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Recent changes in university systems, debates on academic freedom, and changing roles of knowledge in society all point to questions regarding how higher education and research should be governed and the role of scientists and faculty in this. Rationalizations of systems of higher education and research have been accompanied by the questioning and erosion of faculty authority and challenges to academic collegiality. In light of these developments, we see a need for a more conceptually precise discussion about what academic collegiality is, how it is practiced, how collegial forms of governance may be supported or challenged by other forms of governance, and finally, why collegial governance of higher education and research is important.

We see collegiality as an institution of self-governance that includes formal rules and structures for decision-making, normative and cognitive underpinnings of identities and purposes, and specific practices. Studies of collegiality then, need to capture structures and rules as well as identities, norms, purposes and practices. Distinguishing between vertical and horizontal collegiality, we show how they balance and support each other.

Universities are subject to mixed modes of governance related to the many tasks and missions that higher education and research is expected to fulfill. Mixed modes of governance also stem from reforms based on widely held ideals of governance and organization. We examine university reforms and challenges to collegiality through the lenses of three ideal types of governance – collegiality, bureaucracy and enterprise – and combinations thereof.

While companies in developed countries are increasingly turning to indigenous employees, integration measures have met with mixed results. Low integration can lead to breach of the psychological contract, i.e. perceived mutual obligations between employee and employer. The purpose of this paper is to identify how leadership and organizational integration measures can be implemented to promote the perceived insider status (PIS) of indigenous employees, thereby fostering fulfillment of the psychological contract.

A search for relevant literature yielded 128 texts used to identify integration measures at the level of employee–supervisor relationships (leader-member exchanges, inclusive leadership) and at the level of employee–organization relationships (perceived organizational support, pro-diversity practices).

Measures related to leadership included recruiting qualified leaders, understanding cultural particularities, integrating diverse contributions and welcoming questions and challenges. Organizational measures included reaching a critical mass of indigenous employees, promoting equity and participation, developing skills, assigning meaningful tasks, maintaining good work relationships, facilitating work-life balance, providing employment security, fostering support from communities and monitoring practices.

While PIS has been studied in western and culturally diverse contexts, it has received less attention in indigenous contexts. Yet, some indigenous cultural values are incompatible with the basic assumptions of mainstream theories. Furthermore, colonial policies and capitalist development have severely impacted traditional indigenous economic systems. Consequently, indigenous people are facing many barriers to employment in ways that often differ from the experiences of other minority groups.

Collegiality is often discussed and analyzed as a challenged form of governance, a form of working that used to function well in universities prior to the emergence of contemporary and modern forms of governance. This seems to suggest that collegiality used to dominate, while other forms of governance are now taking over. The papers in volume 86 of this special issue support the notion of challenged collegiality, but also show that for the most part, nostalgic notions of “the good old days” are neither true nor helpful if we are to revitalize academic collegiality. After examining whether a golden age of collegiality ever existed, we discuss why collegiality matters. Exploring what are often described as limitations or “dark sides” of collegiality, we address four such “dark sides” related to slow decision-making, conflicts, parochialism, and diversity. This is followed by a discussion of how these limitations may be handled and what measures must be taken to maintain and develop collegiality. With a brief summary of the remaining papers under two headings, “Maintaining collegiality” and “Revitalizing collegiality,” we preview the rest of this volume.

Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care.

The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data.

The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements.

Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

Adolescence is a time when a young person develops his or her identity, acquires greater autonomy and independence, experiments and takes risks and grows mentally and physically. To successfully navigate these changes, an accessible and health system when needed is essential.

We assessed the structure and content of national primary care services against these standards in the field of adolescent health services. The main criteria identified by adolescents as important for primary care are as follows: accessibility, staff attitude, communication in all its forms, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community.

We found that although half of the Models of Child Health Appraised countries have adopted adolescent-specific policies or guidelines, many countries do not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care or respond to life-threatening behaviour is limited. Many countries provide good access to contraception, but specialised care for a pregnant adolescent may be hard to find.

Access needs to be improved for vulnerable adolescents; greater advocacy should be given to adolescent health and the promotion of good health habits. Adolescent health services should be well publicised, and adolescents need to feel empowered to access them.