scholarly journals Pay-for-performance in primary health care: A comparative study of health policymaking in England and New Zealand

2021 ◽  
Author(s):  
◽  
Verna May Smith
Keyword(s):  
Health Care ◽  
New Zealand ◽  
Policy Change ◽  
Large Scale ◽  
Pay For Performance ◽  
Decision Makers ◽  
Multiple Streams ◽  
Incremental Change ◽  
Multiple Streams Framework

<p>England and New Zealand introduced pay-for-performance schemes in their primary health care systems, with incentives for general practitioners to achieve improved population-based health outcomes, between 2001 and 2007. These schemes were part of health reforms to change the relationship between the state and the medical profession, giving the state increased influence over the quality and allocation of publicly funded health care. Two schemes of differing size, scope and impact were implemented. This research takes a comparative approach to exploring each policymaking process, utilising quasi-natural experimental conditions in these two Westminster governing systems to test the relevance of Kingdon’s multi-theoretic Multiple Streams Framework and other theoretical approaches to explain policy variation and change.  The research documented and analysed the agenda-setting, alternative selection and implementation phases in the two policymaking processes and identified the key drivers of policymaking in each case study. A qualitative methodology, based upon documentary analysis and semi-structured interviews with 26 decision-makers, leaders and participants, was used to develop the two case studies, providing rich descriptive details and rare insights into closed policymaking approaches as seen by the participants. From this case study evidence, themes were drawn out and reviewed for consistency with Kingdon’s Multiple Streams Framework as it has been interpreted and adapted by Zahariadis. The case study evidence and themes were considered in a framework of comparative analysis where patterns of similarity and difference were established. The utility of Kingdon’s Multiple Streams Framework in interpreting the case study evidence was assessed.  This analysis demonstrated that Kingdon’s Framework, as interpreted by Zahariadis, had high descriptive power for both case studies but failed to predict the patterns of non-incremental change observed or the importance of institutional factors such as ownership and governance arrangements for public services, interest group structure and historical antecedents seen in the two policymaking processes.  The research finds that the use of bargaining in England and not in New Zealand is the reason for major differences in speed, scope and outcomes of the two pay-for-performance schemes. Institutional structures in the general practice sub-system are therefore the primary driver of policy change and variation. These acted as enablers of non-incremental change in the English case study, providing incentives for actors individually and collectively to design and rapidly to implement a large-scale pay-for-performance scheme. The institutional features of the general practice sub-system in New Zealand acted as a constraint to the development of a large-scale scheme although non-incremental change was achieved. Phased approaches to implementation in New Zealand were necessary and slowed the delivery of outcomes from the scheme.  With respect to other drivers of policy change and variation, the role of individual actors as policy and institutional entrepreneurs was important in facilitating policy design in each country, with different types of entrepreneurs with different skills being observed at different stages of the process. These entrepreneurs were appointed and working within the bureaucracy to the direction of decision-makers in both countries. England and New Zealand shared ideas about the benefits of New Public Management approaches to public policymaking, including support for pay-for-performance approaches, and there was a shared positive socio-economic climate for increased investment in health services.  The research provides evidence that Westminster governing systems are capable of purposeful and orderly non-incremental health policy change and that Kingdon’s Multiple Streams Framework, which theorises policy formation in conditions of ambiguity, needs to be enhanced to improve its relevance for such jurisdictions. Recommendations for its enhancement are made.</p>

scholarly journals Pay-for-performance in primary health care: A comparative study of health policymaking in England and New Zealand

2021 ◽  
Author(s):  
◽  
Verna May Smith
Keyword(s):  
Health Care ◽  
New Zealand ◽  
Policy Change ◽  
Large Scale ◽  
Pay For Performance ◽  
Decision Makers ◽  
Multiple Streams ◽  
Incremental Change ◽  
Multiple Streams Framework

