A study of outcomes measures in forensic mental health

Outcomes measures, which is the measurement of effectiveness of interventions and services has been propelled onto the health service agenda since the introduction of the internal market in the 1990s. It arose as a result of the escalating cost of inpatient care, the need to identify what interventions work and in what situations, and the desire for effective information by service users enabled by the consumerist agenda introduced by Working for Patients white paper. The research reported in this thesis is an assessment of the readiness of the forensic mental health service to measure outcomes of interventions. The research examines the type, prevalence and scope of use of outcomes measures, and further seeks a consensus of views of key stakeholders on the priority areas for future development. It discusses the theoretical basis for defining health and advocates the argument that the present focus on measuring effectiveness of care is misdirected without the input of users, particularly patients in their care, drawing together the views of the many stakeholders who have an interest in the provision of care in the service. The research further draws on the theory of structuration to demonstrate the degree to which a duality of action, which is necessary for the development, and use of outcomes measures is in place within the service. Consequently, it highlights some of the hurdles that need to be surmounted before effective measurement of health gain can be developed in the field of study. It concludes by advancing the view that outcomes research can enable practitioners to better understand the relationship between the illness of the patient and the efficacy of treatment. This understanding it is argued would contribute to improving dialogue between the health care practitioner and the patient, and further providing the information necessary for moving away from untested assumptions, which are numerous in the field about the superiority of one treatment approach over another.

The missing ingredient:inter-municipal cooperation and central-local relations in the UK

The thrust of the argument presented in this chapter is that inter-municipal cooperation (IMC) in the United Kingdom reflects local government's constitutional position and its exposure to the exigencies of Westminster (elected central government) and Whitehall (centre of the professional civil service that services central government). For the most part councils are without general powers of competence and are restricted in what they can do by Parliament. This suggests that the capacity for locally driven IMC is restricted and operates principally within a framework constructed by central government's policy objectives and legislation and the political expediencies of the governing political party. In practice, however, recent examples of IMC demonstrate that the practices are more complex than this initial analysis suggests. Central government may exert top-down pressures and impose hierarchical directives, but there are important countervailing forces. Constitutional changes in Scotland and Wales have shifted the locus of central- local relations away from Westminster and Whitehall. In England, the seeding of English government regional offices in 1994 has evolved into an important structural arrangement that encourages councils to work together. Within the local government community there is now widespread acknowledgement that to achieve the ambitious targets set by central government, councils are, by necessity, bound to cooperate and work with other agencies. In recent years, the fragmentation of public service delivery has affected the scope of IMC. Elected local government in the UK is now only one piece of a complex jigsaw of agencies that provides services to the public; whether it is with non-elected bodies, such as health authorities, public protection authorities (police and fire), voluntary nonprofit organisations or for-profit bodies, councils are expected to cooperate widely with agencies in their localities. Indeed, for projects such as regeneration and community renewal, councils may act as the coordinating agency but the success of such projects is measured by collaboration and partnership working (Davies 2002). To place these developments in context, IMC is an example of how, in spite of the fragmentation of traditional forms of government, councils work with other public service agencies and other councils through the medium of interagency partnerships, collaboration between organisations and a mixed economy of service providers. Such an analysis suggests that, following changes to the system of local government, contemporary forms of IMC are less dependent on vertical arrangements (top-down direction from central government) as they are replaced by horizontal modes (expansion of networks and partnership arrangements). Evidence suggests, however that central government continues to steer local authorities through the agency of inspectorates and regulatory bodies, and through policy initiatives, such as local strategic partnerships and local area agreements (Kelly 2006), thus questioning whether, in the case of UK local government, the shift from hierarchy to network and market solutions is less differentiated and transformation less complete than some literature suggests. Vertical or horizontal pressures may promote IMC, yet similar drivers may deter collaboration between local authorities. An example of negative vertical pressure was central government's change of the systems of local taxation during the 1980s. The new taxation regime replaced a tax on property with a tax on individual residency. Although the community charge lasted only a few years, it was a highpoint of the then Conservative government policy that encouraged councils to compete with each other on the basis of the level of local taxation. In practice, however, the complexity of local government funding in the UK rendered worthless any meaningful ambition of councils competing with each other, especially as central government granting to local authorities is predicated (however imperfectly) on at least notional equalisation between those areas with lower tax yields and the more prosperous locations. Horizontal pressures comprise factors such as planning decisions. Over the last quarter century, councils have competed on the granting of permission to out-of-town retail and leisure complexes, now recognised as detrimental to neighbouring authorities because economic forces prevail and local, independent shops are unable to compete with multiple companies. These examples illustrate tensions at the core of the UK polity of whether IMC is feasible when competition between local authorities heightened by local differences reduces opportunities for collaboration. An alternative perspective on IMC is to explore whether specific purposes or functions promote or restrict it. Whether in the principle areas of local government responsibilities relating to social welfare, development and maintenance of the local infrastructure or environmental matters, there are examples of IMC. But opportunities have diminished considerably as councils lost responsibility for services provision as a result of privatisation and transfer of powers to new government agencies or to central government. Over the last twenty years councils have lost their role in the provision of further-or higher-education, public transport and water/sewage. Councils have commissioning power but only a limited presence in providing housing needs, social care and waste management. In other words, as a result of central government policy, there are, in practice, currently far fewer opportunities for councils to cooperate. Since 1997, the New Labour government has promoted IMC through vertical drivers and the development; the operation of these policy initiatives is discussed following the framework of the editors. Current examples of IMC are notable for being driven by higher tiers of government, working with subordinate authorities in principal-agent relations. Collaboration between local authorities and intra-interand cross-sectoral partnerships are initiated by central government. In other words, IMC is shaped by hierarchical drivers from higher levels of government but, in practice, is locally varied and determined less by formula than by necessity and function. © 2007 Springer.

