External control and red tape: the mediating effects of client and organizational feedback

Bozeman’s (1993, 2000) external control model of red tape posits that organizations with higher degrees of external control will have higher levels of red tape. According to the model, this is compounded by entropy affecting the communication of rules and their results, limited discretion over rules and procedures, and non-ownership of rules. However, the model predicts that red tape will be mediated by communication from clients and within the organization. Bozeman’s model is often cited in the literature, but it has not been subjected to empirical verification. This study tests the model using data from a multiple informant survey of 136 upper tier English local governments conducted in 2004 and several secondary sources. Statistical results show that external control does indeed lead to higher levels of red tape. We then test a number of organizational feedback mediators and find that client feedback does little to mediate the effects of red tape; the major factor is trust between politicians and officers. We discuss these findings and propose some changes to the model.postprin

Personnel constraints in public organizations: a study of intraorganizational variation and performance

Prior research has shown that personnel constraints are far more prevalent in the public sector than in the private sector. Anecdotal accounts suggest that public managers are hamstrung by these personnel constraints – particularly their inability to reward and punish employees to promote higher performance. As a result, more than three decades of public management reform has attempted to loosen these constraints on the assumption that more personnel system flexibility will lead to increased organizational performance. We mount an empirical study to test this assumption with data taken from a large-scale survey of English local authorities and other sources. We operationalize personnel constraints using Rainey’s (1979; Rainey et al. 1976) longstanding measures: "difficulty in removing poor managers" and "difficulty in rewarding good managers". We show that attitudes towards personnel constraint vary within organizations in statistically significant ways. The results from our lagged autoregressive multiple regression models also show that one of our personnel constraint measures – "difficulty in removing poor managers" – is harmful to performance but that the other "difficulty in rewarding good managers" has weak but positive short-term effects. The implications of these findings for public management research and practice are considered in the concluding section of the paper.postprintThe 10th Biennial Public Management Research Conference, Ohio State University, Columbus, OH., 1-3 October 2009

Bureaucratic malaises and their remedies in Public and Nonprofit Organizations

Many experts have observed that bureaucratic malaises are endemic in public sector organizations. These so-called “diseases,” which include personnel constraints, red tape and risk avoidance, can discourage workers, damage organizational performance, and lower the quality of public services. The depth and impact of these malaises are tested across the public and nonprofit sectors using data from the third National Administrative Studies Project (NASP III). NASP III surveyed randomly selected managers in public and nonprofit organizations in Georgia and Illinois. Multiple informant data are aggregated to the organizational level resulting 47 public and 64 nonprofit organizations for further analysis. Multivariate statistical analysis suggests that most of the maladies have harmful effects on work quality in the public sector, but not on the nonprofit agencies studied in this sample. The results further show that task clarity does not mitigate the performance effects of these maladies in the public sector whereas in the nonprofit sector it is associated with higher levels of performance. The implications for theory and practice are discussed.postprin

The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices

Madhu Pai and colleagues introduce the BCG World Atlas, an open access, user friendly Web site for TB clinicians to discern global BCG vaccination policies and practices and improve the care of their patients

Austerity, ageing and the financialisation of pensions policy in the UK

This article offers a detailed analysis of the recent history of pensions policy in the United Kingdom, culminating in two apparent ‘revolutions’ in policy now underway: the introduction of ‘automatic enrolment’ into private pensions, and proposals for a new ‘single-tier’ state pension. These reforms are considered exemplary of the ‘financialisation’ of UK welfare provision – typified in pensions policy by the notion that individuals must take personal responsibility for their own long-term financial security, and engage intimately with the financial services industry to do so. As such, the reforms represent the continuation of pensions policy between the Labour and coalition governments, despite the coalition government’s novel rhetorical commitment to austerity. In fact, the pensions revolutions will actually cost the state significantly more than current arrangements, yet the importance of fears about population ageing means that the government is both able to marshal the imagery of austerity to justify financialisation, but is also required to partly conceal the increased expenditure this requires. The article shows therefore how the financialisation agenda in pensions policy was evident before the financial crisis, but has evolved to both take advantage, and mitigate the constraints, of a post-crisis political climate

Toward optimal implementation of cancer prevention and control programs in public health: A study protocol on mis-implementation

