Bridging divides:patient and public involvement on both sides of the Atlantic

Guest editorial

Revolution or evolution:the challenges of conceptualizing patient and public involvement in a consumerist world

Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice. Objective This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly. Conclusions A framework for conceptualizing PPI is presented that differentiates between the different types and aims of involvement and their potential impact. Approaches to involvement are different in those countries that adopt a rights-based rather than a regulatory approach. I conclude with a discussion of the tension and interaction apparent in the globalization of both involvement and patient choice in both policy and practice. © 2009 Blackwell Publishing Ltd.

Organisational receptivity for change:combining context and capability to explain competitive advantage

This thesis explores efforts to conjoin organisational contexts and capabilities in explaining sustainable competitive advantage. Oliver (1997) argued organisations need to balance the need to conform to industry’s requirements to attain legitimization (e.g. DiMaggio & Powell, 1983), and the need for resource optimization (e.g. Barney, 1991). The author hypothesized that such balance can be viewed as movements along the homogeneity-heterogeneity continuum. An organisation in a homogenous industry possesses similar characteristics as its competitors, as opposed to a heterogeneous industry in which organisations within are differentiated and competitively positioned (Oliver, 1997). The movement is influenced by the dynamic environmental conditions that an organisation is experiencing. The author extended Oliver’s (1997) propositions of combining RBV’s focus on capabilities with institutional theory’s focus on organisational context, as well as redefining organisational receptivity towards change (ORC) factors from Butler and Allen’s (2008) findings. The authors contributed to the theoretical development of ORC theory to explain the attainment of sustainable competitive advantage. ORC adopts the assumptions from both institutional and RBV theories, where the receptivity factors include both organisational contexts and capabilities. The thesis employed a mixed method approach in which sequential qualitative quantitative studies were deployed to establish a robust, reliable, and valid ORC scale. The adoption of Hinkin’s (1995) three-phase scale development process was updated, thus items generated from interviews and literature reviews went through numerous exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to achieve convergent, discriminant, and nomological validities. Samples in the first phase (semi structured interviews) were hotel owners and managers. In the second phase, samples were MBA students, and employees of private and public sectors. In the third phase, samples were hotel managers. The final ORC scale is a parsimonious second higher-order latent construct. The first-order constructs comprises four latent receptivity factors which are ideological vision (4 items), leading change (4 items), implementation capacity (4 items), and change orientation (7 items). Hypotheses testing revealed that high levels of perceived environmental uncertainty leads to high levels of receptivity factor. Furthermore, the study found a strong positive correlation between receptivity factors and competitive advantage, and between receptivity factors and organisation performance. Mediation analyses revealed that receptivity factors partially mediate the relationship between perceived environmental uncertainty, competitive advantage and organisational performance.

A statistical analysis of the structure of language found in the essay writing of a sample of technical college students and public school boys

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Outsourcing:assessing the risks and benefits for organisations, sectors and nations

Purpose - This research aims to assess the risks and benefits of outsourcing for organisations, sectors and nations. The literature on outsourcing contains little evidence of research on holistic issues of its impact at systems levels beyond the firm, notably sectors and nations. Design/methodology/approach - A Delphi study with senior strategists from private and public sectors captured perspectives and specific observations on benefits and risks of outsourcing. Emergent issues on outsourcing policy, strategy and decision-making processes were synthesised into a framework for analysing factors associated with outsourcing. Findings - The findings suggest that a more holistic view of outsourcing is needed, linking local, organisational issues with sector and national level actions and outcomes. In this way, aggregate risks and benefits can be assessed at different systems levels. Research limitations/implications - Future research might address the motivations for outsourcing; currently there is little research evidence to assess whether outsourcing is a mechanism for failing to solve internal problems, and moving responsibility and risk out of the firm. Additionally most outsourcing research to date has concentrated on an activity either being "in" or "out"; there is little research exploring the circumstances in which mixed models might be appropriate. Practical implications - The framework provides an aid to research and an aide memoire for managers considering outsourcing. Originality/value - This paper contributes to knowledge on understanding of outsourcing at different systems levels, particularly highlighting the implications of outsourcing for sectors and nations. Previously most research has focused at the level of the firm or dyadic relationship. © Emerald Group Publishing Limited.