<p>England and New Zealand introduced pay-for-performance schemes in their primary health care systems, with incentives for general practitioners to achieve improved population-based health outcomes, between 2001 and 2007. These schemes were part of health reforms to change the relationship between the state and the medical profession, giving the state increased influence over the quality and allocation of publicly funded health care. Two schemes of differing size, scope and impact were implemented. This research takes a comparative approach to exploring each policymaking process, utilising quasi-natural experimental conditions in these two Westminster governing systems to test the relevance of Kingdon’s multi-theoretic Multiple Streams Framework and other theoretical approaches to explain policy variation and change.  The research documented and analysed the agenda-setting, alternative selection and implementation phases in the two policymaking processes and identified the key drivers of policymaking in each case study. A qualitative methodology, based upon documentary analysis and semi-structured interviews with 26 decision-makers, leaders and participants, was used to develop the two case studies, providing rich descriptive details and rare insights into closed policymaking approaches as seen by the participants. From this case study evidence, themes were drawn out and reviewed for consistency with Kingdon’s Multiple Streams Framework as it has been interpreted and adapted by Zahariadis. The case study evidence and themes were considered in a framework of comparative analysis where patterns of similarity and difference were established. The utility of Kingdon’s Multiple Streams Framework in interpreting the case study evidence was assessed.  This analysis demonstrated that Kingdon’s Framework, as interpreted by Zahariadis, had high descriptive power for both case studies but failed to predict the patterns of non-incremental change observed or the importance of institutional factors such as ownership and governance arrangements for public services, interest group structure and historical antecedents seen in the two policymaking processes.  The research finds that the use of bargaining in England and not in New Zealand is the reason for major differences in speed, scope and outcomes of the two pay-for-performance schemes. Institutional structures in the general practice sub-system are therefore the primary driver of policy change and variation. These acted as enablers of non-incremental change in the English case study, providing incentives for actors individually and collectively to design and rapidly to implement a large-scale pay-for-performance scheme. The institutional features of the general practice sub-system in New Zealand acted as a constraint to the development of a large-scale scheme although non-incremental change was achieved. Phased approaches to implementation in New Zealand were necessary and slowed the delivery of outcomes from the scheme.  With respect to other drivers of policy change and variation, the role of individual actors as policy and institutional entrepreneurs was important in facilitating policy design in each country, with different types of entrepreneurs with different skills being observed at different stages of the process. These entrepreneurs were appointed and working within the bureaucracy to the direction of decision-makers in both countries. England and New Zealand shared ideas about the benefits of New Public Management approaches to public policymaking, including support for pay-for-performance approaches, and there was a shared positive socio-economic climate for increased investment in health services.  The research provides evidence that Westminster governing systems are capable of purposeful and orderly non-incremental health policy change and that Kingdon’s Multiple Streams Framework, which theorises policy formation in conditions of ambiguity, needs to be enhanced to improve its relevance for such jurisdictions. Recommendations for its enhancement are made.</p>

scholarly journals Implementing pay-for-performance in primary health care: the role of institutional entrepreneurs

2021 ◽  
Author(s):  
Verna Smith ◽  
Jacqueline Cumming
Keyword(s):  
Policy Change ◽  
Pay For Performance ◽  
Comparative Case Study ◽  
Multiple Streams ◽  
Institutional Entrepreneurs ◽  
Institutional Settings ◽  
Health Policymaking ◽  
Better Than

© 2017 The Author(s). Institutional entrepreneurs are vital for facilitating non-incremental health policy change in complex institutional settings where established traditions and practices carry considerable weight. This paper describes a comparative case study of health policymaking which shows that Kingdon’s Multiple Streams Framework for non-incremental policy change requires enhancement to explain results in policy-making in two Westminster unitary majoritarian jurisdictions. The most similar systems comparative study found that historical, rational choice, organisational and discursive institutionalist approaches explained the policy change and variation observed better than agency-based approaches did. However, institutional entrepreneurs were important in both cases. Differences in coordinative discourse help to explain the differences in degree of change achieved in each case study and highlight the importance of discursive institutionalist approaches in bridging institutional and agency-based approaches.

Implementing pay-for-performance in primary health care: the role of institutional entrepreneurs

2021 ◽  
Author(s):  
Verna Smith ◽  
Jacqueline Cumming
Keyword(s):  
Policy Change ◽  
Pay For Performance ◽  
Comparative Case Study ◽  
Multiple Streams ◽  
Institutional Entrepreneurs ◽  
Institutional Settings ◽  
Health Policymaking ◽  
Better Than

© 2017 The Author(s). Institutional entrepreneurs are vital for facilitating non-incremental health policy change in complex institutional settings where established traditions and practices carry considerable weight. This paper describes a comparative case study of health policymaking which shows that Kingdon’s Multiple Streams Framework for non-incremental policy change requires enhancement to explain results in policy-making in two Westminster unitary majoritarian jurisdictions. The most similar systems comparative study found that historical, rational choice, organisational and discursive institutionalist approaches explained the policy change and variation observed better than agency-based approaches did. However, institutional entrepreneurs were important in both cases. Differences in coordinative discourse help to explain the differences in degree of change achieved in each case study and highlight the importance of discursive institutionalist approaches in bridging institutional and agency-based approaches.

