Provider diversity in the NHS: impact on quality and innovation

The overall objective of the research project has been to assess the impact of provider diversity on quality and innovation in the NHS. The specific research aims were to identify the differences in performance between non-profit Third Sector organisations, for-profit private enterprises, and incumbent public sector institutions within the NHS as providers of health care services, as well as the factors that affect the entry and growth of new private and Third Sector providers. The study used both qualitative and quantitative methods based on case studies of four Local Health Economies (LHEs). Qualitative methods included documentary analysis and interviews with key informants and managers of both commissioning and provider organisations. To provide a focus to the study, two tracer conditions were followed: orthopaedic surgery and home health care for frail older people. In the case of hospital inpatient care, data on patient characteristics were also collected from the HES database. The analysis of this data provided preliminary estimates of the effects of provider type on quality, controlling for client characteristics and case mix. In addition, a survey of patient experience in diverse provider organisations was analysed to compare the different dimensions of quality of provision of acute services between incumbent NHS organisations and new independent sector treatment centres. The research has shown that, in respect of inpatient hospital services, diverse providers supply health services of at least as good quality as traditional NHS providers, and that there is ample opportunity to expand their scale and scope as providers of services commissioned by the NHS. The research used patient experience survey data to investigate whether hospital ownership affects the quality of services reported by NHS patients in areas other than clinical quality. The raw survey data appear to show that private hospitals provide higher quality services than the public hospitals. However, further empirical analysis leads to a more nuanced understanding of the performance differences. Firstly, the analysis shows that each sector offers greater quality in certain specialties. Secondly, the analysis shows that differences in the quality of patients’ reported experience are mainly attributable to patient characteristics, the selection of patients into each type of hospital, and the characteristics of individual hospitals, rather than to hospital ownership as such. Controlling for such differences, NHS patients are on average likely to experience a similar quality of care in a public or privately-run hospital. Nevertheless, for specific groups of patients and for specific types of treatments, especially the more straightforward ones, the private sector provides an improved patient experience compared to the public sector. Elsewhere, the NHS continues to provide a high quality service and outperforms the private sector in a range of services and for a range of clients.

Mid-term evaluation of African Technology Policy Studies Network Phase VI Strategic Plan: for the period January 1, 2009 to December 31, 2010

