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New Public Management-informed pay-for-performance policies are common in public sectors internationally but can be controversial with delivery agents. More attention is needed on contingent forms of bottom-up implementation of challenging policies, in emerging market economies, for professionals who face tensions between policies and their codes of practice. Street-level bureaucrats (SLBs) mediate policy implementation through discretionary practices; health professionals have enhanced space for discretion based on autonomy derived from professional status. The authors explore policy implementation, adaptation and resistance by physicians, focusing on payments for health workers in Turkey.

The researchers conducted semi-structured qualitative interviews with 12 physicians in Turkish hospitals and thematic analysis of interview transcripts, using a blended (deductive and inductive) approach.

The policy fostered discretionary behaviours such as cherry-picking (high volume, low risk procedures) and pro-social rule-breaking (e.g. “upcoding”), highlighting clinical autonomy to navigate within policy restrictions. Respondents described damage to relationships with patients and colleagues, and dissonance between professional practice and perverse policy incentives, sometimes leading to disengagement from clinical work. Policymakers were perceived to be detached from the realities experienced by SLBs. Tensions between the policy and professional values risked alienating physicians.

This study utilises participant self-reported perceptions of discretionary behaviours. Further work may adopt alternative methods to explore the relationship between self-reporting and observed practice.

The authors contribute to research on differentiated, contingent roles of groups with high scope for discretion in bottom-up implementation, pointing to the potential for policy-professional role conflicts between top-down P4P policies, and the values and codes of practice of professional SLBs.

Māori (Indigenous New Zealanders) and Pacific students tend not to attain the same levels of educational success as New Zealanders of European descent. Addressing this problem is a particular challenge at tertiary level in science, engineering, and architecture and design (SEAD). Te Rōpū Āwhina (Āwhina), an initiative at Victoria University of Wellington (VUW), aims to produce Māori and Pacific professionals who contribute to Māori and Pacific development and leadership. The objective of this analysis was to summarise quantitative results from the first 11 years of Āwhina and to show they are consistent with an Āwhina ‘effect’; that is, a positive influence on (combined) Māori and Pacific success in the SEAD disciplines. Individual-level records held in the VUW student database were used to generate smoothed trends in SEAD and non-SEAD graduate and postgraduate degree completions since 1991. Substantial improvements in SEAD Māori and Pacific completions occurred between 1999 and 2010, including a 50%- increase in Māori and Pacific postgraduate completions relative to all SEAD postgraduate completions. In the same period, non-SEAD Māori and Pacific postgraduate completions increased at a similar rate to all non-SEAD postgraduate completions. Results were consistent with a strong Āwhina effect, which has important implications for the nature of tertiary institutions, their cultural and social disconnection with Indigenous and minority students, and their social obligations and responsiveness. This analysis did not account for students who did not complete a qualification or include key confounders such as entry qualifications and gender. Definitive confirmation of an Āwhina effect is the subject of ongoing research.

Involving communities, citizens and service users in the design and delivery of public services has long been a key aim of government policy and arguably has it never been more important than within times of austerity. Yet, whilst acknowledging the importance of engagement, many health and social care organisations struggle with this in practice. This paper sets out some guiding principles for engagement.

This paper draws on conversations at a series of events in 2013 which brought together researchers, those charged with delivering on government policy at the local level and active citizens, to debate and explore evidence and practice on how to involve and mobilise citizens in local decision making in a time of austerity. Learning is distilled from these events to provide a useful guide for working effectively with communities.

As with any issue as complex as this, there is no magic bullet, quick fix, simple check-list or solve-all tool. Like doing anything worthwhile, working with communities is difficult, takes time and is at its core about building relationships. However, this does not mean that every attempt to design involvement processes needs to start entirely from scratch. There is a wealth and diversity of experience in designing and developing involvement mechanisms to draw upon.

This paper will provide a helpful guide to those who are about to embark on a programme of engagement or who are presently involved in engagement activities with communities, citizens and service users.

The purpose of this paper is to explore their experiences as singers in a community choir called Arrkula (a Yanyuwa word meaning “one voice”) based in the School of Education at the University of Queensland as performance of song, self, social justice and seeing beyond boundaries. Performing at “gigs” inside and outside the university, Arrkula has been singing together since 2011, and despite an environment replete with neo-liberal ideals of individualism, competitiveness and capitalist driven research agendas, at the centre of their song remains a yearning for social connection, equality and renewed consciousness.