How “The Three Rules” guide strategy and investment decisions at Deloitte Consulting LLP

2015 ◽  
Vol 43 (3) ◽  
pp. 7-14 ◽  
Author(s):  
Jim Moffatt
Keyword(s):  
Design Methodology ◽  
Large Scale ◽  
Investment Decisions ◽  
Decision Makers ◽  
Research Project ◽  
Content Type ◽  
First Case ◽  
Practical Implications ◽  
Thought Leadership

Purpose – This case example looks at how Deloitte Consulting applies the Three Rules synthesized by Michael Raynor and Mumtaz Ahmed based on their large-scale research project that identified patterns in the way exceptional companies think. Design/methodology/approach – The Three Rules concept is a key piece of Deloitte Consulting’s thought leadership program. So how are the three rules helping the organization perform? Now that research has shown how exceptional companies think, CEO Jim Moffatt could address the question, “Does Deloitte think like an exceptional company?” Findings – Deloitte has had success with an approach that promotes a bias towards non-price value over price and revenue over costs. Practical implications – It’s critical that all decision makers in an organization understand how decisions that are consistent with the three rules have contributed to past success as well as how they can apply the rules to difficult challenges they face today. Originality/value – This is the first case study written from a CEO’s perspective that looks at how the Three Rules approach of Michael Raynor and Mumtaz Ahmed can foster a firm’s growth and exceptional performance.

scholarly journals Surveillance, anticipation and firefighting: Perspectives of patient safety from a New Zealand case study

2020 ◽  
Author(s):  
J Wailling ◽  
Brian Robinson ◽  
M Coombs
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
New Zealand ◽  
Health Care Professionals ◽  
Nuclear Power ◽  
High Reliability ◽  
Health Care Systems ◽  
Tertiary Hospital ◽  
Structured Interviews

© 2018 John Wiley & Sons Ltd Aim: This study explored how doctors, nurses and managers working in a New Zealand tertiary hospital understand patient safety. Background: Despite health care systems implementing proven safety strategies from high reliability organisations, such as aviation and nuclear power, these have not been uniformly adopted by health care professionals with concerns raised about clinician engagement. Design: Instrumental, embedded case study design using qualitative methods. Methods: The study used purposeful sampling, and data was collected using focus groups and semi-structured interviews with doctors (n = 31); registered nurses (n = 19); and senior organisational managers (n = 3) in a New Zealand tertiary hospital. Results: Safety was described as a core organisational value. Clinicians appreciated proactive safety approaches characterized by anticipation and vigilance, where they expertly recognized and adapted to safety risks. Managers trusted evidence-based safety rules and approaches that recorded, categorized and measured safety. Conclusion and Implications for Nursing Management: It is important that nurse managers hold a more refined understanding about safety. Organisations are more likely to support safe patient care if cultural complexity is accounted for. Recognizing how different occupational groups perceive and respond to safety, rather than attempting to reinforce a uniform set of safety actions and responsibilities, is likely to bring together a shared understanding of safety, build trust and nurture safety culture.

scholarly journals Case study: mapping the tsunami-hazard zone in the Pasir Jambak sub-district, in Padang, Indonesia

2021 ◽  
Vol 331 ◽  
pp. 04006
Author(s):  
Leli Honesti ◽  
Meli Muchlian
Keyword(s):  
Large Scale ◽  
Grid Point ◽  
Tsunami Hazard ◽  
Decision Makers ◽  
Tsunami Inundation ◽  
Tsunami Risk ◽  
Nested Grid ◽  
Inundation Map ◽  
Run Up

A tsunami hazard is an adverse event that causes damage to properties and loss of life. The problem in assessing a tsunami risk zone for a small area is significant, as available tsunami inundation zone data does not give detailed information for tsunami inundation and run-up in every nested grid. Hence, this study aims to establish a tsunami risk map in the Pasir Jambak sub-district, Padang, Indonesia. The map was carried out in every nested grid point of the area and on a large scale (1:5,000). The TUNAMI N3 program was used for the simulation of the tsunami inundation. A tsunami assessment was made through simulations in nine scenarios of fault parameter data for Sipora block earthquakes. The result of the study provides a tsunami inundation map. Furthermore, this tsunami inundation map can be used for communities, local authorities, government, and others for many studies, and decision-makers can come up with mitigation plans for a small study area.

