Electoral accountability and local government efficiency: quasi-experimental evidence from the Italian health care sector reforms

This paper evaluates the effect of two policy changes on the efficiency of Italian regional governments in the provision of health care services: first a change in the electoral system, second a process of fiscal decentralisation. The paper provides two main contributions: (1) a comprehensive analysis of the two main reforms that involved Italian regional governments and the health care sector during the 1990s, (2) the evaluation of the impact of the electoral reform in a quasi-experimental setting. Final results are in line with recent theoretical predictions that show a positive relationship between government efficiency and the electoral accountability enhanced by institutions such as electoral rules and fiscal decentralisation.     

Management by decree. Paradoxes in the reform of the Italian public sector

A call for “better” governance of the public sphere informed by reliance on management and accounting expertise has recently arisen in connection with a variety of legislative initiatives enacted in Italy. This paper looks at the nature and role of this “reform”, and in particular the call for the introduction of managerial accounting. It is argued that far from facilitating a comprehensive introduction of managerial vocabulary and knowledge into the public domain, the Italian legislative mechanism tends to hamper the expression of management and accounting as technically autonomous and coherent systems, while at the same time allowing more established audiences to deliberate on their nature and role. Although the reform was devised in terms of introducing the economic and the measurable into the domains of bureaucracy and formal compliance, its legal articulation seems to be informed by the very logic and ethos it is called upon to change.     

Health sector reform and human resource management: Britain in comparative perspective

This article examines the impact of health service restructuring for employment practices in Europe, using Britain as the basis of comparison. It first considers trends in West European health care reform and examines the extent to which reform measures have been accompanied by changes in employment practices. It focuses on reforms of pay determination arrangements and work organization, examining in particular the experience of nurses, who form the largest occupational group. Finally, some of the implications for a future research agenda are considered. It concludes that research on health sector employment practices is under-developed and outlines a research agenda that recognizes the importance of workplace restructuring within a comparative framework.     

Organised decentralisation,uneven outcomes: employment relations in the Italian public health sector

This article looks at the difficulties of adapting a very centralised employment relations system in a country characterised by a deep regional economic divide. In particular, by looking at the Italian public health sector, it is contended that organised decentralisation of employment relations implemented against wide regional differences led to uneven outcomes in second‐level (organisation) collective bargaining.     

The problem with pay flexibility: changing pay practices in the UK health sector

This paper critically assesses models and policies of pay flexibility as applied to the public sector. Examination of the arguments for greater pay flexibility across three dimensions - external labour market flexibility, organizational flexibility, and macroeconomic flexibility - reveals a number of weaknesses, rooted in a failure to problematize the conflicting motives for greater pay flexibility in the context of pressures internal and external to the organization. An alternative 'model' of changing pay systems is developed and applied to the case of the UK health sector where there have been attempts to introduce various forms of flexible local pay arrangements. Drawing on interviews conducted during the mid-1990s with personnel and HRM managers at fifteen NHS Trusts, a number of issues are examined, such as: the impact of differential external labour market conditions of workers on the development of strategies designed to tie local pay to improved performance; the introduction of performance-related pay as a means to institutionalize wider earnings differentials within the organization; and the potential conflict between pressures to link local pay structures with local labour market conditions, on the one hand, and customary employee-held norms that link pay to occupational skills and professional status, on the other.     

The emergence of hybrid professional roles: GPs and secondary school teachers in a context of public sector reform

Responding to recent calls for more context and history in studying (semi-)professionals in the public sector, this article examines the emergence of hybrid professional roles along with large-scale reforms of Dutch healthcare and education since 1965. Using a theoretical framework based on public management literature and key professional attributes, the article shows how hybrid role expectations are developed by accumulation rather than replacement of successive reform models. Within a single national context, it also highlights considerable sectoral variation in how reform affects professionals’ roles, suggesting a complex mutual relationship between reform and professions rather than a one-sided policy impact.     

