority of command and control. In this way, the rhetoric of collaboration and partnership between government and the community sector is not necessarily matched by policy and action supporting the practice of ‘new ways of working’ although these ‘experiments in service delivery’ have opened the way for adopting more innovative and effective approaches to service delivery.     

Introduction — Building Local Government

In this and the last issue, the Australian Journal of Public Administration has profiled issues of current importance to Australian local/regional government. Contributors to Building Local Government looked at organisational change, performance measurement, leadership and social–capital–building roles in local government. Future of Regionalism now focuses on local and subnational government generally, in the financial, administrative and constitutional context. A major trigger for this focus is the present inquiry of the Commonwealth House of Representatives Standing Committee on Economics, Finance and Public Administration into the financial position of local government.     

Causes of death of patients in an institution for the developmentally disabled

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.     

The paradoxical politics of provider reempowerment

The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.     

When silence threatens safety: lessons from the first Canberra Hospital neurosurgical inquiry

Despite widespread institutional and professional support, the recommendations of the Bristol Royal Infirmary Inquiry may be insufficient to reduce patient risk from impaired senior medical practitioners. Using the First Inquiry into Neurosurgical Services at the Canberra Hospital as a case study, this article argues that the Bristol-type recommendations--which emphasise reformulation of clinical governance structures, including early reporting of "sentinel events" and compulsory clinical audits--will be ineffective without a reformed institutional ethos that encourages open transparency and respect for those committed to such processes. Such reformulation may need to commence in medical education and involve new strategies including the use of portable digital technology to facilitate self-assessment of performance and immediate reporting of adverse incidents.