Understanding before implementing: the context of Lean in public healthcare organizations

A three-year study of Lean implementation in public healthcare organizations in Québec identified poor understanding of the organizational context as a contributing factor to unsustainable Lean implementation. This paper presents a holistic perspective of the unique context of public healthcare organizations and discusses its implications with regards to Lean implementation.     

Lean in a cold fiscal climate: the public sector in an age of reduced resources

Reflecting on recent public sector reform, this paper examines the use of Lean during a period of financial austerity. The paper outlines several challenges for public sector organizations as they manage performance targets, and engage in service re-design. The author challenges the current use of Lean working arguing for a re-evaluation of the traditional public sector model of work and for a collective approach to co-production of service redesign.     

Lean and mean in the civil service: the case of processing in HMRC

The public sector has been importing private sector methods and practices aimed at generating efficiencies and cost savings. However, the consequences of these changes on the working lives of civil servants are under-researched. This article uses detailed fieldwork to investigate the impact of Lean on labour processes in HM Revenue and Customs (HMRC). We argue that Lean has a detrimental effect on employees, their working lives, and the service that is provided to the public. The consequences of Lean on public sector work are highly problematic, which is of serious concern given its progressive impact on other civil service departments in the UK.     

Pillar or platform—a taxonomy for process improvement activities in public services

Research into Lean in public services and particularly implementation, needs to develop from reporting cases to provide a taxonomy for researchers and practitioners. The paper outlines two approaches to process improvement activities (PIAs)—’Pillar’ and ‘Platform’ and tests the validity of these approaches through two organizational case studies (96 PIAs are considered). The degree to which this taxonomy supports decision-making is explored and issues associated with implementation are discussed.     

New development: Wang Anshi's Wanyanshu as the origins of modern public management?

The drive for efficiencies across all areas of public spending in the UK has accelerated the need for improvements in service performance. This article considers how police performance might be improved through the adoption of a ‘Lean’ philosophy. This is seen as a potential driver for internal police improvements and is made in response to the government's call for reform and to address the challenges of a decrease in future police funding.     

New development: 4P recommendations for implementing change,from research in hospitals

How are hospital staff involved in process improvement initiatives such as Lean? What can we learn from Lean implementation experiences about the sustainability of such initiatives? The authors considered such questions in a study of workplace change in Australia and Canada. They found that Lean is more likely to be sustained when leaders adopted the 4P recommendations presented in this article.     

Using bandwidths to visualize and improve patient pathways

Global healthcare systems are struggling to manage the increasing demand for services. What is becoming apparent is the need for a greater understanding of the design of existing patient care pathways (journeys) and how these might be improved. Taking a Lean perspective, a popular approach employed for improving healthcare services, the authors consider how existing patient pathways can be visualized. Examples are used to illustrate varying degrees of complexity within the design and when Lean principles might help in providing a standardized and predictable service. The merits and challenges associated with using bandwidths are discussed and suggestions for future research are provided.     

New development: Consolidated financial reporting as a stimulus for change in Italian local government

This article analyses the potential effect of consolidated financial reporting (CFR) on the accounting and reporting systems in Italian local government. As consequence of the increased use of decentralized entities in delivering a variety of public services, Italian local government needs to improve internal and external accountability. Although a number of obstacles (technical, legal and cultural) have been encountered in Italy, initial experience in Tuscany has demonstrated that CFR has benefits for internal and external users. CFR, in addition, is a potential stimulus for the full implementation of accrual accounting and reporting.     

New development: First steps towards an evaluation of the North East Transformation System

The North East Transformation System (NETS) is a programme that aims to engage the elements of NHS North East in a common vision, reshape the clinician/employer compact, and use Lean methodology to redesign work processes. After initial implementation in pathfinder sites, NETS is now to encompass other trusts in the region.     

基本养老保险服务均等化区域差异分析——陕西省省级统筹前后的对比

公共服务均等化的实质在于缩小城乡之间、不同区域之间、不同群体之间的差距。作为基本公共服务的养老保险,其均等化要求在不同区域之间、不同社会群体之间享有的服务水平和质量大体相等。通过实证对比分析,实行基本养老保险省级统筹后,陕西省11个地市间退休职工基本养老金水平差距比省级统筹前大大减少,养老保险公共服务均等化第一阶段的目标初步实现。下一阶段政策的重点应该转为缩小养老保险和其他公共服务不同人群间的差距。     

Impure public goods,matching grant rates and income redistribution in a federation with decentralized leadership and imperfect labor mobility

We examine the decentralized provision of an impure public good by regional governments in a federation similar in certain respects to both the European Union and the United States. The central authority redistributes income and provides matching grants on a per rate basis after it observes the regions’ contributions to the impure public good. Imperfectly mobile workers react to regional and central governments’ policies by establishing residence in their most preferred region. We show that the allocations of the impure public good and the population are generally efficient in a federation with decentralized leadership.     

Public Management: Raising Our Game

Whatever the colour of the new government after the election, success in tackling social and economic policy problems will prove elusive without a fundamentally different approach to policy making and implementation. The authors argue that the fundamental challenge to the new government is to change the architecture of the system of public policy formulation and implementation to make it fit for purpose. There is growing evidence that the current system can no longer deliver effective responses to the increasingly complex problems faced by society. Radical change is needed to the processes and machinery which exist today, without abandoning innovations in public service management or the Thatcher and Major regimes, or returning to previous systems of government. The practice of public management is central to this change.     

