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BACKGROUND: Workers tasked with specific responsibilities around patient and public involvement (PPI) are now routinely part of the organizational landscape for applied health research in the United Kingdom. Even as the National Institute for Health and Care Research (NIHR) has had a pioneering role in developing a robust PPI infrastructure for publicly funded health research in the United Kingdom, considerable barriers remain to embedding substantive and sustainable public input in the design and delivery of research. Notably, researchers and clinicians report a tension between funders' orientation towards deliverables and the resources and labour required to embed public involvement in research. These and other tensions require further investigation. METHODS: This was a qualitative study with participatory elements. Using purposive and snowball sampling and attending to regional and institutional diversity, we conducted 21 semi-structured interviews with individuals holding NIHR-funded formal PPI roles across England. Interviews were analysed through reflexive thematic analysis with coding and framing presented and adjusted through two workshops with study participants. RESULTS: We generated five overarching themes which signal a growing tension between expectations put on staff in PPI roles and the structural limitations of these roles: (i) the instability of support; (ii) the production of invisible labour; (iii) PPI work as more than a job; (iv) accountability without control; and (v) delivering change without changing. CONCLUSIONS: The NIHR PPI workforce has enabled considerable progress in embedding patient and public input in research activities. However, the role has led not to a resolution of the tension between performance management priorities and the labour of PPI, but rather to its displacement and - potentially - its intensification. We suggest that the expectation to "deliver" PPI hinges on a paradoxical demand to deliver a transformational intervention that is fundamentally divorced from any labour of transformation. We conclude that ongoing efforts to transform health research ecologies so as to better respond to the needs of patients will need to grapple with the force and consequences of this paradoxical demand.

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In the last twenty years, France has gone through health policy changes that are perceived as paradigm shifts. After briefly describing the reforms driven by the new public management and the subsequent re-centralization of the French health system for budgetary purposes, it appears that those reforms had outcomes below expectations. The regrouping of policy decisions within the Regional Health Agencies and the rise of a French Welfare elite weakened the medical profession. Blame-shifting strategy, political dilution, and spatial inequality linger. The COVID-19 epidemic highlights those limitations. The negative societal and political impact of failed public reforms is increasingly evident.

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This study investigates the potential economies of scope in the Norwegian public hospital sector after a major structural and organizational reform. Economies of scope refers to potential cost savings occurring from the scope of production rather than the scale. We use a data driven approach to distinguish between relatively specialized and differentiated hospitals. Using registry data spanning the period 2013-2019, we use non-parametric data envelopment analysis with bootstrapping procedures to investigate the potential presence of economies of scope. This is done separately for three different dimensions of which hospital production can be either specialized or differentiated. The findings suggest that economies of scope are present in the Norwegian hospital sector, meaning that there are cost savings related to the optimal differentiation of the activity. It is difficult to conclude on how these findings relate to the reform.

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The study examines former home care workers' reasons for leaving their jobs from the perspective of reforms in public services and eldercare policies impacted by New Public Management (NPM) in Finland. Written narratives from former home care workers (n = 39) were collected online and analyzed using thematic content analysis. Former home care workers' reasons for leaving their jobs were connected to four interconnecting themes: mismatch between needs and resources, measurement-driven practices, unbalancing work-life, and ethical burden. These reasons reflected critical changes in the organization of care work and the work environment in older adults' home care. Contradictions between needs, resources, and values lead to ethical dilemmas and push away from the workforce in eldercare. To improve care workers' willingness to remain in the eldercare sector, changes are needed in the resourcing and organization of home care, including managerial support in everyday care work.

