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While the need for leadership in health care is well recognised, there is still the need to better understand how leadership contributes to improving healthcare services. The body of knowledge concerning improvement has grown significantly in recent years, but evidence about links between leadership and health services improvement remains poor, especially within the UK National Health Service. It remains unclear how and why leadership is important to service improvement, and how leadership development can optimise service improvement.This paper describes a study commissioned by The Health Foundation, exploring the links between leadership behaviours reported by clinicians and managers in NHS organisations and their service improvement work. The study highlights leadership behaviours that appear to be positively associated with NHS improvement work. This paper provides insights into which aspects of leadership are used for different types of improvement work and considers lessons for leadership development.

The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four National Health Service (NHS) hospital Trusts in England. It seeks to examine this development in the context of current policy initiatives aimed at increasing the level of staff involvement in decision‐making, and the related literature.

A mixed‐methods approach incorporating document analysis, interviews, a survey and appreciative inquiry, informed by the principles of impact evaluation design, was used.

The main finding to emerge was that leadership was crucial if widespread staff engagement was to be achieved. Indeed, in some of the trusts the staff engagement programmes were seen as mechanisms for developing leadership capability. The programmes had greater impact when they were “championed” by the Chief Executive. Effective communication throughout the organisations was reported to be a prerequisite for staff engagement. Problems were identified at the level of middle management where the lack of confidence in engaging with staff was a barrier to implementation.

The nature of the particular organisational context is crucial to the success of efforts to increase levels of staff engagement. The measures that were found to work in the trusts would need to be adapted and applied to best meet the needs of other organisations.

Many health care organisations in England will need to harness the efforts of their workforce if they are to meet the significant challenges of dealing with financial restraint and increasing patient demand. This paper provides some insights on how this can be done.

The way change occurred at a strategic level and in four clinical services in three hospitals was examined. The purpose of this paper is to report how the hospitals designed and delivered change at organisational and clinical service level to improve services for patients, and the role of clinical leadership in this process.

A comparative case study involving semi-structured interviews was undertaken. These involved a range of senior managers in 2009 (n=77), 2011 (n=21) and 2012 (n=29). Interviews with staff involved directly in service delivery were also carried out in 2011 (n=92). The interviews were recorded digitally, transcribed verbatim, and analysed thematically using the Framework Method.

The value of, and approach taken to clinical leadership varied across the hospitals and over time. This was affected by the culture and priorities of the organisation. Some strategies for developing clinical leadership were developed, however they were limited. It was expected that capable clinical leaders would emerge, and be supported. Effective clinical leadership during organisational and service change required direct executive or managerial support and relied on clinical “champions”.

The paper demonstrates that despite the importance of clinical leadership being widely recognized in policy and research, there were no established programmes in place at the hospitals that were studied to support it. Rather there was a reliance on clinical staff coming forward to take on leadership roles as part of organizational efforts to bring about change.

A project was undertaken to determine the appropriateness of providing subject‐based courseware in an academic library's software center or microcomputer lab. The courseware was intended to provide remedial instructional support to re‐entry students in selected subjects. For this project, college algebra became the chosen subject because there appeared to be widespread local agreement that a number of adult students needed remedial instruction in college algebra. The question of the appropriateness of CAI in the library remains open. This service seems to be a viable one for academic libraries to offer. Success would be dependent on wide ranging cooperation involving the library, teaching faculty, computing staff, and instructional technologists.

Purpose – Emergency situations are known to have significant effects on public attitudes toward the police. However, little is known about these effects over prolonged periods of time, and how they vary across different types of attitudes. Moreover, it is unclear what the root causes of fluctuations in public sentiments of the police in emergency situations are. The present chapter reviews the findings of a research project designed to address these questions.

Methodology/Approach – A three-wave panel survey carried out in Israel in the first three peaks (and corresponding lockdowns) of the COVID-19 pandemic: April, September and December, 2020.