Biologising parenting:neuroscience discourse, English social and public health policy and understandings of the child

In recent years, claims about children's developing brains have become central to the formation of child health and welfare policies in England. While these policies assert that they are based on neuro-scientific discoveries, their relationship to neuroscience itself has been debated. However, what is clear is that they portray a particular understanding of children and childhood, one that is marked by a lack of acknowledgment of child personhood. Using an analysis of key government-commissioned reports and additional advocacy documents, this article illustrates the ways that the mind of the child is reduced to the brain, and this brain comes to represent the child. It is argued that a highly reductionist and limiting construction of the child is produced, alongside the idea that parenting is the main factor in child development. It is concluded that this focus on children's brains, with its accompanying deterministic perspective on parenting, overlooks children's embodied lives and this has implications for the design of children's health and welfare services.

Procedural justice in procurement management and inclusive interorganizational relations:An institutional perspective

This paper applies the concept of procedural justice to one of the most important focal points of interorganizational relations: the purchaser-supplier relationship. The few extant studies of the concept in the purchaser-supplier domain have overlooked an important aspect of this key relationship: that is, inclusiveness in procurement. This is despite the fact that interest in the specific empirical context of supply chain links between large purchasing organizations (LPOs) and ethnic minority suppliers (EMSs) from disadvantaged communities proceeds apace on both sides of the Atlantic. Institutional theory is used to examine the form that procedural justice takes in eight case studies of LPOs from the private and public sectors, which actively engage with inclusive procurement management initiatives in England. The guiding question is twofold: 'What may LPO approaches to installing procedural justice in procurement management entail?' and 'How are these approaches shaped?' This paper identifies specific approaches to installing procedural justice for inclusive procurement and submits theoretical propositions about how these are shaped. The study contributes to a macro-level assessment of procedural justice, i.e. interorganizational procedural justice, as a significant aspect of inclusive interorganizational relationships, which is a domain in need of theoretical development.

Mothering and ‘insider’ dilemmas:feminist sociologists in the research process

This paper is about care, insider positions and mothering within feminist research. We ask questions about how honest, ethical and caring can we really be in placing the self into the research process as mothers ourselves. Should we leave out aspects of the research that do not fit neatly and how ethical can we claim to be if we do? Moreover, should difficult differences, secrets and silences that emerge from the research process and research stories that might 'out' us as failures be excluded from research outcomes so as to claim legitimate research? We consider the use of a feminist methods as crucial in the reciprocal and relational understanding of personal enquiry. Mothers invest significant emotional capital in their families and we explore the blurring of the interpersonal and intrapersonal when sharing mothering experiences common to both participant and researcher. Indeed participants can identify themselves within the process as 'friends' of the researcher. We both have familiarity within our respective research that has led to mutual understanding of having insider positions. Crucially individuals' realities are a vital component of the qualitative paradigm and that 'insider' research remains a necessary, albeit messy vehicle in social research. As it is we consider a growing body of literature which marks out and endorses a feminist ethics of care. All of which critique established ways of thinking about ethics, morality, security, citizenship and care. It provides alternatives in mapping private and public aspects of social life as it operates at a theoretical level, but importantly for this paper also at the level of practical application.

Biologising parenting:neuroscience discourse, English social and public health policy and understandings of the child

In recent years, claims about children's developing brains have become central to the formation of child health and welfare policies in England. While these policies assert that they are based on neuro-scientific discoveries, their relationship to neuroscience itself has been debated. However what is clear is that they portray a particular understanding of children and childhood, one that is marked by a lack of acknowledgment of child personhood. Using an analysis of key government-commissioned reports and additional advocacy documents, this chapter illustrates the ways that the mind of the child is reduced to the brain, and this brain comes to represent the child. It is argued that a highly reductionist and limiting construction of the child is produced, alongside the idea that parenting is the main factor in child development. It is concluded that this focus on children's brains, with its accompanying deterministic perspective on parenting, overlooks children's embodied lives and this has implications for the design of children's health and welfare services.