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New Public Management-inspired reforms in the Norwegian hospital sector have introduced several features from the private sector into a predominantly public healthcare system. Since the late 1990s, several reforms have been carried out with the intention of improving the utilization of resources. There is, however, limited knowledge about the long-term, and sector-wide effects of these reforms. In this study, using a panel data set of all public hospital trusts spanning nine years, we provide an analysis of the efficiency of hospital trusts using data envelopment analysis (DEA), as well as a Malmquist productivity index. Thereafter we use the efficiency scores as the dependent variable in a second-stage panel data regression analysis. We show that during the period between 2011 and 2019, on average, efficiency has increased over time. Further, in the second-stage analysis, we show that New Public Management features related to incentivization are associated with the level of hospital efficiency. We find no association between degree of competition and efficiency.

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BACKGROUND: Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate "healthcare entrepreneurship", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer's disease. METHODS: A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have. RESULTS: The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship - two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level. CONCLUSION: Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing.

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This article historicises practices called 'personalization' in the UK. It presents data from interviews with practitioners to show how business leaders, public sector managers, policy analysts, activists and others have crafted their personalizing practices through commercial and governmental work over a 40-year period. These public histories are illuminated by professional biographies, which reveal common interests in the transfer and application of technology, data and data analytics. Yet they also illuminate attempts to reform bureaucracies in public and private sectors alike during the late 20th and early twenty-first century. The article asks how mobility - of professionals and their personalizing practices - has affected the pre-existing contrast between, and separation of, public and private organizations. This article contributes to commentaries on personalization that view it as an essentially private and privatizing process. What remains of such domains once they have been crossed, and from whose perspective? This UK history raises questions for comparative histories of personalization and its synonyms elsewhere.

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The article highlights several outstanding features of French healthcare reforms in light of New Public Management (NPM). The paper exposes the economic, administrative, and social context of reforms. It investigates horizontal integration, as exemplified by the concentration of power within the Regional Health Organizations, the verticalization of the chain of command, and ensuing conflicts between the French welfare elite and the operating core (eg, the medical profession). Outcomes were below expectations in many areas. The NPM-endorsed fragmentation of public organizations has yet to take root in the French healthcare system. There was little consultation with the medical profession. Physicians' autonomy and patients' rights receded.

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INTRODUCTION: Globally, overweight and obesity are more prevalent in rural areas than in urban areas. The purpose of this study was to determine to what extent public health nurses in rural areas in Norway feel equipped to tackle the overweight and obesity epidemic within two sets of national guidelines: The National Guidelines for the Standardized Measurement of Height and Weight and The National Guidelines for the Prevention, Identification, and Treatment of Overweight and Obesity in Children and Adolescents. These guidelines are inspired by New Public Management (NPM) logic, which emphasises more market orientation within the public sector to obtain a more cost-effective supply of public goods. The focus is on the weighing of schoolchildren, available resources, inter-agency cooperation and the rural context. METHODS: The data were collected using a structured questionnaire among 40 public health nurses working with children in rural areas, as well as qualitative interviews with 25 informants involved in the prevention and treatment of overweight and obesity among rural children. RESULTS: The study shows that rural public health nurses worry about the lack of resources for follow-up with children with a body mass index greater than what is characterised as 'normal'. The public health nurses suggested better cooperation between different stakeholders to work around the lack of resources and at the same time be able to see the whole picture, considering that overweight and obesity are complex problems connected to different challenges. They believed that it is an advantage to see the individuals in their local surroundings, to know their family history, their leisure activities and so on. This might be easier in rural areas than in urban areas, as these areas are often more transparent. CONCLUSION: There was consensus among the public health nurses involved in this study that national guidelines for treating overweight and obesity in children with the principles of NPM, and simplifying and standardising services, adds challenges instead of solutions. Such practices also hinder the use of experience-based knowledge about both the individual and the local context. There is a need for more flexible guidelines that can easily be adapted to the local (rural) context.

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COVID-19 arrived in Chile amid social protests that questioned the State's ability to protect children's rights. Nevertheless, child policy workers continued working despite the drastic changes to their daily work generated by both the pandemic and conflicts within the child welfare system. In this article, we aim to understand how these workers have experienced and overcome these challenges. We show that they have continued doing interventions with children at the expense of their economic resources and well-being. Our findings highlight the need for the government to take immediate action, offering guidelines to improve child policy workers' labor conditions.

