An Integrated Multitheoretical Perspective of Public Healthcare Services Delivery Organizations

This study seeks to create an integrated multitheoretical model of public healthcare services delivery organizations. A literature review of selected organization theories and their relevance to healthcare was conducted. By illuminating the aspects of control over resources, isomorphism, adaptation to the changing environment and contracts between parties based on the key elements of the resource-dependence theory, institutional theory, population ecology and transaction-cost economics theory, an integrated multitheoretical model of a public healthcare services delivery organization has been presented. There is a need for empirically testing the model proposed by this study.

     

WTO框架下会计国际化的中国困境与创新

本文通过分析WTO对各国会计制度的要求,探讨了WTO框架下中国会计国际化所带来的四大困境；并试图从制度变迁成本的角度,提出了以制度借鉴为主线的中国会计国际化创新战略的基本原则,进一步给出了中国会计国际化创新战略实施的路径设计图。文章认为,充分利用国际会计资源解决我国的现实问题,减少我国会计国际化变迁的成本,应该是后WTO时代中国会计国际化制度困境突破与创新的基本路径取向。     

5 Public Administration and Organization Studies

Abstract

The study of public organizations has withered over time in mainstream organization studies research, as scholars in the field have migrated to business schools. This is so even though government organizations are an important part of the universe of organizations—the largest organizations in the world are agencies of the U.S. government. At the same time, the study of public administration, once in the mainstream of organization studies, has moved into a ghetto, separate and unequal. Centered in business schools, mainstream organization research became isomorphic to its environment—coming to focus on performance issues, which are what firms care about. Since separation, the dominant current in public administration has become isomorphic with its environment. In this case, however, this meant the field moved backward from the central reformist concern of its founders with improving government performance, and developed instead a focus on managing constraints (i.e., avoiding bad things, such as corruption or misuse of power, from occurring) in a public organization environment. Insufficient concern about performance among public administration scholars is particularly unfortunate because over the past 15 years, there has occurred a significant growth of interest among practitioners in improving government performance. The origins and consequences of these developments are discussed, and a research agenda for organization studies research that takes the public sector seriously is proposed.     

Institutional forces and the written business plan

In this study, we examined factors that led nascent organizations to write business plans, following 396 nascent entrepreneurs during a two-year period. We examined both the production and the outcomes of written business plans produced in nascent organizations. Our findings show that institutional variables, such as coercion and mimetic forces, are important predictors influencing the propensity of new organizations to write business plans. Our results are contrary to rationalist predictions of planning-performance, and are more in line with institutional predictions. Interestingly there was no evidence to support positive outcomes, in terms of profitability, for those nascent organizations that produced business plans during a two-year initial period. We discuss the implications for institutional theory and studies of nascent businesses, as well as for the literature on business planning.     

Discerning Possibilities for Action: A Typology of Approaches to Moral Imagination

The existing literature on moral imagination proposes that actors can best respond to ethical dilemmas by tailoring their actions to the practical demands of the situation. It has done little to develop this insight, however. To address this gap, I used institutional theory to identify six ideal type approaches to moral imagination. I proposed that in addressing ethical dilemmas, the morally imaginative actor takes account of two situational factors: first, the social construction of the unmet ethical claim or obligation which constitutes the ethical dilemma, and in particular whether or not it is broadly perceived to be legitimate; and second, its own degree of power. The framework presented represents the first attempt to systematically enumerate approaches to moral imagination and identify their boundary conditions.     

Performance Decline and Turnaround in Public Organizations: A Theoretical and Empirical Analysis*

Public sector performance is currently a significant issue for management practice and policy, and especially the turnaround of those organizations delivering less than acceptable results. Theories of organizational failure and turnaround derive largely from the business sector and require adaptation to the public service. The performance of public organizations is more complex to measure, is related to institutional norms, and the idea of ‘failure’ is problematic. Empirical findings from a real‐time, longitudinal study of poorly performing English local authorities are used to develop an initial theory of performance failure and turnaround suited to public organizations. The paper argues that the typical performance of public organizations over time is cyclical. Where cognition and leadership capability are absent, organizations fail to self‐initiate turnaround. In this situation authoritative external intervention is necessary. The strategies applied are principally concerned with building a leadership capability that engages senior politicians and managers in order to overcome inertia and collective action problems. The theory is presented in the form of seven propositions that provide a basis for further research across the public sector.     

