Política publica de saúde: análise da agenda do Estado do Rio de Janeiro

Esta tese analisa a política de saúde no estado do Rio de Janeiro, focando nas modificações estruturais produzidas pela adoção da contrarreforma de natureza neoliberal. O marco temporal da análise é partir de 2006, com a eleição de Sérgio Cabral governador do estado. Num contexto histórico mais amplo, buscamos compreender os processos que conduziram as escolhas políticas desde a hegemonia da política neoliberal no Brasil na década de 1990, até a situação atual. Da análise das prioridades do governo estadual centradas na adoção de novos modelos de gestão e seus resultados, conclui-se, do ponto de vista financeiro e social, que a proposta de contrarreforma na saúde continua direcionando a política para ampliar a participação privada no setor público, que permite a transferência de recursos públicos para ente privados. Entretanto a eficiência da gestão privada se mostrou falaciosa, os quesitos de qualidade, eficiência e economicidade na assistência à saúde, usados para justificar ideologicamente a contrarreforma, não foram alcançados. Ao contrário a gestão privada ampliou os gastos operacionais em saúde e não foi capaz de manter constante a oferta de serviços.

Métodos de custeio no setor público: Um estudo sobre como as informações de custos atendem aos diversos stakeholders de um hospital universitário público

O setor de saúde pública convive com uma constante escassez de recursos combinada com uma necessidade crescente de investimentos em tecnologia e inovação. Portanto, é necessário que os gestores públicos de saúde busquem maneiras de maximizar o uso destes recursos orçamentários escassos. Uma das alternativas é implementar estudos sobre custos, que possibilitem ao gestor exercer o controle, o combate ao desperdício e o planejamento dos investimentos futuros. No entanto, na área governamental, existem outros grupos, além do gestor, que têm interesse em conhecer as informações de custos do setor de saúde. Esses grupos são chamados pela teoria da administração de Stakeholders. Cada stakeholder, tais como médicos, pacientes, fornecedores, sociedade entre outros podem demandar informações distintas de custos. Por este motivo, o objetivo deste trabalho é investigar qual o método de custeio que melhor se adequa as necessidades dos diferentes stakeholders de um hospital público. Para tanto, elaborou-se uma pesquisa bibliográfica que abordasse os métodos de custeio por absorção, custeio variável e custeio baseado em atividades, que são os métodos mais debatidos pela literatura contábil. Dessa forma, com objetivo de responder a questão de pesquisa, o presente trabalho desenvolve um cenário hipotético de um hospital universitário público, no qual estão identificados os seus stakeholders e suas respectivas necessidades de informações de custo. Como resultado das análises, observa-se que cada um destes stakeholders apresenta um método de custeio, ou uma combinação de dois destes, que melhor se adequa as suas necessidades de informação de custos.

Knowledge based strategy: appraising knowledge creation capability in organisations.

This thesis sets out a journey which culminates in the development of an analytical framework, the "Organisational Creativity Appraisal" which is intended to assist organisations in evaluating their ability to support and develop creativity. This framework is derived from the common thread of the thesis, which is drawn from a range of research and consultancy projects, and the resulting published work, spanning an eight year period, centring on the role of knowledge and creativity in the strategy and performance of organisations. The literature of strategy, learning and creativity increasingly recognises that organisational context is critical to the formation of strategy, to the content of the strategy and to its successful implementation. The thesis explores the ways in which learning and creativity, the basis of knowledge-based strategy, are influenced by organisational context or social architecture. The research explores the ways in which managers can gain greater understanding of the social architectures of their organisations so as to assist in supporting their strategic development. The central core of the thesis is the nine published papers upon which it is based but it also derives from the broader perspective of my published work in the form of both articles and books. The thesis further draws upon my own experience as a leader and manager in the context of university business schools and as a consultant, researcher and developer in the context of a range of international private and public sector organisations. The work is based upon a premise that theory should inform practice and that practice should inform theory. The "Organisational Creativity Appraisal" framework is informed by both theory and practice and is intended to assist in management practice. There is no assumption that management research can arrive at prescriptions for managerial and organisational behaviour. On the other hand management research can usefully inform management and organisational behaviour, as long as it is employed in a critically reflective manner. The "Organisational Creativity Appraisal" presented in this work should be regarded as the framework in its present form which is likely to develop further as my research progresses in the future.

Applications of outsourcing theory to collaborative purchasing and licensing

Urquhart, C. (2003). Applications of outsourcing theory to collaborative purchasing and licensing. VINE: The Journal of Information and Knowledge Management Systems, 32(4), 63-70.

Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya.

Insecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection.