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THE STUDY'S RATIONALE: The Scandinavian nursing tradition is based on caring science as the ontological backdrop. This means that meeting the patient with openness and respect is essential in care. The experiences of an elderly woman receiving home nursing provide insight into a world many healthcare workers need to understand; meaning what is important in the encounter with the fragile old patient whose voice is not often heard in the society nor in research. Caring science with its person-oriented care clashes with the New Public Management's ideal for municipal health care in Norway, at the expense of the needs of the elderly patients. AIMS AND OBJECTIVES: This article aims to express the phenomenon of lived experience as presented by an elderly woman, more specifically her experience of care in home nursing run according to the principles of new public management. METHODOLOGICAL DESIGN: The article is based on an empirical narrative in the form of an individual qualitative research interview. FINDINGS: The patient has needs that cannot be defined without the nurse having an ethical understanding of what may be important in the patient´s lifeworld. The core findings are: Feeling disregarded as a human being, Broken agreements, Surrendering in anonymous relationships and Each day is a different day with altered needs. CONCLUSION: The system of New Public Management sets a strain on the time at hand for the nurse to develop a relationship that acknowledges and supports the patient´s life courage. The ethical demand and care ethics can explain how the patient´s will to live can be preserved, and provide knowledge of how the caregiver can best attend to the patient's ways of expressing what is important to her. Nevertheless, within the time at disposal, the nurse has an opportunity to either marginalize or strengthen the old person´s dignity.

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Resumo: Este trabalho indaga o caráter avaliativo do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica na Atenção Primaria à Saúde no Brasil, a partir do caráter performativo deste instrumento no cenário mundial de crescente managerialização das políticas sanitárias. Objetivo: Compreender como a qualidade do acesso se define em termos práticos e quais ações são promovidas aos trabalhadores da Atenção Primaria à Saúde através da Portaria 1.645 e o Instrumento de Avaliação aplicado aos profissionais do Núcleo Ampliado de Saúde da Família e Atenção Básica. Métodos: Foi realizada uma Análise Pragmática do Discurso, com auxílio dos Softwares Atlas.ti 8 e Microsoft Excel 2010. Resultados: Os resultados revelam estândares e indicadores promovidos pelo Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica, assim como o papel ambivalente de gestores e profissionais da saúde, entre seu caráter voluntário e proativo e, revelam o desmonte do modelo de Atenção Primária à Saúde sob lógica comunitária no Brasil, em comparação à abordagem do Novo Management Público e a atuação em função de indicadores. Conclusões: O papel do Estado na garantia de direito a saúde é minimizado e dá lugar ao Novo Management Público na saúde.

Resumen: Este trabajo cuestiona el carácter evaluativo del Programa Nacional para la Mejora del Acceso y la Calidad de la Atención Primaria en la Atención Primaria de Salud en Brasil, a partir del carácter performativo de este instrumento en el escenario mundial de creciente managerialización de las políticas sanitarias. Objetivo: Comprender cómo se define la calidad del acceso en términos prácticos y qué acciones se promueven a los trabajadores de Atención Primaria de Salud a través de la Ordenanza 1.645 y el Instrumento de Evaluación aplicado a los profesionales de Núcleo Ampliado de Saúde da Família e Atenção Básica. Métodos: Se realizó un Análisis Pragmático del Discurso, con la ayuda de Softwares Atlas.ti 8 y Microsoft Excel 2010. Resultados: Los resultados revelan estándares e indicadores promovidos por el Programa Nacional para la Mejora del Acceso y la Calidad de la Atención Primaria, así como el papel ambivalente de los gerentes y profesionales de la salud, entre su carácter voluntario y proactivo y revelan el desmantelamiento del modelo de Atención Primaria de Salud bajo lógica comunitaria en Brasil, en comparación con el enfoque del Nuevo Management Público y el desempeño en función de los indicadores. Conclusiones: Se minimiza el papel del Estado en la garantía del derecho a la salud y se da paso al Nuevo Management Público en la salud.

