Service Reform Research Articles

Using vignettes to compare the views of social workers and service-users: Some findings and reflections regarding assessments in child welfare

While vignette studies have become more prevalent in social work research, it is, however, uncommon to include both practitioners and service-users in the research design to provide their views on an identical case. In this article, the aim is both to reflect on the usefulness of the vignette method in exploring assessments of the needs for services from the points of view of practitioners and service-users and to explore empirically those views on an identical case. The article is built on 28 group interviews with 120 practitioners and 14 group interviews with 41 care-experienced young people and parents of children in care. There are considerable similarities across the groups in their emphasis on ‘more information’ but the groups of practitioners and service-users also differ in their views on the nature of required information (what vs. why) and the purpose of the assessment (intake vs. solving problems). The analysis highlights some mundane manifestations of the implications of recent reforms in family and child welfare services in Finland, and most importantly, the ethical potential which the inclusion of both service-users and practitioners in the vignette design entails.

An equity indicator for assessing mental healthcare access: a national population case study.

Achieving equitable healthcare access is a global challenge. Improving whole-population mental health and reducing the global burden of mental disorders is a key recommendation of the 2018 Lancet Global Mental Health Commission, which proposed monitoring national indicators, including the proportion of people with severe mental disorders who are service-users. This study aims to derive an equity indicator from national datasets integrating need, service utilisation and socioeconomic status, and demonstrate its utility in identifying gaps in mental health service use amongst those with the greatest need, thereby guiding equitable healthcare delivery. We present a case study of a universal health insurance scheme (Medicare) in Australia. We developed the equity indicator using three national datasets. Geographic areas were linked to an area-based socioeconomic deprivation quintile (Census 2016). Per geographic area, we estimated the number with a mental healthcare need using scores ≥30 on the Kessler-10 (Australian National Health Surveys 2015 and 2018), and obtained the number of services used, defined as mental health-related contacts with general practitioners and mental health professionals (Medicare administrative data 2015-2019). We divided the number of services by the population with an estimated mental healthcare need and averaged these use-rates across each socioeconomic deprivation quintile. The equity indicator is the ratio of the use-rates in the least versus most deprived quintiles. Those estimated to have the greatest need for mental healthcare in 2019 ranged between 8.2% in the most disadvantaged area quintile (Q1) and 2.4% in the least (Q5), corresponding to a proportional increase of 27.7% in Q1 and 19.5% in Q5 since 2015. Equity-indicator-adjusted service rates of 4.2 (3.8-4.6) and 23.9 (22.4-25.4) showed that individuals with the highest need for care residing in Q1 areas received a stark 6 times fewer services compared to their Q5 counterparts, producing an equity indicator of 6. As the global prevalence of common mental disorders may be increasing, it is crucial to calculate robust indicators evaluating the equity of mental health service use. In this Australian case study, we developed an equity indicator enabling the direct comparison of geographic areas with different need profiles. The results revealed striking inequities that persisted despite publicly-funded universal healthcare, recent service reforms and being a high-income country. This study demonstrates the importance and feasibility of generating such an indicator to inform and empower communities, healthcare providers and policymakers to pursue equitable service provision.

Festschrift for Mike Jackson: Applying critical systems thinking through phronetic pluralism: Learning from human learning systems and the adaptive learning pathway

AbstractContemporary governance challenges require both systemic leadership and adaptive learning to navigate effectively. Yet systems theory and systems thinking remain on the relative margins of management praxis, subject to accusations of theoretical remoteness or impracticality. In this paper, we explore how concepts central to Critical Systems Theory (CST) can be impactfully carried into practice. We discuss the genesis and operation of Human Learning Systems (HLS), a recent complexity‐informed development in public service reform, and the Adaptive Learning Pathway (ALP) for systemic leadership, as two such exemplars. Through these two illustrative cases, we highlight the significance of pragmatism and pluralism in applying CST in practitioner‐orientated and policy contexts and consider the implications for knowledge production and academic relevance. We describe how a spirit of ‘phronetic pluralism’ may act as an appropriate translational device for integrating systems theory in practice and help realise practical improvements in the public policy and management landscape.

