Calibrating Public Sector Accountability: Translating experimental findings to public sector accountability

Accountability mechanisms are among the most important means with which governments guard and improve the performance of public sector organizations. However, research documents a plethora of accountability-failures. A key issue is: how can public sector accountability become more effective? This paper seeks to answer this question by connecting two largely separated strands of research: public administration research on real-world organizations and experimental research on the effects of different forms of accountability on decision-making. The paper develops the Calibrated Public Accountability-model (CPA-model) from experimental research findings which can be used to investigate how accountability can be calibrated to task requirements of organizations.     

The how and why of integrated reporting in a public health care organization: The stakeholders' perspective

Despite the widespread calls for in‐depth case studies on adoption of the International Integrated Reporting Council Framework, in practice, it appears to be underexplored, above all in the public sector. Our aim is to explore how and why a public health care organization (PHO) has chosen to adopt the practice of integrated reporting, and we then delve into whether the PHO's perception of the document's value coincides with that of the stakeholders, who are its recipients. Often, society's perception of value can differ considerably from an organization's. Thus, for our research purposes, a case study was examined, adopting a qualitative approach and action research methodology. Our findings demonstrate the centrality of the value created for patients and of the “normative” scenario that takes place during the implementation of an integrated report in a PHO. Moreover, the concept of legitimacy was found to be virtually synonymous with institutionalization.     

论我国政府绩效评价主体体系的构建——基于政府公共受托责任视角的分析

政府内外部的公共受托责任关系是确定政府绩效评价主体的基本依据.具体而言,政府公共受托责任关系链中不同层次的委托人及其代表均应构成政府绩效评价的主体.在西方,许多国家已经构建起合理的多元化政府绩效评价主体体系,但我国政府绩效评价主体仍然较为单一.为此,我国应当根据政府公共受托责任的具体要求,并参考西方发达国家的成功经验,构建一个多元化的政府绩效评价主体体系,从而促使政府更好地履行公共受托责任.     

An examination of anti-violence human resource management practices in the context of health care and aged care

Although accumulated research has demonstrated the negative impacts of workplace violence and called for effective solutions from a human resource management (HRM) perspective, a valid measure of anti-violence HRM practices is missing. In this paper, we develop a scale of anti-violence HRM practices that is critical for both theoretical advancement and managerial practices in health care and aged care contexts. Through an inductive approach in Study 1, we generated items for the scale to be used in health care and aged care contexts, which we then subjected to a content validity test in Study 2. Using the newly developed scale, we further demonstrated in Study 3 that anti-violence HRM practices that are implemented in aged care facilities reduce workers' experienced violence, improve workers' emotional wellbeing, and enhance workers' organisational and career commitment.     

Public accountability: reforms and resistance in social housing

The paper illustrates and discusses the changing nature of public accountability relations in public services that are transferred to a mutual organization. The paper contributes to the literature that studies resistance to the neo-liberal restructuring process, highlighting civil society campaigns as important actors. A social housing case study in Britain is developed, combining a critical realist and dialogical influenced analysis. The case study identifies the role of private finance, illustrating tensions between democratic-styled and NGO-styled public accountability relations. A conclusion that housing mutuals are in danger of being apologia for private capitalism is established.     

Unit determination: National Labor Relations Board rule making in the health care industry

This article reviews the events leading up to the National Labor Relations Board's (NLRB) historic decision to engage in substantive rule making over appropriate bargaining units in the health care industry. It describes the rule-making process and outcomes, and the reaction of hospital unions and management to the rules. Finally, the potential for the use of rule making for other issues facing the NLRB is analyzed. This analysis uses a cost/benefit framework from the agency's perspective to predict the likelihood of future rule making. The article concludes that rule making is sufficiently costly to make extensive use in other situations unlikely.The order of the author's names was determined randomly and should not be interpreted as implying an unequal contribution.     

Accounting for change in public sector industrial relations: the erosion of national bargaining in further education in England and Wales

The recent transformation of industrial relations in further education in England and Wales is examined, in particular the role of the national ‘Silver Book’ dispute over lecturers’ conditions of service in causing the erosion of national bargaining in the sector. The experience of further education points to the limits of the strategic choice approach as a device for explaining change in public sector industrial relations and to the importance of supplementing it with a perspective that emphasises the role of power.     

