Governance Arrangements Research Articles

Managing Local Health System Interdependencies: Referral and Outreach Systems for Maternal and Newborn Health in Three South African Districts

In complex health systems, referral and outreach systems (ROS) are formal strategies for connecting and managing interdependencies between facilities in service delivery pathways. Well-functioning maternal and newborn ROS are critical to successful outcomes, and therefore, a good lens through which to examine the management of local interdependencies. We conducted a qualitative study of maternal–newborn ROS, involving interviews with 52 senior, middle, and frontline managers, in three health districts of three different provinces in South Africa. We analyse the differences in functioning of ROS as an interplay of setting (urban, rural), individual facility strengths and weaknesses, the quality of emergency medical services (EMS), and the wider provincial strategic and organisational context. ROS are strengthened by sub-district governance arrangements that recognise and enable connectedness—in particular, between primary health care and district hospital services; by informal, day-to-day communication and collaboration across levels and professions; and by hybrid clinical–managerial players as system brokers and systems thinkers. We also identify leverage points, places where small shifts could have wider system effects, most notably in the design and functioning of EMS, and in addressing small, but significant bottlenecks in supply chains in lower level facilities that negatively impact the system as a whole.

How well do participatory governance arrangements serve political leadership?

AbstractParticipatory governance arrangements are assumed to strengthen elected representatives' capacity for political leadership. This study argues that the relationship between participatory arrangements and perceived political leadership depends on the design of the participatory arrangements. Drawing on a survey to local councilors in Norway, we found that sharing power with citizens through interactive governance arrangements was associated with lower perceived capacity for political leadership than giving power away through distributive arrangements. Case studies exploring how politicians experienced interactive and distributive participatory arrangements showed that politicians were especially ambivalent about interactive arrangements that were perceived to disrupt their traditional ways of doing political leadership. Notably, interactive arrangements were believed to decrease leadership capacity because politicians remained responsible for matters over which they no longer had full control, challenging their ability to stay accountable to the voters.

Navigating collaborative governance: Network ignorance and the performative planning of South Australia's emergency management

This paper examines the roles for emergency and disaster risk management plans as policy artefacts that guide centralised governance networks. Past scholarship has been sceptical of the instrumental worth of these artefacts for informing and elaborating governance arrangements. Some suspect that such plans are purely symbolic devices, mere ‘fantasy documents’. This paper examines the role of South Australia's state emergency management plan during the Black Summer bushfires of 2019–2020. The study provides confirmation of the symbolic utility of these plans for central government, while also providing evidence for some suggested difficulties with centralised emergency management networks, about which there is still limited empirical demonstration. Drawing on focus group and interview testimony from senior actors at strategic, tactical and operational levels of South Australia's emergency network, however, we also demonstrate instrumental-heuristic worth of these plans for network actors seeking to make sense of a continually changing bureaucratic landscape, and when reflecting on the value of the network in the aftermath of extreme events.

Transnational constitutionalism – conflicts‐law constitutionalism – economic constitutionalism: the exemplary case of the European Union

AbstractTransnational constitutionalism is both a sociological given and a legal challenge. We observe the emergence of ever more legally framed transnational arrangements with ever more power and impact. Do such arrangements deserve to be called legitimate rule in Habermasian terms? Is it at all conceivable that the proprium of law can be defended against the rise of its informal competitors? This article opts for a third way that listens to neither the siren songs on law beyond the state nor to the defences of nation‐state constitutionalism as the monopolist of legitimate rule. The proposed alternative suggests that transnational legal ordering of the European Union should build on its reconceptualization as a ‘three‐dimensional conflicts law’ with a democracy‐enhancing potential. This reconceptualization operationalizes the ‘united in diversity’ motto of the Draft Constitutional Treaty of 2004, preserves the essential accomplishments of Europe's constitutional democracies, provides for co‐operative problem solving of transnational regulatory tasks, and retains supervisory powers over national and transnational arrangements of private governance.