Abstract Background Much of the cancer burden in the USA is preventable, through application of existing knowledge. State-level funders and public health practitioners are in ideal positions to affect programs and policies related to cancer control. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Greater attention to mis-implementation should lead to use of effective interventions and more efficient expenditure of resources, which in the long term, will lead to more positive cancer outcomes. Methods This is a three-phase study that takes a comprehensive approach, leading to the elucidation of tactics for addressing mis-implementation. Phase 1: We assess the extent to which mis-implementation is occurring among state cancer control programs in public health. This initial phase will involve a survey of 800 practitioners representing all states. The programs represented will span the full continuum of cancer control, from primary prevention to survivorship. Phase 2: Using data from phase 1 to identify organizations in which mis-implementation is particularly high or low, the team will conduct eight comparative case studies to get a richer understanding of mis-implementation and to understand contextual differences. These case studies will highlight lessons learned about mis-implementation and identify hypothesized drivers. Phase 3: Agent-based modeling will be used to identify dynamic interactions between individual capacity, organizational capacity, use of evidence, funding, and external factors driving mis-implementation. The team will then translate and disseminate findings from phases 1 to 3 to practitioners and practice-related stakeholders to support the reduction of mis-implementation. Discussion This study is innovative and significant because it will (1) be the first to refine and further develop reliable and valid measures of mis-implementation of public health programs; (2) bring together a strong, transdisciplinary team with significant expertise in practice-based research; (3) use agent-based modeling to address cancer control implementation; and (4) use a participatory, evidence-based, stakeholder-driven approach that will identify key leverage points for addressing mis-implementation among state public health programs. This research is expected to provide replicable computational simulation models that can identify leverage points and public health system dynamics to reduce mis-implementation in cancer control and may be of interest to other health areas

Approach to Dyslipidemia, Lipodystrophy, and Cardiovascular Risk in Patients with HIV Infection

There is a significant prevalence (20%–80% depending on the population and the study) of lipid disorders and other cardiovascular risk factors in people living with HIV infection. This review focuses on HIV and HIV treatment–associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascular risk and other problems associated with these syndromes are discussed. Screening for cardiovascular risk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed

New Public Management reforms in Europe and their effects: findings from a 20-country top executive survey

This article assesses the impact of New Public Management (NPM)-style reforms in European countries as perceived by top public sector officials. Using data from an executive survey conducted in 20 European countries, we look at the relationship between five key NPM reforms (downsizing, agencification, contracting out, customer orientation and flexible employment practices) and four dimensions of public sector performance: cost efficiency, service quality, policy coherence and coordination, and equal access to services. Structural equation modelling reveals that treating service users as customers and flexible employment are positively related to improvements on all four dimensions of performance. Contracting out and downsizing are both positively related to improved efficiency, but downsizing is also associated with worse service quality. The creation of autonomous agencies is unrelated to performance. This suggests that policy-makers seeking to modernize the public sector should prioritize managerial reforms within public organizations over structural transformations

Excitotoxicity Triggered by Neurobasal Culture Medium

Neurobasal defined culture medium has been optimized for survival of rat embryonic hippocampal neurons and is now widely used for many types of primary neuronal cell culture. Therefore, we were surprised that routine medium exchange with serum- and supplement-free Neurobasal killed as many as 50% of postnatal hippocampal neurons after a 4 h exposure at day in vitro 12–15. Minimal Essential Medium (MEM), in contrast, produced no significant toxicity. Detectable Neurobasal-induced neuronal death occurred with as little as 5 min exposure, measured 24 h later. D-2-Amino-5-phosphonovalerate (D-APV) completely prevented Neurobasal toxicity, implicating direct or indirect N-methyl-D-aspartate (NMDA) receptor-mediated neuronal excitotoxicity. Whole-cell recordings revealed that Neurobasal but not MEM directly activated D-APV-sensitive currents similar in amplitude to those gated by 1 µM glutamate. We hypothesized that L-cysteine likely mediates the excitotoxic effects of Neurobasal incubation. Although the original published formulation of Neurobasal contained only 10 µM L-cysteine, commercial recipes contain 260 µM, a concentration in the range reported to activate NMDA receptors. Consistent with our hypothesis, 260 µM L-cysteine in bicarbonate-buffered saline gated NMDA receptor currents and produced toxicity equivalent to Neurobasal. Although NMDA receptor-mediated depolarization and Ca2+ influx may support survival of young neurons, NMDA receptor agonist effects on development and survival should be considered when employing Neurobasal culture medium

A Preference for Contralateral Stimuli in Human Object- and Face-Selective Cortex

Visual input from the left and right visual fields is processed predominantly in the contralateral hemisphere. Here we investigated whether this preference for contralateral over ipsilateral stimuli is also found in high-level visual areas that are important for the recognition of objects and faces. Human subjects were scanned with functional magnetic resonance imaging (fMRI) while they viewed and attended faces, objects, scenes, and scrambled images in the left or right visual field. With our stimulation protocol, primary visual cortex responded only to contralateral stimuli. The contralateral preference was smaller in object- and face-selective regions, and it was smallest in the fusiform gyrus. Nevertheless, each region showed a significant preference for contralateral stimuli. These results indicate that sensitivity to stimulus position is present even in high-level ventral visual cortex