Abstract: This paper questions the evaluative process of the National Program for Improving Access and Quality of Primary Care in Primary Health Care in Brazil, based on the performative character of this instrument in the world scenario of increasing management of health policies. Objective: To understand how the quality of access is defined in practical terms and what actions are promoted to Primary Health Care workers through Ordinance 1,645 and the Evaluation Instrument applied to Extended Centers for Family Health and Primary Care professionals. Methods: A Pragmatic Discourse Analysis was performed, with the help of Atlas.ti 8 and Microsoft Excel 2010 Software. Results: The results reveal standards and indicators promoted by the National Program for Improving Access and Quality of Primary Care, as well as the ambivalent role of managers and health professionals, between their voluntary and proactive character and reveal the dismantling of the Primary Health Care model under community logic in Brazil, compared to the New Public Management approach and the performance in function of indicators. Conclusions: The role of the State in guaranteeing the right to health is minimized and gives way to New Public Management in healthcare.

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We analyze the relationship between the party affiliation of politicians at different levels of government and the spatial distribution of funding for research, development and innovation projects. In particular, we are investigating whether more federal grants are being granted in Germany for projects in federal states whose government is led by the same political party as the responsible ministry at federal level. Our dataset contains detailed information on publicly funded projects in Germany in the period 2010-2019. Using a fixed-effects estimation approach, we find a link between grant allocation and party affiliation of funding for research, development and innovation projects, in particular smaller ones. For these projects, political alignment is associated with an average increase in public funding by almost 10,000 euro. Our results suggest that public funds for research, development and innovation projects could be used more efficiently than they are.

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The Mental Health Act as amended 2007 democratised who could qualify for the Approved Mental Health Professional (AMHP) role to include not only social workers, but psychologists, occupational therapists, and nurses. The amendments raised questions on how to appropriately train AMHPs from the professional groups without social work education to have adequate skills and decision-making capacity when considering the use of compulsory powers. Essential to the AMHP role is the obligation to 'bear in mind the social perspective', which incorporates the social dimensions to a persons mental health presentation and is considered a safeguard against the erroneous detention of service users. However, despite claims to further professionalise AMHPs there has been a difficulty defining what AMHP expertise is. This paper draws upon 'theories of professionalisation' to argue that the genericism movement and the adoption of New Public Management has limited the professionalisation of AMHPs and therefore adequate implementation of 'the social perspective'.

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While New Public Management practices (NPM) have been adopted in academia and higher education over the past two decades, this paper is investigating their role in a specifically socio-philosophical way: The preeminent question is what organization of science is likely to make science and research work well in the context of a complex society. The starting point is an obvious intuition: that academia would be "economized" by NPM (basically, that something is coming from the outside and is disturbing the inside). Habermas provides a sophisticated theorization for this intuition. In contrast, the thesis advanced here is that we should consider NPM potentially problematic-but not for descending from economics or administration outside academia. It is because NPM often cannot help research and science to function well. In this (rather "essayistic" than strictly deductive) consideration, I will therefore tentatively discuss an alternative approach that takes up critical intuitions while transposing them into a different setting. If we understand science and research as a form of life, a different picture emerges that can still bring immanent standards to bear, but at the same time compose them more broadly. This outlines a socio-philosophical critique of NPM. Accordingly, the decisive factor is not NPM's provenance. What is decisive is that it addresses some organizational problems while at the same time creating new ones. At the end, an outlook is sketched on how the specific situation of NPM allows some hypotheses on academy's [by "academy", I am referring to the whole research community (like "academia")] future organization. Ex negativo, it seems likely that qualitative evaluation criteria and creative freedom will have to play a greater role.