The state of play of ethno-racial representation on boards: A comparative analysis

Progress on ethno-racial diversity on boards in Europe, the United Kingdom and Australia has been at best variable. The map of ethno-racial diversity in the top ten largest listed companies across these regions provides comparative evidence of varying degrees of weak outcomes on this front, with the profile of Australian boards being the least favourable. In examining the reality of diversity on a sample of boards, we delve deeper into why the barriers persist despite internal-facing diversity and inclusion policies and external facing environmental, social, governance and government-led policies. This study proposes that governance and regulatory arrangements shape access opportunities for ethno-racial minorities on boards. Notwithstanding the varieties of such arrangements across the three regions, the reasons underscoring the lack of board diversity overall remains opaque. We offer fresh empirical evidence surrounding the limited ethno-racial diversity on boards through a cross-regional comparison and provide lessons and insights for both scholars and practitioners.

Innovation Promoter or Inhibitor? Non-Family CEO's Effect on Innovation in Family Businesses

Increasing scholarly and practical attention is being paid to determining whether a nonfamily chief executive officer (NFC) is a remedy for the lack of firm innovativeness in the face of ever-changing markets. Departing from the inconclusive findings of NFC research, this article aims to revisit the NFC effect on a family firm's investment in innovation, which is subject to the contextual influence of governance arrangements. In a sample of 6201 firm-year observations of Taiwanese family firms in high-tech industries in the period from 2002 to 2017, we found that the mixed relationship between the NFC and innovation investment is better clarified by considering family involvement in management (FIM) and board independence (BI), both of which yield significantly negative and positive moderating effects on the innovation investment of NFCs, respectively. This article further examines the configurational effect of two moderators on the main relationship, and shows that the negative effect of FIM not only outweighs, but also deteriorates, the positive moderating effect of BI. Our findings contribute not only to family business research, but also to innovation literature by arguing that the risk-taking orientation of an NFC is not universally held, but rather is deliberately arranged for effect.

Artificial Intelligence, Climate Change and Innovative Democratic Governance

AbstractThis policy-oriented article explores the sustainability dimension of digitalisation and artificial intelligence (AI). While AI can contribute to halting climate change via targeted applications in specific domains, AI technology in general could also have detrimental effects for climate policy goals. Moreover, digitalisation and AI can have an indirect effect on climate policy via their impact on political processes. It will be argued that, if certain conditions are fulfilled, AI-facilitated digital tools could help with setting up frameworks for bottom-up citizen participation that could generate the legitimacy and popular buy-in required for speedy transformations needed to reach net zero such as radically revamping the energy infrastructure among other crucial elements of the green transition. This could help with ameliorating a potential dilemma of voice versus speed regarding the green transition. The article will further address the nexus between digital applications such as AI and climate justice. Finally, the article will consider whether innovative governance methods could instil new dynamism into the multi-level global climate regime, such as by facilitating interlinkages and integration between different levels. Before implementing innovative governance arrangements, it is crucial to assess whether they do not exacerbate old or even generate new inequalities of access and participation.

Local Health Department Values and Organizational Authorities Guiding Cross-Sector Work During COVID-19.

The COVID-19 pandemic highlighted the role that local health departments (LHDs) have in cross sector can address alone, including the work of value alignment and the strategic use of organizational authorities. The practices by which LHDs used their authorities to conduct cross-sector work during the pandemic need exploration. We conducted semi-structured interviews with 19 public health leaders from metropolitan LHDs across the United States. Our interview guide assessed the values that LHD leadership prioritized in their cross-sector work as well as the range of organizational authorities they leveraged to influence external decision-making in other sectors. We found that LHDs approached cross-sector work by leaning on diverse values and authorities, each with unique implications for their work. The LHDs emphasized their approach to value alignment on a sector-by-sector basis, strategically using diverse organizational authorities-economic, political, moral, scientific, and logistical. While each authority and value we assessed was present across all interviewees, how each shaped action varied. Internally, LHDs emphasized certain authorities more than others to the degree that they more closely aligned with prioritized core values. Our findings highlight the ongoing need for LHD leadership to improve their ability to effectively communicate public health values and the unique authorities by which health-supporting work can be facilitated, including how this message must be adapted, depending on the specific sectors with which the LHD needs to partner and the governance arrangement in which the LHD is situated.

