Improving Service Delivery in Education Through Collaboration: An Exploratory Study of the Role of Cross‐Sectoral Alliances in the Development and Support of Charter Schools*

Objective. This article explores cross‐sectoral alliances as mechanisms for enhancing service delivery in public education. We assess the extent to which the three economic sectors—nonprofit, for‐profit, and public—are involved in partnerships with charter schools and identify the benefits that charter schools receive from partnering with other organizations. Methods. The study utilized a qualitative approach: data collection involved interviews with charter school experts in 37 states. Results. We found that organizations from each of the three economic sectors were involved in alliances with charter schools and that these alliances offered a range of financial (e.g., facilities, salaries), political (e.g., legitimacy, credibility), and organizational (e.g., curriculum, management) benefits. Conclusions. Our findings from this exploratory study suggest that cross‐sectoral alliances have the potential to enhance the capacity of charter schools to deliver high‐quality educational services. Three hypotheses generated from the findings are also offered to guide future research on charter school alliances.     

"Bridging the Gap": New Relationships between Primary Care Groups and Local Authorities

Current policy places great emphasis on the development of "partnerships", particularly between NHS and local authority services, with the aims of increasing service coordination and delivery and improving health. To this end, primary care groups (PCGs), at the forefront of NHS organizational developments, are required to include a social services representative on their governing boards; similarly, primary care trusts (PCTs) have a social services representative on their executive committees. Drawing on a representative longitudinal national survey of English PCGs, the paper evaluates the contribution of these new governance arrangements to the development of inter-agency partnerships. Despite poor histories of collaboration and some major organizational barriers, there are some signs of progress, with social services representatives playing an active part in PCG affairs and having clear lines of communication about PCG matters with their employing authorities. Equally significantly, PCGs have also quickly established a wide range of contacts directly with other local authority services and departments. However, these early gains risk being limited by traditional professional inequalities between social work and medicine and, in particular, by the prospect of further organizational upheaval as PCGs merge with each other and/or acquire trust status.     

Unequal Partners? Local Government Reorganization and the Voluntary Sector

British local government has recently undergone its most far-reaching reorganization for twenty-five years. The impact of this reorganization was considerable within local authorities but it also substantially affected other organizations with which they worked at a local level. This paper explores the perspectives of voluntary sector organizations involved in social care: a set of actors which, prior to reorganization, had been encouraged by central and local government, through notions of partnership and through community care legislation, to undertake more direct roles in service delivery, consultation and strategic planning. During the consultative period prior to reorganization, many voluntary organizations reported that they had been marginal to the process. Reflecting on the process of reorganization itself, many voluntary organization respondents commented that it had been disruptive and provoked considerable anxiety. Post-reorganization, voluntary organizations felt that rebuilding of relationships was necessary and that the promise of partnership had meant little in practice at a time of potential crisis for local.     

Decentring the NHS: A Case Study of Resource Allocation Decisions within a Health District

The aim of New Labour's health policy is to shift more of the balance of power and responsibility for services to the local level. But, while the government proclaims a new decentralized NHS, doubts exist about the extent to which the reality on the ground matches the tone of policy. This article reports empirical work examining the level of autonomy purchasers have over budgetary allocation. A case study analysis of purchasing within a single district was undertaken for the financial year 2001/2 which included semi‐structured interviews with key officers responsible for budget allocation. Purchasers approach a new financial year with a starting position that matches the previous year's allocation—the “baseline”, this is adjusted for inflation and, as has happened over the last few years, increased further in real terms by “growth funds” for service modernization and government initiatives. The analysis shows a clear dissonance between policy and practice; although purchasers have complete control over their “baseline budgets”, the study found that this does not “ring true” at the local level. Only about a fifth of growth funds were at the discretion of purchasers as most are taken by national priorities and pay and price inflation. Further decentralization is planned, which includes transferring more control of funds to primary care trusts by 2004, the extent to which these measures will change the perceptions of those working in the service remains to be seen—only then will the government be able to claim a truly decentred service.     

Links between social environment and health care utilization and costs

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.     