scholarly journals Special Section: Assessing Information Technologies for Health: Evaluation and Implementation: A Call for Action

2006 ◽  
Vol 15 (01) ◽  
pp. 11-15
Author(s):  
J. L. Talmon
Keyword(s):  
Health Care ◽  
Information Technologies ◽  
Large Scale ◽  
Special Section ◽  
Evaluation Studies ◽  
Evidence Base ◽  
Decision Makers ◽  
Unintended Effects ◽  
Evaluation Practice ◽  
Recommendations For Action

SummaryTo raise awareness for actions that are urgently needed to accompany the large scale implementations of ICT in Health Care that are currently taking place in many countries around the world.An analysis of a few studies that have recently been described in the literature guided by recent suggestions for research and development of evaluation of health ICT.Six specific recommendations for action are specified:Development of good implementation practice,Development of an experience base of implementation of ICT in health care,Setting up a surveillance system for unintended effects,Build an evidence base of best evaluation practice,Developing guidelines for proper reporting of evaluation studies,Education of clinicians and decision makers.

scholarly journals Design of Visibility for Order Lifecycle using Datawarehouse

2019 ◽  
Vol 8 (6) ◽  
pp. 4700-4707
Keyword(s):  
Health Care ◽  
Supply Chain ◽  
Data Warehouse ◽  
Historical Data ◽  
Decision Makers ◽  
Health Care Education ◽  
Business Decisions ◽  
The Public ◽  
Design Considerations

Data warehouse, shortly called DW, a repository to store historical data was widely used across organizations for analyzing the data for any business decisions to be decided. It acts as a decision support system, which will help the decision makers to provide any conclusion based on the analyzed data. DW can be used across any particular fields in the public domain. Some of them would include Retail, Insurance, Finance, Sales, Services, Health Care, Education, etc. This paper analyses and proposes the datawarehouse design considerations for the supply chain. The design was explained with a detailed case study on understanding the visibility of sales order at various stages.

scholarly journals The Use of Telerehabilitation Technologies for Cardiac Patients to Improve Rehabilitation Activities and Unify Organizations: Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Birthe Dinesen ◽  
Helle Spindler
Keyword(s):  
Health Care ◽  
Community Of Practice ◽  
Health Care Professionals ◽  
Large Scale ◽  
Qualitative Interviews ◽  
Cardiac Patients ◽  
Long Term Effects ◽  
Interorganizational Cooperation ◽  
Health Care Centers

BACKGROUND Cardiovascular disease is a leading cause of death globally causing 31% of all deaths worldwide. The Danish health care system is characterized by fragmented delivery of services and rehabilitation activities. The Teledialog Telerehabilitation Program for cardiac patients was developed and tested to rectify fragmentation and improve the quality of care. The Teledialog program was based on the assumption that a common communication platform shared by health care professionals, patients, and relatives could reduce or eliminate the fragmentation in the rehabilitation process and improve cooperation between the health professionals. OBJECTIVE This study aimed to assess the interorganizational cooperation between health care professionals across sectors (hospitals, municipal health care centers) in a cardiac telerehabilitation program. METHODS Theories of networks between organizations, the sociology of professions, and the “community of practice” approach were used in a case study of a cardiac telerehabilitation program. A triangulation of data collection techniques were used including documents, participant observation (n=76 hours), and qualitative interviews with healthcare professionals (n=37). Data were analyzed using NVivo 11.0. RESULTS The case study of cooperation in an interorganizational context of cardiac telerehabilitation program is characterized by the following key themes and patterns: (1) integrated workflows via a shared digital rehabilitation plan that help integrate workflow between health care professions and organizations, (2) joint clinical practice showed as a community of practice in telerehabilitation developed across professions and organizations, and (3) unifying the organizations as cooperation has advanced via a joint telerehabilitation program across municipalities and hospitals. CONCLUSIONS The Teledialog Telerehabilitation Program was a new innovative cardiac program tested on a large scale across hospitals, health care centers, and municipalities. Assessments showed that the Teledialog program and its associated technologies helped improve interorganizational cooperation and reduce fragmentation. The program helped integrate the organizations and led to the creation of a community of practice. Further research is needed to explore long-term effects of implementation of telerehabilitation technologies and programs. CLINICALTRIAL ClinicalTrials.gov NCT01752192; http://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6yR3tdEpb)

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