Frame alignment processes for locally useful agricultural soil research and extension: The role of farm advisors

AbstractFarm advisors are recognised as playing an increasingly central role in facilitating interactions between scientists and farmers to improve local implementation of sustainable soil management practices and agricultural innovations more broadly. However, there has been limited scrutiny of what farm advisors do when faced with conflicting interpretations among actors over techniques or approaches for facilitating agricultural innovation. This article advances knowledge in this area by investigating the role of farm advisors in aligning different frames on agricultural soil research and extension across seven Australian mixed farming regions. Drawing upon theoretical work on frame alignment, we argue that farm advisors use three types of strategies to align conflicting frames—frame bridging, frame amplification and frame transformation. These strategies seek to frame local soil research and extension priorities in ways that are assumed to resonate more closely with the frames of multiple constituents, such as farmers and soil scientists. Through our analysis, we argue that the application of a frame alignment approach enables greater precision in identifying which (a) interactive and social learning processes, (b) key local influencers and communities of practice and (c) resourcing and governance arrangements are most likely to be effective in facilitating soil research and extension that is locally useful and useable.

Renewing the social contract for education: Governing education as a common good

In its report published in 2021, the UNESCO International Commission on the Futures of Education invited the international community to forge a “new social contract for education” in order to repair past injustices and build a more equitable and sustainable planet. This new social contract should involve all education stakeholders and be governed by the principle of education as a common good. However, neither the concept of the new social contract nor the principle of education as a common good appear to be clearly defined in the 2021 UNESCO report, and this results in a lack of political discussion regarding the relationship among the institutions that should govern the new social contract for education. This article discusses the extent to which the notion of education as a common good provides the political framing for such a new social contract. It recalls the theoretical background of this concept and identifies some key areas that may be relevant to the discussion on the governance arrangements required to forge a new social contract for education with a view to revisiting existing hierarchies of power and strengthening democratic processes.

The Control of Microplastic Pollution in Semi-Closed Seas: Good-Faith Cooperation and Regional Practice

The impacts of microplastic (MP) pollution in the marine environment have already been illustrated by natural science. The issues resulting from MPs have revealed the problem of the current international governance arrangement, and international agreements are found to be inadequate to curb the growing MP pollution. This article explores reasons for the failure of governance cooperation from legal normativism and positivism. By analyzing the semi-closed sea system in the UNCLOS, this article concludes that the principle of good faith makes it possible to moderate geographic political tensions during cooperation and help reach an agreement on matters of mutual concern. Then, from the perspective of regional ocean governance, propose strategies for states bordering semi-enclosed seas and others to gradually control MP pollution in the marine environment through legal and policy measures.

Everyday politics in collaborative governance of (non)networked water infrastructures in rural and small towns of Ghana

Following the increasing failure of participatory governed planning interventions in attaining inclusive outcomes, critical governance scholars have articulated the need to pay attention to politics, especially in the global South. Motivated by this pertinent scholarly invitation, this study examines the politics in a state-community collaboration involving the provision, operations and maintenance of water infrastructures in rural and small towns of Ghana. By drawing on everyday politics and the qualitative case study, we explore the actors involved and their roles, the rules guiding the collaboration, the power relations, and how activities were performed; and offer a reflection on the implications for inclusive governance. We showed that though state-community collaboration holds the potential for joint deliberation towards the operations and maintenance of water projects, instead, it manifested more of a representation in practice, where rules and principles of the collaboration were pre-defined by state actors and served non-state actors in the implementation (provision of labour, financial/material inputs and meetings). These were shaped by the diverse interests and uneven power relations between state and non-state actors and among community-level representatives, including experts’ power of dominance by knowledge, and the quest for incentives in the collaboration. The findings suggest that the constellation of actors and the uneven power relations inherent in collaborative governance arrangements tend to empower actors with the “powers over” and “powers to” empower non-state actors. Therefore, we recommend that planners and policy-makers pay attention to power relations and dynamics among actors by conducting power dynamic mapping toward building partnerships for inclusive governance.