An applied stochastic model of the quality–quantity trade-off in the public health care sector

It is a striking feature of the many of the developing country public service sectors that the sectors in question often overproduce the quantity of services but underproduce the quality. This feature, which is exemplified in this paper, is rooted in a wide spectrum of economic and sociological factors ranging from the economic and sociological profile of the service receiving people to the asymmetric density of service-receiving population across their regions. This feature, we conjecture, is a source of a considerable degree of suboptimality in some of the developing countries. If our conjecture is correct, correcting such suboptimalities is likely to yield significant welfare improvements that could help speed up the process of development in the underdeveloped regions of the world. To analyze the supoopimalites in question, we will first develop a concept (and a model) of optimal quality in the public service sector, which indicates the level of quality that maximizes expected public satisfaction subject to available resources. Resources are used in an efficient manner to produce the service in question. The concept and the model in the paper make a needed contribution to the quality discourse by presenting a way of determining the quality improvements (or adjustments) necessary to achieve optimum in the public service sector. The paper presents an application (a case study) of this new concept in the public healthcare sector in Turkey, and explores the differences between the actual and optimal quality in the sector in question. It turns out that there is a considerable difference between the actual and optimal levels of quality (as well as those of quantity) in the Turkish public healthcare sector in an overpopulated city (Istanbul), indicating a significant overproduction of quantity and underproduction of quality. Thus, to achieve the optimal levels, the sector should increase quality and reduce quantity by a considerable margin. The quantified differences (gaps) between actual and optimal levels point out a considerable room for welfare improvement. Optimum-seeking adjustments closing these gaps could be shown to lead to considerable satisfaction and welfare gains, the measurement of which is worthy of future research.     

Client organizations and the management of professional agency work: The case of English health and social care

A growing reliance on agency workers can lead to significant risks for client organizations, especially in core organizational roles. It has been suggested while these risk can be mitigated through investments in human resource management (HRM) directed at agency workers, in reality these will be hard to implement. This article draws upon Lepak and Snell's (1999) HR architecture model and uses a comparative case study method to explore this issue, focusing on agency working in core nursing and qualified social worker roles. The findings illustrate how client organizations can become more involved in the management of agency workers than has previously been acknowledged. Our analysis also identifies the conditions that shape this client‐side involvement, including the nature of agency worker contracts, the role of temporary work agencies, competing organizational cost‐control priorities, and perceptions of the regulatory context. These conditions are brought together in a general model for understanding the largely neglected role that client organizations play in the HR management of agency workers.     

(Co)-Contamination as the Dark Side of Co-Production: Public value failures in co-production processes

Co-production is associated with the expanding role that citizens and other third-party actors assume in the development and delivery of public services. While there are benefits to co-production, there are also challenges. This study draws from the marketing literature on value co-destruction to describe the processes in co-production of public services that can negatively affect public values from regular producers and users. We refer to this public value failure as co-contamination. Two case studies are used to explore some of the ‘dark sides’ of co-production. Our analyses reveal the co-contaminating aspects of this process and offer implications for public managers.     

Hospital efficiency and equity in health care delivery: A study based in China

Hospital efficiency and equity in health care delivery are two enduring research topics. Yet little research has been done to examine the relationship between them. This paper studies the impact of hospital efficiency on equity in health care delivery based on a proprietary dataset of hospital characteristics and 630,000 inpatient records from 149 public hospitals in a representative Chinese city. To measure the hospitals' efficiencies, this study takes the hospitals' operational features and case-mix indexes into account, and computes the efficiency levels using data envelopment analysis with bootstrapping. Through regressions that control for a variety of the patients’ personal characteristics (e.g., age, disease, residence, hospital visit frequency), this study shows that the gap between hospitalization expenses of urban and rural inpatients in more efficient hospitals is smaller than those in less efficient hospitals. Thus efficiency enhances equity in expenditure between urban and rural patients. But the dwindling urban-rural gap in expenditure is achieved by raising the spending of rural patients, thereby undermining their access to health care. This pattern is more conspicuous in large and sophisticated high-tier hospitals. Further analysis shows that hospital efficiency impacts equity of health care delivery by inducing different lengths of stay and uncovered parts of total expenditure for urban and rural groups. The findings imply that an efficiency-oriented health care policy may lead to social benefit loss.     