The African Technology Policy Studies Network (ATPS) is a multidisciplinary network of researchers, private sector actors, policymakers and civil society. ATPS has the vision to become the leading international centre of excellence and reference in science, technology and innovation (STI) systems research, training and capacity building, communication and sensitization, knowledge brokerage, policy advocacy and outreach in Africa. It has a Regional Secretariat in Nairobi Kenya, and operates through national chapters in 29 countries (including 27 in Africa and two Chapters in the United Kingdom and USA for Africans in the Diaspora) with an expansion plan to cover the entire continent by 2015. The ATPS Phase VI Strategic Plan aims to improve the understanding and functioning of STI processes and systems to strengthen the learning capacity, social responses, and governance of STI for addressing Africa's development challenges, with a specific focus on the Millennium Development Goals (MDGs). A team of external evaluators carried out a midterm review to assess the effectiveness and efficiency of the implementation of the Strategic Plan for the period January 1, 2009 to December 31, 2010. The evaluation methodology involved multiple quantitative and qualitative methods to assess the qualitative and quantitative inputs (human resources, financial resources, time, etc.) into ATPS activities (both thematic and facilitative) and their tangible and intangible outputs, outcomes and impacts. Methods included a questionnaire survey of ATPS members and stakeholders, key informant interviews, and focus group discussions (FGDs) with members in six countries. Effectiveness of Programmes Under all six strategic goals, very good progress has been made towards planned outputs and outcomes. This is evidenced by key performance indicators (KPIs) generated from desk review, ratings from the survey respondents, and the themes that run through the FGDs. Institutional and Programme Cost Effectiveness Institutional Effectiveness: assessment of institutional effectiveness suggests that adequate management frameworks are in place and are being used effectively and transparently. Also technical and financial accounting mechanisms are being followed in accordance with grant agreements and with global good practice. This is evidenced by KPIs generated from desk review. Programme Cost Effectiveness: assessment of cost-effectiveness of execution of programmes shows that organisational structure is efficient, delivering high quality, relevant research at relatively low cost by international standards. The evidence includes KPIs from desk review: administrative costs to programme cost ratio has fallen steadily, to around 10%; average size of research grants is modest, without compromising quality. There is high level of pro bono input by ATPS members. ATPS Programmes Strategic Evaluation ATPS research and STI related activities are indeed unique and well aligned with STI issues and needs facing Africa and globally. The multi-disciplinary and trans-boundary nature of the research activities are creating a unique group of research scientists. The ATPS approach to research and STI issues is paving the way for the so called Third Generation University (3GU). Understanding this unique positioning, an increasing number of international multilateral agencies are seeking partnership with ATPS. ATPS is seeing an increasing level of funding commitments by Donor Partners. Recommendations for ATPS Continued Growth and Effectiveness On-going reform of ATPS administrative structure to continue The on-going reforms that have taken place within the Board, Regional Secretariat, and at the National Chapter coordination levels are welcomed. Such reform should continue until fully functional corporate governance policy and practices are fully established and implemented across the ATPS governance structures. This will further strengthen ATPS to achieve the vision of being the leading STI policy brokerage organization in Africa. Although training in corporate governance has been carried out for all sectors of ATPS leadership structure in recent time, there is some evidence that these systems have not yet been fully implemented effectively within all the governance structures of the organization, especially at the Board and National chapter levels. Future training should emphasize practical application with exercises relevant to ATPS leadership structure from the Board to the National Chapter levels. Training on Transformational Leadership - Leading a Change Though a subject of intense debate amongst economists and social scientists, it is generally agreed that cultural mindsets and attitudes could enhance and/or hinder organizational progress. ATPS’s vision demands transformational leadership skills amongst its leaders from the Board members to the National Chapter Coordinators. To lead such a change, ATPS leaders must understand and avoid personal and cultural mindsets and value systems that hinder change, while embracing those that enhance it. It requires deliberate assessment of cultural, behavioural patterns that could hinder progress and the willingness to be recast into cultural and personal habits that make for progress. Improvement of relationship amongst the Board, Secretariat, and National Chapters A large number of ATPS members and stakeholders feel they do not have effective communications and/or access to Board, National Chapter Coordinators and Regional Secretariat activities. Effort should be made to improve the implementation of ATPS communication strategy to improve on information flows amongst the ATPS management and the members. The results of the survey and the FGDs suggest that progress has been made during the past two years in this direction, but more could be done to ensure effective flow of pertinent information to members following ATPS communications channels. Strategies for Increased Funding for National Chapters There is a big gap between the fundraising skills of the Regional Secretariat and those of the National Coordinators. In some cases, funds successfully raised by the Secretariat and disbursed to national chapters were not followed up with timely progress and financial reports by some national chapters. Adequate training in relevant skills required for effective interactions with STI key policy players should be conducted regularly for National Chapter coordinators and ATPS members. The ongoing training in grant writing should continue and be made continent-wide if funding permits. Funding of National Chapters should be strategic such that capacity in a specific area of research is built which, with time, will not only lead to a strong research capacity in that area, but also strengthen academic programmes. For example, a strong climate change programme is emerging at University of Nigeria Nsukka (UNN), with strong collaborations with Universities from neighbouring States. Strategies to Increase National Government buy-in and support for STI Translating STI research outcomes into policies requires a great deal of emotional intelligence, skills which are often lacking in the first and second generation universities. In the epoch of the science-based or 2GUs, governments were content with universities carrying out scientific research and providing scientific education. Now they desire to see universities as incubators of new science- or technology-based commercial activities, whether by existing firms or start-ups. Hence, governments demand that universities take an active and leading role in the exploitation of their knowledge and they are willing to make funds available to support such activities. Thus, for universities to gain the attention of national leadership they must become centres of excellence and explicit instruments of economic development in the knowledge-based economy. The universities must do this while working collaboratively with government departments, parastatals, and institutions and dedicated research establishments. ATPS should anticipate these shifting changes and devise programmes to assist both government and universities to relate effectively. New administrative structures in member organizations to sustain and manage the emerging STI multidisciplinary teams Second Generation universities (2GUs) tend to focus on pure science and often do not regard the application of their know-how as their task. In contrast, Third Generation Universities (3GUs) objectively stimulate techno-starters – students or academics – to pursue the exploitation or commercialisation of the knowledge they generate. They view this as being equal in importance to the objectives of scientific research and education. Administratively, research in the 2GU era was mainly monodisciplinary and departments were structured along disciplines. The emerging interdisciplinary scientific teams with focus on specific research areas functionally work against the current mono-disciplinary faculty-based, administrative structure of 2GUs. For interdisciplinary teams, the current faculty system is an obstacle. There is a need for new organisational forms for university management that can create responsibilities for the task of know-how exploitation. ATPS must anticipate this and begin to strategize solutions for their member institutions to transition to 3Gus administrative structure, otherwise ATPS growth will plateau, and progress achieved so far may be stunted.