Intrinsic motivation: the case for healthcare systems in Malaysia and globally

The intrinsic motivational aspects that improve the psychological well-being of health practitioners have been usurped by an insulated reliance on financial incentives and other external factors. This paper examines issues pertinent to the motivation of doctors in the healthcare system in Malaysia. The article also attempts to identify problem areas that could benefit from interventions focusing on intrinsic motivation. Financial incentives and the deterioration in intrinsic motivation levels partly influence the exodus of healthcare workers from public healthcare organizations to private practice. A multidimensional approach is required to improve intrinsic motivation amongst healthcare workers. Leadership strength, organizational citizenship, modification of job design, career management, and a democratized work environment are seen as crucial factors to remedy work morale in healthcare systems. A prospective conceptual framework described in this article could serve as the foundation to analyse motivational outcomes through research in the future.     

ISOMORPHISM IN REVERSE: INSTITUTIONAL THEORY AS AN EXPLANATION FOR RECENT INCREASES IN INTRAINDUSTRY HETEROGENEITY AND MANAGERIAL DISCRETION

DiMaggio and Powell (1983) argued that organizations, in their quest for legitimacy, are subjected to isomorphic pressures which produce increasing similarity among peer organizations over time: “Once an organizational field becomes well established ... there is an inexorable push toward homogenization.” Yet, in contradiction to this “iron cage” hypothesis, many industries became more heterogeneous, not more homogeneous, in their profiles during the latter decades of the twentieth century, particularly between about 1980 and 2000 (at least on the American landscape). Why didn’t “inexorable homogenization” occur? We argue that DiMaggio and Powell were correct about the forces that give rise to isomorphism but failed to anticipate several major macrosocial trends that caused those forces all to move in directions that diminished, rather than accentuated, isomorphism. For example, DiMaggio and Powell argued that ambiguity about goals will propel isomorphic change; but the goals for publicly-traded U.S. corporations became less ambiguous. They hypothesized that the fewer the alternative organizational models in a field, the faster the rate of isomorphism; but the array of organizational models increased significantly. We empirically illustrate the increased heterogeneity that occurred within American industries by tracing the trend toward divergence – on several dimensions of strategy and performance – within the steel industry. An analysis of 18 additional industries similarly yields far more evidence of increased heterogeneity than of increased homogeneity over the latter decades of the twentieth century. We go on to argue that reduced isomorphic pressures not only engendered greater intraindustry variety, but also increased managerial discretion, which contributed greatly to the romanticization of CEOs that occurred during the period 1980–2000.     

Who Does the Public Trust? The Case of Genetically Modified Food in the United States

Trust is important for the perception of many types of risk, including those relating to genetically modified (GM) food. Who the public trusts in any given circumstance, however, is not well understood. In this study of public trust regarding GM food, an exploratory factor analysis with Promax rotation reveals public classification of three common institutional types-evaluators, watchdogs, and merchants. The structure of relationships among these stakeholders can act to enable or constrain public support for this new technology. Evaluators-scientists, universities, and medical professionals-are the most trusted. Watchdogs-consumer advocacy organizations, environmental organizations, and media sources-are moderately trusted. Merchants-grocers and grocery stores, industry, and farmers-are least trusted. While the federal government is seen as closest to being an evaluator, it is not highly correlated with any of the factors. The lack of trust in the organizations with the greatest resources and responsibilities for ensuring the safety of GM food should be seen as an important obstacle to the adoption of the technology.     

Community‐Driven Hypothesis Testing: A Solution for the Tragedy of the Anticommons

Shared ownership of property and resources is a longstanding challenge throughout history that has been amplifying with the increasing development of industrial and postindustrial societies. Where governments, project planners, and commercial developers seek to develop new infrastructure, industrial projects, and various other land‐and resource‐intensive tasks, veto power shared by various local stakeholders can complicate or halt progress. Risk communication has been used as an attempt to address stakeholder concerns in these contexts, but has demonstrated shortcomings. These coordination failures between project planners and stakeholders can be described as a specific kind of social dilemma that we describe as the “tragedy of the anticommons.” To overcome such dilemmas, we demonstrate how a two‐step process can directly address public mistrust of project planners and public perceptions of limited decision‐making authority. This approach is examined via two separate empirical field experiments in Portugal and Tunisia, where public resistance and anticommons problems threatened to derail emerging industrial projects. In both applications, an intervention is undertaken to address initial public resistance to such projects, where specific public stakeholders and project sponsors collectively engaged in a hypothesis‐testing process to identify and assess human and environmental health risks associated with proposed industrial facilities. These field experiments indicate that a rigorous attempt to address public mistrust and perceptions of power imbalances and change the pay‐off structure of the given dilemma may help overcome such anticommons problems in specific cases, and may potentially generate enthusiasm and support for such projects by local publics moving forward.     