Trust, leadership and economic necessity in post-compulsory education

Trust is a complex concept that has increasingly been debated in academic research (Kramer and Tyler, 1996). Research on 'trust and leadership' (Caldwell and Hayes, 2007) has suggested, unsurprisingly, that leadership behaviours influence 'follower' perceptions of leaders' trustworthiness. The development of 'ethical stewardship' amongst leaders may foster high trust situations (Caldwell, Hayes, Karri and Bernal, 2008), yet studies on the erosion of teacher professionalism in UK post-compulsory education have highlighted the distrust that arguably accompanies 'new managerialism', performativity and surveillance within a climate of economic rationalisation established by recent deterministic skills-focused government agendas for education (Avis, 2003; Codd, 1999, Deem, 2004, DFES, 2006). Given the shift from community to commercialism identified by Collinson and Collinson (2005) in a global economic environment characterised by uncertainty and rapid change, trust is, simultaneously, increasingly important and progressively both more fragile and limited in a post compulsory education sector dominated by skills-based targets and inspection demands. Building on such prior studies, this conference paper reports on the analysis of findings from a 2007-8 funded research study on 'trust and leadership' carried out in post-compulsory education. The research project collected and analysed case study interview and survey data from the lifelong learning sector, including selected tertiary, further and higher education (FE and HE) institutions. We interviewed 18 UK respondents from HE and FE, including principals, middle managers, first line managers, lecturers and researchers, supplementing and cross-checking this with a small number of survey responses (11) on 'trust and leadership' and a larger number (241) of survey responses on more generalised leadership issues in post-compulsory education. A range of facilitators and enablers of trust and their relationship to leadership were identified and investigated. The research analysed the ways in which interviewees defined the concept of 'trust' and the extent to which they identified that trust was a mediating factor affecting leadership and organisational performance. Prior literature indicates that trust involves a psychological state in which, despite dependency, risk and vulnerability, trustors have some degree of confident expectation that trustees will behave in benevolent rather than detrimental ways. The project confirmed the views of prior researchers (Mayer, Davis and Schoorman, 1995) that, since trust inevitably involves potential betrayal, estimations of leadership 'trustworthiness' are based on followers' cognitive and affective perceptions of the reliability, competence, benevolence and reputation of leaders. During the course of the interviews it also became clear that some interviewees were being managed in more or less transaction-focused, performative, audit-dominated cultures in which trust was not regarded as particularly important: while 'cautious trust' existed, collegiality flourished only marginally in small teams. Economic necessity and survival were key factors influencing leadership and employee behaviours, while an increasing distance was reported between senior managers and their staff. The paper reflects on the nature of the public sector leadership and management environment in post-compulsory education reported by interviewees and survey respondents. Leadership behaviours to build trust are recommended, including effective communication, honesty, integrity, authenticity, reliability and openness. It was generally felt that building trust was difficult in an educational environment largely determined by economic necessity and performativity. Yet, despite this, the researchers did identify a number of examples of high trust leadership situations that are worthy of emulation.

Accelerating innovation in the built environment by research and education

Awareness of climate change and adaptations of building stock play a key role in the UK government’s environmental agenda. While some European countries and countries like Japan move forward by bringing their sustainability agenda to the public sector, the UK seems to be slow in embracing these ideas and long term sustainability in improved products and processes for better performance, efficiency and innovative application of renewable technology is yet to come. While funding remains a major constraint research show that a number of detrimental issues including; organisation, risk, mind sets of the stakeholders, planning constraints, reluctance to accept change and the unexploited markets are major contributing factors. Most of these barriers can be overcome with research, development and information and knowledge transfer techniques. Educating all stakeholders can act as an accelerator for innovation. This paper examines innovation in the built environment and how research and education can stimulate this process. It explores drivers and barriers for innovation and how research and education in construction, design, engineering and project management can enhance this process. It presents and discusses lessons learnt from two action research projects in relation to innovation.

North/South Infrastructure Development via Cross-border PPP Mechanism

Both Northern Ireland and Republic of Ireland governments recognise the current infrastructural deficits in their respective jurisdictions which, if not addressed, will undermine the future economic prosperity of both regions. This paper considers the adoption of a collaborative approach on the island to addressing the deficit, using public private partnerships (PPP) as the delivery vehicle. It presents a critical perspective of the challenges and opportunities posed by adopting such a cross-border approach. Whilst PPPs have the potential to bring about North-South co-operation, bridge gaps in infrastructure capacity and facilitate the advancement of sectoral knowledge, their adoption on a cross border basis will require significant reorganisation and change at administrative and sectoral levels. This review concludes that governments and construction sector representatives in Northern Ireland and the Republic of Ireland have still some work to do in order to enhance the capability and readiness of public and private partners to evolve an all-island PPP infrastructure development approach.

Vision and reality: community involvement in Irish urban regeneration

This article examines the processes and outcomes of community involvement in six Irish urban regeneration case studies, three in Dublin and three in Belfast. The findings are part of a wider study using a Complex Adaptive Systems perspective to analyse public sector decision making. Key points included: (1) the community ‘vision’ of the regeneration as an emergent property, which converged towards the vision held by the implementing agencies in the four most successful programmes; and (2) the identification of three features that contribute to non-linear (unpredictable) behaviour: a history of community involvement; the availability of resources; and the intervention of key individuals at crisis points.

The Global Financial Crisis and UK PPPs

Purpose – This paper seeks to examine how Public Private Partnerships (PPPs) have been affected by the global financial crisis (GFC). After briefly discussing PPPs and the GFC, the paper considers whether the latter has been a contributing factor in the declining number of projects reaching financial close.

