Jenny M. Lewis

Bureaucracy, Network, or Enterprise? Comparing Models of Governance in Australia, Britain, the Netherlands, and New Zealand

Theories of democratic government traditionally have relied on a model of organization in which officials act impartially, accept clear lines of accountability and supervision, and define their day–to–day activities through rules, procedures, and confined discretion. In the past 10 years, however, a serious challenge to this ideal has been mounted by critics and reformers who favor market, network, or “mixed–economy” models. We assess the extent to which these new models have influenced the work orientations of frontline staff using three alternative service types—corporate, market, and network—to that proposed by the traditional, procedural model of public bureaucracy. Using surveys of frontline officials in four countries where the revolution in ideas has been accompanied by a revolution in methods for organizing government services, we measure the degree to which the new models are operating as service–delivery norms. A new corporate–market hybrid (called “enterprise governance”) and a new network type have become significant models for the organization of frontline work in public programs.

Quasi-Markets and Service Delivery Flexibility Following a Decade of Employment Assistance Reform in Australia

In 1998, we were witnessing major changes in frontline social service delivery across the OECD and this was theorised as the emergence of a post-Fordist welfare state. Changes in public management thinking, known as New Public Management (NPM), informed this shift, as did public choice theory. A1998 study of Australias then partially privatised employment assistance sector provided an ideal place to test the impact of such changes upon actual service delivery. The study concluded that frontline staff behaviour did not meet all the expectations of a post-Fordist welfare state and NPM, although some signs of specialisation, flexibility and networking were certainly evident (Considine, 1999). Ten years on, in 2008, frontline staff working in Australias now fully privatised employment sector participated in a repeat study. These survey data showed convergent behaviour on the part of the different types of employment agencies and evidence that flexibility had decreased. In fact, in the ten years between the two studies there was a marked increase in the level of routinisation and standardisation on the frontline. This suggests that the sector did not achieve the enhanced levels of flexibility so often identified as a desirable outcome of reform. Rather, agencies adopted more conservative practices over time in response to more detailed external regulation and more exacting internal business methods.

Partnerships in primary care in Australia: network structure, dynamics and sustainability

Partnerships represent a prescriptive form of network governance, based on the idea of cooperation. This article has four aims. The first is to describe why network governance and partnerships are important now, and what one particular example - Primary Care Partnerships - is addressing. The second is to analyse the network structure of two of these partnerships, and the third is to examine network dynamics. The fourth aim is to explore relationships and sustainability over the longer term. Two government-funded and steered partnerships, which were established to increase coordination between primary care services in Victoria, Australia, were examined. Annual interviews at three points in time between 2002 and 2005 were used to explore relationships between organizations within these two partnerships. The structure of two different communication networks, based on contacts for work and contacts for strategic information, were examined using social network analysis. Tracing network structures over time highlighted partnership dynamics. The network structures changed over the three years of the study, but an important constant was the continuing centrality of the independent staff employed to manage the partnerships. Over the longer term, it seems to be more important to fund independent partnership staff, rather than people who connect partnerships to the funding agency. If partnerships are seen as valuable in improving service coordination and health outcomes, then long term rather than just start-up funding support is required.

Reform and autonomy: perceptions of the Australian general practice community

Reforms in health care in the 1990s across industrialised nations have had profound consequences for the autonomy of general/family practitioners (GPs). Research suggests that the professional autonomy of GPs is declining across countries, related to policy reform processes and to challenges from other actors. Important questions remain, however, around appropriate ways to conceptualise autonomy, and about the perceptions that GPs themselves have of their autonomy. It is these questions in the context of more than a decade of general practice reform in Australia that are the focus of this paper. Using a multi-component model of autonomy, which separates out micro, meso and macro dimensions of autonomy, we undertook an analysis of 343 items on autonomy and reform collected from 3 key general practice journals. We argue that members of the GP community profess an enjoyment for general practice, and operate with an ideal of what it means to be a GP. However, the reform process is perceived to challenge this enjoyment and the ideal of professional practice. In particular, there exists uncertainty as to what it means to be a GP, with members of the GP community expressing a loss of control across important dimensions of autonomy. While numerically most discussion focused on control over earnings, the intensity of feeling was most evident around control over clinical practice. Our results suggest the importance of using a multi-component model of autonomy, as it allows for a nuanced analysis of the relationship between the reform process and autonomy. At the same time, however, our analysis indicates that it is also crucial to recognise autonomy is constituted by the interaction of these components.

A network approach for researching partnerships in health.

