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The authors explore the under-researched area of post-decision evaluation in PPPs (public–private partnerships), focusing upon how and whether Post-decision Project Evaluation (PdPE) is considered and provided for in United Kingdom (UK) public infrastructure projects.

The authors’ research design sought insights from overviewing UK PPP planning and more focused exploration of PPP operational practice. The authors combine the extensive analysis of planning documents for operational UK PPP projects with interviews of different stakeholders in PPP projects in one city. Mobilising an open critical perspective, documents were analysed using ethnographic content analysis (ECA) and interviews were analysed using thematic analysis consistent therewith. The authors theorise the absence and ambiguities of PdPE drawing on the sociology of ignorance.

The authors find a long-standing absence and lack of PdPE in PPP projects throughout planning and operational practice, reflecting a dynamic, multi-faceted ignorance. Concerning planning practice, the authors’ documentary analysis evidences a trend in PdPE from its absence in the early years (which may indicate some natural or genuine ignorance) to different levels or forms of weak inclusion later. Regarding this inclusion, the authors find strategic ignorance played a substantive role, involving “deliberate engineering” by both public sector and private partners. Interview findings indicate lack of clarity over PdPE and its under-development in PPP practice, deficiencies again suggestive of natural and strategic ignorance.

The authors draw from the sociology of ignorance vis-à-vis accounting's absence and ambiguity in the context of PPP, contributing to an under-researched area.

Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.

This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.

The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.

This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.

Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

This chapter contributes to the Public Value (PV) literature in relation to accounting by providing evidence on its content's operationalization through performance measurement. In particular, it establishes the link with Sustainable Development Goals (SDGs), which may work as guiding principles of a public organization’s action. Accordingly, organizations embedding SDGs include them in their strategic decisions and disclose them through performance measurement and narratives.

The SDGs' presence is explored in the PV of a sample of Italian health institutes through documentary analysis of their performance plans. The aim is to verify if and how SDGs are pursued and whether the COVID-19 pandemic has affected PV content.

Besides Goal No. 3 (Health), the PV content of the investigated institutes contains various SDGs. Before the pandemic, their PV was aligned with SDGs mainly related to prosperity, economic growth and social inclusion. In the following period, the number of SDGs increased, introducing planet and environmental protection dimensions. No one explicitly mentions pursuing SDGs, revealing a non-institutionalized sensitivity of managers towards SDGs. The analysis distinguishes between ‘core’ SDGs, revealed mostly by traditional performance measures disclosing the achievement of institutes' mission, and ‘complementary’ SDGs, expressed mostly through narratives. This can derive from performance measurement, which employs the language of performativity, while the contribution to society is relegated in the narratives, making them less incisive.

In a competitive environment, eHealth small and medium-sized enterprises’ (SMEs’) barriers to survival differ from those of large enterprises. Empirical research on barriers to eHealth SMEs in less prosperous areas has been largely neglected. This study fills this gap by employing an integrated approach to analyze barriers to the development of eHealth SMEs. The purpose of this paper is to address this issue.

The authors collected data through semi-structured interviews and conducted thematic analysis to identify 16 barriers, which were used as inputs into total interpretive structural modeling (TISM) to build interrelationships among them and identify key barriers. Cross-impact matrix multiplication applied to classification (MICMAC) was then applied validate the TISM model and classify the 16 barriers into four categories.

This study makes significant contributions to theory by identifying new barriers and their interrelationships, distinguishing key barriers and classifying the barriers into four categories. The authors identify that transcultural problems are the key barrier and deserve particular attention. eHealth SMEs originating from regions with cultural value orientations, such as hierarchy and embeddedness, that differ from the UK’s affective autonomy orientation should strengthen their transcultural awareness when seeking to expand into UK markets.

By employing an integrated approach to analyze barriers that impede the development of eHealth SMEs in a less prosperous area of the UK, this study raises entrepreneurs’ awareness of running businesses in places with different cultural value orientations.

The purpose of this study is to define and investigate the governance requirements of supply chain finance (SCF).

A qualitative analysis of 849 news articles published in UK newspapers (2000–2022) using the Gioia method.

SCF governance relies on developing capacities for reflexive scrutiny at two stages: (1) prior to entering into an SCF relationship and (2) during its operation. Based on the notion of SCF as a complex adaptive system, we theorise SCF governance requirements as a dual-layered semipermeable boundary. The semipermeability of the two layers allows for a dynamic exchange between the SCF system and its environment. The first layer is the capacity to selectively enable or control the entry and access of certain actors and practices into the SCF system. The second layer is a capacity for ongoing scrutiny of the SCF operation and its development. Further, we identify five aspects of governance to be enabled, i.e. enhancing adaptability, building confidence, improving efficiency, advancing technology and promoting transparency; and four aspects to be controlled, i.e. preventing abuse of power, curbing fraud risk, constraining operational risk and restricting risky extensions to SCF practices.