Africa's World Cup:critical reflections on play, patriotism, spectatorship, and space

Africas World Cup: Critical Reflections on Play, Patriotism, Spectatorship, and Space focuses on a remarkable month in the modern history of Africa and in the global history of football. Peter Alegi and Chris Bolsmann are well-known experts on South African football, and they have assembled an impressive team of local and international journalists, academics, and football experts to reflect on the 2010 World Cup and its broader significance, its meanings, complexities, and contradictions. The World Cups sounds, sights, and aesthetics are explored, along with questions of patriotism, nationalism, and spectatorship in Africa and around the world. Experts on urban design and communities write on how the presence of the World Cup worked to refashion urban spaces and negotiate the local struggles in the hosting cities. The volume is richly illustrated by authors photographs, and the essays in this volume feature chronicles of match day experiences; travelogues; ethnographies of fan cultures; analyses of print, broadcast, and electronic media coverage of the tournament; reflections on the World Cups private and public spaces; football exhibits in South African museums; and critiques of the World Cups processes of inclusion and exclusion, as well as its political and economic legacies. The volume concludes with a forum on the World Cup, including Thabo Dladla, Director of Soccer at the University of KwaZulu-Natal, Mohlomi Kekeletso Maubane, a well-known Soweto-based writer and a soccer researcher, and Rodney Reiners, former professional footballer and current chief soccer writer for the Cape Argus newspaper in Cape Town. This collection will appeal to students, scholars, journalists, and fans. Cover illustration: South African fan blowing his vuvuzela at South Africa vs. France, Free State Stadium, Bloemfontein, June 22, 2010. Photo by Chris Bolsmann.

Firm-level productivity growth in Northern Ireland:the impact of exporting, innovation and public financial assistance

Motivated by the historically poor productivity performance of Northern Ireland firms and the longstanding productivity gap with the UK, the aim of this thesis is to examine, through the use of firm-level data, how exporting, innovation and public financial assistance impact on firm productivity growth. These particular activities are investigated due to the continued policy focus on their link to productivity growth and the theoretical claims of a direct positive relationship. In order to undertake these analyses a newly constructed dataset is used which links together cross-sectional and longitudinal data over the 1998-2008 period from the Annual Business Survey, the Manufacturing Sales and Export Survey; the Community Innovation Survey and Invest NI Selective Financial Assistance (SFA) payment data. Econometric methodologies are employed to estimate each of the relationships with regards to productivity growth, making use in particular of Heckman selection techniques and propensity score matching to take account of critical issues of endogeneity and selection bias. The results show that more productive firms self-select into exporting but there is no resulting productivity effect from starting to export; contesting the argument for learning-by-exporting. Product innovation is also found to have no impact on productivity growth over a four year period but there is evidence of a negative process innovation impact, likely to reflect temporary learning effects. Finally SFA assistance, including the amount of the payment, is found to have no short term impact on productivity growth suggesting substantial deadweight effects and/or targeting of inefficient firms. The results provide partial evidence as to why Northern Ireland has failed to narrow the productivity gap with the rest of the UK. The analyses further highlight the need for access to comprehensive firm-level data for research purposes, not least to underpin robust evidence-based policymaking.

Disentangling patient and public involvement in healthcare decisions:why the difference matters

Patient and public involvement has become an integral aspect of many developed health systems and is judged to be an essential driver for reform. However, little attention has been paid to the distinctions between patients and the public, and the views of patients are often seen to encompass those of the general public. Using an ideal-type approach, we analyse crucial distinctions between patient involvement and public involvement using examples from Sweden and England. We highlight that patients have sectional interests as health service users in contrast to citizens who engage as a public policy agent reflecting societal interests. Patients draw on experiential knowledge and focus on output legitimacy and performance accountability, aim at typical representativeness, and a direct responsiveness to individual needs and preferences. In contrast, the public contributes with collective perspectives generated from diversity, centres on input legitimacy achieved through statistical representativeness, democratic accountability and indirect responsiveness to general citizen preferences. Thus, using patients as proxies for the public fails to achieve intended goals and benefits of involvement. We conclude that understanding and measuring the impact of patient and public involvement can only develop with the application of a clearer comprehension of the differences.