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Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds. Managerial workarounds have seldom been analysed. This paper does so by extending and modifying existing knowledge of the causes and character of clinical and IT workarounds, to produce a conceptualisation of the managerial workaround. It further develops and revises this conceptualisation by comparing the practical management, at both provider and purchaser levels, of hospital DRG payment systems in England, Germany and Italy.

We make a qualitative test of our initial assumptions about the antecedents, character and consequences of managerial workarounds by comparing them with a systematic comparison of case studies of the DRG hospital payment systems in England, Germany and Italy. The data collection through key informant interviews (N = 154), analysis of policy documents (N = 111) and an action learning set, began in 2010–12, with additional data collection from key informants and administrative documents continuing in 2018–19 to supplement and update our findings.

Managers in all three countries developed very similar workarounds to contain healthcare costs to payers. To weaken DRG incentives to increase hospital activity, managers agreed to lower DRG payments for episodes of care above an agreed case-load ‘ceiling' and reduced payments by less than the full DRG amounts when activity fell below an agreed ‘floor' volume.

Empirically this study is limited to three OECD health systems, but since our findings come from both Bismarckian (social-insurance) and Beveridge (tax-financed) systems, they are likely to be more widely applicable. In many countries, DRGs coexist with non-DRG or pre-DRG systems, so these findings may also reflect a specific, perhaps transient, stage in DRG-system development. Probably there are also other kinds of managerial workaround, yet to be researched. Doing so would doubtlessly refine and nuance the conceptualisation of the ‘managerial workaround’ still further.

In the case of DRGs, the managerial workarounds were instances of ‘constructive deviance' which enabled payers to reduce the adverse financial consequences, for them, arising from DRG incentives. The understanding of apparent failures or part-failures to transform a health system can be made more nuanced, balanced and diagnostic by using the concept of the ‘managerial workaround'.

Managerial workarounds also appear outside the health sector, so the present analysis of managerial workarounds may also have application to understanding attempts to transform such sectors as education, social care and environmental protection.

So far as we are aware, no other study presents and tests the concept of a ‘managerial workaround'. Pervasive, non-trivial managerial workarounds may be symptoms of mismatched policy objectives, or that existing health system structures cannot realise current policy objectives; but the workarounds themselves may also contain solutions to these problems.

Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England, it considers: how do the internal managerial regimes of differently owned healthcare providers differ, or not? In what respects did any such differences arise from differences in ownership or for other reasons?

An observational systematic qualitative comparison of differently owned providers was the strongest feasible research design. The authors systematically compared a maximum variety (by ownership) sample of community health services; out-of-hours primary care; and hospital planned orthopaedics and ophthalmology providers (n=12 cases). The framework of comparison was the ownership theory mentioned above.

The connection between ownership (on the one hand) and organisation structures and managerial regimes (on the other) differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations, the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways.

This study was empirically limited to just one sector in one country, although within that sector the case-study organisations were typical of their kinds. It focussed on formal structures, omitting to varying extents other technologies of power and the differences in care processes and patient experiences within differently owned organisations.

Type of ownership does appear, overall, to make a difference to at least some important aspects of an organisation’s governance structures and managerial regime. For the broader field of health organisational research, these findings highlight the importance of the owners’ agency in explaining organisational change. The findings also call into question the practice of copying managerial techniques (and “fads”) across the public–private boundary.

Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use power within them, and system-wide policy interventions, for instance to improve care coordination and for the correspondingly required foci of healthcare organisational research.

This paper aims to gain an understanding of the behaviour of iron ore when melted by a laser beam in a continuous manner. This fundamental knowledge is essential to further develop additive manufacturing routes such as production of low cost parts and in-situ reduction of the ore during processing.

Blown powder directed energy deposition was used as the processing method. The process was observed through high-speed imaging, and computed tomography was used to analyse the specimens.

The experimental trials give preliminary results showing potential for the processability of iron ore for additive manufacturing. A large and stable melt pool is formed in spite of the inhomogeneous material used. Single and multilayer tracks could be deposited. Although smooth and even on the surface, the single layer tracks displayed porosity. In case of multilayered tracks, delamination from the substrate material and deformation can be seen. High-speed videos of the process reveal various process phenomena such as melting of ore powder during feeding, cloud formation, melt pool size, melt flow and spatter formation.