Mechanisms for providing obstetric service with medical supplies in accordance with the National classifier of medical devices NK 024:2023

Every woman has an indisputable right to realize reproductive health and ensure the birth of a child in professional conditions. The reform of the medical service of Ukraine is aimed at ensuring the efficiency and accessibility of the provision of medical services to every citizen, and improving their quality. In addition to improving the quality of coordination between different levels of medical care, the qualification of medical personnel, it is necessary to provide health care facilities with medical equipment.In order to bring the country’s regulatory framework in the field of application of medical devices to international approaches in Ukraine, the classification of medical devices has been coordinated with the international nomenclature of medical devices Global Medical Device Nomenclature.Mechanisms for providing the obstetric service with medical supplies in accordance with the National Classifier of Medical Devices of Ukraine NC 024:2023 is presented in the article as a result of the study with the application of bibliosemantic method and the method of structural-and-logical analysis. The practical application of the classifier is ensured by the use of a five-digit numerical code of the classifier, which is cross-referenced with the exact wording of the term of the medical device, its definition, and description in Ukrainian and English. Practical mechanisms for providing the obstetric service with medical supplies in accordance with the National Classifier of Medical Devices of Ukraine NC 024:2023 consist in the use of methodological recommendations approved by the Ministry of Health of Ukraine and the computer program “System of on-line access to the classifier of medical devices”, which ensure the methodological and technical use of the specified National Classifier of Medical Devices. The use of these methodological materials makes it possible to establish the availability of the necessary medical device in Ukraine, its manufacturer, price and providers.

Re-Imagining Transformative Strategies to End Minority Marginalization in Ethiopia

Abstract Since 1991, Ethiopia embarked on a journey to create an ethnically egalitarian state, aiming to rectify historical injustices and protect minority rights. Ironically, what was meant to be a beacon of equality has turned into a pervasive experience of minority marginalization. This stark reality underscores the failures of the existing legal and institutional frameworks. This article, therefore, critically examine the transformative strategies to end marginalization of minorities in Ethiopia. The study employed a qualitative research approach blending both primary and secondary data sources. The findings revealed that the failures of existing constitutional promises and institutional frameworks regarding the protection of minority rights, necessitating re-imaginations of transformative strategies. The study advocates for the progression of national and local minority rights institutions, the implementation of transitional justice measures, the instigation of electoral reforms, and the decentralization of power. Furthermore, the establishment of minority autonomous governance and the augmentation of local government capacity are recommended. Additionally, the formation of national minority councils, accentuating parliamentary endorsement for legislative reforms by minority representatives and public service reform is suggested to enhance minority employment opportunities. Lastly, the study recommended equal media access to promote the political participation and freedom of expression of marginalized minority groups.

Civil Service Reforms in Nigeria

Adequate and effective management of the civil service are critical to sustainable socio – economic development of any nation. In Nigeria, as in most countries in Africa, the civil service has declined in proficiency, probity and morale in the past decades. Consequently, the State’s capability and potential to fulfill its responsibilities as service providers to the citizens has declined and progressively a crisis developed in the Nigerian civil service. In order to improve service delivery, successive post – independent governments have undertaken various civil service reforms to reposition the skills, capability, influence and morale of the civil servants. Yet, the civil servants have remained ineffective, demotivated, have low morale, limited training, low capacity and capability to perform their functions. This study reviews the various civil service reforms in post – independence Nigeria and their short comings. It also considers the challenges encountered by these reform initiatives. The secondary means of data collection was employed. The study concludes that civil service reforms have remained difficult to implement due to strong institutional, political, administrative and psychological hindrances. The study recommends that the government should collaborate with various stakeholders like political leaders, the media, civil society organizations, private sector and the international community. Their cooperation and synergy are highly needed for reforms to be successful. Government should also invest in human capital development by organizing capacity building programmes and also implement good welfare packages that will motivate workers to put in their best to see that government’s business and reforms are well implemented among others.