A profile of low vision services in England the Low Vision Service Model Evaluation (LOVSME) project

In the UK, low vision rehabilitation is delivered by a wide variety of providers with different strategies being used to integrate services from health, social care and the voluntary sector. In order to capture the current diversity of service provision the Low vision Service Model Evaluation (LOVSME) project aimed to profile selected low vision services using published standards for service delivery as a guide. Seven geographically and organizationally varied low-vision services across England were chosen for their diversity and all agreed to participate. A series of questionnaires and follow-up visits were undertaken to obtain a comprehensive description of each service, including the staff workloads and the cost of providing the service. In this paper the strengths of each model of delivery are discussed, and examples of good practice identified. As a result of the project, an Assessment Framework tool has been developed that aims to help other service providers evaluate different aspects of their own service to identify any gaps in existing service provision, and will act as a benchmark for future service development.

The antecedents and consequences of e-business adoption in Malaysian manufacturing firms

Theory suggests that firms that adopt innovation share some common characteristics, just as those who do not adopt innovation and firms adopt a particular technology because the functions provided by the chosen technology fulfils their needs. Building on these arguments, this research project investigates the antecedents and consequences of e-business adoption among manufacturing firms in Malaysia. This thesis develops from the existing literature of organisational innovation adoption, information technology and strategic marketing/management. It further adds to the existing literature by using cultural-based predictors representing organisational characteristics consisting of market orientation, innovativeness and organisational learning. The study also formalises the theoretical framework of organisational-environment-technology. This study develops a new construct called technology motivation in addition to the introduction of several e-business technology scales. The results substantiate the significance of firm technology motivation in determining firm adoption of the various e-business initiatives. In addition, business environment and market orientation are found to influence firm choice of technology motivation. Meanwhile, innovativeness and organisational learning are shown to influence the magnitude of a firm’s e-business adoption. Finally, the results show that firm adoption of e-business technology does not influence organisational performance. This investigation clarifies the rationale and importance of firm technology motivation in adopting the various e-business initiatives. It also highlights the importance of having the appropriate organisational culture in ensuring a successful technology adoption.

Marketing resources of actively involved exporters

The purpose of this dissertation is to examine the impact of the market orientation and market based resources of actively involved exporters and their distributors on export venture performance. Previous literature in marketing channels has examined the effect of the market orientation of suppliers and their distributors on supplier-distributor relationships, mainly in a domestic context, as well as the impact of the quality of their relationship on business performance in domestic and international contexts. Little or no research focuses on the interplay between the relevant marketing resources, such as market orientation, proactive market orientation, selling, pricing reputation, and market innovation, of an export venture and their distributor, and consequently on export venture performance. This dissertation is mainly a quantitative study using a mail survey among Greek exporting firms in various industries. The final sample comprised 190 exporting ventures. The survey was enhanced through open interviews with export venture managers and their respective distributors and was pre-tested with a small-scale dyadic survey. Survey data were analysed using structural equation modelling. The main research objective was to assess the impact of marketing support resources, namely market orientation and proactive market orientation, and market-based resources of an export venture and its distributor on export performance. In addition, the relationship of marketing support resources of the export venture and those of the distributor was examined. Some of the relationships examined are a migration of traditional domestic theory (Hooley et al. 2005), to an exporting context, testing whether there are differences in the relationships in a different context. This study contributes to the resource-based view, marketing, and export business literature, as findings indicate that high levels of export venture proactive market orientation lead to distributors with high levels of market orientation. In line with findings of domestic context research, the proactive market orientation of the venture renders its market orientation statistically not significant.