Our dynamic framework can guide supply chain (SC) members in making decisions about whether to participate, or continue to operate, in an SCF relationship. Moreover, the findings have implications for policymakers and authorities who oversee entry/access and the involvement of SCF providers, particularly, fintech firms.

The study contributes to both the SC and governance literature by providing a systematic analysis of what SCF governance has to accomplish. Our novel contribution lies in its analysis of SCF governance based on a complex adaptive system approach, which expands the existing literature where SCF is described in rather static terms. More specifically, it suggests a need for a dynamic duality of SCF governance through the semipermeable boundary that selectively enables and controls certain SCF actors and practices.

To demonstrate transparency and accountability, the three boards in this study are required to meet in public in front of an audience, although the boards reserve confidential issues for discussion in private sessions. This study examines boardroom public accountability, contrasting it with accountability in board meetings held in private. The study adopts Erving Goffman's impression management theory to interpret divergences between boardroom behaviour in public and private, or “frontstage” and “backstage” in Goffman's terminology.

The research observes and video-records three board meetings for each of the three boards (nine board meetings), in public and private. The research operationalises accountability in terms of director-manager question-and-answer interactions.

In the presence of an audience of local stakeholders, the boards employ impression management techniques to demonstrate accountability, by creating the impression that non-executive directors are performing challenge and managers are providing satisfactory answers. Thus, they “save the show” in Goffman terms. These techniques enable board members and managers to navigate the interface between demonstrating the required good governance and the competence of the organisations and their managers, while not revealing issues that could tarnish their image and concern the stakeholders. The boards need to demonstrate to the audience that “matters are what they appear to be”, even if they are not. The research identifies behaviour consistent with impression management to manage this complexity. The authors conclude that regulatory objectives have not met their transparency aspirations.

For the first time, the research studies the effect of transparency regulations (“sunshine” laws) on the behaviour of boards of directors meeting in public. The study contributes to the embryonic literature based on video-taped board meetings to access the “black box” of the boardroom, which permits a study of impression management at board meetings not previously possible. This study extends prior impression management theory by identifying eleven impression management techniques that non-executive directors and managers use and which are unique to a boardroom context.

A sense of collective free-thinking with tangible goals makes co-creation an enlightening experience. Yet despite the freedom and organic flow of the methodology, there remain barriers to deploying co-creation in the real-world context. The aim was to understand the barriers and solutions to co-creation, reflect on applying co-creation in practice and co-create an applicable framework for co-creation.

These reflections and conceptual developments were completed using a Participatory Action Research Approach through the co-creation of the Erasmus+ funded Co-creating Welfare course.

Results presented are centric to the experiences in the United Kingdom but led to application at an international level. Problem formulation led to solutions devised about who should co-create, what co-creation aims to achieve, how to receive management buy-in, co-creating beyond the local face to face context and evaluation.

The Three Co’s Framework is proposed using the outline of: Co-Define, Co-Design and Co-Refine. Those who take part in co-creation processes are recommended to be called co-creators, with less focus on “empowerment” and more about facilitating people to harness the power they already have. Utilising online and hybrid delivery methods can be more inclusive, especially in response to the COVID-19 pandemic. The use of co-creation needs to be evaluated more moving forwards, as well as the output co-created.

The paper traces the development of employee ownership in the UK since the 1980s. It proposes that employee ownership is a function of macro-level contexts and micro-level decisions, with the latter framed and guided by the former. The macro context comprises the regulatory framework and the provision of incentives to adopt employee ownership. The paper shows how the evolution of these has led to a steep increase in employee ownership in the last eight years.

The paper draws on several sources of empirical data to chart the development of employee ownership in the UK since the 1980s and to identify the current features of employee ownership. Two firm-level surveys conducted in 2015 and 2020/21 are supplemented by qualitative case study data collected in the early 1990s. An annual census of all employee-owned firms facilitates a comprehensive overview of the current state of UK employee ownership.

It is found that there has been a steep increase in the number of UK employee-owned firms since 2014 after several decades of uneven growth. This is attributed to the introduction of new incentives and to refinements of the regulatory framework. Over the period, there has been a shift from hybrid employee ownership, combining direct and indirect forms, to indirect ownership associated with the employee ownership trust model.

The paper provides an original history of employee ownership in the UK using rich and unique data, along with the most comprehensive picture of current employee ownership to date.