An Examination of Civil Servants’ Assessment of the New Civil Service Reforms in Kazakhstan

An Examination of Civil Servants’ Assessment of the New Civil Service Reforms in Kazakhstan

Managers’ Productivity and Recruitment in the Public Sector

Governments face many constraints in attracting talented managers to the public sector, which often lacks high-powered incentives. In this paper, we study how a civil service reform in Chile changed the effectiveness of a vital group of public sector managers: school principals. First, we estimate principal effectiveness by using an extension of the canonical teacher value-added model. Then we evaluate the effect of the reform on principal effectiveness using a difference-in-differences approach. We find that public schools appointed more effective managers and improved their students’ outcomes after increasing the competitiveness and transparency of their selection process. (JEL D73, H83, I21, J24, J45, O15)

Violence against women: diverse facets.

Gender-based violence, a crucial element of sexual and reproductive health and rights, deserves intensified efforts for its control. Elimination of violence against women is an important aspect of social development, whether for policy formulation by governments, support by professional bodies or delivery of care at the grassroots level. Instead of being merely a platform on 25 November for oft-heard rhetorics, the International Day for the Elimination of Violence against Women provides a unique opportunity for promoting the implementation of effective interventions for service reform addressing intimate-partner violence and sexual violence.

Making integration happen: managers’ views on multidisciplinary work in Finnish health system

Abstract Background In Finland, a large-scale health and social service reform was implemented in 2023. The structural reform centralised the organising of health and social services from some 200 organisations to 22 wellbeing services counties (WBSC). One goal of the reform was to promote service integration between and within health and social services. The reform offers a unique opportunity for investigating how such change unfolds. This study addresses the integration aspirations of those who are responsible for implementing the change, that is middle managers in WBSCs. We focus on micro and meso levels and explore how the aim of multidisciplinary collaboration is interpreted as part of advancing service integration by middle managers in one newly formed WBSC. Methods The data for this qualitative study were derived from 11 semi-structured interviews with senior and middle managers responsible for various fields of health and social care services in a single WBSC between October 2022 and June 2023. Inductive thematic analysis was applied. Results The managers framed multidisciplinary collaboration very positively and easier to achieve in the new organisation with health and social services united under the same management. The managers acknowledged the need to form collaborative structures (e.g. meetings) and processes at all levels of organisation. Leadership plays a crucial role in creating space for the professionals to form an experience of a shared every-day work. However, previous structures and patterns of work still seemed to limit these endeavours. Tensions between, for example, professional groups or units were left essentially untouched. Multidisciplinary collaboration will serve especially persons with complex and multiple needs and was framed key to cost savings. Conclusions While the structural reform opens a window of opportunity to new collaborative patterns, competing logics and interests as well as power imbalances may hamper the development if not addressed. Key messages • Middle managers had high hopes for multidisciplinary work after the health system reform, including effects on the difficult issues concerning costs and health workforce availability. • While the managers were prepared to promote multidisciplinary work, the prior organisational boundaries and logics hindered integration. Different tensions between stakeholders need more attention.

Politico-Administrative Culture and Public Service Reform in Post-Independence Kazakhstan

