Bringing Anglo-governmentality into public management scholarship : the case of evidence-based medicine in UK health care

The field of public administration and management exhibits a limited number of favored themes and theories, including influential New Public Management and Network Governance accounts of contemporary government. Can additional social science–based perspectives enrich its theoretical base, in particular, analyzing a long-term shift to indirect governance evident in the field? We suggest that a variant of Foucauldian analysis is helpful, namely “Anglo-governmentality.” Having reviewed the literatures, we apply this Anglo-governmentality perspective to two case studies of “post hierarchical” UK health care settings: first, the National Institute for Health and Clinical Excellence (NICE), responsible for producing evidence-based guidelines nationally, and the second, a local network tasked with enacting such guidelines into practice. Compared with the Network Governance narrative, the Anglo-governmentality perspective distinctively highlights (a) a power–knowledge nexus giving strong technical advice; (b) pervasive grey sciences, which produce such evidence-based guidelines; (c) the “subjectification” of local governing agents, herein analyzed using Foucauldian concepts of the “technology of the self” and “pastoral power”; and (d) the continuing indirect steering role of the advanced neoliberal health care State. We add to Anglo-governmentality literature by highlighting hybrid “grey sciences,” which include clinical elements and energetic self-directed clinical–managerial hybrids as local governing agents. These findings suggest that the State and segments of the medical profession form a loose ensemble and that professionals retain scope for colonizing these new arenas. We finally suggest that Anglo-governmentality theory warrants further exploration within knowledge-based public organizations

Business schools inside the academy: What are the prospects for interdepartmental research collaboration?

Established literature about the role of business schools tends towards more parochial concerns, such as their need for a more pluralist and socially reflexive mode of knowledge production (Starkey and Tiratsoo 2007; Starkey et al 2009) or the failure of management’s professionalism project expressed through the business school movement (Khurana 2007). When casting their gaze otherwise, academic commentators examine business schools’ weakening links with management practice (Bennis and O’Toole 2005). Our theme makes a novel contribution to the business school literature through exploring prospects for research collaborations with other university departments. We draw upon the case of UK business schools, which are typically university-based (unlike some of their European counterparts), and provide illustrations relating to collaboration with medical schools to make our analytical points. We might expect that business schools and medical schools effectively collaborate given their similar vocational underpinnings, but at the same time, there are significant differences, such as differing paradigms of research and the extent to which the practice fields are professionalised. This means collaboration may prove challenging. In short, the case of collaboration between business schools and medical schools is likely to illuminate the challenges for business schools ‘reaching out’ to other university departments

Strategic Management in Public Organizations: Profiling the Public Entrepreneur as Strategist

Our core argument is that the entrepreneurial school of thought in strategic management as conceptualized by Mintzberg and colleagues holds explanatory value for advancing knowledge about the behavior of public sector organizations, as it does for private firms, albeit with important qualifications when applied to public services: chiefly, the temporal limitation in post for the office-holder of a public organization. After describing our methods, we present qualitative data from a longitudinal case study of strategy making in an European Union (EU) agency, the European Aviation Safety Agency, which has become a key actor globally in civil aviation. Our interpretation of the case suggests the additional usefulness of the entrepreneurial school of strategy, suitably adapted for public agency settings, as an explanatory prism to enlarge the repertoire of conceptual tools for the study of public agencies. Our broader argument is that the field of strategic management may provide theoretical resources for the study of public agencies, provided its theoretical lenses are properly selected and adapted

Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review

Introduction The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. Methods A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. Results 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. Conclusion The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation efforts should be focussed, and also how to build contingency at the strategic level for agile responses to macro-level environmental influences