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Resumen (analítico) Chile es un caso emblemático en la instalación de una política de protección a la infancia con orientación neoliberal. Actualmente, esta política es ejecutada casi completamente por organizaciones privadas, financiadas conforme al logro de indicadores de desempeño estandarizados. Algunas investigaciones plantean que estos indica-dores gobiernan la racionalidad de los trabajadores y trabajadoras; empero, estudios internacionales señalan que este tipo de gobernanza no solo es racional, sino también afectiva. A partir de un análisis textuala-fectivo de 14 entrevistas individuales y dos talleres grupales realizados a cinco trabajadoras y un trabajador de distintos organismos colaboradores del Servicio Nacional de Menores, se reporta que este modelo de gestión consume y maquiniza los cuerpos de estas y estos profesionales. No obstante, el afecto es el que hace posible la resistencia.

Abstract (analytical) Chile is an emblematic case in the implementation of a neoliberal child welfare policy. This policy is now almost entirely undertaken by private organizations, financed based on their achievement of standardized performance indicators. Scientific literature suggests that these indicators govern workers' rationality. However, international studies indicate that the effect of indicators is not just rational but also affective. From a textual-affective analysis of 14 interviews and 2 workshops conducted with 5 female workers and 1 male worker from different partner organizations within the Chilean National Service for Minors, participants reported that this management model consumes and mechanizes the work carried out by these professionals. However, it is affectivity that makes resistance possible.

Resumo (analítico) O Chile é um caso emblemático na instalação de uma política neoliberal de proteção à criança. Esta, é hoje quase inteiramente executado por organizações privadas, financiadas de acordo com a obtenção de indicadores de desempenho padronizados. Pesquisas sugerem que estes indicadores governam a racionalidade dos trabalhadores; enquanto estudos internacionais indicam que este governo não é apenas racional, mas também afetivo. A partir de uma análise textual-afetiva de 14 entrevistas e duas oficinas realizadas a cinco trabalhadoras e um trabalhador de diferentes Organizações Colaboradoras do Serviço Nacional de Menores, é relatado que este modelo de gestão consome e mecaniza os órgãos destes profissionais. No entanto, é o afeto que torna possível a resistência.

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OBJECTIVE: Both public (government-run), and not-for-profit (nongovernment) service providers provide alcohol and other drug (AOD) treatment services. Research has rarely studied the structural features of these providers, such as workforce characteristics, procurement arrangements, and funding security. The study reported here sought to document and analyze the differences between these two AOD treatment provider types in Australia. METHODS: The study administered an online survey instrument targeted at managers of AOD treatment sites. The survey comprised three sections: (1) the service (e.g., treatment types); (2) workforce (e.g., total number of staff); and (3) funding and procurement arrangements (e.g., contract length). The study completed a total of 207 site surveys. The studied compared government and nongovernment services on structural features that may create a more or less sustainable or vulnerable service (funding arrangements, payment mechanisms, and contract length). RESULTS: Government providers were more likely to provide medically oriented treatment types such as withdrawal management and pharmacotherapy, whereas nongovernment organization (NGO) providers were more likely to offer rehabilitation. Consistent with this, government services were more likely to employ medical professionals and nurses, indicative of a more medically oriented workforce, while NGO services were more likely to employ AOD workers, youth workers, peer workers, and counselors. Our data illustrate that NGO services were more likely to be subject to competitive tendering and to have shorter contract lengths, compared with government services, and overall to be more structurally vulnerable. CONCLUSION: Despite the reliance on NGOs to provide the majority of specialist care (71% of all treatment episodes in Australia), these services are more vulnerable than their government counterparts. To ensure that a comprehensive suite of treatment services is available, procurement arrangements that support stability and security in nongovernment service providers and government service providers are essential.

