Outsourcing in the Australian health sector : the interplay of economics and politics

Purpose – The paper discusses the reasons and approaches used at three health organisations in introducing outsourcing. It specifically answers the question: why have managers of health organisations outsourced some functions in preference to others?

Design/methodology/approach – This research employs a case study method making use of qualitative analysis. The health organisations were chosen first as representatives of their type, and secondly due to the nature of the outsourcing decisions made. The first health organisation operates in the rural sector; the second is a metropolitan network; and the third is a large metropolitan hospital, which, in contrast to the other two case study organisations, had made only one decision to outsource, producing the largest outsourcing contract in health in Australia. Furthermore, this situation was distinctive as the contract was terminated and re-issued to another private sector organisation.

Findings – The reasons for outsourcing varied within and between health organisations. Although generally they were made on the bases of the characteristics of the labour market, employee skill levels and the nature of industrial relations, the perception of what was core, the level of internal management skills, the ability of internal teams to implement change and the relationship between management and staff. Even though cost savings and a downsized labour force resulted, generally these occurred even when services were not outsourced, through the use of other change processes, such as introducing new technology, changing structures and promoting workforce flexibility. The interplay of political reasons and economic effects was evident along with the political nature of the decision-making and processes used. The paper concludes that the power of managers was a moderating factor between the desire for outsourcing and whether outsourcing actually occurred.

Research limitations/implications – Although this research was conducted solely within the health sector it has implications for other public sector bodies and the private sector.

Practical implications – Managerial decision making can be enhanced with the exploration of the full complement of reasons for the outsourcing decision.

Originality/value – The paper has value to both academics researching in the public sector and public sector managers.

An overview of IT outsourcing in public secto agenices

For the past 15 years, governments in the developed, Western world have been contracting out, or outsourcing, services as a key part of public sector reforms. Outsourcing has been argued to lead to cost savings, improved discipline, better services, access to scarce skills, and the capacity for managers to focus more time on the core business of their organizations (Domberger, 1998). Government outsourcing initiatives have encompassed a range of services, but given the large sums of money invested in IT assets, the outsourcing of IT services (IT outsourcing, or ITO) has been a major initiative for many agencies. Lacity and Willcocks (1998, p. 3) defined ITO as "handing over to a third party [the] management of IS/IT assets, resources and/or activities for required results." For public-sector outsourcing, this handover is usually made by way of a competitive tender. Case studies have reported ITO successes and failures (e.g., Currie & Willcocks, 1998; Rouse & Corbitt, 2003; Willcocks & Currie, 1997; Willcocks & Lacity, 2001; Willcocks & Kern, 1998), but much of the evidence presented to public-sector decision makers to justify this reform is anecdotal and unsystematic, and when investigated in depth, does not necessarily support widespread conclusions.

Ethical, economic and efficient sector : is it a gamble? The case of New Zealand Health

The New Zealand public sector has gone through major reform as a result of fiscal deficit in 1984 (KettI, 1997; Schwartz, 1997), resulting in shift of emphasis from quality service provision to establishing financial supremacy (Kettl, 1997). This raises concern as to how public sector employees are attaining balance between their service objectives with financial ones and how is the ethics negotiated in this process. Following this concern, this paper focuses on determining the organisational variables consisting of organisational policies in the District Health Boards (DHBs) and hospitals of New Zealand on ethical behaviours of managers and the ethical climate of these departments. The aim of this study is to increase our understanding of the ethical climate of the public health. Our findings suggest that little emphasis has been provided to the aspect of ethics in New Zealand health sector. There is no reward for employees who exhibit exemplary ethical behaviour, no hot line to consult/report about ethics, any detailed guidelines and policies, and not enough ethics-related training provided to staff.

