Suchergebnisse

The peasant farmers of Taishan County in southern China's Guangdong Province have created a pattern of village settlement which, using very limited resources, has produced an agricultural landscape and village environment that is a model of ecological integration. The pattern serves both the social and functional needs of the inhabitants by taking advantage of simple microclimatic modifications and the efficient use and recycling of resources. The result is a pattern of small dense villages set in a landscape that is highly evolved both aesthetically and ecologically.

PurposeNew Public Management-informed pay-for-performance policies are common in public sectors internationally but can be controversial with delivery agents. More attention is needed on contingent forms of bottom-up implementation of challenging policies, in emerging market economies, for professionals who face tensions between policies and their codes of practice. Street-level bureaucrats (SLBs) mediate policy implementation through discretionary practices; health professionals have enhanced space for discretion based on autonomy derived from professional status. The authors explore policy implementation, adaptation and resistance by physicians, focusing on payments for health workers in Turkey.Design/methodology/approachThe researchers conducted semi-structured qualitative interviews with 12 physicians in Turkish hospitals and thematic analysis of interview transcripts, using a blended (deductive and inductive) approach.FindingsThe policy fostered discretionary behaviours such as cherry-picking (high volume, low risk procedures) and pro-social rule-breaking (e.g. "upcoding"), highlighting clinical autonomy to navigate within policy restrictions. Respondents described damage to relationships with patients and colleagues, and dissonance between professional practice and perverse policy incentives, sometimes leading to disengagement from clinical work. Policymakers were perceived to be detached from the realities experienced by SLBs. Tensions between the policy and professional values risked alienating physicians.Research limitations/implicationsThis study utilises participant self-reported perceptions of discretionary behaviours. Further work may adopt alternative methods to explore the relationship between self-reporting and observed practice.Originality/valueThe authors contribute to research on differentiated, contingent roles of groups with high scope for discretion in bottom-up implementation, pointing to the potential for policy-professional role conflicts between top-down P4P policies, and the values and codes of practice of professional SLBs.

Meta-governance involves orchestrating the 'rules of the game' in public management. Arm's-length bodies are particularly important vehicles for this. We consider the case of an arm's-length body (NHS England) created to oversee the English NHS' day-to-day operation, and remove 'political interference'. Although mandated by the Department of Health it has increasingly operated as policy-maker, developing policies in tension with existing legislation, while Ministers have faded from public-facing accounts of service operation. This suggests NHS England operates as a meta-governor, insulating government whilst pursuing its own agenda, and raises crucial questions about governmental accountability whilst simultaneously making answers harder to obtain.

Public-Private Innovation Partnerships (PPIPs) are increasingly used as a tool for addressing 'wicked' public sector challenges. 'Innovation' is, however, frequently treated as a 'magic' concept: used unreflexively, taken to be axiomatically 'good', and left undefined within policy programmes. Using McConnell's framework of policy success and failure and a case study of a multi-level PPIP in the English health service (NHS Test Beds), this paper critically explores the implications of the mobilisation of innovation in PPIP policy and practice. We highlight how the interplay between levels (macro/micro and policy maker/recipient) can shape both emerging policies and their prospects for success or failure. The paper contributes to an understanding of PPIP success and failure by extending McConnell's framework to explore inter-level effects between policy and innovation project, and demonstrating how the success of PPIP policy cannot be understood without recognising the particular political effects of 'innovation' on formulation and implementation.

