Greta Nasi

A New Theory for Public Service Management? Toward a (Public) Service-Dominant Approach

This article argues that current public management theory is not fit for purpose—if it ever has been. It argues that it contains two fatal flaws—it focuses on intraorganizational processes at a time when the reality of public services delivery is interorganizational, and it draws upon management theory derived from the experience of the manufacturing sector and which ignores the reality of public services as “services.” The article subsequently argues for a “public service dominant” approach. This not only more accurately reflects the reality of contemporary public management but also draws upon a body of substantive service-dominant theory that is more relevant to public management than the previous manufacturing focus. We argue that this approach makes an innovative contribution to public management theory in the era of the New Public Governance. The article concludes by exploring the implications of this approach in four domains of public management and by setting a research agenda for a public-service dominant theory for the future.

ACCOUNTING REFORMS: DETERMINANTS OF LOCAL GOVERNMENTS' CHOICES

The introduction of accrual accounting in Italian Local Governments has been mandated in a way that permits, and in fact encourages, a merely formal compliance. Local Governments must produce accrual-based financial statements, but double-entry bookkeeping is not mandatory, nor may traditional budgetary accounting be abandoned. Why, then, should they bother to introduce an integrated system of budgetary and accrual accounting? In this paper, we empirically investigate the determinants of Local Governments choices of accounting innovation. According to our results, rational elements such as complexity, types of activities performed, presence of surpluses, and access to capital markets are seemingly unhelpful in explaining why a Local Government decides to introduce accrual accounting. What counts are institutional and cultural explanations, such as the perceptions of CFOs and the North-South divide.

Implementation of accounting reforms

Abstract Innovations in financial and accounting techniques represent a fundamental aspect of the reforms undergone by public administrations in recent decades. The article presents the results of a survey, conducted on 237 local governments, whose purpose is to assess the implementation of accounting reforms in Italy, aimed at introducing accruals reporting in the traditional budgetary accounting system to enhance accountability and transparency in the overall modernization process. The analysis shows that the importance of cash- and commitment-based accounting in the overall system is overwhelming, whereas the marginality of the ‘new’ accrual-based reporting is evident. In the opinions of preparers, accruals accounting is not seen as a useful tool and the link with internal needs and managerial control systems is absent. Is the time ripe for a new reform?

The Role of Mobile Technologies in Health Care Processes: The Case of Cancer Supportive Care

Background Health care systems are gradually moving toward new models of care based on integrated care processes shared by different care givers and on an empowered role of the patient. Mobile technologies are assuming an emerging role in this scenario. This is particularly true in care processes where the patient has a particularly enhanced role, as is the case of cancer supportive care. Objective This paper aims to review existing studies on the actual role and use of mobile technology during the different stages of care processes, with particular reference to cancer supportive care. Methods We carried out a review of literature with the aim of identifying studies related to the use of mHealth in cancer care and cancer supportive care. The final sample size consists of 106 records. Results There is scant literature concerning the use of mHealth in cancer supportive care. Looking more generally at cancer care, we found that mHealth is mainly used for self-management activities carried out by patients. The main tools used are mobile devices like mobile phones and tablets, but remote monitoring devices also play an important role. Text messaging technologies (short message service, SMS) have a minor role, with the exception of middle income countries where text messaging plays a major role. Telehealth technologies are still rarely used in cancer care processes. If we look at the different stages of health care processes, we can see that mHealth is mainly used during the treatment of patients, especially for self-management activities. It is also used for prevention and diagnosis, although to a lesser extent, whereas it appears rarely used for decision-making and follow-up activities. Conclusions Since mHealth seems to be employed only for limited uses and during limited phases of the care process, it is unlikely that it can really contribute to the creation of new care models. This under-utilization may depend on many issues, including the need for it to be embedded into broader information systems. If the purpose of introducing mHealth is to promote the adoption of integrated care models, using mHealth should not be limited to some activities or to some phases of the health care process. Instead, there should be a higher degree of pervasiveness at all stages and in all health care delivery activities.

Transparency for Trust in Government: How Effective is Formal Transparency?

Many countries refer to transparency not only as the right to access information, but also as a tool for enhancing government efficiency and accountability. However, the practice of transparency is still linked to the need to comply with legal obligations, not necessarily meeting citizens’ needs. The purpose of this article is twofold: it measures the levels of transparency of governments and the needs of citizens for government information and consequently assesses whether there is a gap, offering recommendations for reducing it. This should contribute to reaching higher levels of useful rather than formal transparency and may help in facilitating government-constituent relations.