Classical organizational management literature draws clear parallels between organizational culture and climate and effective use of power and influence as key to successful policy implementation of reforms in public sector organizations. On the other hand, the public policy literature, in particular, policy transfer as a strand within policy studies, emphasizes the role of the national context, more specifically, ‘facilitators’ and ‘constraints’ of ‘‘politico-administrative culture” within the national context, as crucial to understanding processes of transfer, convergence, and diffusion of public policy. There is a plethora of studies by Western scholars of public management who have successfully utilized these theoretical underpinnings to study the effectiveness of public service reforms in mature policy environments such as the UK, the US, Australia, New Zealand, and others. However, the public policy and comparative public management literature only offers a limited number of case studies from developing, middle-/upper-middle countries, which rely on concepts of organizational management in addition to narratives on the impact of policy learning from global doctrines, such as Weberianism, New Public Management (NPM), and New Public Governance (NPG), and national politics, on the implementation of administrative reforms in those contexts. Kazakhstan, as a resource-affluent post-Soviet country and a bastion of modernization and ‘open government’ in Central Asia or the Commonwealth of Independent States (CIS) in the post-Soviet era is a case in point. Based on ethnographic research consisting of interviews with elite academics, civil servants, and think-tank activists, as well as reviews of OECD and government strategy reports in Astana, the findings point to a potential abatement of the impact of context constraints such as large power distance and collectivist behavior by context facilitators such as those surrounding the use of ‘trilingualism’ and public diplomacy towards reforms in Kazakhstan particularly in recent years.

Unlocking the learning in formal complaints: the development of an end-of-life care complaint analysis tool

Background/Aims End-of-life care is a targeted area of healthcare service reform. Complaints are increasingly recognised as a valuable source of evidence for evaluating practice and informing service improvement work. This project aimed to develop a tool to support the standardised coding, categorisation and organisational use of formal complaint data concerning end-of-life care for adults. Methods A service evaluation was conducted using existing data. Deductive analysis was conducted with 59 letters of formal complaint submitted to an NHS trust in the Midlands, UK. A published healthcare complaints analysis tool served as a thematic framework for use in conjunction with framework analysis. The project was carried out in two stages: the first comprised preliminary work to produce a template of end-of-life care concerns; the second involved pilot testing the face validity of the template when used as a coding and categorising scheme. Results An initial template of 20 subcategories of end-of-life care concerns were developed from the data during preliminary work. This template was deemed to enable the analyst to focus on predefined areas of interest, organise concerns into relevant themes, concisely present the data in a summarised form and provide meaningful objective conclusions. During pilot testing, 185 complainant concerns were coded and categorised, over half of which fell into the domain of ‘relationship problems’ (n=99; 53.5%). Within this domain, the most common problem categories were ‘communication’ (n=44) and ‘respect and rights’ (n=44). A total of five new subcategory concerns were also derived and added to the template. Collectively, the outcomes of complaint data analysis informed the structure of a dedicated end-of-life care complaint analysis tool comprising 25 subcategories of end-of-life care concerns and accompanying exemplar indicators, together with criteria that were meaningful to identifying the context of the care concerns. Conclusions A systematic approach to analysing and reporting complainants' experiences of end-of-life care has the potential to support organisational learning, quality monitoring and bespoke service improvements in response to collective complaints and concerns.

Bearing the standard - Prosocial expert leadership is essential for mental healthcare service reform and renewal.

There are many identified challenges for mental healthcare services in Australia and New Zealand including design, infrastructure and workforce shortfalls. In the 2024 RANZCP Workforce Report over 75% of trainees and psychiatrists endorsed symptoms of burnout, and over 80% reported that workforce shortages contributed. There is a need for effective leadership to reform and renew healthcare services. Clinical expertise is necessary, but not sufficient for leadership of mental healthcare services through substantial cultural and organisational renewal. Expertise and prosocial skills are needed for effective cultural leadership, based upon expressed generosity and kindness that leads to a corresponding reputation that empowers cooperation. Leaders will need such skills to effect change and improve mental healthcare delivery and patient experiences.

Guy Ah-Moye: London GP who led reform of health services in his native Seychelles

Guy Ah-Moye: London GP who led reform of health services in his native Seychelles

Sharing midwifery philosophy through a positive learning environment prepares students for a future providing midwifery continuity of care: A mixed method study

