Partnership working across health and social care is considered key to manage rising service demand whilst ensuring flexible and high-quality services. Evidence suggests…
Partnership working across health and social care is considered key to manage rising service demand whilst ensuring flexible and high-quality services. Evidence suggests that partnership working is a local concern and that wider structural context is important to sustain and direct local collaboration. “Top down” needs to create space for “bottom up” management of local contingency. Scotland and Norway have recently introduced “top down” structural reforms for mandatory partnerships. The purpose of this paper is to describe and compare these policies to consider the extent to which top-down approaches can facilitate effective partnerships that deliver on key goals.
The authors compare Scottish (2015) and Norwegian (2012) reforms against the evidence of partnership working. The authors foreground the extent to which organisation, finance and performance management create room for partnerships to work collaboratively and in new ways.
The two reforms are held in place by different health and social care organisation and governance arrangements. Room for manoeuvre at local levels has been jeopardised in both countries, but in different ways, mirroring existing structural challenges to partnership working. Known impact of the reforms hitherto suggests that the potential of partnerships to facilitate user-centred care may be compromised by an agenda of reducing pressure on hospital resources.
Large-scale reforms risk losing sight of user outcomes. Making room for collaboration between user and services in delivering desired outcomes at individual and local levels is an incremental way to join bottom up to top down in partnership policy, retaining the necessary flexibility and involving key constituencies along the way.
The purpose of this paper is to give a comprehensive and updated analysis of the available academic literature (2000–2016) on management and reforms in the Nordic hospital landscape.
A systematic literature review was conducted by searching articles in Scopus database, as well as applicable journals.
The vast majority of the Nordic articles are relatively coherent on the following: first, the reforms have created a change in the manager role or rather there are new expectations about the content of the manager role. Second, the reforms entail tension between profession and administration. Doctors who are managers identify themselves primarily as doctors, implicating that the medical logic has not competed out by an administrative logic. Third, the reforms have brought new opportunities for nurses. Still, nurse managers perceive tension between the profession and administration. Fourth, new public management (NPM) is often the framework or background for understanding change in hospitals or manager roles in the articles. Fifth, the majority of the articles are focusing on management as a general key concept.
The search was limited to the period 2000–2016 and have only included articles published in English. There are several limitations around these choices: first, research published in a language other than English (i.e. Norwegian, Swedish, Finnish or Danish) are excluded. Second, it may take years before consequences of hospital reforms have impact on management and manager roles. Some of the articles are published relatively shortly after the implementation of the reform. Third, many factors in a reform have impact on management or manager roles, thus it is challenging to give simple explanations.
The authors would welcome a more pluralistic approach, and contributions that are not quite so busy describing and criticizing the NPMization of hospitals and management. In particular, the authors look forward to more research on how other reform trends, such as NPG, affect management in hospitals.
This review summarizes the literature on how academic literature (2000–2016) – in a Nordic reform context – has dealt with management in hospitals. The study reflects upon the academic literature per se. There are tendencies to explore reforms and management with some conceptual equivalence.
As known from nearly incompressible elasticity, selective reduced integration (SRI) is a simple and effective method of overcoming the volumetric locking problem in 2D and…
As known from nearly incompressible elasticity, selective reduced integration (SRI) is a simple and effective method of overcoming the volumetric locking problem in 2D and 3D solid elements. This method of finite elastoviscoplasticity is discussed as are its well‐known limitations. In this context, an isochoric‐volumetric decoupled material behavior is assumed and thus the additive deviatoric‐volumetric decoupling of the consistent algorithmic moduli tensor is essential. By means of several numerical examples, the performance of elements using selective reduced integration is demonstrated and compared to the performance of other elements such as the enhanced assumed strain elements. It is shown that a minor modification, with little numerical effort, leads to rather robust element behaviour. The application of this process to so‐called solid‐shell elements for thin‐walled structures is also discussed.