The governance of Higher Education Systems: A public Management Perspective

European higher education (HE) systems experienced major changes, and many publications have already proposed to assess and analyse this evolution. But looking at the state of the art on this issue, as will be done in the first section of this introduction, it appears that none adopted a public management perspective and considered wider patterns of public sector ‘reforming’ and how they have been applied to higher education systems within the EU. Although most HE systems in Europe, but also in the US, are publicly funded, admit the highest share of students and, by contrast with the US benefit from higher reputation than many private institutions, HE has rarely been studied as a public policy or management topic, so has not been one of the traditional areas covered by generic political scientists or public management scholars ‘Bringing in’ more generic concepts from political science and public management more fully into the study of HE institutions (HEIs) is a promising avenue to explore academically, and may re-invigorate the study of HEIs. Often the HE sector is seen as a ‘stand alone’ sector, which is not directly or easily comparable with other types of organization, even within the public sector. The ideology of academic and institutional autonomy as described by Merton, which is so well developed within the HE sector supports this sectoralist approach. There may be some evidence to support this notion of difference even at the organizational level: for example, UK universities retain more self direction and less central control than some other UK public sector settings, such as the National Health Service (the very name describes a national rather than a local service). Yet at a more fundamental level, the organizational similarities with other professionalized public sector settings such as health care are more important than the differences: European universities are largely dependent on the state for financing; the state is concerned to regulate their behaviour as they influence citizens' life chances significantly; they contain a mix of professional and bureaucratic elements and they operate within strongly structured institutionalized fields. There are many fundamental similarities with other public service settings such as health care. Within organizational analysis, they fit well with the more general archetype of the professionalized organization developed by Mintzberg (1979)

A Call for University-Based Business Schools to “Lower Their Walls:” Collaborating With Other Academic Departments in Pursuit of Social Value

The walls around many business schools remain high, eroding interdisciplinary education and research collaboration that might address some grand challenges facing society. In response, we adopt a public interest perspective and argue business schools should lower their walls to engage with other academic departments to address such grand challenges in a way that engenders social value. We identify forces for lower and higher walls that surround business schools and influence prospects for interdisciplinary collaboration. We highlight examples of successful relationships between business schools and other academic departments, which offer some optimism for a reimagined public interest mission for business schools. Finally, we draw out some boundary conditions to take a more contingent view of possibilities for such interdisciplinary collaboration encompassing business schools

Biopolitics, space and hospital reconfiguration

Major service change in healthcare – whereby the distribution of services is reconfigured at a local or regional level - is often a contested, political and poorly understood set of processes. This paper contributes to the theoretical understanding of major service change by demonstrating the utility of interpreting health service reconfiguration as a biopolitical intervention. Such an approach orients the analytical focus towards an exploration of the spatial and the population – crucial factors in major service change. Drawing on a qualitative study from 2011–12 of major service change in the English NHS combining documentary analyses of historically relevant policy papers and contemporary policy documentation (n = 125) with semi-structured interviews (n = 20) we highlight how a particular ‘geography of stroke’ in London was created building upon multiple types of knowledge: medical, epidemiological, economic, demographic, managerial and organisational. These informed particular spatial practices of government providing legitimation for the significant political upheaval that accompanies NHS service reconfiguration by problematizing existing variation in outcomes and making these visible. We suggest that major service change may be analysed as a ‘practice of security’ – a way of redefining a case, conceiving of risks and dangers, and averting potential crises in the interests of the population.</p

The impact of leadership and leadership development in higher education: a review of the literature and evidence

Leadership development and its effectiveness has not been explored in depth empirically, especially across university settings. It is therefore timely that the Leadership Foundation has sought to invest in exploring what is known in the area of the impact of leadership development in higher education settings

Personalisation - An Emergent Institutional Logic in Healthcare? Comment on “(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare”

Abstract This commentary on the recent think piece by Mannion and Exworthy reviews their core arguments, highlighting their suggestion that recent forces for personalization have emerged which may counterbalance the strong standardization wave which has been evident in many healthcare settings and systems over the last two decades. These forces for personalization can take very different forms. The commentary explores the authors’ suggestion that these themes can be fruitfully examined theoretically through an institutional logics (ILs) literature, which has recently been applied by some scholars to healthcare settings. This commentary outlines key premises of that theoretical tradition. Finally, the commentary makes suggestions for taking this IL influenced research agenda further, along with some issues to be addressed