The evolution of innovation capability in multinational enterprise subsidiaries: dual network embeddedness and the divergence of subsidiary specialisation in Taiwan

This paper examines how innovation-related capabilities for production, design and marketing develop at the subsidiary level within multinational enterprises (MNEs). We focus on how subsidiary autonomy and changing opportunities to access internal (MNE) and external (host country) sources of capability contribute in a combined way to the accumulation of specialist capabilities in five Taiwan-based MNE subsidiaries in the semiconductor industry. Longitudinal analysis shows how the accumulation process is subject to discontinuities, as functional divisions are (re)opened and closed during the lifetime of the subsidiary. A composite set of innovation output measures also shows significant variations in within-function levels of capability across our sample. We conclude that subsidiary specialisation and unique subsidiary-specific advantages have evolved in a way that is strongly influenced by the above factors.

UK innovation systems for new and renewable energy technologies: drivers, barriers and systems failures

A better understanding of the systemic processes by which innovation occurs is useful, both conceptually and to inform policymaking in support of innovation in more sustainable technologies. This paper analyses current innovation systems in the UK for a range of new and renewable energy technologies, and generates policy recommendations for improving the effectiveness of these innovation systems. Although incentives are in place in the UK to encourage innovation in these technologies, system failures—or ‘gaps’—are identified in moving technologies along the innovation chain, preventing their successful commercialisation. Sustained investment will be needed for these technologies to achieve their potential. It is argued that a stable and consistent policy framework is required to help create the conditions for this. In particular, such a framework should be aimed at improving risk/reward ratios for demonstration and pre-commercial stage technologies. This would enhance positive expectations, stimulate learning effects leading to cost reductions, and increase the likelihood of successful commercialisation.

New wine into old skins: the enactment of literacy policy in Singapore

To better comprehend how educational reforms and classroom practice interconnect, we need to understand the epistemic environments created for learning, as well as the pedagogical activities and the modes of classroom discourse related to these activities. This article examines how a particular innovation in English literacy, Strategies for English Language Learning and Reading (STELLAR), has been implemented in Singapore. Outlining the broader curriculum initiatives, current literacy policy landscape and pedagogical effect of classroom discourse, we look at how English language teachers in grades 1 and 2 interpret the STELLAR curriculum. Situated within the larger international zeal of educational reform, Singapore presents a rich case for the study of policy–pedagogy initiatives, literacy instruction and cultural values. Adding to the existing policy enactment research, this investigation provides an opportunity to probe both the prospects and limitations of policy implementation associated with centralised educational structures, examination-oriented systems and societal cultural frameworks.

Creativity and Growth in: Edmund Phelps (2013),Mass Flourishing. How Grassroots Innovation Created Jobs, Challenge and Change

This article reviews the thesis presented by Edmund Phelps, Mass Flourishing. How Grassroots Innovation Created Jobs, Challenge and Change (Princeton University Press, 2013) that modern economic growth is an indirect outcome of human creativity, and that the object of enlightened policy ought to be to promote this creativity, or flourishing, rather than economic growth per se. The book is a remarkable contribution to the literature on economic growth, with its focus on how entrepreneurship and innovation generates endogenous growth and, more importantly to the author, improves human satisfaction.

How culture and government shape entrepreneurial innovation: the case of Korean and UK online gaming firms

This paper examines institutional sources of product innovation with reference to the online gaming sector of Korea and the UK. It examines the combined impact of formal and informal institutions and their interaction with multiple case studies. Despite the growing importance of innovative products in contemporary entertainment (including interactive games), the ‘informal’ source of innovation has attracted limited attention. By closely looking at the idea exploration, generation and selection process (where creativity plays a major role), we intend to find out how values and public policy affect product innovation. This study shows that the value of Korean and UK online gaming firms (regardless of their different socio-economic contexts) plays an important role in generating product innovation. An additional point is that Korean firms are likely to take advantage of government policy support to overcome inadequate institutional settings in conjunction with the initial conditions of online game development.