Postcritical school leadership encounters

Establishing quality education as a human right, public undertaking, and common good representative of humanity and the planet through imagining a “new social contract for education” is an ambitious endeavor and crucial to (post)humanity’s myriad ways of knowing, living, and being. This article introduces postcritical educational leadership as an indispensable element in shaping the future of education by informing and implementing new social contracts within schools, the wider education system, and other potential spaces of response-ability and intra-action (Barad in Meeting the universe halfway: quantum physics and the entanglement of matter and meaning, Duke University Press, Durham, 2007; Derrida Today 3(2):240–268, 2010). Within complex, rapidly changing, and self-generating systems, modes, models, and mechanisms of governance become re-territorialized, constantly forming new assemblages consisting of new structures, actors, and context-dependent educational landscapes. Dynamic and heterogeneous assemblages make a static understanding of governance not only superfluous; they make it impossible. We need to loosen power, stability, and neoliberal structures to generate new forms of participative leadership—particularly at the school level—characterized by cooperation, solidarity, trust, and justice. We therefore reframe educational leadership as becoming among all actors within multifaceted, rhizomatic (education) system(s) (Deleuze and Guattari in A thousand plateaus: Capitalism and schizophrenia, Minnesota University Press, Minneapolis, 1987). We argue for a multi-perspectival view of leadership that includes a focus on how school leaders perceive their own becoming (e.g., their needs, positionalities, emotions) and how this becoming intra-acts with increasing social, cultural, political, and ecological complexity. Deeper engagement through introspection, self-analysis, and a processing of self-in-context together with exploration of school leaders’ experiences with entanglements and assemblages will inform new governance arrangements and just and sustainable future-thinking and future-acting in education.

Interventions for the uptake of evidence-based recommendations in acute stroke settings.

There is a growing body of research evidence to guide acute stroke care. Receiving care in a stroke unit improves access to recommended evidence-based therapies and patient outcomes. However, even in stroke units, evidence-based recommendations are inconsistently delivered by healthcare workers to patients with stroke. Implementation interventions are strategies designed to improve the delivery of evidence-based care. To assess the effects of implementation interventions (compared to no intervention or another implementation intervention) on adherence to evidence-based recommendations by health professionals working in acute stroke units. Secondary objectives were to assess factors that may modify the effect of these interventions, and to determine if single or multifaceted strategies are more effective in increasing adherence with evidence-based recommendations. We searched CENTRAL, MEDLINE, Embase, CINAHL, Joanna Briggs Institute and ProQuest databases to 13 April 2022. We searched the grey literature and trial registries and reviewed reference lists of all included studies, relevant systematic reviews and primary studies; contacted corresponding authors of relevant studies and conducted forward citation searching of the included studies. There were no restrictions on language and publication date. We included randomised trials and cluster-randomised trials. Participants were health professionals providing care to patients in acute stroke units; implementation interventions (i.e. strategies to improve delivery of evidence-based care) were compared to no intervention or another implementation intervention. We included studies only if they reported on our primary outcome which was quality of care, as measured by adherence to evidence-based recommendations, in order to address the review aim. Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias and certainty of evidence using GRADE. We compared single implementation interventions to no intervention, multifaceted implementation interventions to no intervention, multifaceted implementation interventions compared to single implementation interventions and multifaceted implementation interventions to another multifaceted intervention. Our primary outcome was adherence to evidence-based recommendations. We included seven cluster-randomised trials with 42,489 patient participants from 129 hospitals, conducted in Australia, the UK, China, and the Netherlands. Health professional participants (numbers not specified) included nursing, medical and allied health professionals. Interventions in all studies included implementation strategies targeting healthcare workers; three studies included delivery arrangements, no studies used financial arrangements or governance arrangements. Five trials compared a multifaceted implementation intervention to no intervention, two trials compared one multifaceted implementation intervention to another multifaceted implementation intervention. No included studies compared a single implementation intervention to no intervention or to a multifaceted implementation intervention. Quality of care outcomes (proportions of patients receiving evidence-based care) were included in all included studies. All studies had low risks of selection bias and reporting bias, but high risk of performance bias. Three studies had high risks of bias from non-blinding of outcome assessors or due to analyses used. We are uncertain whether a multifaceted implementation intervention leads to any change in adherence to evidence-based recommendations compared with no intervention (risk ratio (RR) 1.73; 95% confidence interval (CI) 0.83 to 3.61; 4 trials; 76 clusters; 2144 participants, I2 =92%, very low-certainty evidence). Looking at two specific processes of care, multifaceted implementation interventions compared to no intervention probably lead to little or no difference in the proportion of patients with ischaemic stroke who received thrombolysis (RR 1.14, 95% CI 0.94 to 1.37, 2 trials; 32 clusters; 1228 participants, moderate-certainty evidence), but probably do increase the proportion of patients who receive a swallow screen within 24 hours of admission (RR 6.76, 95% CI 4.44 to 10.76; 1 trial; 19 clusters; 1,804 participants; moderate-certainty evidence). Multifaceted implementation interventions probably make little or no difference in reducing the risk of death, disability or dependency compared to no intervention (RR 0.93, 95% CI 0.85 to 1.02; 3 trials; 51 clusters ; 1228 participants; moderate-certainty evidence), and probably make little or no difference to hospital length of stay compared with no intervention (difference in absolute change 1.5 days; 95% CI -0.5 to 3.5; 1 trial; 19 clusters; 1804 participants; moderate-certainty evidence). We do not know if a multifaceted implementation intervention compared to no intervention result in changes to resource use or health professionals' knowledge because no included studies collected these outcomes. We are uncertain whether a multifaceted implementation intervention compared to no intervention improves adherence to evidence-based recommendations in acute stroke settings, because the certainty of evidence is very low.

Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana.

Eliminating Tuberculosis is one of the targets of Sustainable Development Goal Three. Decentralizing TB care beyond health facilities by leveraging community involvement is crucial for safeguarding effective tuberculosis care. In this study, we explored potential facilitators and inhibitors of the implementation and sustainability of community-based interventions for the prevention and treatment of TB in the Moshupa district, Botswana. This study adopted a qualitative approach using a collective case design. An interpretive paradigm based on relativist ontology and subjectivist epistemology along with abductive research logic was used. The study enrolled treatment supporters of tuberculosis patients diagnosed with drug-susceptible tuberculosis between January 2019 and December 2019 in Moshupa Village for semi-structured interviews, Health care professionals for in-depth interviews, and e community leaders for focus group discussions. Clinic-based observations in Mma-Seetsele clinic were also conducted to corroborate the participants' views. The data collected was analyzed using the NVivo version 12 software package, and statements of the participants were presented as quotes to substantiate the issues discussed. This study highlighted effective partnerships between health services and external stakeholders, community empowerment, and the availability of policies and standard operating procedures as facilitators of community TB implementation and sustainability. However, Insufficient funding, low service provider training, policies not embracing age and educational eligibility for treatment supporters, shortage of equipment, medicines, and supplies, inadequate transport availability and incentives to meet clients' basic needs, paper-based systems, inadequate supervision, incomplete data reporting, and low service quality affected the Community TB program efficacy and sustainability in Moshupa. We also found that there was low service provider motivation and retention and that clients had low trust in treatment supporters. The findings of this study imply that the operational effectiveness of the community TB care approach to disease elimination is compromised; therefore, initiatives addressing the key components, including the availability of resources, governance arrangements and supportive systems for community health workers, are required for successful community TB implementation and sustainability.

Understanding organizational identity in universities: Unravelling autonomy, governance and leadership in the case of the Vrije Universiteit Amsterdam

AbstractThis paper offers a historical analysis of organizational identity development at a particular Dutch university, the Vrije Universiteit (VU) Amsterdam. Our analysis contributes to the discussion on what factors contribute to organizational identity maintenance and evolution. Whereas the literature suggests a rather straightforward development, with national and institutional governance arrangements offering more institutional autonomy and providing significant scope for identity development and profiling, this case study shows that these relationships between identity, governance, and autonomy are not that obvious. In this particular case, the opposite happened. Despite more autonomy, VU Amsterdam was not able to maintain its historically distinctive identity, nor was it able to replace this with a new, unambiguous identity. External factors (demographics) and internal dynamics (leadership strategies) explain the anomalies.

