Co-creating public service leadership development in a new era of collaboration

The UK Government’s policy report (Cabinet Office, 2008) entitled “Excellence and Fairness in Public Services”, sets out the new phase of reform which should enable public services to go from “good to great” focused on the needs of service users and citizens, who are empowered to express their needs and make informed choices, rather than around traditional professional structures of service provider hierarchies and organisational boundaries or “….moving to Dynamic capability – becoming more creative and more capably handling the wicked problems of leadership rather than working in the old familiar ways” (Clark cited in Public Servant (Thomas, 2008)). However, recent departmental capability reviews across the UK government (Barwise et al. 2007) identified improving leadership within the UK civil service, as key to achieving “world class” public services (Cabinet Office, 2008). In addition, Sutherland and Ley (2009), who interviewed senior civil servants responsible for leading the delivery of the UK government’s strategic objectives, clearly identified the need to improve the quality of, and the skills required for, effective collaboration across the public service as one of their key challenges. In a new era of collaboration, public service leaders in the 21st century need to be able to work collaboratively across the whole public service system horizontally across organisational and sector boundaries, but also vertically across national, regional and local levels of governance (Seddon, 2008; Benington and Hartley, 2009). This will need to use traditional skills such as diplomat and specialist, but also move“towards using post conventional action logics (mindsets) such as individualist, strategist and alchemist, stepping beyond their existing frameworks into new and more integrative and inclusive action logics” (Mead, 2009). This provides a significant challenge to both public services and to their respective leadership academies. Such an alliance of sector based public service leadership academies is attempting to model collaborative working across organisational and sector boundaries, to co-create and deliver a new leadership development initiative. This collaboration builds public service leaders capacity to work collaboratively across the whole public service system to improve outcomes for individuals, citizens and communities of place and interest. This working paper sets out an emerging approach for exploring two key issues arising from this work. Firstly, the challenges faced by the leaders of a disparate group of organisations, working within different business models, seeking to work together to create better public service leaders capable of responding to intractable, interdependent, socio-economic problems or “wicked issues” (Grint, 2008; Thomas, 2008). Secondly, whether in developing their new collaborative leadership initiative, the alliance is able to resist being drawn back into institutional silos and into delivering old models of leadership “teaching the right answers instead of co-creating new knowledge and theory about how to effectively lead across the public service system (Mead, 2008). This exploratory research will seek to build theory from observation and interpretation of people’s experiences (Yin, 2003). It will use the development of the leadership initiative by the alliance as a case study, using quantitative as well as qualitative methods in a mixed methodology approach also known as the “pragmatic paradigm” (Tashakkori and Teddlie, 1998)

Managing Supply Chain Networks: A Framework for Achieving Superior Performance through Leadership Capabilities Development in Supply Chain Node

Leadership capability is acknowledged as a major challenge for organizations and a pre-requisite for sustaining high levels of organizational performance and supply chain competitiveness. Recent research highlights how globalisation has led to the extension of domestic supply chains, particularly SME ones, to include both suppliers and customers globally. This paper examines the role capabilities development in managers and leaders as nexus of their supply chain networks have to play in achieving better performance through case studies. Once banished to the backburners of business management thinking, leveraging core leadership competencies is now critical to company‟s superior performance in supply chain networks

The effectiveness of support groups: a literature review

Purpose: Support groups are a common feature of the mental health support engaged by carers and consumers. The purpose of this paper is to update and consolidate the knowledge and the evidence for the effectiveness of mental health support groups. Design/methodology/approach: This paper is based on a systematic literature review of relevant databases around support groups for mental health. Support groups are defined as meetings of people with similar experiences, such as those defined as carers of a person living with a mental illness or a person living with a mental illness. These meetings aim to provide support and companionship to one another. Findings: The results show that there is a consistent pattern of evidence, over a long period of time, which confirms the effectiveness of mental health support groups for carers and people living with mental illness. There is strong, scientifically rigorous evidence which shows the effectiveness of professionally facilitated, family-led support groups, psychoeducation carers support groups, and professionally facilitated, program-based support groups for people living with mental illness. Research limitations/implications: This research implies the use of support groups is an important adjunct to the support of carers and people with mental illness, including severe mental illness. Originality/value: This research brings together a range of studies indicating the usefulness of support groups as an adjunct to mental health therapy

Constraining the Carbon Budget of Peat Ecosystems: Application of Stoichiometry and Enthalpy Balances

We consider how the stoichiometry and energy content of organic matter reservoirs and fluxes through and from a peatland enable the fluxes and storage of carbon within a peatland to be constrained. We include the elemental composition of the above- and below-ground biomass, litter, the peat profile, and the dissolved and particulate organic matter within a blanket bog in northern England for which the C budget has previously been measured. The study shows, based only on the elemental composition, and calculation of oxidation and energy contents, that: (a) Dissolved organic carbon (DOC) in first-order streams is significantly more oxidized than in peat pore water but that there was no significant difference in organic carbon oxidation state down the peat profile; (b) The occurrence and speciation of N uptake and release in the peatland with N used and recycled can be predicted; (c) The relatively high oxidation state of DOC in stream water acts as an endpoint for peat-forming reactions; (d) Methanogenesis does not result in deep peat formation as its requirement for energy consumes too much organic matter to form residual peat at depth; (e) Sulfate reduction does occur during the formation of deep peat; (f) Organic matter elemental composition could be constrained to within three bounding equations though the proportions of carbon species could not be specified. (g) The formation of deep peat in this catchment could only be achieved if the dissolved organic matter (DOM) in the peat pore water is the dominant electron acceptor and energy source in the production of residual organic matter; however, it is unclear as to the flux of DOM up or down the peat profile

Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia

<p>Abstract</p> <p>Background</p> <p>In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up.</p> <p>Methods</p> <p>Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation.</p> <p>Results</p> <p>Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme.</p> <p>Conclusions</p> <p>Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation.</p

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348