Public Services Programme

Programme research on Medical Regulation published as special issue

Rikki Dean — Thu, 18 Nov 2010 16:45:33 +0000

A special issue of the Journal of Health Organization and Management, edited by Mary Dixon-Woods, Justin Waring and Sue Kilminster, and featuring research on medical regulation from the Public Services Programme, has been published in November 2010.

More details here.

Special issue of Journal of Health Organization and Management

Rikki Dean — Thu, 18 Nov 2010 16:39:10 +0000

A special issue of the Journal of Health Organization and Management was published in November 2010.

Edited by Mary Dixon-Woods, Justin Waring and Sue Kilminster, the journal issue is based on the Programme’s Medical Regulation projects and includes the following papers:

Volume 24 issue 6

Modernising medical regulation: where are we now?
Justin Waring, Mary Dixon-Woods, Karen Yeung (pp. 540 – 555)

Learning practice? Exploring the links between transitions and medical performance
Sue Kilminster, Miriam Zukas, Naomi Quinton, Trudie Roberts (pp. 556 – 570)

Disclosing clinical performance: the case of cardiac surgery
Mark Exworthy, Glenn Smith, Jonathan Gabe, Ian Rees Jones (pp. 571 – 583)

The creation of risk-related information: The UK General Medical Council’s electronic database
Sally Lloyd-Bostock (pp. 584 – 596)

Medical regulation, spectacular transparency and the blame business
Gerry McGivern, Michael Fischer (pp. 597 – 610)

BBC Radio 4: The Long View

Rikki Dean — Fri, 08 Oct 2010 08:07:07 +0000

On Tuesday 12 October 2010, Christopher Hood will take part in the BBC Radio 4 Programme ‘The Long View’ in which Jonathan Freedland compares the present public spending review with the ‘Geddes Axe’ of 1921-22.

The programme will be broadcast on Tue 12 Oct 2010 at 09:00 BBC Radio 4 (LW), 09:05 BBC Radio 4 (FM) and 21:30 BBC Radio 4.

Further details here.

Continuity and Trust in Primary Care – paper by Mary Dixon-Woods and colleagues

Rikki Dean — Fri, 17 Sep 2010 08:21:17 +0000

An article by Mary Dixon-Woods and colleagues has been published in Annals of Family Medicine, a major US medical journal. This article is based on Mary Dixon-Woods’ PSP Fellowship work.

Continuity and Trust in Primary Care: A Qualitative Study Informed by Game Theory
Carolyn Tarrant, Mary Dixon-Woods, Andrew M. Colman,and Tim Stokes.
Annals of Family Medicine 8:440-446 (2010)

Abstract

PURPOSE The relationship between continuity of care and patient trust in primary care is not fully understood. We report an empirical investigation, informed by game theory, of patients� accounts of their trust in general practitioners (GPs).

METHODS We conducted an analysis based on the constant comparative method of 20 semistructured interviews with patients about trust in GPs in the United Kingdom.

RESULTS People use institutional trust, derived from expectations of medicine as an institution and doctors as professionals, as a starting point for their transactions with unfamiliar doctors. This expectation may be enough to allow patients the minimum of what they want from doctors and is often sufficient for single-episode encounters, where patients have specific goals. Repeated interactions with the same doctor can allow patients to develop more secure expectations, based on a history of other interactions and anticipation of future interactions. Secure trust can develop over time, especially if patients are convinced that the doctor has their interests at heart.

CONCLUSIONS This work identifies dynamics inherent in repeated interactions that enable secure trust to develop. These findings have important implications for the design of services, which in the United Kingdom and elsewhere are increasingly focused on enhancing access rather than continuity. They suggest that patients do not see GPs as interchangeable and that the move toward organizing services around single encounters may disrupt the development of secure trust.

Final Programme Newsletter No 10, Summer 2010

Rikki Dean — Thu, 12 Aug 2010 09:40:35 +0000

Number 10, Summer 2010 (pdf)

The final edition of the ESRC Public Services Programme Newsletter – a summary of the Programme’s five-year history, news of recent highlights and publications, and some of the future plans of PSP researchers.

Devolution in practice 2010

Rikki Dean — Wed, 21 Jul 2010 03:21:44 +0000

Devolution to Scotland, Wales and Northern Ireland was a landmark reform, but one born in relatively benign economic and political circumstances. The picture today could not be more different, following political upheaval and a rapid transformation in the economic sphere. The prospect of deep cuts to public spending is likely to put questions about resource allocation across the UK high on the public and political agendas and the strength of the devolution settlement will be tested in the coming years.

Devolution in Practice 2010 is divided into four parts.
� Part 1: Devolution and social citizenship
� Part 2: Devolution in a downturn
� Part 3: Public services and social policy
� Part 4: Devolution and delivery.

Curtice, J (2010) ‘Policy divergence : recognising difference or generating resentment’ in Lodge, G. and Schmuecker, K. (2010) (eds), Devolution in practice 2010, London, Institute for Public Policy Research

Theories of Public Service Improvement:Theories and Evidence

Rikki Dean — Wed, 21 Jul 2010 01:02:03 +0000

Description:��The performance of the public services, from education and policing to health and recycling, is a matter of concern in many countries. Issues of public service efficiency, cost, and effectiveness have moved to the forefront of political debate. This book applies the latest thinking from Management and Organization Studies to the performance of public organizations in order to evaluate the merits of different mechanisms for driving improvement in the public sector.