BackgroundGlobal and national frameworks for midwifery education recognise and prioritise the provision of midwifery continuity of care. Previous studies report that learning is enhanced when students have professional experience placements within these models, however there remains wide variation in midwifery students’ access to placements within these models in Australia. AimTo evaluate Bachelor of Midwifery students’ experiences in midwifery continuity of care models within two local health districts in New South Wales, Australia. MethodA mixed methods design was used: qualitative data collected through interviews, and quantitative data collected via an online survey using the Midwifery Student Evaluation of Practice (MidSTEP) tool. Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken. ResultsSixteen students responded, four students were interviewed, and 12 students completed the survey. The MidSTEP mean scores for all sub-scales rated above 3.0/4.0. Participants rated ‘work across the full scope of midwifery practice’ and five out of eight subscales of Philosophy of Midwifery Practice at 100 %. ‘Experiences prepare me to be a change agent for maternity service reform’ rated the lowest (67 %). Three qualitative themes emerged: care versus carer model; learning experience; and future career as a caseload midwife. ConclusionA mixed method approach using a validated tool to measure student experiences, contributes to the evidence that students value professional experience placements within midwifery continuity of care models. Currently this is not an option for all midwifery students and as midwifery continuity of care models expand, these findings will inform further implementation of student professional experience placement within these models.

Do children receiving care and support have higher rates of school exclusion than their peers?

The Children, Young People and Education Committee recently held an inquiry to scrutinise the Welsh Government’s progress in delivering its Programme for Government Commitment to ‘explore radical reform of current services for children looked after and care leavers’. A key observation highlighted in their report was that there was a lack of robust data collected about various aspects of the care system. Notably it was highlighted that there is a lack of data collected about permanent exclusions and suspensions from school amongst children looked after in out of home care (CLA). This study was therefore designed to fill this evidence gap. Using anonymised linked administrative data held in SAIL Databank to identify those receiving care and support (CRCS) from their local authority, rates of permanent exclusion and suspension have been determined for the different groups within the CRCS cohort (CLA, those on the child protection register (CPR) and those receiving support who are neither CLA nor CPR) which have then been compared to their peers without this experience. Factors such as phase of education, setting, free school meal entitlement, having additional learning needs, age and gender have also been considered along with the reason for the suspension or exclusion. In drawing comparisons with peers, an intersectional approach was adopted to identify disparity. It is hoped that findings from this student study will stimulate debate and contribute towards the development of changes in Welsh policy.

Revisiting the nexus between governance and poverty in Sub‐Saharan Africa

AbstractThe aim of this study is to investigate the influence of different components of governance on poverty. Hence, the study investigates the direct impact of four pillars of governance and 16 subindicators of governance on poverty in Sub‐Saharan Africa (SSA). This is unlike most previous studies that use a composite index of governance which does not have a bearing on specific policy variables. A panel data set of 41 SSA countries over a period from 2012 to 2022 is analyzed using the System GMM (Generalised Method of Moment) estimation technique. The findings show that improvement in the four pillars of governance (security and rule of law; participation, rights and inclusion; foundation for economic opportunity; and human development) would yield significant reduction of poverty in SSA. However, not all the sub‐indicators have a direct impact on poverty, those that show significant effects are: (a) rule of law and justice, (b) accountability and transparency, (c) anticorruption, (d) public administration, (e) infrastructure, (f) rural development, (g) social welfare, and (h) sustainable environment. All the significant indicators have bearing on the creation and protection of an enabling environment and opportunity for productive activities. Hence, it is recommended that policymakers should undertake judicial system reforms including reforms of the police services. Civil service reform is also recommended, while the business of government should be carried out transparently with zero tolerance for corruption.

How the role of digital leadership and public service reform on bureaucratic revitalization? An empirical study of e-government implementation

