Governing with the citizens: strategic planning in four Italian cities

In recent years there has been much political and academic interest in new modes of local governance, which are increasingly based on deliberative mechanisms and aim at engaging larger sectors of the population (i.e. governance by networks, territorial pacts, strategic planning). Whereas the literature on urban governance has focused on the emergence of novel governance arrangements at city and regional levels and on the formation of a collective actor, deliberative democracy scholars have examined the democratic dimension (i.e. the deliberative forums) and assessed the applicability of their normative models to the real world; the literature on planning helps to understand the implementation gap that plagues many of these new arrangements. All these approaches often study the same empirical phenomena, however, with a few exceptions, debates within these literatures take no account of one another. This comparative case-study of strategic planning in four medium-sized Italian cities (Trento, Prato, Lecce, and Sassari), characterized by different socio-political and economic contexts, intends to contribute to bridging the gap between the above theoretical paradigms. Thus, the impact of strategic planning on the local polity is assessed on three levels: the formation of a collective actor, the democratic process, and implementation. Comparative analysis can help to evidence how such an impact is either hindered or enhanced by different forms and resources of leadership and how the latter interact with endogenous (i.e. pre-existing associational density) and exogenous factors (i.e. institutional constraints and opportunities at other jurisdictional levels). Different typologies of leadership will influence each dimension of the dependent variable (i.e. the formation of the collective actor, the democratic process, the implementation) to varying degrees. The type of leadership now required within the new multilevel governance system could be defined as facilitative leadership, which arises from the activity of working with, rather than exercising power over, others. This leadership is no longer identified solely with political institutions but often emerges from the coordinated work of a political sponsor and a public service CEO that acts as the champion of the governance process. Institutional constraints might affect outcomes, as weak administrative capacity and resistance to change from within the bureaucracy will hinder implementation. A facilitative leadership can help to drive cultural change and organisational learning within local institutions, while offering identity incentives to the wider community. While pre-existing associational dynamics do not influence outcomes, since an inclusive leadership can encourage greater participation even where the social fabric would seem weaker, poor policy coordination among jurisdictional tiers will inevitably hamper the positive effects of strategic planning at the local level, which might be lost in a plethora of fragmented initiatives

Public engagement on the Internet of Things is essential if we are to put societal values at the centre of technologicaldevelopments

How do we ensure that the ‘next big thing’ – the Internet of Things – be harnessed for the public good? Sonia Bussu of Involve argues that the involvement of the public is key to ensure that a common language is developed, and that societal values at put at the centre of technological developments

Organisational Development to support integrated care in East London: the perspective of clinicians and social workers on the ground

Organisational Development (OD), with its focus on partnership working and distributed leadership, is increasingly advocated as an effective approach to driving change. Our evaluation of the impact of OD on delivery of integrated care in three London boroughs sheds light on how OD is being understood and implemented within health services, and what impact it is having on delivery of care. The findings presented here are based on a qualitative and participatory evaluation. We looked at how health and social care professionals communicated and coordinated delivery of care and evaluated the impact of current OD activities on the ground to evidence whether and to which degree they are enabling frontline staff to change their working routines towards greater coordination. Our findings highlight the limited reach and scope of a top-down approach to OD based on ad hoc coaching and staff engagement events, often delivered by external consultancies, and mostly focused at the senior management level. This approach fell short of enabling the creation of sustainable, integrated and collaborative organisations. Instead, some of the professionals that participated in our study tried to develop spaces that facilitated ongoing dialogue and mutual support among professionals on the ground. Initiatives of bottom-up OD such as those described in this paper have greater potential to change working routines as they enable staff to move towards more collaborative and coordinated work. These findings contribute to the literature on OD in public services and highlight the benefits of a context-sensitive, pragmatic, and long-term approach to OD to help create sustainable collaborative organisations

(Dis)integrated care? Lessons from East London

Introduction: This paper examines one of the NHS England’s Pioneers programmes of Integrated Care, which was implemented in three localities in East London, covering the area served by one of the largest hospital groups in the UK and bringing together commissioners, providers and local authorities. The partners agreed to build a model of integrated care that focused on the whole person. This qualitative and participatory evaluation looked at how an ambitious vision translated into the delivery of integrated care on the ground. The study explored the micro-mechanisms of integrated care relationships based on the experience of health and social care professionals working in acute and community care settings. Methods: We employed a participatory approach, the Researcher in Residence model, whereby the researcher was embedded in the organisations she evaluated and worked alongside managers and clinicians to build collaboration across the full range of stakeholders; develop shared learning; and find common ground through competing interests, while trying to address power imbalances. A number of complementary qualitative methods of data generation were used, including documentary analysis, participant observations, semi-structured interviews, and coproduction workshops with frontline health and social care professionals to interpret the data and develop recommendations. Results: Our fieldwork exposed persistent organisational fragmentation, despite the dominant rhetoric of integration and efforts to build a shared vision at senior governance levels. The evaluation identified several important themes, including: a growing barrier between acute and community services; a persisting difficulty experienced by health and social care staff in working together because of professional and cultural differences, as well as conflicting organisational priorities and guidelines; and a lack of capacity and support to deliver a genuine multidisciplinary approach in practice, despite the ethos of multiagency being embraced widely. Discussion: By focusing on professionals’ working routines, we detailed how and why action taken by organisational leaders failed to have tangible impact. The inability to align organisational priorities and guidelines on the ground, as well as a failure to acknowledge the impact of structural incentives for organisations to compete at the expense of cooperation, in a context of limited financial and human resources, acted as barriers to more coordinated working. Within an environment of continuous reconfigurations, staff were often confused about the functions of new services and did not feel they had influence on change processes. Investing in a genuine bottom-up approach could ensure that the range of activities needed to generate system-wide cultural transformation reflect the capacity of the organisations and systems and address genuine local needs. Limitations: The authors acknowledge several limitations of this study, including the focus on one geographical area, East London, and the timing of the evaluation, with several new interventions and programmes introduced more or less simultaneously. Some of the intermediate care services under evaluation were still at pilot stage and some teams were undergoing new reconfigurations, reflecting the fast-pace of change of the past decade. This created confusion at times, for instance when discussing specific roles and activities with participants. We tried to address some of these challenges by organising several workshops with different teams to co-interpret and discuss the findings

Understanding integrated care at the frontline using organisational learning theory: a participatory evaluation of multi-professional teams in East London

Integrated care has been proposed as an organising principle to address the challenges of the rising demand for care services and limited resources. There is limited understanding of the role of learning in integrated care systems. Organisational Learning (OL) theory in the guise of ‘Learning Practice’ can offer a lens to study service integration and reflect on some of the challenges faced by multi-professional teams in developing a learning culture. The study presents findings from two qualitative evaluations of integrated care initiatives in three East London boroughs, England, undertaken between 2017 and 2018. The evaluations employed a participatory approach, the researcher-in-residence model, to coproduce findings with frontline staff working in multi-professional teams in community care. Thematic analysis was undertaken using an adapted version of the ‘Learning Practice’ framework. The majority of learning in the teams was single loop i.e. learning was mainly reactive to issues that arise. Developing a learning culture in the three boroughs was hindered by the differences in the professional and organisational cultures of health and social care and challenges in developing effective structures for learning. Individual organisational priorities and pressures inhibited both the embedding of learning and effective integration of care services at the frontline. Currently, learning is not inherent in integrated care planning. The adoption of the principles of OL optimising learning opportunities, support of innovation, managed risk taking and capitalising on the will of staff to work in multidisciplinary teams might positively contribute to the development of service integration