‘Test Driving’ a Financing Instrument for Climate Adaptation: Analyzing Institutional Dilemmas using Simulation Gaming

Urban physical public infrastructure is a frontline defense mechanism to manage and mitigate climate-related impacts. Market instruments are often cited as possible means to spread risk and reduce financial burdens on the public sector. The authors argue that existing research tends to focus on the technical issues of instruments and neglects considering institutional dynamics that may enable or constrain local market-based financing mechanisms. In this article, three core dilemmas (values uncertainty, planning horizon, and indirect benefits) are used to analyze the responses of practitioners to a possible financing instrument. The findings indicate that the practitioner’s responses to tax increment financing were largely shaped by the adaptation dilemmas and not the characteristics of the instrument per se. By mapping the dilemmas onto whether they would recommend it, participants imposed a financial barrier on climate adaptation investments. The authors conclude that a key imperative in the design of policy instruments is to pay attention to the congruency of informal institutions at the ‘street level’ in order to be in-step with the current sociopolitical conditions. The findings also point to four key attributes that a local market-based instrument would need to be aligned and responsive to the Dutch planning and development context.     

Getting to the Helm: Women in Leadership in Federal Regulation

Why is it important for women to hold leadership positions in organizations? If it is important for women to hold leadership positions in organizations, how do women get into such positions? Both public administration research and organizational research provide answers to these questions. However, the integration of these two bodies of literature remains limited. This study joins public administration scholarship on representative bureaucracy and management scholarship on women in leadership to hypothesize and test institutional, organizational, and political explanations for women’s attainment of leadership positions together in one model. This study examines how women get into upper-level leadership positions in 12 federal regulatory organizations over more than 20 years of time. Findings suggests that women are more likely to gain access to leadership positions when the dominant political ideology is democratic and in agencies that work in feminine policy contexts, are younger, and where the risk of failure is higher.     

Towards New Public Management in Greek Public Organizations: Leadership vs. Management,and the Path to Implementation

In the beginning of the 21st century, when the notion of constant transformation is so frequently invoked, organizational change in the public sector is gaining increased attention. Responding to regulatory, economic, competitive and technological shifts, the challenge of reorganization is universal for all public organizations. This paper aims to explore the shift from Traditional to New Public Management (NPM), as well as the driving forces (such as the information economy, the need for better public performance, the opening of global markets, greater knowledge intensity etc.) that lead to the formulation of transformational programs to Greece. A presentation of a transformational program called Politeia, will be provided, analysed and compared to previous efforts. Finally, we address the important role of leadership and management in Greek public organizations that want successful to implement any change effort successfully.     

Enacting Leadership for Collaborative Advantage: Dilemmas of Ideology and Pragmatism in the Activities of Partnership Managers

Working across organizations has long been recognized as a characteristic of public management, but recent years have seen a worldwide intensification in partnership working. Rhetoric about the benefits is endemic but so are complaints about the difficulty of partnership working in practice. Understanding the way that collaborative approaches may provide value is therefore an essential element of understanding the changing roles of public-sector organizations. The particular aim of this paper is to contribute to a growing understanding of the way in which individuals enact leadership roles in such situations. The focus is on partnership managers, whose main role is to organize the activities of a collaboration. The way in which partnership managers enact leadership is explored and insight into the kinds of activities that typically occupy them, the types of challenges and dilemmas that they face and typical ways in which they respond to these is provided. We suggest that the main categories of activities split into two opposing perspectives on leadership. We propose an overarching concept which suggests that collaborative leadership involves the management of a tension between ideology and pragmatism.     