Assessing performance and value-creation capabilities in Lean healthcare: insights from a case study

ABSTRACT

Lean thinking is increasingly being applied worldwide. Yet its actual impact is still a puzzle, particularly when a ‘full-implementation approach’—which entails the adoption of a strategic approach to Lean dissemination on policy deployment procedures—is used. Focusing on the healthcare sector, this paper presents and tests a comprehensive measurement framework for Lean interventions. The paper explains how Lean testing can help decision-makers to solve managerial issues related to Lean initiatives.     

The political economy of pricing and capacity decisions for congestible local public goods in a federal state

This paper studies the political economy of pricing and investment for excludable and congestible public goods in a federal state. Although the model applies to many local congestible public facilities (such as libraries, museums and public swimming facilities), our main motivation is the problem of providing and pricing road infrastructure in federal states. The two-region model we develop allows for spill-overs between regions, it takes into account congestion, and it captures demand heterogeneity both between and within regions. Regional decisions are taken by majority voting; federal decisions are taken by a minimum winning coalition in a legislature of regionally elected representatives. We have the following results. First, when users form the majority in at least one region, decentralized decision making performs certainly better than centralized decision making if spill-overs are not too large. Centralized decisions may yield higher welfare than decentralization only if users have a large majority and the infrastructure in a given region is intensively used by both local and outside users. Second, if non-users form a majority in both regions, centralized decision making and decentralized decision making yield the same socially undesirable outcome, with prices that are much too high. Third, the performance of decentralized supply is strongly enhanced by local self-financing rules; this prevents potential exploitation of users within regions.     

The rise of decentralized cryptocurrency exchanges: Evaluating the role of airdrops and governance tokens

While most cryptocurrency financial activity is conducted on centralized exchanges, decentralized finance (DeFi) has experienced a particular surge with roughly 90,000 users at the start of 2020 to 4.28 million by the end of 2021. Based on data collected from a popular crypto-asset data aggregation service and manually collected data, we document the rapid growth in decentralized exchanges and their differences in volume and price dynamics from centralized exchanges. Next, we investigate the role of airdrops and governance tokens as mechanisms for expanding the base of users and driving up the value of an exchange. While our results do not have a causal interpretation, they provide preliminary evidence that both mechanisms are effective for expanding and strengthening networks, particularly for decentralized exchanges. We also exploit two event studies that suggest the growth in decentralized exchanges is not driven by speculation, but at least partially by value-creating cybersecurity benefits.     

DEVOLVED BUDGETARY MANAGEMENT IN LOCAL GOVERNMENT: LESSONS FROM A SHIRE COUNTY

The changing environment of public sector organisations has, in recent years, focused attention on the management processes employed to achieve effective service delivery as economically and efficiently as possible. One approach has been the importation into the public sector ofa number ofprivate sector management strategies and practices, most notably those based on devolved bud- getary management principles. This paper analyses the approach of a large local authority to the implementation of devolved budgetary management, based, in large part, on interviews with line managers to whom budgets were devolved. It examines the process of devolution within the authority and the reactions of line managers to that process. It concludes that while the implementation of truly devolved budgetary management is an important, and perhaps essential, managerial technique in the 'new' local government environment, it should not be implemented in ways which ignore the differ- ences between public and private sector organisations and between different local authority departments.     

New development: Financial reforms played in two octaves— yet again?

Major public service reforms are underway at the national level in Australia. The reforms are being implemented progressively over a three-year period. This is the third in a series of articles looking at the implementation of these reforms and focuses on the second stage, which was supposed to be completed in 2015. The author examines the recent report of the Joint Committee of Public Accounts and Audit which reviewed the development of the ‘Performance Framework’ through a series of public hearings. He explains why, for good governance, particularly in a difficult economic and budgetary climate (domestically and internationally), public interest considerations must prevail, not just in issues about ‘how’ but also about ‘what’ is being actually achieved. There is considerable scope for shared learning and experience across governments and sectors of the economy in any reforms of the public sector.     

Strategic provision of local public inputs for oligopolistic firms in the presence of endogenous location choice

We develop a model in which two regional governments compete for a mobile oligopolistic firm by providing local public inputs. The central mechanism of our model is the interaction of an agglomeration advantage (partial nonrivalness of the local public inputs) and an agglomeration disadvantage (costs associated with the change of location of firms). We show that a central government of both regions induces an interregionally optimal allocation of firms by providing the optimal levels of local public inputs. The decentralized provision of local public inputs by regional governments, however, leads in most cases to a (interregionally) suboptimal allocation.     

Performance measurement in academic departments: the strategy map approach

This article describes the implementation of the balanced scorecard (BSC) strategy map in a university department. The department is a good example of a complex public sector service organization—therefore the article has relevance beyond universities. The strategy map was found to be an extremely good way of measuring performance. In addition, the BSC/strategy map helps in monitoring and building departmental mission and goals and the authors recommend wider use.     

Risk allocation and the costs and benefits of public‐‐private partnerships

We study the agency costs of delegated public service provision, focusing on the link between organizational forms and uncertainty at project implementation. We consider a dynamic multitask moral hazard environment where the mapping between effort and performance is ex ante uncertain but new information may arise during operations. Our analysis highlights the costs and benefits that bundling planning and implementation—as under public‐‐private partnerships—can bring in terms of project design and operational costs under various scenarios, possibly allowing for asymmetric information, moral hazard and renegotiation. It also shows that relying on private finance enhances the benefits of bundling only if lenders have enough expertise to assess project risks.