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.

Cooperative patronage: The National Smallholder Farmers’ Association of Malawi in Kasungu District

This paper estimates the determinants of farmers’ decisions to join a rural producer organisation, the National Smallholder Farmers’ Association of Malawi (NASFAM), in Kasungu District. Data for the study were collected in June and August 2003 using household-level questionnaires and stratified random sampling, where strata were membership status and gender. Probit analysis of 250 farmers shows that off-farm sources of income, distance of the farmer’s household from Kasungu District centre, age of the farmer, tobacco farming, education, household level land holding and gender determined the decision to join NASFAM. These results suggest that farmers should be informed of the potential benefits of participating in rural development efforts, and that rural communication and information infrastructure should be improved so as to reduce the costs of information access and transactions in general, if participation in organisations such as NASFAM is to be enhanced.

Space heating and hot water demand analysis of dwellings connected to district heating scheme in UK

To achieve CO2 emissions reductions the UK Building Regulations require developers of new residential buildings to calculate expected CO2 emissions arising from their energy consumption using a methodology such as Standard Assessment Procedure (SAP 2005) or, more recently SAP 2009. SAP encompasses all domestic heat consumption and a limited proportion of the electricity consumption. However, these calculations are rarely verified with real energy consumption and related CO2 emissions. This paper presents the results of an analysis based on weekly head demand data for more than 200 individual flats. The data is collected from recently built residential development connected to a district heating network. A methodology for separating out the domestic hot water use (DHW) and space heating demand (SH) has been developed and compares measured values to the demand calculated using SAP 2005 and 2009 methodologies. The analysis shows also the variance in DHW and SH consumption between both size of the flats and tenure (privately owned or housing association). Evaluation of the space heating consumption includes also an estimation of the heating degree day (HDD) base temperature for each block of flats and its comparison to the average base temperature calculated using the SAP 2005 methodology.

Innovation in construction: a sociology of technology approach

An alternative approach to understanding innovation is made using two intersecting ideas. The first is that successful innovation requires consideration of the social and organizational contexts in which it is located. The complex context of construction work is characterized by inter-organizational collaboration, a project-based approach and power distributed amongst collaborating organizations. The second is that innovations can be divided into two modes: ‘bounded’, where the implications of innovation are restricted within a single, coherent sphere of influence, and ‘unbounded’, where the effects of implementation spill over beyond this. Bounded innovations are adequately explained within the construction literature. However, less discussed are unbounded innovations, where many firms' collaboration is required for successful implementation, even though many innovations can be considered unbounded within construction's inter-organizational context. It is argued that unbounded innovations require an approach to understand and facilitate the interactions both within a range of actors and between the actors and technological artefacts. The insights from a sociology of technology approach can be applied to the multiplicity of negotiations and alignments that constitute the implementation of unbounded innovation. The utility of concepts from the sociology of technology, including ‘system building’ and ‘heterogeneous engineering’, is demonstrated by applying them to an empirical study of an unbounded innovation on a major construction project (the new terminal at Heathrow Airport, London, UK). This study suggests that ‘system building’ contains outcomes that are not only transformations of practices, processes and systems, but also the potential transformation of technologies themselves.

Understanding the early stages of the innovation diffusion process: awareness, influence and communication networks

The themes of awareness and influence within the innovation diffusion process are addressed. The innovation diffusion process is typically represented as stages, yet awareness and influence are somewhat under-represented in the literature. Awareness and influence are situated within the contextual setting of individual actors but also within the broader institutional forces. Understanding how actors become aware of an innovation and then how their opinion is influenced is important for creating a more innovation-active UK construction sector. Social network analysis is proposed as one technique for mapping how awareness and influence occur and what they look like as a network. Empirical data are gathered using two modes of enquiry. This is done through a pilot study consisting of chartered professionals and then through a case study organization as it attempted to diffuse an innovation. The analysis demonstrates significant variations across actors’ awareness and influence networks. It is argued that social network analysis can complement other research methods in order to present a richer picture of how actors become aware of innovations and where they draw their influences regarding adopting innovations. In summarizing the findings, a framework for understanding awareness and influence associated with innovation within the UK construction sector is presented. Finally, with the UK construction sector continually being encouraged to be innovative, understanding and managing an actor’s awareness and influence network will be beneficial. The overarching conclusion thus describes the need not only to build research capacity in this area but also to push the boundaries related to the research methods employed.

Innovation clusters: key concepts

Innovation is easier to describe than it is to systematically analyse, and easier to analyse than it is to effectively promote. Part of the problem, of course, is the imprecise way in which the activity of innovation itself is conceptualised. To achieve more precision, the logic of analysis suggests that innovation should be should be systematically analysed and then divided into rough categories to produce a working taxonomy based on a number of key dimensions. A major part of the purpose of this paper is to develop such a working taxonomy.