Beyond the boundaries of care: Electronic health records and the changing practices of healthcare

Healthcare systems across the globe are riding a wave of clinical health IT investment, centered on electronic health records (EHR) systems. Supported by governmental incentives, this build-out has positioned the healthcare system for a period of transformation as EHR functionality has become ingrained in the work routines of healthcare providers and other system participants. We report on a field study of healthcare participants in the United States to explore the influence of EHR use on the boundaries and practices of the field. Our grounded theory analysis reveals the interplay between the field practices of individual communities and the boundary spanning practices that unite them. Through the adoption of a practice perspective, we highlight the changes to both boundary spanning and field practices engendered by enterprise EHR use and propose the complementary mechanisms of reticulation and boundary molding by which those changes emerge. We conclude with a consideration of the positive and potentially negative consequences of EHR use for delivery of healthcare services.     

Paying the piper: choice and constraint in changing HR functional roles

HR directors are often exhorted to play a more ‘strategic’ role in their organisations. However, it is not necessarily clear what is meant by this, or whether it is possible for departments to change their role at a whim. In this article we examine the changing role of the HR function within two contrasting organisations – an NHS trust and a bank – over a period of seven years. Drawing on role‐set theory and concepts of negotiated order, we illustrate how HR functional roles are located within a complex and dynamic social setting, and present a model that seeks to map these interrelationships.     

Introduction: Transitional economies and changing notions of accounting and accountability

This paper explores the issue of the true and fair view (TFV) and the overriding principle within the European Union (EU), via a legally based analysis of the relationship between EU and national laws. We apply the supremacy of European law to methods of incorporating the TFV into national legislation, using Austria as a detailed case study, showing that all countries – maybe against their original intention – either have an override (as does Austria, contrary to the prevailing local opinion) or have failed to honour their EU commitments. As part of our argument, we explain the importance of the Roman law teleological principle in legal application and interpretation, as is well known in Continental countries. We show that the effect of the UK TFV override is in principle exactly analogous, only arguably even more powerful, which is not at all well known in Anglo-Saxon countries. We suggest reasons why the status quo ante in particular countries may be adhered to, and generalise the implications of our arguments.     

深化改革转机制不断创新促发展

武汉市物资储运总公司根据企业实际,抢抓机遇,坚持对企业从体制上、制度上、管理上入手改革创新,规范管理,实行新的运行制机,确保经营业务稳定运行,使企业走上了一条良性发展的道路。     

Unions in a changing climate: MSF and Unison experiences in the new public sector

Through an examination of national policies, case study and survey material, this article looks at the question of the possibility of union renewal through an examination of the various and varying responses of two unions, MSF and Unison, to the changing work and employment practices in the NHS.     

The service sector: Challenges and imperatives for research in operations management

The United States has undergone a transformation from an industrial society to the first postindustrial society. Consequently, the service sector has outstripped manufacturing in its contribution to the GNP and in employment. This paper discusses the challenges and imperatives for research in service operations management (SOM). Service operations have unique characteristics that must be considered in developing research strategies. Recent attempts at evolving a general theory of service organizations are reviewed, and it is suggested that these conceptual models provide a unifying framework for the study of SOM. Research in SOM requires a broad perspective that includes the customer and the interactions with other functional areas. It requires an integration of conventional production concepts with behavioral and marketing considerations.     

Entry regulations and labour market outcomes: Evidence from the Italian retail trade sector

The paper analyzes the relationship between entry regulations and employment in the Italian retail trade sector. In Italy the opening of large outlets is regulated at the regional level. First, by using differences-in-differences estimators the paper presents evidence that in regions with less stringent entry regulations, retail trade employment does not decrease. Second, the paper focuses on the effects of the rules implemented in Abruzzo and Marche, two otherwise close and similar Italian regions which adopted very different policies: the first set tight restrictions on the opening of large stores; the second did not impose substantial entry regulations. The results show that in Marche after the inception of the flexible regulations the share of total retail trade employment in total population increased by 0.8 percentage points more than in Abruzzo. Fiercer competition also led to a recomposition of employment in small retail shops. These findings are robust to a number of checks.     

Worker representation in health and safety: options for regulatory reform

Worker representation in health and safety in Britain has received statutory support since the Safety Representatives and Safety Committees Regulations 1977. Subsequent developments have, however, acted to undermine the effectiveness of these regulations. The paper consequently discusses a range of reforms that could be introduced to strengthen the present regulatory regime.