Users as Citizens: Collective Action and the Local Governance of Welfare

Self-organization amongst users of community care services preceded the consumerist developments of the 1980s and early 1990s, but can be considered to have been "legitimized" by top-down objectives relating to "user involvement". Nevertheless, the objectives and value bases of disabled people's organizations and organizations of users (or survivors) of mental health services have not always been consistent with those of consumerism, and user groups have experienced tensions in determining the extent to which they should respond to official agendas. Drawing on theories of new social movements and of citizenship, this paper considers the developing place of user organizations within systems of local governance. It looks at the way in which groups have sought to assert the legitimacy both of experiential knowledge and of their position as citizens in the face of official responses which have constructed them as self-interested pressure groups. It draws on empirical research investigating local groups of disabled people and of mental health service users conducted in the first part of the 1990s. It discusses the significance of shared identity as a basis for collective action alongside more pragmatic motivations to influence the nature of health and social care services. In the context of appeals to "community" and "partnership" which are starting to replace the discourse of markets and contracts as the key metaphor for both policy-making and service delivery, the article considers likely future roles for groups comprising people often excluded from community.     

Risk Management Paradigms in Health and Social Services for Professional Decision Making on the Long-Term Care of Older People

Risk management systems and structures are developing rapidlywithin UK health and personal social services. However, therisk management strategies of organizations need to take intoaccount the conceptual frameworks used by professionals. Thisgrounded theory study used data from nineteen focus groups andnine semi-structured interviews (ninety-nine staff in total)to explore perspectives on risk and decision-making regardingthe long-term care of older people. Focus group participantsand interviewees comprised social workers, care managers, consultantgeriatricians, general medical practitioners, community nurses,occupational therapists, home care managers and hospital dischargesupport staff. Social work and health care professionals conceptualizedrisk and its management according to six paradigms that appearedto be in a state of reciprocal tension: (i) Identifying andMeeting Needs; (ii) Minimizing Situational Hazards; (iii) Protectingthis Individual and Others; (iv) Balancing Benefits and Harms;(v) Accounting for Resources and Priorities; and (vi) Warinessof Lurking Conflicts. The effective translation into practiceof risk management strategies needs to address the complex andoften contradictory issues facing health and social servicesprofessionals.     

Local Participatory Democracy in Britain's Health Service: Innovation or Fragmentation of a Universal Citizenship?

A political emphasis upon the devolution of governance and management in the British National Health Service has, since 1997, been paralleled by an apparent concern to reinvigorate patient and public involvement in aspects of planning and decision‐making. A quasi‐communitarian rhetoric and echoes of nineteenth‐century welfare mutualism have accompanied significant reform of arrangements for patient and public involvement. This article considers the degree to which this fusion of normative exhortation and structural reform heralds a marked evolution in the principles and practice of participatory democracy in the planning and governance of health care. The reforms, in historical perspective, appear to constitute a significant extension of the arenas within which citizens can explore and debate issues pertaining to the health service. But selective political recourse to quasi‐communitarian sentiment points to an embryonic policy discourse that links entitlements to obligations on the part of those reliant on the NHS. This may be of considerable significance in a system of health care to which entitlement has, historically, been cast as a right of citizenship.     

Public–Private Partnerships: Implications for Primary Schooling in Pakistan

Since the early 1990s, the government of Pakistan has promoted a policy of public–private partnerships to increase access and improve the quality of education in Pakistan. This article describes the evolution of the policy and discusses a variety of partnership arrangements aimed to establish and govern primary schools. It suggests that, while partnerships have positive outcomes and may be a viable option for resourceful communities, they are located in a hierarchical structure and lack equal distribution of power and trust between partners. Partnerships are often temporary and established for the purpose of a transition to privatization. These problems make them an unlikely strategy for a sustained increase in the chances of access to good‐quality schooling for the poor and disadvantaged.     

Organizational Form as a Mechanism to Involve Staff,Public and Users in Public Services: A Study of the Governance of NHS Foundation Trusts

In addition to introducing markets and market‐like structures into public services, New Labour wished to promote the involvement of users and the public in decision‐making in other ways than as individual consumers. One way was to involve the public in the governance of organizations. This could be done by removing public services from state control, and transferring them to mutual ownership; or by increasing public involvement in the governance of public bodies. NHS foundation trusts (FTs) were presented as mutuals. Our study shows FTs are not mutuals, as they continue to be owned by the state. Moreover, staff of FTs were generally not engaging with the new governance structures. In general, there was mixed experience of the new structures enabling governors to increase accountability of the hospitals to the public. On the other hand, having a membership did enhance the legitimacy of FTs, as opposed to other NHS organizations. The findings of the study are of current interest as the coalition government is continuing with the policy of FTs, and also encouraging mutuals and other forms of public involvement.     