Research in Management and Organization Studies on the private sector has identified a number of ‘drivers’ of improved performance, including innovation, organizational culture, leadership, and strategic planning. Many of these ‘private sector’ characteristics have emerged within public sector organisations in recent years. However, public managers face additional pressures, whether from regulators, constrained resources, or political interference. This book takes each of these drivers in turn and assesses whether they lead to improvement in public services.

Written for students and researchers of Public Management, this book will also be of interest to public managers and consultants.

1. Rachel Ashworth, George Boyne, and Tom Entwistle: Theories of Public Service Improvement: An Introduction
2. Rhys Andrews: Organizational Environments and Public Service Improvement
3. Stephen Martin: Regulation and Public Service Improvement
4. George Boyne: Strategic Planning and Public Service Improvement
5. Nicolai Petrovsky: The Role of Leadership
6. Rachel Ashworth: Organizational Culture and Improvement
7. Julian Gould-Williams: HRM and Public Service Improvement
8. Richard Walker: Innovation and Public Service Improvement
9. Tom Entwistle: Partnerships, Networks, and Alliances in Collaborative Public Service Delivery
10. James Downe: Organizational Learning and Public Service Improvement
11. Rachel Ashworth, George Boyne, and Tom Entwistle: Reflections on Public Service Improvement

Ashworth, R., Boyne, G.A. and Entwistle, T. (eds) (2010) Theories of Public Service Improvement: Theories and Evidence, Oxford, Oxford University Press

Gaming in Targetworld: The Targets Approach to Managing British Public Services�

Rikki Dean — Wed, 21 Jul 2010 00:26:55 +0000

�Abstract: To what extent did the extensive system of managing public services by targets, introduced by Tony Blair’s New Labour government in the United Kingdom in 1998, reproduce the classic gaming responses associated with the Soviet Union and other centralized performance-setting systems? Combining evidence from documentary sources and interviews with high-level officials in the Whitehall bureaucracy, the author suggests that the three classic types of target gaming can be identified in this public management regime. However, the central managers of the target regime did not put substantial resources into checking performance data, took reported performance gains at face value, and had no coherent antigaming strategy.

Hood, C. (2006) �Gaming in Targetworld: The Targets Approach to Managing British Public Services� Public Administration Review,��66 (4): 515�-�521

Using SitReps performance data to monitor the delayed discharge process

Rikki Dean — Tue, 20 Jul 2010 23:59:54 +0000

Abstract: Situation Reports (SitReps) is an internal Department of Healthperformance data collecting system. Although intended primarilyfor internal use, the data are also used to answer parliamentaryquestions, brief ministers and to inform national performanceindicators. This paper reviews the data collection system anddata-set, and shows how it can be used to evaluate delays inhospital discharge under the Community Care (Delayed Dischargesetc.) Act 2003. However, limitations in the data include thefact that the data have only recently been extended to NationalHealth Service (NHS) non-acute settings and do not include NHSpatients in the private acute sector. Further, as the data-setderives from a weekly aggregate return rather than from individualizedperson-based records, it cannot be used to evaluate length ofdelay, or to link to other relevant data such as emergency readmissions.The provision of individualized data to facilitate linkage andextending coverage would increase its potential future use.Categories of delay should be further refined to facilitatemonitoring of delays due to disputes about eligibility.

Godden S., McCoy D., Pollock AM.,(2008) ‘Using SitReps performance data to monitor the delayed discharge process’, Health Services Management Research, 21:155-160

Did �Targets and Terror� Reduce Waiting Times in England for Hospital Care?

Rikki Dean — Tue, 20 Jul 2010 21:31:27 +0000

Abstract: Waiting times have been a central concern in the English NHS, where care is provided free at the point of delivery and is rationed by waiting time. Pro-market reforms introduced in the NHS in the 1990s were not accompanied by large drops in waiting times. As a result, the English government in 2000 adopted the use of an aggressive policy of targets coupled with the publication of waiting times data at the hospital level and strong sanctions for poor performing hospital managers. This regime has been dubbed �targets and terror�. We estimate the effect of the English target regime for waiting times for hospital care after 2001 by a comparative analysis with Scotland, a neighbouring country with the same healthcare system that did not adopt the target regime. We estimate difference-in-differences models of the proportion of people on the waiting list who waited over 6, 9 and 12 months. Comparisons between England and Scotland are sensitive to whether published or unpublished data are used but, regardless of the data source, the �targets and terror� regime in England lowered the proportion of people waiting for elective treatment relative to Scotland.

�Propper, C., Sutton, M., Whitnall, C. and Windmeijer, F., (2008) ‘Did �Targets and Terror� Reduce Waiting Times in England for Hospital Care?,’ The B.E. Journal of Economic Analysis & Policy, �8� (2) Contributions -�Article 5.