'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.     

Mixed electoral rules’ impact on party systems

The growing literature about mixed electoral systems has addressed their effect on party systems, voting behavior, campaign strategies, legislative roll-call voting, and other issues in a handful of countries. But, the effect of mixed systems has not been fully evaluated cross-nationally or longitudinally. Using data from the World Bank’s Database of Political Institutions, we address this gap in the literature by investigating two related questions. First, do mixed electoral rules produce different election outcomes than other election rules? Second, are these results attenuated by the definitions of mixed systems that scholars employ? We find that mixed systems generate outcomes that are distinct from other electoral systems and that these findings are generally robust across different definitions.