Design/methodology/approach – The paper employs document content analysis to compare the time between notification of a project in the Official Journal of the European Union and its financial close in order to assess whether this period has increased since the beginning of the GFC. Two case studies are also presented.

Findings – Apart from a very small number of projects, the time between official project notification and financial close is lengthening, with the case studies providing some possible explanations for this.

Originality/value – Whilst Burger et al. provide some general statistics on the impact of the GFC on PPPs in a number of countries, this paper examines over 600 PPPs in the UK and supplements this analysis with two case studies, in order to assess whether the GFC has led to delays in projects reaching financial close.

Understanding Accountability in Social Enterprise Organisations: A Framework

Purpose: Social enterprise organisations (SEOs) operate across the boundaries of the public, private and not‐for‐profit (NFP) sectors in delivering public services and competing for resources and legitimacy. While there is a rich literature on accountability in the private and public sectors, together with the wider NFP sector, SEOs have received comparatively little attention and remain a relatively under‐researched organisational form. Drawing on accountability, legitimacy and user‐needs theories, the purpose of this paper is to develop a practical framework which can be used to explore how accountability within SEOs is constructed and discharged.

Design/methodology/approach: This paper draws on user‐needs, accountability, legitimacy and impression management theories expounded in relation to the private, public and NFP sectors.

Findings: A framework to better understand how accountability can be discharged by SEOs is developed and discussed.

Research limitations/implications: While a framework for better understanding SEO accountability is presented, it is not empirically tested. However, the framework has the potential to facilitate a deeper appreciation of the theory and practice of accountability within SEOs and, notwithstanding the inherent difficulties in measuring and managing accountability, could be used to stimulate practitioner involvement.

Practical implications
– As little is known about the current extent of SEO information disclosure or accountability relationships, the framework could be used to assess the discharge of accountability by SEOs, with the findings informing future developments. This should provide useful insights into internal processes and organisational views on accountability bases and mechanisms and can then be used to inform the debate on how SEOs can best discharge their duty to account.

Social implications
– Understanding the nature of SEO accountability reporting has important implications for those involved in advancing the SEO agenda. At a time of public sector cutbacks, and with the government searching for new and more effective ways of delivering services, the role of SEOs in this process is likely to receive greater attention and scrutiny.

Originality/value
– SEOs have grown extensively in size and prominence in recent years and policymakers have come to embrace the role that they play in societal development. This paper responds to a gap in the theoretical literature and contributes to the debate by developing a framework which can be empirically tested. Moreover, it can be used to prompt practitioner involvement and facilitate a better understanding of the complex issues surrounding accounting and accountability in this under‐researched area.

Crucial silences: When Accountability Met PFI and Finance Capital

During recent years, a wide spectrum of research has questioned whether public services/infrastructure procurement through private finance, as exemplified by the UK Private Finance Initiative (PFI), meets minimum standards of democratic accountability. While broadly agreeing with some of these arguments, this paper suggests that this debate is flawed on two grounds. Firstly, PFI is not about effective procurement, or even about a pragmatic choice of procurement mechanisms which can potentially compromise public involvement and input; rather it is about a process where the state creates new profit opportunities at a time when the international financial system is increasingly lacking in safe investment opportunities. Secondly, because of its primary function as investment opportunity, PFI, by its very nature, prioritises the risk-return criteria of private finance over the needs of the public sector client and its stakeholders. Using two case studies of recent PFI projects, the paper illustrates some of the mechanisms through which finance capital exercises control over the PFI procurement process. The paper concludes that recent proposals aimed at “reforming” or “democratising” PFI fail to recognise the objective constraints which this type of state-finance capital nexus imposes on political process.

The translation and sedimentation of accounting reforms. A comparison of the UK, Austrian and Italian experiences

Since the late 1980s, there has been a significant and progressive movement away from the traditional Public Administration (PA) systems, in favour of NPM-type accounting tools and ideas inspired by the private sector. More recently, a new focus on governance systems, under the banner Public Governance (PG), has emerged. In this paper it is argued that reforms are not isolated events, but are embedded in more global discourses of modernisation and influenced by the institutional pressures present in a certain field at certain points in time. Using extensive document analysis in three countries with different administrative regimes (the UK, Italy and Austria), we examine public sector accounting and budgeting reforms and the underlying discourses put forward in order to support the change. We investigate the extent to which the actual content of the reforms and the discourses they are embedded within are connected over time; that is, whether, and to what degree, the reform “talk” matches the “decisions”. The research shows that in both the UK and in Italy there is consistency between the debates and the decided changes, although the dominant discourse in each country differs, while in Austria changes are decided gradually, and only after they have been announced well in advance in the political debate. We find that in all three countries the new ideas and concepts layer and sediment above the existing ones, rather than replace them. Although all three countries underwent similar accounting and budgeting reforms and relied on similar institutional discourses, each made its own specific translation of the ideas and concepts and is characterised by a specific formation of sedimentations. In addition, the findings suggest that, at present in the three countries, the PG discourse is used to supplement, rather than supplant, other prevailing discourses.