"Marketing and flexibility":debates past present and future

Special issue editorial: Purpose – The purpose of this paper is to outline the articles presented in the Special Issue on the topic of “Marketing and flexibility”, and to discuss key issues associated with major debates relating to flexibility in order to position the articles within a wider context and highlight some key issues for further research. Design/methodology/approach – Themes in prior research relating to “Marketing and flexibility” are documented and the growth of research interest into strategic flexibility is tabulated. The contributions of each article are briefly discussed. Findings – There has been a steady growth of research interest into flexibility. To provide an example of this growth, the increase in the number of articles published on the topic of strategic flexibility in scholarly journals is highlighted over a 20-year period. Key issues in prior research such as alternative definitions and the different postulated relationships between market orientation and strategic flexibility are revealed, as are issues for future research. Originality/value – Key issues relating to research into flexibility for marketing scholars are revealed.

The role of the sales employee in securing customer satisfaction

Purpose: Previous research has emphasized the pivotal role that salespeople play in customer satisfaction. In this regard, the relationship between salespeople's attitudes, skills, and characteristics, and customer satisfaction remains an area of interest. The paper aims to make three contributions: first, it seeks to examine the impact of salespeople's satisfaction, adaptive selling, and dominance on customer satisfaction. Second, this research aims to use dyadic data, which is a better test of the relationships between constructs since it avoids common method variance. Finally, in contrast to previous research, it aims to test all of the customers of salespeople rather than customers selected by salespeople. Design/methodology/approach: The study employs multilevel analysis to examine the relationship between salespeople's satisfaction with the firm on customer satisfaction, using a dyadic, matched business-to-business sample of a large European financial service provider that comprises 188 customers and 18 employees. Findings: The paper finds that customers' evaluation of service quality, product quality, and value influence customer satisfaction. The analysis at the selling firm's employee level shows that adaptive selling and employee satisfaction positively impact customer satisfaction, while dominance is negatively related to customer satisfaction. Practical implications: Research shows that customer-focus is a key driver in the success of service companies. Customer satisfaction is regarded as a prerequisite for establishing long-term, profitable relations between company and customer, and customer contact employees are key to nurturing this relationship. The role of salespeople's attitudes, skills, and characteristics in the customer satisfaction process are highlighted in this paper. Originality/value: The use of dyadic, multilevel studies to assess the nature of the relationship between employees and customers is, to date, surprisingly limited. The paper examines the link between employee attitudes, skills, and characteristics, and customer satisfaction in a business-to-business setting in the financial service sector, differentiating between customer- and employee-level drivers of business customer satisfaction.

Strategic marketing and business performance:a study in three European 'engineering countries'

In spite of its relevance, the effects of strategic marketing on business performance are sparingly studied, especially in particular business contexts. We address this gap in two ways. First, we examine the influence of four key strategic marketing concepts—market orientation, innovation orientation, and two marketing capability categories (outside-in and inside-out capabilities)—on company performance. Second, these relationships are studied in three European “engineering countries:” Austria, Finland and Germany. Their relative homogeneity enables testing the generality versus context-specificity of strategic marketing's performance impact. Using SEM analysis, surprisingly weak relationships between market orientation and outside-in capabilities, and business performance are identified, as opposed to the strong role of inside-out capabilities and innovation orientation. These results can be understood through the “engineering country” characteristics. Moreover, clear differences in results are identified among these relatively homogenous countries. This is a major finding as it challenges the widely assumed generality of the strategic marketing–performance relationship. Country-specific results have also considerable managerial relevance.

E-government strategy in Turkey:a case for m-government

Market orientation strategies are now expected to be integrated and enacted by firms and governments alike. While private services will surely continue to take the lead in mobile strategy orientation, others such as government and Non-Governmental Organizations (NGOs) are also becoming prominent Mobile Players (m-Players). Enhanced data services through smart phones are raising expectations that governments will finally deliver services that are in line with a consumer ICT lifestyle. To date, it is not certain which form of technological standards will take the lead, e.g. enhanced m-services or traditional Internet-based applications. Yet, with the introduction of interactive applications and fully transactional services via 3G smart phones, the currently untapped segment of the population (without computers) have the potential to gain access to government services at a low cost.

From transferred technology to technological capability:a framework for examining the acquisition of technological capability by Chinese enterprises

This paper conceptualises the enhancement of technological capability by firms, following international technology transfer, as an evolutionary process. During this process, the existing technological, managerial and other complementary resources may require restructuring. Since China is in transition from central planning to market orientation, the organisational and managerial practices of Chinese firms are different from those of international technology suppliers. Resourcebased and evolutionary theories of the firm, which provide insights into the evolution of structures, mechanisms, skills, experiences and technical know-how, have been applied to outline the processes of acquiring technological capability. Selected case studies have been used to illustrate the issues and the framework provides guide for further empirical work.