Trust, risk and control within an indigenous–non-indigenous social service partnership

Partnerships between organisations are seen as one of the building blocks of the 'third way' approach to welfare provision in both Europe and New Zealand. While there is much discussion on building social capital and partnership working, such partnerships are usually perceived as being between government and community or private organisations. There is a gap in the literature in two specific areas: partnerships formed between two community-based social service organisations and partnerships formed between indigenous, or immigrant peoples, and non-indigenous organisations. This article explores such a partnership – that between the Ngai Tahu Maori Law Centre (an indigenous organisation) and the Dunedin Community Law Centre (a non-indigenous organisation). The article analyses this relationship and strategies employed by both organisations to develop trust, diminish risk and equalise control. Lastly, the article suggests that the model of interaction articulated here could be promulgated to other sites within the social services in New Zealand and the Americas, and within the European context.     

Strategic philanthropy: an opportunity for partnership between corporations and health/human service agencies

The study is a national survey of corporate philanthropy programs. The original problem underlying the study is the long-term decline in the percentage of total corporate contributions to health and human services. A questionnaire, mailed in May of 1993, was used to investigate the impact of strategic philanthropy on the relationship between corporations and health/human service organizations. Corporations strategically prioritizing their philanthropic support were expected to create new opportunities for partnerships between business and health/human service agencies. The survey resulted in a sample of 226 corporations. The results showed statistically significant support for the hypothesis that highly strategic philanthropy programs will be more likely to enter into a health/human service partnership than less strategic programs. The multiple regression analysis method was used to control for the effects of corporate size, industry type, the (corporate) contributions management organization, and United Way credibility. Based upon the results of the study, United Way is recommended to consider new roles for itself as a facilitator of partnerships between business and health/human service organizations.     

Does partnership funding improve coordination and collaboration among early childhood services? – Experiences from the Communities for Children programme

Partnerships among service providers are an important aspect of human service delivery, including in the early childhood and family service sector. There is extensive international literature on factors contributing to partnerships – also termed service coordination, collaboration or integration – but little evidence of partnership outcomes exists where partnerships are a funded and mandatory component of large‐scale programmes. This paper reports findings from an evaluation of the Australian Government's Communities for Children (CfC) programme. Under CfC, partnerships were mandated and funded, and the evaluation findings show that the programme resulted in an increased number of agencies working together to support families with young children (0–5 years) and that working relationships between agencies improved. The effectiveness of these partnerships depended on funding for partnership activities and on organisational and practical factors.     

Is GP Restratification Beginning in England?

English National Health Service general practice is being restructured through the introduction of primary care groups (PCGs) and trusts (PCTs), and the personal medical services (PMS) schemes. Theories of GPs' professional organization have to be modernized accordingly. Past theories have tended to concentrate on the occupational level rather than consider the effects of different forms of market and quasi–market on practitioners' income and their ability to control their everyday practice. This paper extends the theory of professionalization, as an occupational group's strategy for control over its work, to cover these matters, and thereby hypothesizes an explanation of GP responses to current changes in NHS primary health care. Case study data from four PCGs and four PMS pilots suggest that general practitioners are responding in some cases by defending enclaves of traditional general practice; in others by concentrating on clinical rather than managerial interests; and in others again by forming a new dominant coalition with NHS managers. Restratification seems to be beginning in NHS general practice although other policy developments may yet prevent it. Researchers should monitor this potentially important change as PCTs form.     

The SESS multisite collaborative research initiative: establishing common ground

Multidisciplinary intervention approaches are needed for meeting service needs for families in which substance abuse and mental health disorders may be interfering with child‐rearing. Experiences from the Starting Early Starting Smart (SESS) initiative, a 12‐site national collaborative investigation of integrating behavioural health services in early childhood and primary health care service settings for children aged 0–5 years and their families and caregivers, are described. This 4‐year applied research initiative was co‐funded by the Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services and Casey Family Programs, a private operating foundation. SESS, which was developed and implemented in 12 geographically and culturally diverse cities in the USA during 1997–2001, encouraged federal, state, and local public/private partnerships. Opportunities and challenges in using an inclusive, consensus‐based, stakeholder model to maximize study relevance and utility for researchers, practitioners, and fiscal sponsors are discussed, and lessons for multidisciplinary, multisite research collaborations are identified.     