Adaptive governance: livelihood innovation for climate resilience in Uganda

Adaptive governance is the use of novel approaches within policy to support experimentation and learning. Social learning reflects the engagement of interdependent stakeholders within this learning. Much attention has focused on these concepts as a solution for resilience in governing institutions in an uncertain climate; resilience representing the ability of a system to absorb shock and to retain its function and form through reorganisation. However, there are still many questions to how these concepts enable resilience, particularly in vulnerable, developing contexts. A case study from Uganda presents how these concepts promote resilient livelihood outcomes among rural subsistence farmers within a decentralised governing framework. This approach has the potential to highlight the dynamics and characteristics of a governance system which may manage change. The paper draws from the enabling characteristics of adaptive governance, including lower scale dynamics of bonding and bridging ties and strong leadership. Central to these processes were learning platforms promoting knowledge transfer leading to improved self-efficacy, innovation and livelihood skills. However even though aspects of adaptive governance were identified as contributing to resilience in livelihoods, some barriers were identified. Reflexivity and multi-stakeholder collaboration were evident in governing institutions; however, limited self-organisation and vertical communication demonstrated few opportunities for shifts in governance, which was severely challenged by inequity, politicisation and elite capture. The paper concludes by outlining implications for climate adaptation policy through promoting the importance of mainstreaming adaptation alongside existing policy trajectories; highlighting the significance of collaborative spaces for stakeholders and the tackling of inequality and corruption.

Geography, skills and careers patterns at the boundary of creativity & innovation: digital technology and creative arts graduates in the UK

In the last decades, research on knowledge economies has taken central stage. Within this broader research field, research on the role of digital technologies and the creative industries has become increasingly important for researchers, academics and policy makers with particular focus on their development, supply-chains and models of production. Furthermore, many have recognised that, despite the important role played by digital technologies and innovation in the development of the creative industries, these dynamics are hard to capture and quantify. Digital technologies are embedded in the production and market structures of the creative industries and are also partially distinct and discernible from it. They also seem to play a key role in innovation of access and delivery of creative content. This chapter tries to assess the role played by digital technologies focusing on a key element of their implementation and application: human capital. Using student micro-data collected by the Higher Education Statistical Agency (HESA) in the United Kingdom, we explore the characteristics and location patterns of graduates who entered the creative industries, specifically comparing graduates in the creative arts and graduates from digital technology subjects. We highlight patterns of geographical specialisation but also how different context are able to better integrate creativity and innovation in their workforce. The chapter deals specifically with understanding whether these skills are uniformly embedded across the creative sector or are concentrated in specific sub-sectors of the creative industries. Furthermore, it explores the role that these graduates play in different sub-sector of the creative economy, their economic rewards and their geographical determinants.

Pharmaceutical benefits in Australia and Sweden: welfare policy and the cost of prescription drugs

Pharmaceutical benefits provide a stable framework within which consumers, prescribers, suppliers, pharmacists and other actors undertake transactions. The state in effect delivers a good that enhances individual autonomy. A major reason for the legitimacy enjoyed by pharmaceutical benefits in both Australia and Sweden is that these programs have strong attributes of universalism (rather than targeting). Sweden's predominantly public health system allows greater scope for pharmaceutical policy innovation. Australia's Pharmaceutical Benefits Scheme (PBS), while historically resilient and effective, is now wedged precariously between traditional considerations of equity and public health on the one hand, and constant pressure for increased marketisation on the other.

Transitional labour markets : a social investment and risk mitigation strategy for social policy

Drawing on transitional labor market (TLM) theory, this introductory chapter highlights major themes, overviews the contributions to this volume and suggests a future agenda for policy makers. The focus of applied research projects has been the impact of post-modem social transformations on systems of social protection, looking through the lens of the labor market and shifts in household and family structure. The Transitional Labor Market project uses the TLM model as a means of developing new thinking on how flexibility and innovation might be paired with social investment and new forms of social protection. TLM theory emphasizes the importance of institutions and of the links between different institutions which frequently operate as policy silos, rather than integrated systems to buffer risks and support capability and enhance employability. The great advantage of the TLM model is that it draws attention to the right places for strategic reform. It does not offer a standard set of institutions to facilitate transitions however.

