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Managing complexity within care ecosystems is an increasing universal challenge. In health, this is emphasised by recent calls for greater care integration to achieve service improvement as levels of comorbidity and frailty grow within populations. This research takes a service-dominant logic (SDL) stance in examining the sources, types and nature of complexity within a care ecosystem in the UK.

This illustrative case research focuses on a community care ecosystem. A multi-method approach is used combining semi-structured interviews, descriptive statistics and secondary data. The results were independently assessed and validated by participants through a second interview phase.

The findings from this research provide empirical support for the six complexities discussed in the supply chain literature. Identifying these complexities proffers the opportunity of applying manufacturing-derived complexity management strategies in care ecosystems. The conceptual model for institutional complexity, derived from the illustrative case study, showed that care professionals face additional complexity challenges in operating care ecosystems.

The management of complexity in care ecosystems requires professionals to be considerate of institutional arrangements when addressing the consequences of increasing levels of complexity. This necessitates the development of a balanced approach between reducing complexity while absorbing institutional arrangements which minimise risk.

Drawing on the supply chain complexity literature, the paper has developed a framework which guides care professionals facing increasing levels of complexity within the context of their institutional arrangements. As such, this research furthers our understanding of supply chain complexity effects in care ecosystems and provides a platform for future research.

This research examines how knowledge and information are managed within two care networks. We develop a conceptual framework drawing on the notion of brokering and the 3T framework, which is used to describe the relative complexity of boundaries (referred to in the framework as syntactic, semantic and pragmatic) as well as capabilities and processes required to exchange information within the network. Previous research on brokering has focused on healthcare managers and professionals, but this research extends to patients and caregivers. Understanding knowledge exchange and brokering practices in healthcare is critical to the delivery of effective services.

For this case research, non-participant observation and experienced-based interviews were undertaken with healthcare professionals, patients and caregivers within two care networks.

The findings reveal brokering roles occupied by healthcare professionals, patients and caregivers support the transfer, translation and transformation of knowledge and information across functional and organisational boundaries. Enablers and disablers to brokering and the exchange of knowledge and information are also identified.

The study is limited to two care networks for long-term conditions within the UK. Further research opportunities exist to examine similar care networks that extend across professional and organisational boundaries.

This research informs healthcare professionals of the brokering capabilities that occur within networks and the enabling and disabling factors to managing knowledge across boundaries.

This paper provides a conceptual framework that categorises how increased levels of knowledge and information exchange and brokering practices are managed within care networks.

This paper aims to identify reverse flows and exchanges that support public service provision. Reverse flow literature has focused on manufacturing based supply chains using the lens of exchange (recovery, reuse, repair and recycle) to gain performance improvement in product flows. Limited research is available to support an understanding of customer-derived reverse exchange (RE) service processes. The authors contribute to the service literature through the development of RE antecedents and derive new and revised definitions with the supporting constructs of RE service processes.

This paper synthesises literature creating a framework of antecedents for RE. Antecedents reflect differences of service flow (level of service inseparability and ‘acting upon’). These antecedents are empirically tested within an illustrative pre-existing UK healthcare case study against the synthesised antecedents and existing RE definitions. Two teams of researchers reviewed the data generated from public service supply chain processes. Definitions of RE were either revised or derived from the empirical data by each team.

The service concept of ‘acting upon’ for inseparable public service supply chain flows provides a basis for examining the existence of reverse flows and exchanges. Revised and new classifications to the RE model are proposed to stimulate contextual performance improvement and innovation in public service provision. Psychological utility is an additional feature to economic, environmental and social utility in public service RE. RE offers practitioners and academics a strategic operational competence to achieve improvement and innovation in public services and further advance this concept.

Extending the literature beyond the manufacturing derived RE concept to develop an understanding of the customer’s role in preserving and co-creating value in RE and flows in public service. New RE antecedents for public services, including the potential of psychological utility, are presented.

The research aim is to identify and evaluate “value” and “effectiveness” in the system of temporary staffing in one NHS Trust. Temporary staffing, known as Bank and Agency (B & A) staffing, is an increasing proportion of NHS expenditure (Bank staff are already contracted with the Trust and work extra shifts, while Agency staff are independently employed through the agency, costing more per shift). The system is reviewed in terms of quality, delivery and cost in relation to customers. The study assesses if unnecessary complexity, and poor standards significantly impact on effective performance.

A diagnostic action research field based approach is taken with qualitative and quantitative analysis of the current system. This includes, cross‐functional mapping, stakeholder value analysis and historical data collection. The theoretical perspective includes system theory, stakeholder theory and value.

Research results indicate that the requirement for temporary staffing is predictable (previously thought to be unpredictable). Consequently, agency staffing can more readily be replaced with bank nurses. This could improve the outcomes of quality in service, delivery and reduce Trust expenditure.

Research results could be idiosyncratic and contextual therefore a comparative study is underway to determine validity. Indications are NHS expenditure on temporary staffing, particularly agency nurses, could be reduced while increasing effectiveness of the service.