Assessing Transparency in Government: Rhetoric, Reality and Desire

Transparency in government is a highly regarded value and a critical ingredient for efficient and well-functioning economic and political markets. Many countries, including Italy, refer to transparency as a tool to enhance government accountability, as a principle to promote in order to reduce corruption in public administration and as a means for circulating information on government performance. However, transparency is preached more often than it is practiced in many cases (Heald 2006). Conversely, not all of the information disclosed is easily accessible or accessed by external stakeholders. The purpose of this paper is to assess the degree of transparency of governments and to ascertain the type of information that can be accessed by external stakeholders, especially the general public, in order to evaluate the performance of their government. In particular, the paper focuses on the information disclosed through government websites and assesses the case of larger municipalities in Italy. The paper presents the findings of the analysis and suggests some recommendations for academics and policy makers.

Evaluation of the Impacts of Innovation in the Health Care Sector: A comparative analysis

Assessing impacts related to the adoption of an innovation represents a particular challenge. However, the use of innovation in government organizations does have some effects: some intended, others unintended; some desirable, others undesirable. Findings in literature now suggest that the use of innovation in government organizations produces beneficial results for the most part. The purpose of this article is to provide a multi-dimensional framework for assessing the impacts of innovation on an organization’s performance as perceived by individual stakeholders and at organizational level. In particular, this framework is designed to evaluate the impacts resulting from the introduction of electronic medical records, namely an organizational, cultural, and technological innovation that many health care providers are currently undertaking. It provides the results of a comparative analysis carried out in Spain and Italy and discusses the need for a more systematic evaluation assessment of the innovation processes.

Vision and Practice of E-Government: An Empirical Study

With the internet expanding rapidly in the 1990s, most of the reform agendas of Western countries embedded information technologies in their vision for change (Heeks, 1999; and Holmes, 2001). Existing studies into the diffusion of e-government has mainly centred on the USA and exposed a limited diffusion of digital delivery systems. This paper focuses on e-government by way of the adoption and use of ICT and internet for the delivery of information and services and explores the extent to which local governments endorse the e-government agenda by looking at the strategies and policies of municipalities and their actual use of e-government for the delivery of services and information. The paper utilizes data from a survey conducted during the winter of 2005-2006, addressed to the Chief Information Officers at Italian MUs with a population greater than 40,000. The results show that despite a certain degree of endorsement in terms of strategies for e-government, the use of e-government for the delivery of services is still quite limited.

Coordination Mechanisms for Implementing Complex Innovations in the Health Care Sector

Abstract Coordination is a central element in the public sector, especially for introducing complex innovations. In health care, this issue takes on great importance since many stakeholders are involved, pursuing multiple interests, and influencing the outputs and outcomes of the health care system. This paper discusses the introduction of a specific health care innovation (i.e. electronic patient records) in two Italian regions, and it aims to contribute to the debate on coordination in health care, depicting the coordination mechanisms that took place in two different contexts in order to introduce the same kind of innovation, and highlighting any potential enabling conditions.

Understanding key factors affecting electronic medical record implementation: a sociotechnical approach

BackgroundRecent health care policies have supported the adoption of Information and Communication Technologies (ICT) but examples of failed ICT projects in this sector have highlighted the need for a greater understanding of the processes used to implement such innovations in complex organizations. This study examined the interaction of sociological and technological factors in the implementation of an Electronic Medical Record (EMR) system by a major national hospital. It aimed to obtain insights for managers planning such projects in the future and to examine the usefulness of Actor Network Theory (ANT) as a research tool in this context.MethodsCase study using documentary analysis, interviews and observations. Qualitative thematic analysis drawing on ANT.ResultsQualitative analyses revealed a complex network of interactions between organizational stakeholders and technology that helped to shape the system and influence its acceptance and adoption. The EMR clearly emerged as a central ‘actor’ within this network. The results illustrate how important it is to plan innovative and complex information systems with reference to (i) the expressed needs and involvement of different actors, starting from the initial introductory phase; (ii) promoting commitment to the system and adopting a participative approach; (iii) defining and resourcing new roles within the organization capable of supporting and sustaining the change and (iv) assessing system impacts in order to mobilize the network around a common goal.ConclusionsThe paper highlights the organizational, cultural, technological, and financial considerations that should be taken into account when planning strategies for the implementation of EMR systems in hospital settings. It also demonstrates how ANT may be usefully deployed in evaluating such projects.