Transacting with citizens: Australian government policy, strategy and implementation of online tax lodgement

Many governments have shown leadership in encouraging their citizenry to conduct transactions on-line. The policies that underpin these initiatives refer to a blend of civic benefits and efficiency goals. They combine the rhetoric of customer service with social shaping through ‘government as model user’ and procedures that require online activities. Many initiatives are described as ‘electronic service delivery’, terms that indicate an intention to provide much more than an additional channel for government interaction with citizens. Australia, as an innovator in eGovernment is a good example of this approach and its national government has specified policy goals for its online strategy. In this paper we examine the case of one Australian online delivery initiative, electronic tax lodgement (e-tax) and consider how well that initiative has met the policy goals of the government. Combining insights from Rogers’ Diffusion of Innovation theory and political analysis, we outline potential difficulties that governments face in implementing ESD initiatives. Our conclusion from this case study is that the provision of good technology is only a small part of the ESD challenge. It shows how success of an ESD implementation may yield contradictory outcomes in terms of overall eGovernment strategies. This case highlights the need for long-term
implementation plans and integration of initiatives with broader government strategy.

'Creative destruction': knowledge economy policy and the future of arts and humanities in the academy

Policy conceptualizations of the global knowledge economy have led to the channelling of much Higher Education and Research and Development funding into the priority areas of science and technology. Among other things, this diversion of funding calls into question the future of traditional humanities and creative arts faculties. How these faculties, and the disciplines within them, might reconfigure themselves for the knowledge economy is, therefore, a question of great importance, although one that as yet has not been adequately answered. This paper explores some of the reasons for this by looking at how innovation in the knowledge economy is typically theorized. It takes one policy trajectory informing Australia's key innovation statement as an example. It argues that, insofar as the formation of this knowledge economy policy has been informed by a techno-economic paradigm, it works to preclude many humanities and creative arts disciplines. This paper, therefore, looks at how an alternative theorization of the knowledge economy might offer a more robust framework from within which to develop humanities and creative arts Higher Education and Research policy in the knowledge economy, both in Australia and internationally.
1 This article draws on the Australian Research Council project, Knowledge/economy/society: a sociological study of an education policy discourse in Australia in globalising circumstances, being conducted by Jane Kenway, Elizabeth Bullen and Simon Robb. This 3-year project looks at how understandings of the knowledge economy and knowledge society inform current education policy and, in turn, how this policy translates into educational practice. The methodology includes policy analysis, interviews with policy makers in government, and supranational organizations. It also includes cameo studies of innovative educational practice, two of which we draw on here.

The need for best practice standards in electronic governance of patient medical records to facilitate innovation

Background : Optimising the use of electronic data offers many opportunities to health services, particularly in rural and remote areas. These include reducing the effect of distance on access to clinical information and sharing information where there are multiple service providers for a single patient. The increasing compilation of large electronic databases of patient information and the ease with which electronic information can be transferred has raised concerns about the privacy and confidentiality of such records.
Aims & rationale/Objectives : This review aims to identify legal and ethical standards for areas of electronic governance where a lack of clarity may currently impede innovation in health service delivery.
Methods : This paper describes best practices for storage and transfer of electronic patient data based on an examination of Australian legislative requirements and a review of a number of current models. This will firstly allow us to identify basic legal requirements of electronic governance as well as areas of ambiguity not fully addressed by legislation. An examination of current models will suggest recommendations for best practice in areas lacking sufficient legal guidance.
Principal findings : We have identified the following four areas of importance, and shall discuss relevant details:
1) Patients' right of ownership to electronic patient records. 2) Custodial issues with data stored in centralised health care institutions 3) IT Security, including hierarchical level access, data encryption, data transfer standards and physical security 4) Software applications usage.
Discussion : Our examination of several models of best practice for the transfer of electronic patient data, both in Australia and internationally, identifies and clarifies many unresolved issues of electronic governance. This paper will also inform future policy in this area.
Implications : Clarification will facilitate the future development of beneficial technology-based innovations by rural health services.
Presentation type : Poster