Decision making to support an integrated infrastructure supply chain industrial ecological approach within public private partnerships

Supply chains are complex adaptive systems for which final performance depends upon numerous interdependent decisions made by numerous firms which synthesise inputs from various resources systems.  The dynamic interdependent behaviour of social, economic, material and informational resource systems within eco-industrial settings that support the built environment life cycle supply chains can be studied at the supply chain level.  The impact of megaprojects is significant and holds promise to explore the impact of decisions on various systems as it combines project and system boundaries.  Megaoprojects considered as major events within systems can produce critical revolutionary impacts on the systems within which they are embedded.  The decisions that are made on megaprojects are central to risk management.  typically major infrastructure projects are procured through a form of public private partnership (PPP).  The core principle of PPP is value for money which refers to the best available outcome attempting to take account of all benefits, costs and risks over the whole life of the procurement.  In this paper the focus is on Australia where there has been considerable acitivity in the use of PPPs.  With recent national infrastucture packages proposed to stimulate the economy due to the global financial crisis, decision modelling on risks is a revelant and critical matter not only in practice but also in the research community.  PPPs encourage the whole-of-lifecycle approach in the procurement and management of public sector assets by transparently recognising the costs and risks associated with the whole life of the required service or facility, thus integrated whole of life supply chains can be considered.  By creating a single point of responsibility for an entire project from inception through operation, a strong incentive is created for thinking about the effects that a design or construction decision will have on the effectiveness and efficiency of managing and maintaining a facility during its operational life.  The decision to procure holistic supply chains becomes a much more viable commercial reality in the PPP environment than previously considered in the usual commercial construction spot transactional approach.  These types of decisions tend to be imprecise, approximate and complex requireing justification and reasoning logic rather than the classical 'truth' logic.  The purpose of this paper is to develop a theoretical decision framework which combines interdependency and multi-values logic for supply chain procurement modelling.

A construct of the 'ethos of codes of ethics' (ECE) : the case of private and public Sweden

Purpose – The objective of this paper is to develop and describe a construct of the “ethos of the codes of ethics” (i.e. an ECE construct) in the private and public sectors of Sweden.

Design/methodology/approach – The paper takes a cross-sector approach to codes of ethics amongst the top private sector companies and the top public sector organisations. The paper then examines the measures put in place by the dual sample in order to describe the ethos of their codes of ethics.

Findings – The multivariate techniques used in the statistical analysis indicated that the ECE-construct consists of five dimensions: ethical bodies, ethical tools, ethical support procedures, internal ethics usage, and external ethics usage.

Research limitations/implications – It should be noted that the ECE construct has been derived from large companies and organisations in private and public Sweden, which may indicate less applicability to smaller operations. Another limitation may be the validity and reliability across other cultural samples. The dual sample contains a variety of different types of operations, but it may not be transferable to other countries.

Practical implications – The outcome is based on data from private companies and public organisations that indicated they had corporate codes of ethics. Therefore, a suggestion for further research is to examine the ECE construct in other countries/cultures that differ from the ones in this research effort performed in the private and public sectors of Sweden.

Originality/value – The ECE construct introduced makes a contribution to theory and practice in the field as it is based upon a dual sample. It makes a contribution to theory as it outlines a construct for the benefit of other researchers working in both the private and the public sectors. The authors also believe that it may be of managerial interest as it provides a grounded framework of areas to be considered in the implementation of the codes of ethics in both private companies and public organisations.

Governance and goodness in the public arena

We discuss the association of governance with notions of goodness and virtue in the public arena. In line with moves away from universal notions of best practice and toward recognition of local initiatives, we suggest that public management research give more explicit attention to the ethical frameworks that underlie and complicate definitional and values-based debates. We suggest that greater consideration of the ethics of public management may assist researchers to move beyond definitional dilemmas and will inform analysis of hybrid or 'reformed' bureaucracies where competing logics may be in play.

Public and private psychiatry : can they work together and is it worth the effort?

OBJECTIVE: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems.

METHOD: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area.

RESULTS: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: 'Difficulty communicating' endorsed by 71.4% of public clinicians and 72% of private psychiatrists, 'Confusion of roles and responsibilities' endorsed by 62.9% and 66%, respectively, and 'Different treatment approach' by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors.

CONCLUSIONS: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.