The authors take an autoethnographic creative approach and bring performance of song together with their stories and interviews with choir members to link the “secret space” of the rehearsal with the “public space” of staged performances.

The authors’ aim is to think and perform the potential the voice and voices of Arrkula hold in terms of heightening senses of agency, provoking and empowering a pursuit of freedom and transforming lived worlds through song.

The value of this paper is the authors’ take up of Maxine Greene’s (2005, p. 38) question, “if we can link imagination to our sense of possibility and our ability to respond to other human beings, can we link it to the making of community as well?” to consider what singing for democracy and difference might mean individually and collectively in the current climate of higher education.

The purpose of this paper is to provide an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the strategic level followed by a section on operational or micro-commissioning. The rest of the paper focusses on the emergence of ideas about outcomes-based commissioning (OBC) in the field of adult social care and ends with critical consideration of the effectiveness of OBC in adult social care as applied to support and care provided in extra care housing.

The review of strategic and operational commissioning in adult social care in England (and Scotland in brief) is based on both policy documents and a review of the literature, as are the sources addressing OBC in adult social care particularly in extra care housing settings.

The core of this paper focusses on the challenges to the implementation of OBC in adult social care in the context of provision for residents in extra care housing. Of central importance are the impact of the squeeze on funding, increasing costs as a result of demographic change and the introduction of a national living wage plus the focus on the needs of service users through the idea of person-centred care and resistance to change on the part of adult social care staff and workers in other relevant settings.

Addressing the implementation of OBC in adult social care in England in the context of extra care housing.

This analysis of the literature examines the implications of the changes in the National Health Service workforce and the ramifications for multi‐professional working practices, patient care and delivery of health services. Changes in medical working practices and education, together with the increasing numbers of doctors, have resulted in proposals for nurses to extend their role and the removal of professional restrictions. Whilst the numbers of nurses in the workforce have marginally increased, the qualified nurse ratio has declined, as has the balance between medical and registered nurses. Few attempts have been made to evaluate these changes in relation to the quality of service and patient outcomes. The changing roles of nurses and their value need to be quantified. Demographic trends, together with international shortages and the lack of educational capacity have also been understated. Adequate and accurate workforce information should be regularly collated and analysed.

This paper aims to explore the cultivation of a learning culture in the US Navy (USN). The intent of preparing and sharing this research is to reveal the particular challenges of developing learning organization capability in national security organizations. This paper believes this effort will contribute to the evolution and establishment of learning organization models that are replicable across and adaptable to distinct industrial settings.

Several efforts were explored and assessed by applying relevant research in the learning organization literature to trends in current organizational practice within the USN.

Recent USN learning culture efforts align with the broader, multi-sector, global trend toward building learning organizations to develop people as a source of competitive advantage. This research reveals the trials of enabling learning organizations across large, hierarchical bureaucracies with substantial structural and cultural barriers. The myriad obstacles currently being addressed by the USN, both at an institutional level and at smaller organization and unit levels, can inform the development of learning cultures. In particular, this research highlights the need to align specific efforts to the appropriate level of the organization.

This paper contributes to the learning organization conversation by examining the associated challenges through a multi-level framework – top, middle and bottom.

Tackling social exclusion, which can lead to social isolation and loneliness, is an important current issue. People with a learning disability have a right to be full members of their communities, yet often experience social exclusion. Community connections play a key role in people developing reciprocal relationships. It is therefore important to know the barriers to full inclusion. The paper aims to discuss this issue.

This paper builds on an inclusive research project exploring these issues (Mooney et al., 2019) and aims to place that study’s main findings in a broader academic, policy and practice context.

Whilst there is a wide range of literature about social exclusion, lack of friendships and loneliness experienced by people with a learning disability, there is a gap in knowledge regarding some of the specific social barriers that prevent wider social inclusion, and therefore opportunities to make and keep friends.

This paper relates the findings of an inclusive research project to the current literature. It identifies the social barriers that limit community involvement and draws on the experience of people with a learning disability to find possible ways forward.