When do Public Managers Imitate Each Other? Mimetic Decision Making in Contracting Decisions of Danish Municipalities

Using organizational new institutional theory, this paper explores a core mechanism underlying contracting decisions in public organizations. A central proposition of this branch of institutional theory is that uncertainty leads to organizational isomorphism. The present study investigates this proposition by asking: When does perceived uncertainty lead public managers to imitative behavior in contracting out decisions? Contrary to most previous studies, we apply an individual level approach and relate different types of perceived uncertainty of decision makers to mimetic decision making. We define mimetic decision making as when decision makers deliberately obtain information about other organizations in order to possibly imitate them. In a survey of Danish municipal managers facing important and complex contracting decisions, we test our hypotheses about three types of perceived uncertainty and mimetic decision making. The results show that technological uncertainty is strongly related to mimetic decision making among public managers. However, we do not find significant results for either volume uncertainty or performance uncertainty. The paper illustrates how uncertainty, through mimetic decision making, is connected to organizational isomorphism. It further highlights that future studies should pay attention to the multidimensionality of uncertainty and its consequences.     

A Comparative Study of Institutionalizing Public Plant Breeding

Public–private partnerships are merely defined as an institutionalized cooperation between the public administration and private companies, but may take very different settings. This paper uses the case of partnerships in the plant breeding sector to study the institutional evolution of such linkages. It is shown how corporatist exclusivity can enter such partnerships, as their setting can have different purposes and be used to transfer subsidies from the public to companies or professional associations through low prices for resources transferred to the sector. The inefficiencies connected with such rents and possible alternatives are outlined and conclusions are drawn for the institutional theory of organizations.     

Community is not a Place but a Relationship<Superscript>1</Superscript>: Lessons for Organizational Development

The premise of this article is that organizations need to be “organized” differently if we want to re-invigorate the power of community in contemporary life. A central theme within the current reform movement toward restorative justice is the devolution of authority from formal governmental systems to community. In order to effectively socialize young people, communities and families must perform certain functions well. As more and more societal activities take place within organizations, we face the dilemma that the weakened communities create a demand for increasing involvement of public organizations in the life of the community. Yet modern organizations do not effectively perform functions unique to families and communities. Drawing on insights from a unique community-system partnership in restorative peacemaking circles, this paper argues we may need to reinvent our organizations so that they learn to behave as members of the community. ¹This apt phrase and fundamental insight about the meaning of community came from the seminal article by Paul McCold and Benjamin Wachtel (1998).     

Dissecting Public Sector Corruption in Bangladesh: Issues and Problems of Control

The public sector in Bangladesh is ridden with corruption of various dimensions and shades. Apart from bribery, rent-seeking and misappropriation of funds, the performance of public organizations is adversely affected by a host of other factors like excessive lobbying, delays in service provision, pilferage and larceny, irresponsible conduct of officials, bureaucratic intemperance, patronage and clientelism. The several institutional mechanisms to combat administrative malfeasance are rendered ineffective by a non-committed political leadership, a blase"d bureaucracy, weak accountability structures, and unproductive legislative labors. The public body for controlling corruption is itself associated with all sorts of malpractices and conducts its affair most unprofessionally. Despite several attempts, the constitutionally authorized ombudsman is yet to find its place in the governance framework.     

Beyond the purely commercial business model: Organizational value logics and the heterogeneity of sustainability business models

The business model has been conceived as a commercial logic of value proposition, creation, exchange and capture. However, its underlying conceptual structure of an organizational value logic holds promise also for application beyond a purely commercial context, for partially commercial and even noncommercial organizations. This paper unlocks this potential by conceptualizing homogeneous and heterogeneous organizational value logics shaped by a variety of institutional logics. Homogeneous value logics are dominantly shaped by individual institutional logics, such as the value logic of businesses shaped by an institutional logic of the commercial market, or that of a churches shaped by an institutional logic of religion. Heterogeneous value logics, however, are co-shaped by two or more institutional logics. The application of these concepts is exemplified in the context of sustainability business models, which are built on a heterogeneous value logic that combines elements from commercial, sustainability, welfare and government logics. The paper contributes to the business model discussion by extending it to partially commercial and noncommercial organizations; by creating a conceptual space between value logics and institutional logics; and by proposing the meta-logic of value proposition, creation, exchange and capture, a novel analytical tool for the study of organizations shaped by plural institutional logics.     

Institutional Theory: Employing the Other Side of Rationality in Non-profit Organizations1

The non-profit sector has become increasingly important in diverse economic, political and social environments. It is not clear that we have effectively communicated, to colleagues, students and decision makers, theoretical developments useful for understanding and managing non-profit organizations. This paper discusses the potential implications of institutional theory to the management of one type of non-profit organization, the publicly supported non-profit organization with input-output relationships that are not well understood. We review institutional theory and discuss the implications of institutional theory to the management and evaluation of publicly supported non-profit organizations.