Findings – Following what appears to be a rise in support for the police at the first peak of the pandemic, the authors find a significant drop in numerous types of attitudes in the second peak. Between the second and the third peaks, broad evaluations of the police (not directly related to the pandemic) stabilized, while some pandemic-specific attitudes continued to deteriorate. The drop in diffused support for the police was associated with participants’ assessments of the government’s performance in handling the pandemic.

Originality/Value – Beyond shedding light on fluctuations in public attitudes toward the police over the course of the COVID-19 pandemic, these findings add to our more general understanding of what happens to the relationship between the police and the public in emergency situations.

The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and ideology of the FTC’s leaders, developments in the field of economics, and the tenor of the times. The over-riding current role is to provide well considered, unbiased economic advice regarding antitrust and consumer protection law enforcement cases to the legal staff and the Commission. The second role, which long ago was primary, is to provide reports on investigations of various industries to the public and public officials. This role was more recently called research or “policy R&D”. A third role is to advocate for competition and markets both domestically and internationally. As a practical matter, the provision of economic advice to the FTC and to the legal staff has required that the economists wear “two hats,” helping the legal staff investigate cases and provide evidence to support law enforcement cases while also providing advice to the legal bureaus and to the Commission on which cases to pursue (thus providing “a second set of eyes” to evaluate cases). There is sometimes a tension in those functions because building a case is not the same as evaluating a case. Economists and the Bureau of Economics have provided such services to the FTC for over 100 years proving that a sub-organization can survive while playing roles that sometimes conflict. Such a life is not, however, always easy or fun.

The Weapon Systems Acquisition Reform Act (WSARA) was enacted in 2009 to improve Department of Defense public procurement processes and limit cost overruns in major acquisition programs.

Seven years later, the authors investigate the effects of WSARA on cost overruns for major Air Force acquisition programs and then conduct an exploratory case study specifically targeting WSARA impacts on the Operations and Support phase of a program’s life cycle.

The authors find that while there are some positive impacts on cost overruns in limited areas, the majority of the models demonstrate either no statistically significant effect from WSARA or an increase in cost overruns post implementation.

These findings are consistent with much of the literature on the historical ineffectiveness of previous acquisition reforms to ameliorate cost overruns.

Many of the emerging and transition economies in Central and Eastern Europe (CEE) have been building their economies largely on the infrastructure inherited from Communist times. It is widely recognized that much of the infrastructure in both the private and public sectors must be replaced if those economies are to achieve acceptable rates of economic growth and participate successfully within the broader European Union (EU) economic zone (The Economist, 2003). Upgrading infrastructure includes the likely importation of technology and management expertise, as well as substantial financial commitments. In this regard, inward foreign direct investment (FDI) is a particularly important potential source of capital for the emerging and transition European economies (ETEEs). FDI usually entails the importation of financial and human capital by the host economy with measurable and positive spillover impacts on host countries’ productivity levels (Holland & Pain, 1998a). The ability of ETEEs to attract and benefit from inward FDI should therefore be seen as an important issue within the broader policy context of how these countries can improve and expand their capital infrastructure, given relatively undeveloped domestic capital markets and scarce human capital.

To develop a framework for systematically defining the relevant market for intermediate goods that incorporates downstream market conditions.

We combine the well-established “Hicks-Marshall” conditions of derived demand for inputs with “critical loss/critical elasticity of demand” to yield insights into the definition of antitrust markets for intermediate goods and the competitive effects from a merger.

We show that examining “Hicks-Marshall” conditions can provide a more rigorous framework for analyzing relevant markets for intermediate goods. We also show that solely examining demand substitution possibilities for direct customers of an input can lead to an incorrect market definition.

Our framework may be difficult to apply in circumstances when several different downstream products use the input being examined and each of those downstream products has a different elasticity of demand.

We illustrate how reasonable ranges for key parameters relating to the ability of firms to substitute to other inputs and to adjust to downstream market conditions will often be sufficient to define antitrust markets for intermediate goods in practice.

Previous antitrust analysis has not systematically analyzed the impact of downstream market conditions in assessing market definition for intermediate goods. The framework we develop will be useful to future researchers attempting to define relevant markets for intermediate goods and evaluating the competitive effects of a merger.