The optimal balance between central governmental authority and the degree of autonomy of local public bodies is an enduring issue in public policy. The UK National Health Service is no exception, with NHS history, in part at least, a history of repeated cycles of centralisation and decentralisation of decision making power. Most recently, a significant reorganisation of the NHS in 2102-13 was built around the creation of new and supposedly more autonomous commissioning organisations (Clinical Commissioning Groups – CCGs). Using Bossert's (1998) concept of 'decision space', we explore the experiences of local commissioners as they took on their new responsibilities. We interviewed commissioning staff from all of the CCGs in two regional health care 'economies', exploring their perceptions of autonomy and their experiences over time. We found significant early enthusiasm for, and perceptions of, increased autonomy tempered in the vertical dimension by increasingly onerous and prescriptive monitoring regimes, and in the horizontal dimension by the proliferation of overlapping networks, inter-organisational groups and relationships. We propose that whatever the balance between central and local control that is adopted, complex public services require some sort of meso-level oversight from organisations able to 'hold the ring' between competing interests and to take a regional view of the needs of the local health system. This suggests that local organisational autonomy in such services will always be constrained.

This paper explores how 'place' is conceptualised and mobilized in health policy and considers the implications of this. Using the on-going spatial reorganizing of the English NHS as an exemplar, we draw upon relational geographies of place for illumination. We focus on the introduction of 'Sustainability and Transformation Plans' (STPs): positioned to support improvements in care and relieve financial pressures within the health and social care system. STP implementation requires collaboration between organizations within 44 bounded territories that must reach 'local' consensus about service redesign under conditions of unprecedented financial constraint. Emphasising the continued influence of previous reorganizations, we argue that such spatialized practices elude neat containment within coherent territorial geographies. Rather than a technical process financially and spatially 'fixing' health and care systems, STPs exemplify post-politics-closing down the political dimensions of policy-making by associating 'place' with 'local' empowerment to undertake highly resource-constrained management of health systems, distancing responsibility from national political processes. Relational understandings of place thus provide value in understanding health policies and systems, and help to identify where and how STPs might experience difficulties.

AbstractResearch has demonstrated that pilots contain multiple shifting purposes, not all of which relate to simple policy testing or refinement. Judging the success of policy pilots is therefore complex, requiring more than a simple judgment against declared goals. Marsh and McConnell provide a framework against which policy success can be judged, distinguishing program success from process and political success. We adapt Boven's modification of this framework and apply it to policy pilots, arguing that pilot process, outcomes and longer‐term effects can all be judged in both program and political terms. We test this new framework in a pilot program in the English National Health Service, the Vanguard program, showing how consideration of these different aspects of success sheds light on the program and its aftermath. We consider the implications of the framework for the comprehensive and multifaceted evaluation of policy pilots.

Research has demonstrated that pilots contain multiple shifting purposes, not all of which relate to simple policy testing or refinement. Judging the success of policy pilots is therefore complex, requiring more than a simple judgment against declared goals. Marsh and McConnell provide a framework against which policy success can be judged, distinguishing program success from process and political success. We adapt Boven's modification of this framework and apply it to policy pilots, arguing that pilot process, outcomes and longer-term effects can all be judged in both program and political terms. We test this new framework in a pilot program in the English National Health Service, the Vanguard program, showing how consideration of these different aspects of success sheds light on the program and its aftermath. We consider the implications of the framework for the comprehensive and multifaceted evaluation of policy pilots.

From Wiley via Jisc Publications Router ; History: received 2021-03-28, rev-recd 2021-09-28, accepted 2021-10-07, pub-electronic 2021-10-25 ; Article version: VoR ; Publication status: Published ; Funder: NIHR Policy Research Programme; Grant(s): PR‐R16‐0516‐22001 ; Abstract: Research has demonstrated that pilots contain multiple shifting purposes, not all of which relate to simple policy testing or refinement. Judging the success of policy pilots is therefore complex, requiring more than a simple judgment against declared goals. Marsh and McConnell provide a framework against which policy success can be judged, distinguishing program success from process and political success. We adapt Boven's modification of this framework and apply it to policy pilots, arguing that pilot process, outcomes and longer‐term effects can all be judged in both program and political terms. We test this new framework in a pilot program in the English National Health Service, the Vanguard program, showing how consideration of these different aspects of success sheds light on the program and its aftermath. We consider the implications of the framework for the comprehensive and multifaceted evaluation of policy pilots.