BackgroundThe last decade has witnessed a significant move towards new modes of governing that are based on coordination and collaboration. In particular, local level partnerships have been widely introduced around the world. There are few comprehensive approaches for researching the effects of these partnerships. The aim of this paper is to outline a network approach that combines structure and agency based explanations to research partnerships in health. Network research based on two Primary Care Partnerships (PCPs) in Victoria is used to demonstrate the utility of this approach. The paper examines multiple types of ties between people (structure), and the use and value of relationships to partners (agency), using interviews with the people involved in two PCPs – one in metropolitan Melbourne and one in a rural area.ResultsNetwork maps of ties based on work, strategic information and policy advice, show that there are many strong connections in both PCPs. Not surprisingly, PCP staff are central and highly connected. Of more interest are the ties that are dependent on these dedicated partnership staff, as they reveal which actors become weakly linked or disconnected without them. Network measures indicate that work ties are the most dispersed and strategic information ties are the most concentrated around fewer people. Divisions of general practice are weakly linked, while local government officials and Department of Human Services (DHS) regional staff appear to play important bridging roles. Finally, the relationships between partners have changed and improved, and most of those interviewed value their new or improved links with partners.ConclusionImproving service coordination and health promotion planning requires engaging people and building strong relationships. Mapping ties is a useful means for assessing the strengths and weaknesses of partnerships, and network analysis indicates concentration and dispersion, the importance of particular individuals, and the points at which they will fragment. A narrative approach adds an assessment of whether the partnerships are being used and valued. The approach outlined here, which examines structure and agency as separate but related explanations, has much to offer in examining partnerships.

Medicine, economics and agenda-setting

The filtering of potential policy issues from a large range of possibilities to a relatively small list of agenda items allows the organisation of power and influence within a policy sector to be examined. This study investigated power and influence in health policy agenda-setting in one State of Australia (Victoria) in the years 1991, 1992 and 1993. The actors seen as influential were predominantly medically trained and working in academia, health bureaucracies and public teaching hospitals. This research supports an elite model of health policy agenda-setting, in which outcomes are dependent on the structured interests within the policy field. However, while the corporate elite of the profession is influential, the frontline service providers are not, as indicated by the location of influentials in large and prestigious organisations. Politicians and professional associations and unions are less well represented, and consumer and community groups are virtually absent. In 1993 there was a sharp increase in economists being nominated as influentials, with a subsequent decrease in influentials with medical training. This relates to a (perceived or real) shift in influence from the medical profession to senior health bureaucrats. Economic concerns appear to be shaping the visible health policy agenda, through an increased number of influentials with economics training, but also through an apparent ability to shape the issues that other influentials are adding as agenda items. The corporate elite of medicine remains powerful, but their range of concerns has been effectively limited to cost containment or cost reduction, better planning and efficiency. This limiting of concerns occurs within an international policy context, where the general trends of globalisation and an emphasis on neo-liberal economics impact on the direction of health policy in individual countries.

Changing professions - General Practitioners' perceptions of autonomy on the frontline

Professional autonomy is a much-used concept which has operated with scant empirical attention directed at understanding its meaning among practitioners. This study investigates how General Practitioners (GPs) understand their professional autonomy, and what they perceive to be the main threats to it. Four focus groups were attended by 25 GPs in Melbourne. We found that GPs aspire to an ‘ideal type’ of professional who has the freedom to determine what is best for patients, but they believe their autonomy is threatened by financial constraints, greater accountability requirements, and more demanding patients. These findings reveal how GPs understand autonomy in their practice, and indicate that their concerns may have little to do with the deprofessionalization and proletarianization theses. Micro-level studies of GPs in the workplace, combined with greater understandings of different aspects of professional autonomy, appear useful in understanding how GPs’ work and autonomy is changing.

Academic governance : disciplines and policy

1. Governing Academia 2. Research policy 3. Disciplinary cultures 4. Individual inclinations 5. Examining academic governance 6. Academic collaboration 7. Discussion networks 8. Research assessment systems 9. From academic work to research outputs 10. Academic governance

Research funding systems in Australia, New Zealand and the UK: Policy settings and perceived effects

The funding of research in universities is increasingly based on direction of resources in support of ‘excellence’. Funding decisions are linked to evaluation through research funding systems, but there has so far been little comparative empirical research on the perceived effects of these systems. This article reports on a study involving interviews with 274 academics at universities in Australia (Melbourne), New Zealand (Auckland) and the UK (Birmingham). Perceptions of the three research funding systems demonstrated significant differences across universities, and some interesting gender and seniority differences, but surprisingly little variance between humanities, science and social science disciplines.

The politics and consequences of performance measurement

Abstract Performance measurement is most often considered as the apolitical application of the use of information, collected and used to demonstrate effectiveness against a set of criteria. In reality, many complexities are hidden behind this seemingly rational and technical enterprise. This paper establishes a conceptual framework for the collection of articles in this volume. It examines the politics of performance measurement — who decides what should be measured, how, and why — and its consequences. It analyses why performance measurement is important, outlines its explicit and implicit purposes and the fundamental assumptions underpinning it, and describes its problems, paradoxes and consequences. A chain of performance measurement is then proposed and two contrasting versions of it (one rational-technical and one realistic-political) are presented. This social structural and political institutional approach to performance measurement highlights dynamics, interactivity and power. In doing so, it discloses the politics and consequences of performance measurement.