From Street‐level Bureaucrats to Street‐level Policy Entrepreneurs? Central Policy and Local Action in Lottery‐funded Community Cancer Care

Recent contributions to the policy implementation literature have applied Kingdon's model of ‘policy windows’ to the implementation of policy on health inequalities in the UK, and have identified the key role played by ‘policy entrepreneurs’ at local as well as national level. Despite this, the picture that emerges is of frustration of central policy intentions at the local level, alongside frustration of local aspirations by the centre. This article explores the relationship between central policy and local implementation in the context of a Lottery‐funded initiative to develop community cancer care in the UK. We examine the relationships: between the BIG Lottery Fund and central government; between BIG and the cancer care projects it funded; and between the projects and their local economy of cancer care. We found evidence of success both in vertical cascading of policy and in local policy innovation; 83 per cent of projects succeeded in obtaining continuation funding at the end of their Lottery funding. We suggest that this was due, in part, to two features of Lottery funding and accountability that combined to differentiate it from the other policy initiatives studied. They meant that projects were ‘buffered’ not just from national policy churn, but also from competing local priorities. In the ‘protected space’ that was thus formed, ‘street‐level policy entrepreneurs’ played a key role in developing cancer care innovations for adoption by mainstream funding agencies.     

A Comparison of Accelerated and Traditional MSW Students: Twenty Years Later

Abstract

There has been concern about the ideal length of time to effectively offer graduate content. Programs of less than two full years have been suspect. Thus study reports on two groups of social workers in the same program who have been professionally active for over twenty years. They completed the master's requirements under two different time conditions: One group completed study in twelve months; the other in the traditional two year period. The accelerated group reported the five major curriculum areas were more useful in their practice. In addition, they reported higher long-range achievement scores on the identical objectives of both programs.     

Minimal rights based solidarity

In a model where individuals with different levels of skills exert different levels of effort, we propose to use individuals’ minimal rights to divide an extra amount of income generated by a change in the skill profile. Priority is given to individuals with a positive minimal right which ensures that the way redistribution is performed depends on the total sum of income available in society. We characterize two families of minimal rights based Egalitarian mechanisms. One family guarantees each individual her claim when claims are feasible. The other family guarantees a non-negative income after redistribution for all individuals.     

Does European Union policy making explain accounting choices? An empirical analysis of the effects of investigations by the Directorate General for Competition on accounting choices

The hypothesis that political costs caused by the regulatory process impact upon accounting has been tested extensively and has found considerable empirical support. However, most studies use data from the United States. Whether the conclusions carry over to different institutional settings is an open question. This study exploits the fact that, in the European Union, there exists a policy area—competition policy—in which the European Commission can act in a manner significantly less constrained than in most other policy areas, imposing substantial fines on companies found to be in infringement of European competition regulations. Companies investigated by the Commission’s Directorate General for Competition have strong incentives to deflect attention and keep a low profile. It is conjectured that such companies will use income-decreasing accruals in order not to appear to be making unjustified profits. The results confirm this conjecture.     

Why is Six Sigma so successful?

There can be little doubt that Motorola, General Electric, Black and Decker, Allied Signal (now Honeywell), ABB and Bombardier, have achieved impressive business performance in recent years. Their annual reports document this success. Furthermore, in several cases, the Annual Report clearly attributes this success to having followed a Six Sigma strategy. Not surprisingly, many other companies wish to learn what Six Sigma can do for them, and their first question is 'What exactly is Six Sigma?'. Unfortunately it is rather difficult, if not impossible, to define Six Sigma in one or two sentences. This paper identifies the essential elements of Six Sigma. Some are obvious, such as the extensive use of statistical techniques by employees known as Blackbelts. However, other more subtle, but very important, features of Six Sigma are concealed within the business culture of these successful companies. It is clear to those who have participated in this success, that any company embarking on Six Sigma will not succeed if it focuses on statistics whilst failing to develop a supporting culture.     

Impact of Economic Conditions and Crises on Mortality and its Predictability

To investigate how economic conditions and crises affect mortality and its predictability in industrialized countries, we review the related literature, and we forecast mortality developments in Spain, Hungary, and Russia—three countries which have recently undergone major transformation processes following the introduction of radical economic and political reforms. The results of our retrospective mortality forecasts from 1991 to 2009 suggest that our model can capture major changes in long-term mortality trends, and that the forecast errors it generates are usually smaller than those of other well-accepted models, like the Lee-Carter model and its coherent variant. This is because our approach is capable of modeling (1) dynamic shifts in survival improvements from younger to older ages over time, as well as (2) substantial changes in long-term trends by optionally complementing the extrapolated mortality trends in a country of interest with those of selected reference countries. However, the forecasting performance of our model is limited (like that of every model): e.g., if mortality becomes extremely volatile—as was the case in Russia after the dissolution of the Soviet Union—generating a precise forecast will depend more on luck than on methodology and expert judgment. In general, we conclude that, on their own, recent economic changes appear to have minor effects on life expectancy in industrialized countries, but that the effects of these changes are greater if they occur in conjunction with other major social and political changes.     

A political economy of accounting standard setting

In recent years accounting researchers have identified “political” lobbying as a problem for accounting standard setting. This paper presents a simple game-theoretic analysis of the political process to identify situations where companies have incentives to lobby the political principal instead of participating in the usual due process of accounting standard setting. Analysis of the model suggests that “political” lobbying is more likely to happen in the EU than in the US. Furthermore it is suggested that if the relevant standard setters wish to achieve harmonization of accounting standards between the EU and the US, European companies have more lobbying leverage than their American counterparts because there are more European veto players than American ones.     

Design and Analysis of Hospital Admission Control for Operational Effectiveness

Variability in hospital occupancy negatively impacts the cost and quality of patient care delivery through increased emergency department (ED) congestion, emergency blockages and diversions, elective cancelations, backlogs in ancillary services, overstaffing, and understaffing. Controlling inpatient admissions can effectively reduce variability in hospital occupancy to mitigate these problems. Currently there are two major gateways for admission to a hospital: the ED and scheduled elective admission. Unfortunately, in highly utilized hospitals, excessive wait times make the scheduled gateway undesirable or infeasible for a subset of patients and doctors. As a result, this group often uses the ED gateway as a means to gain admission to the hospital. To better serve these patients and improve overall hospital functioning, we propose creating a third gateway: an expedited patient care queue. We first characterize an optimal admission threshold policy using controls on the scheduled and expedited gateways for a new Markov decision process model. We then present a practical policy based on insight from the analytical model that yields reduced emergency blockages, cancelations, and off‐unit census via simulation based on historical hospital data.