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The structure of public school systems does not foster or grow leadership. Instead, individuals are promoted through the system most frequently as a result of having held certain positions. Teachers become classroom personnel. Classroom personnel become administrators. Administrators become principals. These progressions from classroom to principal are infrequently accompanied by educational pathways or professional development that ensures that those entering into positions of leadership are actually prepared to lead. Instead, people ascend to positions of leadership after having obtained the “right” credentials or walked in the “right” shoes. The consequence of this practice has led to a significant number of people who hold leadership positions but are ill-equipped to lead. This chapter will address this situation by contemplating what can be done to (a) prevent people who should not be leaders from becoming leaders and (b) create a system that cultivates leaders who both hold leadership positions and are positioned to lead.

To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of international academic research and literature.

A search of the health sciences literature was conducted using PubMed and EMBASE. A total of 114 articles were identified for inclusion and thematically analyzed using a strategy content model for systems-level integration.

Six major, inter-related shifts in integration strategies were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. We propose that underlying many of these shifts is a growing recognition of the value of understanding health care delivery and integration as processes situated in Complex-Adaptive Systems (CAS).

This review builds a descriptive framework against which to assess, compare, and track integration strategies over time.

Traditional fire practices are explored so as to understand transformative relationships to Country and as an analogy for developments in Indigenous Health. Stories of fire encompass the resistance of Indigenous Australians to colonial dispossession. Stories of fire engage Indigenous communities with law and culture and from this with health. Transformative knowledges can be built upon re-kindling Indigenous land and law practices through fire practices. Building relationships with fire and burning practices corresponds with the developing sustainable health and cultural practices across Indigenous communities.

The Vocational Rehabilitation (VR) Service System was created in 1973 in the United States as a way to help people with disabilities access necessary supports and services to return to work and live independently. The program receives federal funds and operates in all 50 states and territories. The program is designed to allow consumers to develop a rehabilitation plan in collaboration with a VR counselor and receive necessary services and supports in order to meet their rehabilitation goals. Unfortunately, there are serious issues with access to services and rehabilitation success for minority individuals in the program, particularly African Americans. The chapter will first provide a brief overview of the Rehabilitation Act and its purpose, then we will introduce some of the research that has been conducted to evaluate the program over the years, with particular emphasis on the outcomes for African Americans, and then will focus on a series of studies that have been conducted by the authors in the state of Illinois. The chapter will conclude with some suggestions about ways in which the system could be improved and ways to empower African Americans in pursue of their rehabilitation and independent living goals, including peer-support and supported employment.

Purpose – The paper explains how internal reporting systems, as embedded practices informing organizational actions and “know-how”, contributed to the inertia in implementing a corporate form of governance in a transitional public organization in a developing country – Egypt.

Design/methodology/approach – The paper synthesizes an institutional theory framework in order to capture the case study mixed results. Drawing on DiMaggio and Powell's (1983) notions of isomorphic mechanisms, Ocasio (1999) and Burns and Scapens’ (2000) notions of organizations’ memory, history, cumulative actions and routines, Brunsson's (1994) notion of organizational institutional confusion as well as Carruthers's (1995) notion of “symbolic window-dressing” adoption of new practices, the paper explores the dynamic of a public hospital corporatization processes. Data collection methods include semi-structured interviews, documentary evidence and direct observation.

Findings – The case study evidence shows that the interplay between the new form of “corporate” governance and the intra-organizational power, routines and “know-how” created internal organizational confusion and changed organizational members’ narrative of risk and uncertainties.

Research limitations/implications – The paper does not reveal the role of reformers involved in the public sector “governance” reform in developing countries. Exploring such a role goes beyond the scope of this paper and represents an area of future research.

Originality/value – The paper provides a comprehensive account of public sector “governance” reform in a developing nation, while exploring the role of management accounting and costing systems in facilitating or otherwise that reform processes.