Trajectories of Value Generation and Capturing by Public–Private Hybrids: Mechanisms of multi-level governance in healthcare

Our paper unpacks the multi-level process through which hybrids generate value in the long term. By combining interviews, archival and survey data, we examine the longitudinal trajectories of value generation of public–private hybrids (PPHs) established in the regionalized Italian healthcare system (1992–2018). We identify three ideal-type trajectories: (a) long-term value generation by stable PPHs; (b) long-term value generation by transient PPHs; and (c) interrupted value generation by terminated PPHs. We uncover how these trajectories are shaped by the interplay between regional governance arrangements – i.e. institutionally embedded norms regarding who is entitled to generate value for the field, the scope for organizational value capturing and the institutional monitoring system – and organizational governance mechanisms – i.e. the strategic orientation of individual PPHs and their internal monitoring functions. Our paper contributes to theory by conceptualizing the mechanism of ‘double filter’, which we define as the set of field- and organizational-level governance compensatory mechanisms that, together, allow long-term value generation by hybrids. We also problematize the relationship between hybrids’ value-generation capacities and the persistence of hybrid organizational forms, and ultimately trace it to different field governance arrangements. In so doing, we conceptualize ‘transient hybrids’ as a distinctive organizational form for long-term value generation.

The politics of expertise in building back better: Contrasting the co-production of reconstruction post-Irma in the Dutch and French Caribbean

Reconstruction processes in post-disaster contexts are both technical and political. In the face of growing losses from disasters to human development, we question how the call to Build Back Better (BBB) is rendered authoritative in different governance settings through the mobilisation of expertise and knowledge. Bringing the idea of knowledge co-production from Science and Technology Studies into critical studies of post-disaster politics, we contrast the politics of expertise emergent after Hurricane Irma in French St Martin and Dutch St Maarten. Although they share a common geography, reconstruction processes unfolded very differently across these two island settings. Governance arrangements contributed to the delineation of different ‘recovery spaces’, i.e. the actors, their resources, relationships and visions as constituted by and through different forms of post-disaster knowledge and expertise. Comparative analysis of these spaces shows how highly differential knowledge outcomes emerged out of common processes on both sides of crafting multiple forms of political legitimacy in order to undertake reconstruction activities. Through the notion of interactional coproduction we illustrate how such processes both drew on established historical repertoires as well as contained potential for co-evolution, which cautions against deterministic views of the relationship between reconstruction actors, their interests, and knowledge claims. Mobilising the contrast between two differing governance regimes that nevertheless share common histories of colonial and post-colonial development as well as environmental hazard, we argue that knowledge co-production needs to be understood in order to take advantage of the emergence in post-disaster policy regimes of possibilities for progressive transformation, but that these are ambiguous and contingent moments in which expertise becomes a flexible political resource through which to both constrain or enable Building Back Better.

Exploring approaches to equal and effective participation of governance actors in trans-local city food networks

This study examines how trans-local city food networks approach participation within their internal governance arrangements. For this purpose, we investigate eleven trans-local city food networks that work on up- and/or out-scaling of sustainable local food system initiatives. The results show that approaches to participation vary, especially when it comes to inclusion, distributive – and collective agency. The analysis suggests that while non-governmental actors are included in many networks, their opportunities for effective participation are limited in comparison with local policymakers. Additionally an improved cooperation and alignment between trans-local city food networks would avoid duplication of efforts. By reflecting on their own approach trans-local city food networks could actively look for other networks that can reinforce or complement their own work.

How country governance situation affect firm financing arrangements: empirical evidence from selected Asian economies

Purpose This study aims to explore the potential impact of country-level governance in corporate financing structures. Design/methodology/approach A two-step system generalized method of moment was used due to the endogeneity issue. The whole sample comprises 3,761 firms in five economies – China, India, Pakistan, Singapore and South Korea – from 2007 to 2016. Findings The results indicate that the debt option for financing is not favorable under governments with an adequate governance arrangement. However, there is a direct and significant link between country governance and equity financing because in adequate governance arrangements, the possibilities of information asymmetry are minimal and businesses consider equity a more appropriate and safer financing instrument. In contrast, firms prefer to trade-credit financing in poor governance economies, which confirms an adverse link between trade credit and adequate governance. Practical implications The country’s governance should be considered a sensitive matter when deciding about corporate financing. Originality/value This arrangement of variables has not been previously analyzed in the literature, suggesting the study’s novelty.