Diverging trends in health care use between 2010 and 2016: Evidence from three groups of transition countries

This paper investigates changes in health care use in 28 transition countries using data on more than 60,000 households from the “Life in Transition” surveys II and III conducted in 2010 and 2016. Following the literature, the transition countries are divided into three groups – Eastern Europe, Southern Europe and the non-Baltic states of the former Soviet Union with Mongolia – based on the speed of their transformation. Regressions based on Andersen’s conceptual framework show no difference in public health care use between the three groups in 2010. By 2016, however, the share of households using the public health care system dropped by remarkable 17.1–22.2% points in Southern Europe and 13.5–27.1% points in the former Soviet Union with Mongolia compared to Eastern Europe. Moreover, by 2016, the probability of a household using the private health care system (with no use of public health care) in Southern Europe and the former Soviet Union was 7.5–18.7% points higher than in Eastern Europe, whereas it was 2.9–6.8% points lower than in Eastern Europe back in 2010. The analyses indicate that differences in household characteristics, as well as perceived corruption and quality of public health care, help to understand these diverging trends in health care use in the three groups of transition countries between 2010 and 2016.     

Interfaces in service modularity: A typology developed in modular health care provision

We conduct case research in a particular service context, i.e. the sector for elderly care, in order to explore characteristics of interfaces and the role they play in service customization. Even though the study of modularity in areas other than goods production is increasing, little is known about interfaces outside the context of modular goods. From our case research, it follows that interfaces can be distinguished at the component level (linkages between components’ contents) and at the service package level (linkages between service providers involved). The contribution of the paper is a first typology on interfaces in modular services. Four interface categories are distinguished, which offer a specification of the interfaces’ function in creating variety and coherence, when linking content components as well as service providers. In addition, we provide a new definition of interfaces for services that differs from the accepted manufacturing definition.     

Social identification: linking high performance work systems,psychological empowerment and patient care

This paper examines the mediating effects of social identification on the relationship between high performance work systems (HPWS) and psychological empowerment and the direct relationship between psychological empowerment and clinician perceptions of quality of patient care. We use structural equation modelling on a sample of 254 health professionals from a large regional hospital in Australia. Results demonstrate, first, a strong effect of HPWS on social identification. Second, social identification mediates the relationship between HPWS and psychological empowerment and, third, psychological empowerment has a strong effect on clinician perceptions of quality of patient care. Implications are drawn for management theory and hospital managers.     

The relevance of personal characteristics in health care rationing: what the Australian public thinks and why

This article examines the preferences of the general public in Australia regarding health care resource allocation. While previous studies have revealed that the public is willing to give priority to particular groups of patients based on their personal characteristics, the present article goes beyond previous efforts in attempting to explain these results. In the present study, there was strong support among respondents for giving “equal priority” to people regardless of their personal characteristics. However, respondents did reveal a preference for married patients over single, for children over adults, for carers of children and the elderly, sole breadwinners, and good community contributors. Further, they would give a lower priority to those perceived as “self-harmers”—smokers, individuals with unhealthy diets, and those who rarely exercise. Variation in the answers according to broad economic and social beliefs across seven different categories (“factors”) influenced the pattern of the public's attitudes towards rationing. The Principal Components Analysis (PCA) indicated that most of the items in our survey are associated with seven factors that explain or capture much of the variation. These relate to a patient's avoidance of self-harm behaviors (Safe Living), their Life Style (diet, exercise, etc.), their contribution to the community through caring for others (Caring), their talents (Gifted), their sexual behavior (Sexuality), their age and marital status (Family), and whether they are an Australian citizen or employed (Citizen). The strength of social preferences—e.g., how strongly respondents would “discriminate” against a recreational drug user or preference a person with a healthy diet—is related to the particular class of preferences.     

Relational care in communication as the basis of nonprofit fundraising: Theorizing professional ethics based in stewardship and ethics of care

At its core, fundraising is relationship building. Therefore, ethical fundraising requires cultivating genuine, care-based relationships between various stakeholders by considering relational goals and communicative practices. We advance an ethics of care-oriented approach toward fundraising based in nurturing authentic relationships with multiple organizational stakeholders, including donors, employees, beneficiaries, and volunteers. Drawing upon ethics of care and stewardship scholarship based in public relations, the purpose of this article is to propose relational care in communication through dialogue as an ethical springboard of nonprofit fundraising.     