Servitization of manufacture:exploring the deployment and skills of people critical to the delivery of advanced services

Purpose - This "research note" sets out to fuel the debate around the practices and technologies within operations that are critical to success with servitization. It presents a study of four companies which are delivering advanced services and reports on the organisation and skill-sets of people within these. Design/methodology/approach - This has been case-based research at four manufacturers leading in their delivery of services. Findings - It describes the desirable behaviour of people in the front-line of service delivery, identifies the supporting skill-sets, how these people are organised, and explains why all these factors are so important. Originality/value - This paper contributes to the understanding of the servitization process and, in particular, the implications to broader operations of the firm. © 2013 Emerald Group Publishing Limited. All rights reserved.

Servitization of the manufacturing firm:exploring the operations practices and technologies that deliver advanced services

Purpose: This paper aims to explore practices and technologies successfully servitised manufacturers employ in the delivery of advanced services. Design/methodology/approach: A case study methodology is applied across four manufacturing organisations successful in servitization. Through interviews with personnel across host manufacturers, their partners, and key customers, extensive data are collected about service delivery systems. Analyses identify convergence in their practices and technologies. Findings: Six distinct technologies and practices are revealed: facilities and their location, micro-vertical integration and supplier relationships, information and communication technologies (ICTs), performance measurement and value demonstration, people deployment and their skills, and business processes and customer relationships. These are then combined in an integrative framework that illustrates how operations are configured to successfully deliver advanced services. Research limitations/implications: The analyses are reductive and rationalising. Future studies could identify other technologies and practices. Case study as a method is inherently limited in the extent to which findings can be generalised. Practical implications: Awareness and interest in servitization is growing, yet adoption of a servitization strategy requires particular organisational capabilities on the part of the manufacturer. This study identifies technologies and practices that underpin these capabilities. Originality/value: This paper contributes to the understanding of the servitization process and, in particular, the implications to broader operations of the firm. © Emerald Group Publishing Limited.

Marketing performance assessment systems and the business context

Purpose ‐ This study provides empirical evidence for the contextuality of marketing performance assessment (MPA) systems. It aims to introduce a taxonomical classification of MPA profiles based on the relative emphasis placed on different dimensions of marketing performance in different companies and business contexts. Design/methodology/approach ‐ The data used in this study (n=1,157) were collected using a web-based questionnaire, targeted to top managers in Finnish companies. Two multivariate data analysis techniques were used to address the research questions. First, dimensions of marketing performance underlying the current MPA systems were identified through factor analysis. Second, a taxonomy of different profiles of marketing performance measurement was created by clustering respondents based on the relative emphasis placed on the dimensions and characterizing them vis-á-vis contextual factors. Findings ‐ The study identifies nine broad dimensions of marketing performance that underlie the MPA systems in use and five MPA profiles typical of companies of varying sizes in varying industries, market life cycle stages, and competitive positions associated with varying levels of market orientation and business performance. The findings support the previously conceptual notion of contextuality in MPA and provide empirical evidence for the factors that affect MPA systems in practice. Originality/value ‐ The paper presents the first field study of current MPA systems focusing on combinations of metrics in use. The findings of the study provide empirical support for the contextuality of MPA and form a classification of existing contextual systems suitable for benchmarking purposes. Limited evidence for performance differences between MPA profiles is also provided.

What determines tax haven FDI

This paper examines the determinants of a multinational enterprise’s (MNEs) decision to invest in countries classified as tax havens. To the best of our knowledge this has not been analysed at the cross-country level before. We use the ownership-location-internalisation (OLI) paradigm and link it with financial specific advantages to develop a number of hypotheses which are subsequently tested by our empirical model. Our analysis is based on a large firm-level database covering 39,543 MNEs across the world for the period 2002- 2011. We find that higher corporate taxes faced by MNEs at home increase the likelihood of locating in a tax haven. Moreover, high technology manufacturing and services MNEs that possess large levels of intangible assets are also more likely to locate subsidiaries in tax havens. Finally, we find evidence that MNEs from countries with a more coordinated market orientation are less likely to locate in tax havens.

A model of transactional and transformational leadership for services personnel

This paper is concerned with the effects that leadership styles (i.e., transactional and transformational) can have upon the level of front-line employees’ service delivery quality. Previous literature has mostly looked at leadership and its effects upon subordinates within a sales, psychology, or human resources context. However, due to the idiosyncrasies inherent in services (i.e., intangibility, heterogeneity, perishability, and inseparability), it is likely that, in such a context, different leadership styles will effect performance outcomes. Consequently, this paper seeks to expand the services marketing literature by developing a conceptual framework of leadership style effects adapted to the field of services marketing. Of particular importance are the effects that leadership styles have upon front-line employee “motivators” and service-related job outcomes. Specific hypotheses are developed and future research directions are also presented for consideration.