Very little literature is available that studies the possible use of ore in additive manufacturing. Although the process studied here is not industrially useable as is, it is a step towards processing cheap unprocessed material with a laser beam.

The purpose of this paper is to develop Delphi methodology toward a holistic method for forecasting market change. Delphi methodology experienced its culmination in marketing research during the 1970s–1980s, but still has much to offer to both marketing scholars and practitioners in contexts where future market changes are associated with ambiguity and uncertainty.

This study revives the Delphi methodology by exemplifying how a recently developed framework on market change can be combined with the Delphi technique for data collection to support forecasting activities and research. The authors demonstrate the benefits of the improved methodology in an empirical study on the impact of the fifth generation of wireless communications technologies (5G) on the Finnish media market.

The developed methodological approach aids marketing scholars in categorizing and analyzing the data collected for capturing market change; and better guiding experts/respondents to provide holistic projections of future market change. The authors show that using a predefined theoretical framework in combination with the Delphi method for data collection and analysis is beneficial for studying future market change.

This paper develops Delphi methodology and contributes with a novel methodological approach to assessing market change.

The purpose of this study is to frame digital transformation (DT) within municipalities to improve the life cycles of urban infrastructure.

The study provides the results from a systematic review of the literature on concepts of DT and its implications for municipalities, barriers and challenges to DT, as well existing DT frameworks for municipalities and their built assets. This literature review leads to the development of a DT framework to help cities conduct a planned and federated DT beforehand. Then, workshops are conducted with two major Canadian municipalities.

The results of these studies point to the need for a dedicated DT framework for municipalities because of their particular context and their role and proximity to citizens. The theoretical framework develops 22 elements, which are divided among 6 categories. Through its application, the framework helps to identify and target the predominant issues hindering the DT of municipalities, specifically “legacy practices” and “data management.”

Limitations include limited experimental conditions and small sample size. Further work is needed to validate the framework. Other approaches are advocated to complement the data collection and analysis to generate more convincing results.

The theoretical framework was validated through two case studies on two large Canadian municipalities.

Municipalities maximize the value they provide to citizens and to be at the forefront of resilience and sustainability concerns. The use of technology, digital processes and initiatives helps cities to improve planning, optimize works and provide better services to citizens.

The framework is original in that it specifically aligns assets management with DT in a municipal context.

The purpose of this paper is to execute the efficiency analysis of the selected metaheuristic algorithms (MAs) based on the investigation of analytical functions and investigation optimization processes for permanent magnet motor.

A comparative performance analysis was conducted for selected MAs. Optimization calculations were performed for as follows: genetic algorithm (GA), particle swarm optimization algorithm (PSO), bat algorithm, cuckoo search algorithm (CS) and only best individual algorithm (OBI). All of the optimization algorithms were developed as computer scripts. Next, all optimization procedures were applied to search the optimal of the line-start permanent magnet synchronous by the use of the multi-objective objective function.

The research results show, that the best statistical efficiency (mean objective function and standard deviation [SD]) is obtained for PSO and CS algorithms. While the best results for several runs are obtained for PSO and GA. The type of the optimization algorithm should be selected taking into account the duration of the single optimization process. In the case of time-consuming processes, algorithms with low SD should be used.

The new proposed simple nondeterministic algorithm can be also applied for simple optimization calculations. On the basis of the presented simulation results, it is possible to determine the quality of the compared MAs.

Work-related violence is a major occupational safety and health (OSH) issue. According to the concept of violence prevention climate, managers play a pivotal role in preventing the risk of violence at work. However, research on this is scarce. The objective of this study was, therefore, to examine line managers' use of violence preventive practices in high-risk sectors.

The authors employed three different sources of data (semi-structured interviews and field notes from both leadership seminars and coaching sessions) that were collected in the context of an intervention study in Denmark aimed at improving violence prevention. The authors conducted a thematic analysis of violence prevention experiences among 16 line managers – eight from the prison and probation services and eight from psychiatric hospitals.

Using an existing prevention framework, the authors categorized the descriptions into three types of violence preventive practices used by the line managers across the two sectors: “preventing violence”, “managing episodes of violence” and “promoting the positive”. Especially the category “promoting the positive” is often neglected in the intervention literature.

The study identified new aspects of managers' violence preventive practices than those included in the violence prevention climate concept. Such knowledge may help organizations devise improved systems for violence prevention in high-risk sectors.