Structural equation modeling of mediation and moderation with contextual factors

This work was supported in part by grants from the NIH to the University of Kansas through the Mental Retardation and Developmental Disabilities Research Center (5 P30 HD002528), the Center for Biobehavioral Neurosciences in Communication Disorders (5 P30 DC005803), an Individual National Research Service Award (F32 MH072005) to the second author while at the University of Kansas, an Individual National Research Service Award (F32 DA016883-03) to the fourth author while at the University of North Carolina at Chapel Hill, and a NFGRF grant (2301779) from the University of Kansas to the first author. This work was also partly supported by grants to the first author from NSF (BCS-0345677), the Merrill Advanced Study Center at the University of Kansas (Mabel Rice, director), and the Society of Multivariate Experimental Psychology (SMEP)

Integrated approach of the citizen’s role in relation to the public services

The paper achieves an integrated, interdisciplinary approach of the citizens’ roles related to public service providers. The contemporary public service development awards multiple roles to the citizen, interacting with the activities of design, decision-making, production, delivery or assessment, specific for various stages of the life cycle of the public services. Such an approach substantiates the public marketing strategies and it integrates aspects concerning service delivery in the private secto

An analysis of ophthalmology services in Finland - has the time come for a Public-Private Partnership?

<p>Abstract</p> <p>Background</p> <p>We studied the prerequisites for Public-Private Partnership (PPP) in the context of the Finnish health care system and more specifically in the field of ophthalmology. PPP can be defined as a more or less permanent cooperation between public and private actors, through which the joint products or services are developed and in which the risks, costs and profits are shared.</p> <p>The Finnish eye care services system is heterogeneous with several different providers and can be regarded as sub-optimal in terms of overall resource use. What is more, the public sector is suffering from a shortage of ophthalmologists, which further decreases its possibilities to meet the present needs. As ophthalmology has traditionally been a medical specialty with a substantial private sector involvement in service provision, PPP could be a feasible policy to be used in the field. We thus ask the following research question: Is there, and to what extent, an open window of opportunity for PPP?</p> <p>Methods</p> <p>In addition to the previously published literature, the research data consisted of 17 thematic interviews with public and private experts in the field of ophthalmology. The analysis was conducted in two stages. First, a literature-based content analysis was used to explore the prerequisites for PPP. Second, Kingdon's (1995) multiple streams theory was used to study the opening of the window of opportunity for PPP.</p> <p>Results</p> <p>Public and private parties reported similar problems in the current situation but defined them differently. Also, there is no consensus on policy alternatives. Public opinion seems to be somewhat uncertain as to the attitudes towards private service providers. The analysis thus showed that although there are prerequisites for PPP, the time has not yet come for a Public-Private Partnership.</p> <p>Conclusion</p> <p>Should the window open fully, the emergence of policy entrepreneurs and an opportunity for a win-win situation between public and private organizations are required.</p

Squaring the circle: a priority-setting method for evidence-based service development, reconciling research with multiple stakeholder views.

BACKGROUND: This study demonstrates a technique to aid the implementation of research findings through an example of improving services and self-management in longer-term depression. In common with other long-term conditions, policy in this field requires innovation to be undertaken in the context of a whole system of care, be cost-effective, evidence-based and to comply with national clinical guidelines. At the same time, successful service development must be acceptable to clinicians and service users and choices must be made within limited resources. This paper describes a novel way of resolving these competing requirements by reconciling different sources and types of evidence and systematically engaging multiple stakeholder views. METHODS: The study combined results from mathematical modelling of the care pathway, research evidence on effective interventions and findings from qualitative research with service users in a series of workshops to define, refine and select candidate service improvements. A final consensus-generating workshop used structured discussion and anonymised electronic voting. This was followed by an email survey to all stakeholders, to achieve a pre-defined criterion of consensus for six suggestions for implementation. RESULTS: An initial list of over 20 ideas was grouped into four main areas. At the final workshop, each idea was presented in person, visually and in writing to 40 people, who assigned themselves to one or more of five stakeholder groups: i) service users and carers, ii) clinicians, iii) managers, iv) commissioners and v) researchers. Many belonged to more than one group. After two rounds of voting, consensus was reached on seven ideas and one runner up. The survey then confirmed the top six ideas to be tested in practice. CONCLUSIONS: The method recruited and retained people with diverse experience and views within a health community and took account of a full range of evidence. It enabled a diverse group of stakeholders to travel together in a direction that converged with the messages coming out of the research and successfully yielded priorities for service improvement that met competing requirements

An exploratory study on the potential of social enterprise to act as the institutional glue of network governance

This study combines two topics of contemporary salience for public administration: social enterprise and governance networks. While operating at different levels, both are institutions which attempt to draw together the three pillars of state, market, and civil society. Nevertheless, the respective literatures focus on particular aspects of the three pillars. We connect the two concepts and suggest that some social enterprises can act as the institutional glue of networks due to their ability to benefit organizations in each of the three sectors. This requires social enterprises to have the managerial capacity to diffuse social know-how, and is facilitated by the trust of other organizations and a supportive policy framework. The links are explicated at the conceptual level before providing evidence from South Korea and the UK. Finally, research propositions are offered, which suggest new avenues for future research

Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed?

Background: The wide-ranging program of reforms brought about by the Health and Social Care Act (2012) in England fundamentally changed the operation of the public health system, moving responsibility for the commissioning and delivery of services from the National Health Service to locally elected councils and a new national public health agency. This paper explores the ways in which the reforms have altered public health commissioning. Methods: We conducted multi-methods research over 33 months, incorporating national surveys of Directors of Public Health and local council elected members at two time-points, and in-depth case studies in five purposively selected geographical areas. Results: Public health commissioning responsibilities have changed and become more fragmented, being split amongst a range of different organisations, most of which were newly created in 2013. There is much change in the way public health commissioning is done, in who is doing it, and in what is commissioned, since the reforms. There is wider consultation on decisions in the local council setting than in the NHS, and elected members now have a strong influence on public health prioritisation. There is more (and different) scrutiny being applied to public health contracts, and most councils have embarked on wide-ranging changes to the health improvement services they commission. Public health money is being used in different ways as councils are adapting to increasing financial constraint. Conclusions: Our findings suggest that, while some of the intended opportunities to improve population health and create a more joined-up system with clearer leadership have been achieved, fragmentation, dispersed decision-making and uncertainties regarding funding remain significant challenges. There have been profound changes in commissioning processes, with consequences for what health improvement services are ultimately commissioned. Time (and further research) will tell if any of these changes lead to improved population health outcomes and reduced health inequalities, but many of the opportunities brought about by the reforms are threatened by the continued flux in the system

Innovation by Experimenting in Public Services

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