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Purpose – The chapter aims to understand what kind of policy approach has been more successful in facilitating the involvement of patients and the public in the design and provision of health-care services at the local level and the explanatory factors justifying the implementation outcome.Methodology – By applying Richard Matland's ambiguity/conflict policy implementation model, the chapter analyses the impact of a number of policies introduced after 1997 in the English National Health Service that targeted final users and the local population in decision-making processes.Findings – The evidence shows that policies emphasising the importance of context-specific contingencies can be more effectively implemented when room for interpretation and discretion in selecting the appropriate means for involvement is given. In this way, the overall aims/purposes of health policies can be locally reshaped by allowing the adoption of flexible strategies within the implementation process.Practical implications – A strong leadership at the top of public sector organisations and, in particular, from the board of directors is needed to steer and facilitate a consensus oriented outcome in organisational decision-making processes that aim to incorporate the views and opinions of patients and the public.Social implications – Local initiatives in increasing participation, for specific purposes, are bound to be more successful than a general initiative, expecting comparatively uniform implementation.

The long-term plan for the National Health Service (NHS, 2019) identifies a blueprint to make the NHS fit for the future with a greater focus on prevention, improving services for patients and the importance of integrating services to make them more effective and efficient. The challenge is in the delivery and who is responsible to implement changes. The key is to enable staff at local levels to have responsibility for ensuring that the health and social needs of their local population are met.

Established to oversee the implementation is the NHS Assembly with 50 individuals from across the health and care sector to advise NHS England and NHS Improvement on the implementation. This requires shared commitment and motivation to change; ensuring patient centred care is at the forefront of any changes to delivering care. At regional level, Sustainability and Transformation Partnerships and Integrated Care Systems are groups of local NHS organisations, local councils and other partners, who are working together in the region to develop and implement the NHS plan. There are many challenges ahead to ensure the plan delivers better regional health and social care, including the impending UK’s decision to leave the European Union. Brexit may present some opportunities but if freedom of movement and membership of the single market and customs union end as planned, NHS and social care face several significant threats in the region.

Performance management (PM) has been developed to a central part of health care reforms. However, ideas of performance are traditionally contested in the health care sector and split up between a professional and a bureaucratic understanding of effective service delivery. With the rise of New Public Management, an additional layer of PM instruments has been put on the already existing structures. As a result, different PM regimes can be distinguished, which vary in the way they define performance, blame underperformance and design accountability instruments to ensure appropriate behaviour. The paper investigates the institutional design of PM schemes of three different cases – Denmark, Germany and England – which are representative for different PM regimes.

The need for independent audit goes back to the agency theory, the theory of delegation of power and the issue of trust. Stakeholders delegate power to management to manage the business on their behalf, yet they face the risk of information asymmetry and management motivations to commit fraud. The main aim of having an independent auditor was therefore to reduce the risk of information asymmetry and fraudulent behaviour by management. Auditors are required by the International Auditing Standards to detect material fraud and error, and they are expected to have a duty of care for stakeholders. However, recently independent auditors, whether conducting private or public audit, have been scrutinised for failing to detect material fraud. There have been a lot of discussions in the literature about the role of private auditors in detecting fraud, but very little discussions about the role of public auditors in detecting fraud. This chapter will outline the difference between private audit and public audit; explain the legal liability of public auditors in relation to fraud detection; the role of public auditors in detecting fraud; and will critically review the root causes for auditors’ failure to detect fraud.

While there is established research that explores individual innovations across countries or developments in a specific health area, there is less work that attempts to match national innovations to specific systems of health governance to uncover themes across nations.

We used a cross-comparison design that employed content analysis of health governance models and innovation patterns in eight OECD nations (Australia, Britain, Canada, France, Germany, the Netherlands, Switzerland, and the United States).

Country-level model of health governance may impact the focus of health innovation within the eight jurisdictions studied. Innovation across all governance models has targeted consumer engagement in health systems, the integration of health services across the continuum of care, access to care in the community, and financial models that drive competition.

Improving our understanding of the linkage between health governance and innovation in health systems may heighten awareness of potential enablers and barriers to innovation success.

This paper focuses on the strategic role of elites in managing institutional and organizational change within English public services, framed by the wider ideological and political context of neo-liberalism and its pervasive impact on the social and economic order over recent decades. It also highlights the unintended consequences of this elite-driven programme of institutional reform as realized in the emergence of hybridized regimes of ‘polyarchic governance’ and the innovative discursive and organizational technologies on which they depend. Within the latter, ‘leaderism’ is identified as a hegemonic ‘discursive imaginary’ that has the potential to connect selected marketization and market control elements of new public management (NPM), network governance, and visionary and shared leadership practices that ‘make the hybrid happen’ in public services reform.

This chapter proposes a global agenda to eliminate racism in nursing by targeting reform at nursing education administration internationally. First, the history of racism in nursing is reviewed, along with two models – the diversity model and the cultural competence model – that were applied unsuccessfully to counteract racism in nursing. Second, a description of how racism is entrenched in nursing leadership globally is presented. Third, the recalcitrant structures that serve to maintain institutionalized racism (IR) in the international nursing education system are carefully examined. Specifically, the components and constructs involved in IR in nursing education are delineated, and the way in which these negatively impact both ethnic minority (EM) students and faculty are explained. Based on this, a global agenda to eliminate racism in nursing education internationally is proposed. Eliminating racism in higher education in nursing is a mandatory social responsibility if global healthcare is ever to be equitable. Five actionable recommendations are made to eliminate racism in higher education are summarized as follows: (1) components of nursing programs which are designed to eliminate racism in nursing education should be governed at the country level, (2) to design and implement a system of surveillance of the global nursing community to enable standardized measurement to ensure nursing education programs in all countries are meeting anti-racism benchmark targets, (3) nursing education programs should be established worldwide to provide individual pipeline and mentorship programs to ensure the career success of EM nursing students and faculty, (4) nursing education programs should be conducted to reduce barriers to EM participation in these individual support programs, and (5) nursing education programs are required to teach their nursing faculty skills in developing anti-racist curricula that seeks to eliminate implicit bias.