Voluntary Organizations as New Street‐level Bureaucrats: Frontline Struggles of Community Organizations against Bureaucratization in a South Korean Welfare‐to‐Work Partnership

In recent years, the role of voluntary organizations in welfare partnership has received considerable critical attention from scholars working in the field. While mainstream debates have valued state–voluntary sector partnership as participatory governance, critical studies have argued that it leads voluntary organizations to serve as a shadow state. The present study, however, contends that partnership does not necessarily entail participatory welfare or the complete subordination of the voluntary sector to the state's bureaucratic system. Rather, as new street‐level bureaucrats, voluntary organizations can exercise a degree of autonomy on the frontline despite the bureaucratic constraints engendered by partnership. Through an ethnographic analysis of Korean community organizations engaged as frontline agencies in a welfare‐to‐work partnership, this study unveils how the former have recreated democratic and inclusive environments in a particular policy setting by organizing non‐work activities and transferring administrative authority to recipients. Delineating such street‐level practices, this article demonstrates that state–voluntary sector partnerships may be sites of struggle where voluntary organizations continuously strive to actualize participatory governance in diverse and indirect ways.     

Using Groups to Advance Social Work Practice–Based Research

A discussion about the importance of research for social work practitioners and the nature of academic–practitioner partnerships set the scene in this article for a discussion about an innovative academic–practitioner partnership. This partnership, aimed at strengthening research mindedness and research activity in social service settings, has been fuelled by a belief in the power of groups to achieve what individuals cannot. The authors reflect on the range of inputs and synergistic group processes that allowed for a series of outcomes that would not have been possible within an individualized initiative. In conclusion, lessons learned from the use of groups to advance practice-based research are outlined.     

‘Problematising’ Australian policy representations in responses to the physical health of people with mental health disorders

Australia, like other jurisdictions, is recognising the poorer physical health of people with mental health disorders. This paper explores policy responses to this issue through discourse analysis of 22 Australian Federal and State government policy documents published in 2006–2011. The paper utilises Bacchi's ‘what's the problem represented to be?‘ approach to explore policy solutions in relation to the representation of the issue, enabling identification of issues which are not problematised and policy solutions that have not been considered. The poor physical health of people with mental health disorders is attributed in policy to poor lifestyle habits and limited access to monitoring of physical health care. Three policy solutions are offered: collaborative care delivery involving greater use of fee‐for‐service primary care to manage physical health; the monitoring of physical health status by mental health teams; and the promotion of lifestyle change. These solutions fail to address ongoing issues with collaboration between specialist mental health and primary care services. Reliance upon fee‐for‐service primary mental health care may, in fact, reduce rather than increase access to services. The strategies are discussed in light of neoliberal ideals of governance and personhood which are underpinned by informed consumer choice and personal responsibility for health.     

Partnership Working and Eligibility Criteria: What Can We Learn from the Implementation of Guidance on Continuing Health Care?

Current government policy places great importance both on clinical governance and on partnership working between health and social services. Separately and together, these policy emphases require greater clarity in and between organizations about who should provide what care where than has often been achieved in the past. A study of the implementation of continuing health care policies suggests that clarity about appropriate long–term health and social care provision was difficult to achieve in the 1990s quasi–markets, because there were too few financial and structural incentives for agencies to cooperate in developing and implementing precise and comprehensive eligibility criteria. This problematic interplay between financial and structural factors is being addressed by a number of government initiatives designed to stimulate joint working, although the difficulty of drawing a clear boundary between health care (free at the point of delivery) and social care (which can be means–tested) remains.     

Analysing Structural Interests in Primary Care Groups

Alford's theory of structural interests in health care has been used as a heuristic device both in the USA and the UK. Despite concerns about its heuristic power it provides a lucid analytical framework and is helpful in exposing the structural interests that underpin political processes in health systems. To date its application in the UK has been primarily in relation to an NHS dominated by health authorities and hospital providers. Recent reforms in the UK have created a new context dominated by primary care organizations. In this paper we identify the key players in English primary care groups as they relate to Alford's structural interest groups: the professional monopolizers, corporate rationalizers and community. The paper outlines the context of the involvement of the key groups and then analyses the relationships between them. In doing so it raises concerns about the structure and purpose of primary care groups and the probability that key tensions between general practitioners who adopt a corporate rationalizer role and those who retain a professional monopolizer role will be damaging to the progress and development of PCGs. Our analysis also highlights the continuing weakness of the community as an interest group despite the emphasis on involving patients and the public. Importantly, we would suggest that the professional monopolizers among GPs will retain a powerful voice, countering the new corporate rationalizers and continuing to claim that they represent the community's interests.