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O percurso escolhido pelo presente estudo tem como principal objetivo trazer elementos sobre as disputas no campo do trabalho na saúde que se colocam a partir da influência neoliberal no Rio de Janeiro nas gestões de Eduardo Paes (2009-2017) e Marcelo Crivella (2017-2021). Para tanto, este trabalho faz um resgate histórico do neoliberalismo nos anos 90 e de seus fundamentos no que diz respeito à administração pública, com destaque para a Nova Gestão Pública. As diretrizes neoliberais que influenciaram a introdução das Organizações Sociais de Saúde no município carioca e a reforma que acompanhou este marco, afetaram, também, a trajetória das disputas no campo da saúde que antecederam este momento. Objetivando desenhar o cenário no qual a Reforma dos Cuidados em Atenção Primária no Rio de Janeiro se materializou, o presente estudo traz algumas perspectivas sobre financiamento e cobertura, contrastando com Belo Horizonte, capital mineira que historicamente apresentou bons números em cobertura e estabilidade na assistência na atenção primária à saúde, mesmo quando o Rio de Janeiro apresentava menos de 5% de cobertura populacional. Estas discrepâncias interessam ao presente estudo e os resultados encontrados apontam a questão dos vínculos de trabalho como ponto central para explicá-las e para, possivelmente, apontar um caminho que possibilite constância e solidez à atenção primária carioca. Como metodologia, foi realizada revisão da bibliografia de interesse, levantamento de dados de acesso público, bem como importante análise dos marcos legais que balizaram as conjunturas políticas destacadas.

The way chosen by this thesis has as its main objective to bring elements about the dispute in the health work field that arise from the neoliberal influence in Rio de Janeiro through Eduardo Paes (2009-2017) and Marcelo Crivella (2017-2021) administrations. To do so, this work brings a retrospective of neoliberalism in the 90's and of its fundamentals in what concerns public administration, highlighting the New Public Management concept. The neoliberal guidelines which have influenced the introduction of Social Organizations in Rio de Janeiro and the reform that accompanied this mark also affected the trajectory of the disputes in health field that precede this moment. Aiming to delineate the scenario in which the Reform of Primary Health Care in Rio de Janeiro took place, the present study introduces some perspectives about financing and coverage, contrasting it with Belo Horizonte, capital of Minas Gerais state that has historically shown high levels of coverage in primary health care and stability in assistance, even when Rio de Janeiro counted with less than 5% of coverage of its population. These discrepancies interest to this study and the results indicate the issue of employment relationships as a key point to explain them and to possibly point out a way that grants constancy and solidity to Rio de Janeiro's primary health care. As methodology, it has been employed literature review, data survey as well as an important analysis of the legal framework that have guided the highlighted public conjunctures.

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The arrival of new technologies in the operating theatre raises questions about surgical practice, in a context of societal changes and hospital reorganisation. These innovations will bring changes to the ethos of the profession and ethical issues will be raised by the increase of the surgeon.

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This study examined the lived experience of Canadian clinical social workers in light of the organizational context in which they work. The literature indicates an alarming rise of occupational psychological distress in social workers, which aligns with the rise of the neoliberal ideology within the Canadian healthcare sector. While we know that organizational constraints and structural reforms affect social worker's workplace well-being, it remains unclear how these changes are represented by front-line practitioners and how they affect the provision of social services in healthcare settings. To deepen our understanding of this issue, we conducted a thematic analysis of thirty semi-directed interviews with social workers currently practicing in three Canadian cities (Ottawa, Moncton and Winnipeg). Discussions of daily work life, responsibilities, autonomy and subjective understandings of the social worker's role revealed which organizational constraints were the most significant in everyday practice and how they relate to their professional identity and mandate. Provincial healthcare reforms were generally found to have negative effects on clinical social workers, whose struggles for recognition were impaired by the fundamentally neoliberal ideologies behind the large-scale restructuring of service provision, themselves at odds with the humanistic principles of social work. Our findings further suggest that structural changes under the New Public Management frame could be detrimental to both the quality of services provided by clinical social workers and their well-being. Overall, this investigation highlights the importance of organizational improvements in the workplace through systemic changes that would concurrently target managerial expectations, resources allocation, autonomy, work-life balance and respect for professional values.