David W. Young

A contingency approach to managing outsourcing risk in municipalities

Abstract We discuss outsourcing risk in relation to different governance models, and provide a framework for classifying the risk related to an outsourcing choice. We argue that different kinds of outsourcing have different degrees of risk, and that the governance model needed for successful outsourcing is contingent on the nature and amount of that risk. As a result, municipalities need to use several different governance models, each attuned to the degree of risk of the service being outsourced. Moreover, a municipalitys managers must be especially careful not to outsource a service unless they have the capability to manage the requisite governance model.

Toward a Framework for Managing High-Risk Government Outsourcing: Field Research in Three Italian Municipalities

Many public sector organizations use outsourcing in an effort to take advantage of a private contractors experience and economies of scale, thereby allowing them to provide high quality public services at a low cost. Although it has received considerable attention in the public policy and management literature for almost three decades, outsourcing has not always achieved a municipalitys goals. To address the strategic and managerial issues of outsourcing, we combine a literature review with data obtained from a field study of three Italian municipalities. The resulting framework can assist public sector managers to determine both the services that are the best candidates for outsourcing, and the issues that must be considered in managing the chosen vendors to guarantee high quality and cost-effective results.

Implementing Change in a Hospital Management Accounting System

A central aspect of the efforts to improve public healthcare systems often is a provider’s management accounting system (MAS). The article focuses on a change effort for a hospital’s MAS. The effort involved implementing low-cost information technology designed to improve efficiency and effectiveness in operating rooms. The article aims to identify and discuss the factors that led to the hospital’s success in achieving improved outcomes at lower costs via the improvement of its MAS. The analysis uses a theoretical framework that can assist managers to identify methods that can help to foster the factors needed for effective change implementation.

Missing Elements in the Institute of Medicine Report on Graduate Medical Education

The Institute of Medicine (IOM) report on graduate medical education has failed to answer (or even address in some instances) some of the most important questions that the US healthcare system faces concerning graduate medical education. Specifically, the report has not: 1) made the case for why

Value-based partnering in healthcare: a framework for analysis.

15 billion is the right amount of funding, or even why there should be any public support for graduate medical education at all; 2) discussed how the actual cost of graduate medical education might be computed; 3) assessed how graduate medical education’s “joint cost problem” might be solved; 4) addressed how the shortage of primary care physicians (especially those who deal with the needs of the elderly) can be reversed via graduate medical education funding incentives; 5) provided a rationale for its proposed strategic shift from supporting education to supporting both education and research; and 6) argued why Medicare and Medicaid should be the only entities that pay for graduate medical education. In July 2014, the IOM issued its report on graduate medical education. The report addressed a variety of concerns about the objectives, costs, and benefits of graduate medical education. It proposed rethinking the logic behind the

Implementing Local Government Strategies: A Framework for Action

15 billion spent annually to support residency training for physicians, most of which is provided by Medicare and Medicare. It concluded that federal support for graduate medical education should continue, and that graduate medical education should be considered as an entitlement program. It also recommended that the way graduate medical education is paid should be restructured, and that the restructuring should include a transformation fund that would support research on ways to improve graduate medical education. Unfortunately, the IOM report missed an important opportunity to propose reforms to the way graduate medical education is financed and structured. The report fell short in 6 areas.

The six levers for managing organizational culture

EXECUTIVE SUMMARY Value‐based partnering is designed to move the healthcare system beyond costbased competition. It recognizes that the healthcare “product” is not a commodity and that much of the value in the system comes from relationships between and among four stakeholders: consumers, providers, health plans, and employers. Given the difficulty of measuring such benefits as quality of care, improved health status, and increased employee productivity, stakeholders within the system traditionally have focused on easily measurable financial considerations such as premium rates. This focus has led to a system that defines relationships in purely financial terms. In contrast, the value‐based partnering model presented in this article recognizes the range of factors that stakeholders consider in their relationships with each other. This approach has the potential to change the nature of competition and presents opportunities for those organizations that can effectively partner with other stakeholders and demonstrate value, rather than just lower cost. Moreover, by recognizing the interdependencies among stakeholder groups, the approach creates a strategic reason for employers, health plans, providers, and consumers to exchange information and create long‐term alliances.

Managing integrated delivery systems : a framework for action

To implement its strategy, a local government (LG) can use six interrelated activites, which we call the Six Cs. These activities comprise coalition building, citizen involvement, conflict management, compensation and rewards, cross-unit collaboration, and control. Each activity is related to one of Chester Barnard’s classic three functions of the executive (communication, coordination, and commitment to purpose). The research was based on in-depth investigations of seven European cities that had received an award for high performance by the European Institute of Public Administration (EIPA). A multiple case study “action research” methodology was used. Although each city had a different strategy, each had used the Six Cs in concert to make its strategy a reality. The Six-C model constitutes a framework that can be used by any city to help implement its strategy. Although there is no “cookbook solution” for using the Six Cs, they nevertheless constitute a conceptual framework that an LG’s management team can use to think about how it will move toward its strategic vision. An LG that wishes to achieve its strategy must think about how it will employ the Six Cs in a coordinated way. The central issues are not only the specifics of each C but how each matches and is aligned with the other five in order to assist the city to move toward its strategic vision.