Factors that predict work ability : incorporating a measure of organisational values towards ageing

This research conducted in an Australian public sector organisation aimed to identify the main factors that predict work ability for employees. According to Ilmarinen's (1999) model of work ability, an individual's work ability is influenced by their general health, attitudes, values and motivation interacting with workplace and other environmental demands. However what is unknown is the influence of value incongruence (i.e. the lack of fit between individual and organisational values), particularly when that incongruence results in age discrimination. This is important in an Australian context where youth and symbols of youth are over-valued in business environments and where older workers themselves perceive age discrimination as the single most important cause of early exit from the labour force.

109 participants completed a survey about work ability. Differences between work ability and health were not found between older and younger workers suggesting that strategies for improving work ability could be targeted at all employees rather than just older employees. However there were significant differences found between older and younger workers on reasons that would influence employees to stay longer in the organisation. Older workers tended to be more influenced by the provision of less demanding work, and positive attitudes towards older workers. Younger workers tended to be more influenced by opportunities to be employed in another section of the organisation, skills training opportunities and career advancement opportunities.

Results from hierarchical regression analyses suggested that good physical and mental health, and low occupational stress related to workplace culture were significant predictors of increased work ability. Results also suggested that occupational stress is likely to decrease with: high work ability and work satisfaction; and high value congruence. Implications for wellbeing programs to include the development of targeted organisational values are discussed.

Measurement and structural properties of organizational codes of ethics in private and public Sweden

Purpose – The purpose of this paper is to test the measurement and structural properties in a model of organizational codes of ethics (OCE) in Sweden.

Design/methodology/approach – The measurement and structural properties of four OCE constructs (i.e. surveillance/training, internal communication, external communication, and guidance) were described and tested in a dual sample based upon private and public sectors of Sweden.

Findings – Results show that the measurement and structural models of OCE in part have a satisfactory fit, validity, and reliability.

Research limitations/implications – The paper makes a contribution to theory as it outlines a set of OCE constructs and it presents an empirical test of and OCE model in respect to measurement and structural properties. A number of research limitations are provided.

Practical implications – It provides a model to be considered in the implementation and monitoring of OCE. The present research provides opportunities for further research in refining, extending, and testing the proposed OCE model in other cultural and organizational settings.

Originality/value – The OCE model extends previous studies that have been predominately descriptive, by using confirmatory factor analysis and structural equation modeling.

Exploring critical factors for achieving successful risk allocation in public-private partnership projects

Public Private Partnerships (PPP) as a procurement mechanism for infrastructure projects is becoming increasingly common. This is principally due to the value for money opportunities it offers the public sector sponsors. This value for money is primarily achieved through the optimisation of the allocation of risk inherent in the project being transferred from the public sector sponsors onto private sector bidders. This paper analyses the influence that these factors have on successful risk allocation with the aim of providing clearer parameters for optimal risk allocation in PPP projects. Through an extensive review of existing literature, the critical success factors for optimal risk allocation in PPP projects are identified. It is found that the optimisation of risk allocation in PPP projects is critically influenced by the identified factors, which will undoubtedly aid in the successful outcome for future PPP projects.

Bringing innovation to centre stage : the rhetoric of commercialisation and cross-sector collaboration

As a key element in Australia's national innovation system, public sector organizations, such as universities and public-funded research agencies, have increasingly become involved in R&D collaborations with firms. Government policy has encouraged this cross-sector collaboration, and in the most recent policy "act" has focused on the commercialisation of research findings (through which R&D outputs are translated into marketable commodities) and has encouraged public sector organizations to become more directly involved in this activity. But while the policy rhetoric has contributed to a discourse of marketization, through which cultural change in the research performing organizations is both promoted and legitimised, there are other voices in the unfolding policy drama which point to the complex and multifaceted nature of commercialisation in national economies. These countervailing voices emphasise the multiple roles that public sector organizations play in national innovation systems, and this introduces organizational role ambiguity into the discourse leading to confusion among the research performing actors. It is concluded that, given the complex and subtle nature of innovation processes, the traditional dichotomy between applied (or commercially-focused) research and "public good" research is no longer tenable nor helpful in the policy debates.