This research analyses working practice and value relationships within the temporary staffing system. A potential future state system is developed, that indicates improved value, quality, delivery, a win for patients, wards and Welsh NHS secondary care Trust, having wider NHS applications.

This article aims to explore quality improvement (QI) at individual, group and organisational level. It also aims to identify restraining forces using formative evaluation and discuss implications for current UK policy, particularly quality, innovation, productivity and prevention.

Learning events combined with work‐based projects, focusing on individual and group responses are evaluated. A total of 11 multi‐disciplinary groups drawn from NHS England healthcare Trusts (self‐governing operational groups) were sampled. These Trusts have different geographic locations and participants were drawn from primary, secondary and commissioning arms. Mixed methods: questionnaires, observations and reflective accounts were used.

The paper finds that solution versus problem identification causes confusion and influences success. Time for problem solving to achieve QI was absent. Feedback and learning structures are often not in place or inflexible. Limited focus on patient‐centred services may be related to past assumptions regarding organisational design, hence assumptions and models need to be understood and challenged.

The authors revise the Plan, Do, Study, Act (PDSA) model by adding an explicit problem identification step and hence avoiding solution‐focused habits; demonstrating the need for more formative evaluations to inform managers and policy makers about healthcare QI processes.

Although UK‐centric, the quality agenda is a USA and European theme, findings may help those embarking on this journey or those struggling with QI.

This paper describes the application of a new variant of process benchmarking called value stream mapping to the development of a supplier network around a prominent distributor of electronic, electrical and mechanical components. This involved mapping the activities of the firm, identifying opportunities for improvement and then undertaking with the firm an improvement programme. The resulting supplier association programme involved around 50 key suppliers across eight product category areas. The paper explores the different methods employed together with the support structure that was created. It concludes with evidence of the early results of the programmes as well as a number of key learning points for other organisations wishing to follow a similar path.

The purpose of this paper is to discuss key elements of lean supply (LS) in light of core concepts in the Industrial Marketing and Purchasing Group (IMP) perspective.

First, the authors examine the literature on LS and identify and discuss important characteristics and key elements of LS. Second, the authors present key concepts in the IMP Perspective, in particular the dyad versus network levels, and the ARA model, capturing activities, resources, and actors. Third, the authors cross-fertilize the concepts from these two streams of research.

The authors identify 12 key LS elements. Relating these to core IMP frameworks, they identify areas of LS that can be expanded. First, the authors found that key elements in LS mainly focus on the dyadic level and that the network level is addressed to a much lesser extent and primarily captures serial “chain” connections among relationships. Second, it was found that key elements in LS predominantly focus on the activity layer and pay much less attention to resources and actors.

The authors suggest that LS theory and practice can benefit from taking a network perspective, and by paying more attention to resource and actor concepts and issues. The study is purely theoretical.

To the best of the authors’ knowledge, no previous studies combine LS and the IMP perspective. The authors add to LS by elaborating how 12 key elements in LS can be expanded.

While numerous articles have stressed the importance of developing and maintaining supply networks, there is still a dearth of studies that address how supply networks arise and change over time. The purpose of this article is to describe and conceptualise how a firm initiates the development of a supply network, and how the structure of the firm's supply network and supply base change over time as a consequence of the type and duration of initiative taken?

Empirically, the article is based on a longitudinal, single case study, which is real‐time, theory‐led and contextual. The case study concerns the efforts of a main contractor (within the construction industry) who changed its sourcing strategy, initiated the development of a supply network, and restructured part of its supply base. Theoretically, the article reviews both supply base and supply network management literature, highlights important issues related to both concepts, and discusses similarities and differences between them.

It is possible to discern between supply network initiatives of more permanent versus more temporary character. Supply network initiatives of a more permanent character comprise the establishment of, for example, organisational structures, functions, manuals and (explicit) routines aimed at continually supporting the maintenance of the supply network. Supply network initiatives of a more temporary character are organised as projects and aim to set in motion a process that may result in the creation of a supply network which develops over time without institutionalised network support structures. A single temporary supply network initiative is useful to consider in relation to the pre‐initiative stage, the ongoing initiative stage and the post‐initiative stage of the initiative. Furthermore, supply networks may be managed through an emergent series of temporary supply network initiatives aimed at supporting the supply network as it emerges over time in a changing context.

Managers may benefit from considering whether a supply network initiative is of a more permanent or a more temporary nature. If it is of a more temporary character, managers may consider analysing the initiative in its pre‐initiative, ongoing initiative, and post‐initiative stages in order to reflect on and learn from the initiative. Furthermore, if the initiative is temporary but form part of a planned or an emerging sequence of initiatives, managers may search for and consider earlier initiatives which may be viewed as “experiments” in a emerging trial‐and‐error learning process aimed at managing supply networks.

The article illustrates how a temporary supply network initiative can be used as a means to instigate reform of a supply base.