This research investigates the relationship between the variables of public service reform (PSR) and bureaucratic revitalization and the relationship between digital leadership (DL) and bureaucratic revitalization. The research method used in this research is quantitative survey research which aims to determine the relationship between two or more variables. The research method for this research is quantitative associative, the population of this study is senior immigration officers. The data analysis method uses structural equation modeling (SEM) partial least squares (PLS), the respondents for this study were 634 senior immigration office employees who were determined using the simple random sampling method—non probability sampling, the questionnaire was designed to contain statement items using a 7 point Likert scale. A closed questionnaire is a list of questions or statements that are equipped with multiple answer choices expressed in scale form. The Likert scale used in this research is (1) strongly disagree, (2) disagree, (3) quite disagree, (4) neutral, (5) quite agree, (6) agree, (7) strongly agree. Data processing in this research used SmartPLS software. The independent variables of this research are digital leadership and public service reform and the dependent variable is bureaucratic revitalization. The stages of data analysis in this research are the outer model test which includes convergent validity, discriminant validity and composite reliability as well as inner model analysis, namely hypothesis testing. The results of this research show that public service reform has a positive and significant relationship to bureaucratic revitalization and digital leadership has a positive and significant relationship to bureaucratic revitalization. This research implies that leaders focus on engaging, using, and handling the uncertainty of emerging technologies, digital tools, and data, leaders to support bureaucratic revitalization, the immigration department must implement digital leadership, immigration leaders should encourage the use of digital platforms in their organizations, support and facilitate digital transformation. The immigration department should increase the revitalization of the bureaucracy, the immigration department should carry out public service reforms. Public services are to be good if they fulfill several principles of public interest, legal certainty, equal rights, balance of rights and obligations, professionalism, participativeness, equality of treatment/non-discrimination, openness, accountability, facilities and special treatment for vulnerable groups, timeliness, speed, convenience and affordability.

Modernization of administrative services in Ukraine based on the approval of new principles of their provision

The article is devoted to the topic of introducing new approaches to the provision of administrative services in Ukraine based on the approval of new principles of their provision. It is noted that administrative services are the leading means of realizing the rights of citizens in the field of public administration, because the absolute majority of cases decided by public administration bodies are initiated by citizens themselves and concern their subjective rights. The Ukrainian state quite successfully coped with the challenges in the field of administrative services after the beginning of the full-scale invasion of the Russian Federation on February 24, 2022. At the current stage, the format of “state-citizen” and “state-business” relations must be modernized taking into account modern technologies, optimization of procedures and improvement of service quality . Of great importance in the process of providing administrative services is the focus on modern, objective principles of their provision determined by socio-economic and technological development. After all, today a widespread phenomenon is the “digitalization” of the process of providing administrative services, which involves the introduction of electronic document management, the creation of online platforms for receiving services, and the automation of administrative procedures. The Center for Political and Legal Reforms developed the “Strategy for the reform of administrative services and their digitalization”. From the analysis of the document, it follows that the principles of providing administrative services today need a doctrinal update in their interpretation. In particular, the system of principles of administrative services should be supplemented with such things as decentralization of powers, simplification of procedures for the provision of administrative services, formality, integration of basic services in the Central Administrative Service, compensability for the provision of administrative services, unification of the procedure for resolving administrative cases, development of electronic public services, proactivity of public administration in in the field of provision of administrative services, protection of personal data.

Indonesian Civil Service Management in the Health and Disaster Management Sector: Post-COVID-19 Pandemic Prospective

The COVID-19 pandemic as a non-natural disaster has made many countries aware of reform in healthcare systems and services and disaster management, including Indonesia. The high intensity of natural disasters in Indonesia and the presence of non-natural disasters such as the COVID-19 pandemic have become the government's momentum to carry out better mitigation in the future. This study aims to identify and analyse the gap between the existing conditions and the ideal conditions for the needs of the State Civil Apparatus (ASN) in the health and disaster management sector in the future. Using a gap analysis approach with qualitative data collection, this study shows a significant gap between the availability of ASN compared to the number of ASN needed in the health and disaster management sectors in Indonesia. Moreover, to make the health and disaster management sector successful, this study formulates the need for ASNs in strategic positions: Specialist Doctor, General Practitioner, Dentist, Pharmacy and Food Supervisor, and Rescuer. In addition, this study suggests the need for developing ASN competencies in this sector, such as digital services, biotechnology, nanotechnology, integrated flood management, construction of drinking water supply systems and landfills, risk management, and review analysis and mitigation