Achieving effective cross-sector R&D collaboration : a proposed management framework

Cross‐sector R&D collaboration, as exemplified by the Australian Cooperative Research Centre Program, is increasing in incidence due to government policies and corporate practices. While the benefits of such collaborations are widely promoted, the resulting relationships (typically involving companies, universities and public sector research agencies) can be difficult to manage so as to achieve beneficial outcomes for all partners. A management framework for establishing these collaborations is proposed. This framework is based on four tensions in cross‐sector collaborations, and it takes the perspective that knowledge created for mutual benefit is the common focus of these ventures.

An ethnography of housing : public housing work in Victoria

This thesis examines the everyday practices of housing officers working in the Victorian Office of Housing, a large public sector statutory authority providing rental housing to low–income households. Housing officer work has changed substantially associated with the shift from the provision of ‘public housing’ in the post–WWII period to the provision of ‘welfare housing’ from the early 1980s. These changes are evident in both the formal organisation of work and day–to–day practices. The principal research question addressed is ‘How has the work of staff in the Victorian Office of Housing changed as a consequence of the shift from the provision of ‘public housing’ in the post–WWII period to the provision of ‘welfare housing’ from the early 1980s?’

This question is addressed by presenting an historically informed ethnography of the Office of Housing. Research was undertaken over a twelve–month period through interviews, participant observation and the collection of documents. The data collected through the use of these methods provided the basis for the presentation of ‘thick descriptions’ of the work of staff employed to provide rental housing to low–income households.

The research into this large hierarchical formal organisation was undertaken in three offices: a local suburban office, a regional office and head office. This enabled connections and tensions in direct service delivery work and policy work to be identified and analysed. It revealed that the experience of the shift from the provision of public housing to the provision of welfare housing has not been uniform and underscores the importance of understanding organisations as socially constructed.

Staff work was analysed by distinguishing four overarching problems consistently referred to by staff and highlighted in formal reviews. First, ‘problems with tenants’ refers to the changing profile of tenants and staff responses and interactions. Second, the ‘problem with rent’ centres on setting and collecting rents from very low–income tenants. Third, the ‘problem with housing standards and assets’ focuses on housing quality, maintaining properties and the tenant use of properties. Fourth, the ‘problems with the organisation’ are found in the constant searching for the best ways of defining roles, leading and communicating within a large and geographically distributed organisation. These are the features of work which present dilemmas for those who seek to produce better services for households who live in public housing.

Barriers and enablers to clinical fieldwork education in rural public and private allied health practice

There is a need to maximise rural clinical fieldwork placement to build health workforce capacity. This study investigated allied health professionals' (AHPs) experience of supervising students as part of work-integrated learning in public and private rural health settings. An anonymous postal questionnaire with 30 questions was used to collect quantitative and qualitative data about the barriers and enablers that AHPs encounter when supervising students in their clinical setting. A total of 113 public and private AHPs from Southwest Victoria, Australia, returned the questionnaire. The AHPs were trained in the disciplines of occupational therapy, physiotherapy, speech pathology, dietetics, podiatry or psychology. The majority of respondents (75%) had previously supervised students. Most respondents had only provided fieldwork education in the public sector. Allied health professionals working in public and private sectors had positive experiences with clinical fieldwork education and often had increased job satisfaction while supervising students. They experienced similar enablers to involvement in clinical fieldwork education programs, however the barriers they encountered were different. The findings highlight the differing issues between rural public and private settings that need to be addressed for successful clinical fieldwork education and work-integrated learning. Strategies to address the identified barriers need to be specific to the work conditions of each setting.

Talking up learning at work : cautionary tales in co‐opting everyday learning

Learning in workplaces is always mediated through talk. It is tempting for management to seek to utilise everyday talk as part of learning and therefore enhance productivity. This paper examines the responses of workers to interventions that aim to formalise informal conversations at work as part of an explicit workplace learning strategy. It draws on interviews with managers and workers in a public sector organisation to examine their experience of these practices. The paper raises questions about whether interventions in the name of fostering informal learning may well be hindering what they seek to promote.