Provisioning health care infrastructure in communities: Empirical evidences from West Bengal,India

We developed a framework to reinvigorate communities in terms of public health care infrastructure provisioning for outpatient needs within the neighborhoods. The health care seeking episode is often influenced by the physical and health care infrastructure availability within the neighborhood, need of the health care seeker as well as personal, household, occupational, and latent perception of the users. This empirical study has been developed for two different groups in West Bengal India, firstly based on location and secondly based on the choice of the health care seeker. In case of resident based approach, we focused on the revisit decision of the rural inhabitants who sometime tend to travel to the regional facilities in urban areas. Facility based approach analyzed the people who were at the regional facilities for health care services. We devised scenarios ascertaining improvisation in service delivery, emergency facility and mobility ease at local public facilities might reduce regional tours and instigate higher utilization of the neighborhood health care facility. We develop integrated choice and latent variable models to incorporate latent perception in choice of scenario for instigating revisit decision. Results showed choice of development scenarios have association with the household structure, social network, locational and infrastructural impedance. This framework lead to two distinct outcomes: (1) method to identify programs, those are essential to by initiate_revisit_to the health care facility (2) perception based assessment of the current mobility and health care infrastructure of the region, which could be instrumental in developing the overall health care infrastructural planning policy as a whole.     

Rater Rating‐Level Bias and Accuracy in Performance Appraisals: The Impact OF Rater Personality,Performance Management Competence,and Rater Accountability

We studied the problem of rating‐level bias and rating accuracy among retail managers of a Fortune 500 retailer. Hypotheses were tested regarding the relationship among managers’ Five‐Factor Model (FFM) personality characteristics, their competence in performance management, and their levels of bias and accuracy in appraisals made in situations differing on levels of rater accountability. Associate store managers (N = 125) rated subordinates, peers and managers under conditions of high and low rater accountability. We found support for the stability of rating‐level bias across rating situations. Raters’ levels of agreeableness and assertiveness were related to mean rating levels across situations, and U‐shaped relationships were found in predicting one measure of rating accuracy such that high and low levels of these two traits were related to greater rating inaccuracy. Conscientiousness scores were significantly (and negatively) correlated with highly accountable mean ratings of subordinates. Performance management competence was related to rating‐level bias in both high‐ and low‐accountability conditions and contributed incremental validity in the prediction of rating level and rating accuracy. Our results indicate that the most lenient raters are more agreeable, less assertive, and less competent in performance management. These raters may also be less accurate. © 2015 Wiley Periodicals, Inc.     

Nursing,bedside care,and the organization of expert knowledge: Professional work as agencement

Professional work such as nursing has traditionally been examined as being localized in the individual’s body where professional know-how and skills are residing in the cognitive faculties and in embodied action. Contrary to such a view, the concept of agencement, recently used in the social study of finance, underlines that agency is in the contemporary technoscientifically determined times of necessity distributed and includes a variety of tempospatially distributed resources. Reporting a study nursing work in a leukemia ward in a Swedish regional hospital, it is demonstrated that the conventional view of nursing as primarily being bedside care is only accommodating a subset of the totality of the nurses’ work. In addition to face-to-face care and patient interaction, nursing work is the mobilization of a great number of actors with different domains of expertise to safeguard the health care status of the patient. Speaking of nursing work as agencement is opening up for alternative and more accurate understandings of nursing work in an increasingly technologically determined health care system.     

Design of a terminal solution for integration of in-home health care devices and services towards the Internet-of-Things

In-home health care services based on the Internet-of-Things are promising to resolve the challenges caused by the ageing of population. But the existing research is rather scattered and shows lack of interoperability. In this article, a business-technology co-design methodology is proposed for cross-boundary integration of in-home health care devices and services. In this framework, three key elements of a solution (business model, device and service integration architecture and information system integration architecture) are organically integrated and aligned. In particular, a cooperative Health-IoT ecosystem is formulated, and information systems of all stakeholders are integrated in a cooperative health cloud as well as extended to patients’ home through the in-home health care station (IHHS). Design principles of the IHHS includes the reuse of 3C platform, certification of the Health Extension, interoperability and extendibility, convenient and trusted software distribution, standardised and secured electrical health care record handling, effective service composition and efficient data fusion. These principles are applied to the design of an IHHS solution called iMedBox. Detailed device and service integration architecture and hardware and software architecture are presented and verified by an implemented prototype. The quantitative performance analysis and field trials have confirmed the feasibility of the proposed design methodology and solution.