Innovation labs in the public sector: what they are and what they do?

This article is a first comprehensive attempt to globally map and analyse innovation labs (i-labs) in the public sector. The article analyzes theoretical reasons why i-labs are created in the public sector and tests these assumptions in practice. During the empirical study, thirty-five such organizations all over the world were identified. The research is based on a two-step approach: first, a comprehensive survey was carried out followed by an extensive in-depth interview with the managing figures of i-labs; eleven i-labs responded. The article finds support for the assumptions of external complexity, technological challenges, emulation, and legitimization as reasons behind the creation of i-labs

Technological capacity in the public sector: the case of Estonia

Technology is clearly a critical factor in the lives of organizations, yet there are only a few studies that deal with technology and public organizations. In this article, we propose to understand technological change in the public sector, in particular, how technology influences administrative capacity, through a new concept of technological capacity. We use the case of Estonia – internationally associated with a strong e-state profile – as an exploratory case to answer two research questions: ‘Why and how does technological change take place in the public sector?’ and ‘How does technological change influence administrative capacity in public organizations?’ We demonstrate how dynamic and static change in technological capacities is influenced by four different public sector feedback and selection mechanisms. We conclude that in spite of the neglected position of technology in the public administration literature, technology is an intrinsic factor in how administrative capacity evolves

Family doctors' involvement with families in Estonia

BACKGROUND: Family doctors should care for individuals in the context of their family. Family has a powerful influence on health and illness and family interventions have been shown to improve health outcomes for a variety of health problems. The aim of the study was to investigate the Estonian family doctors' (FD) attitudes to the patients' family-related issues in their work: to explore the degree of FDs involvement in family matters, their preparedness for management of family-related issues and their self-assessment of the ability to manage different family-related problems. METHODS: A random sample (n = 236) of all FDs in Estonia was investigated using a postal questionnaire. Altogether 151 FDs responded to the questionnaire (response rate 64%), while five of them were excluded as they did not actually work as FDs. RESULTS: Of the respondents, 90% thought that in managing the health problems of patients FDs should communicate and cooperate with family members. Although most of the family doctors agreed that modifying of the health damaging risk factors (smoking, alcohol and drug abuse) of their patients and families is their task, one third of them felt that dealing with these problems is ineffective, or perceived themselves as poorly prepared or having too little time for such activities. Of the respondents, 58% (n = 83) were of the opinion that they could modify also relationship problems. CONCLUSIONS: Estonian family doctors are favourably disposed to involvement in family-related problems, however, they need some additional training, especially in the field of relationship management

Indicators for public sector innovations: Theoretical frameworks and practical applications

The paper maps and analyzes all existing practical exercises aiming to develop indicators for public sector innovations. To our knowledge this is the first attempt to comprehensively gather information about various international efforts. We only considered such exercises where actual indicators were developed and used at least once. We map five such exercises through extensive desk research and 13 interviews with surveyed project members. The paper shows that all existing attempts to measure public sector innovations operate within a rather limited conception of the public sector (efficiency), neglecting other possible logics (e.g. legitimacy); the existing exercises also neglect large areas of public sector activities, e.g. cooperation with business and third sectors (such as service co-creation, public-private partnership practices). This narrow focus often dictates that indicators and their technical assumptions are copied from the private sector; none of the five analyzed exercises utilized public administration experience and research (e.g. on performance measurement). The paper argues that instead of trying to come up with quantified indicators, public sector innovations should be assessed in complex evaluation frameworks

An inter-country comparison of unofficial payments: results of a health sector social audit in the Baltic States

<p>Abstract</p> <p>Background</p> <p>Cross-country comparisons of unofficial payments in the health sector are sparse. In 2002 we conducted a social audit of the health sector of the three Baltic States.</p> <p>Methods</p> <p>Some 10,320 household interviews from a stratified, last-stage-random, sample of 30 clusters per country, together with institutional reviews, produced preliminary results. Separate focus groups of service users, nurses and doctors interpreted these findings. Stakeholder workshops in each country discussed the survey and focus group results.</p> <p>Results</p> <p>Nearly one half of the respondents did not consider unofficial payments to health workers to be corruption, yet one half (Estonia 43%, Latvia 45%, Lithuania 64%) thought the level of corruption in government health services was high. Very few (Estonia 1%, Latvia 3%, Lithuania 8%) admitted to making unofficial payments in their last contact with the services. Around 14% of household members across the three countries gave gifts in their last contact with government services.</p> <p>Conclusion</p> <p>This social audit allowed comparison of perceptions, attitudes and experience regarding unofficial payments in the health services of the three Baltic States. Estonia showed least corruption. Latvia was in the middle. Lithuania evidenced the most unofficial payments, the greatest mistrust towards the system. These findings can serve as a baseline for interventions, and to compare each country's approach to health service reform in relation to unofficial payments.</p

Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

Background Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. Methods Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding. Results A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55). Conclusions Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218. opens in new tab.

Changing public service delivery: Learning in co-creation

Co-creation – where citizens and public organizations work together to deal with societal issues – is increasingly considered as a fertile solution for various public service delivery problems. During cocreation, citizens are not mere consumers, but are actively engaged in building resilient societies. In this study, we analyze if and how state and governance traditions influence learning and policy change within a context of co-creation. We combine insights from the co-creation and learning literature. The empirical strategy is a comparative case study of co-creation examples within the welfare domain in childcare (Estonia), education (Germany) and community work (the Netherlands). We show that state and governance traditions may form an explanation for whether co-creation, learning and policy change occurs. Our paper suggests that this seems to be related to whether there is a tradition of working together with citizens and a focus on rule following or not