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This article provides an overview and analysis of care as a concept and object of policy makers' attention in Europe, mindful especially of the lessons that can be drawn from the European experience. The aim of this paper is to set out a framework to understand care and also to offer an account of the way that different European countries have provided for care (of children and older people) and how existing policies are being reformed and rethought.

The article underlines the complexity of care as a concept and domain of policy and suggests the need for a broad‐ranging approach to its analysis.

It shows that the policy configuration has to be thought of as being embedded in and in many ways a function of the primary location and forms of care, the values and culture surrounding care and the arrangements around the mix of providers and modes of governance. While there are many positive lessons from the extent to which European states have become involved in making provision for care – offering financial and other forms of support to families and those needing care and enabling women to pursue a life not completely defined by their care‐related obligations – there are also negative ones such as the outstanding need to connect up policies for care across the life spectrum (in the term used in this article: a care configuration) and to view care in a global way.

This article takes an overview of recent developments in Europe and draws out the implications of developments in Asia.

Prolonged life expectancy coupled with the retirement of the “post war baby boomers” has resulted in an exponential rise in the 50+ population, peaking in the UK in 2035. Recognising that longevity is often not accompanied by health, mobility or quality of life, the “shifting the balance of care” agenda promotes an integrated care model based around the resident’s home. This study aims to explore the adaptability of the existing social housing stock and how it relates to the requirements and preferences of the ageing population.

This research focuses at the local authority level, with the lead author embedded within North Ayrshire Council to establish the evidence base for their housing strategy for older people. Following a constructivist grounded theory approach, key themes emerge through consultation with a working group, wider stakeholder groups and an iterative review of policy and literature. These themes were explored through an evidence base of available health and housing datasets, and a questionnaire survey of 1,500+ people aged 50+ exploring housing preferences and needs for older people; six focus groups split between residents and social housing providers and stakeholder interviews.

The scale and acute nature of the problem facing social housing providers is highlighted and reveals an alarming information gap within housing data sets, exposing an in-balance between the supply and demand and realising the cost implications for adapting the housing stock.

It is important to resolve this information gap to develop the social housing stock to respond to preferences and establish solutions appropriate for its residents.

This work strengthens calls for a cohesive and integrated housing, health and social care system and exposes the challenge of delivering this at a local authority level.

A critical commentary on policy and practice over time in English health and social care. The paper aims to discuss these issues.

Personal reflections based on prior experience as a senior leader in the English health and care system, combined with insights and relevant evidence from other senior leaders and health and care “think-tanks”.

Shifting the balance of care from a hospital to a community setting can potentially be cost-effective as well as improving quality for service users. However, it will require a change in the approach to planning and implementation, by focussing on service users and communities, rather than on statutory organisations. It will also require a greater level of integration between primary care, community health services, social care and the voluntary sector, and greater levels of “co-production” with service users and the public.

Front-line health and care leaders are generally unaware of the evidence base in this field. Emergent findings in this field need to be rapidly evaluated and then communicated to front-line leaders and practitioners.

Incorporates direct experience of senior leaders in the field together with the existing and emerging evidence base.

In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for physicians while practicing patient-centered medicine and controlling health-care costs. This paper aims to examine the effect of task shifting to nurses and discuss its usefulness from the perspective of health-care value co-creation.

This paper analyzes task shifting to nurses in acute care hospitals in Japan as a solution for the shortage of anesthesiologists. The authors discuss how the value was created from the perspective of the health-care ecosystem, with conceptual consideration of the value co-creation mechanism through patient-centered practices.

The study showed that task shifting initiatives in Japan can improve the motivation of nurses through human resource development while maintaining high quality. The study also suggested that task shifting from physicians to nurses may contribute to improving net income and maintaining the health-care system.

The findings are highly reproducible and can be immediately applied to initiatives at other medical institutions in Japan. Furthermore, it is suggested that these findings might provide some perspective on the realignment of fragmented healthcare in the USA.

It was confirmed in practical terms that micro-level initiatives have an impact on the macro level as well. In addition, the academic presentation of the concept has contributed to the deepening of value research.

Healthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions taken by clinicians, patients and organizations fail to achieve that aim. This paper aims to take a paradox-based perspective to explore five specific tensions that emerge from this shift and provides implications for patient experience research and practice.

This paper uses a conceptual approach that synthesizes literature in health services and administration, organizational behavior, services marketing and management and service operations to illuminate five patient experience tensions and explore mitigation strategies.

The paper makes three key contributions. First, it identifies five tensions that result from the shift to more patient-centered care: patient focus vs employee focus, provider incentives vs provider motivations, care customization vs standardization, patient workload vs organizational workload and service recovery vs organizational risk. Second, it highlights multiple theories that provide insight into the existence of the tensions and how they may be navigated. Third, specific organizational practices that engage the tensions and associated examples of leading organizations are identified. Relevant measures for research and practice are also suggested.

The authors develop a novel analysis of five persistent tensions facing healthcare organizations as a result of a shift to a more consumer-driven, patient-centered approach to care. The authors detail each tension, discuss an existing theory from organizational behavior or services marketing that helps make sense of the tension, suggest potential solutions for managing or resolving the tension and provide representative case illustrations and useful measures.

This paper reports on a comparative qualitative study across four European countries which explored the formation of work identity amongst nurses and other professionals in the field of health care. Within this sector, it identifies trends towards a more flexible, more highly skilled and more mobile workforce. Conversely, however, it is becoming difficult to recruit and retain staff due to increasing workload, decreasing job satisfaction and comparatively low pay. Occupational identity is theorised as a multi‐dimensional phenomenon, with structural, social and individual‐psychological components. A number of emerging common themes across the three dimensions and across the four national settings include structural conflicts between cost efficiency and quality of care, and individual conflicts between the core activity of caring for patients and the increasing demands of administration and other peripheral work. The study identifies a number of strategies used by nurses to balance these conflicting demands. Overall, the professional identity of nurses remains strong, but it is important for policy makers to be aware of the potential negative effects, in terms of staff turnover, mobility and job (dis)satisfaction, of the current state of the health care sector.

Health care organizations are increasingly demanded to balance the institutional logic of “medical professionalism” and “business-like health care,” that is, to both recognize physicians’ professional expertise while locating it in a wider social, economic, and political organizational setting. The purpose of this paper is to examine the implications from this shift in terms of leadership work in health care organizations.

Case study methodology including interviews with 15 residents in Swedish health care organizations.

A study of the willingness of residents to take on leadership positions show that leadership roles are treated as what is potentially hindering the acquisition of the know-how, skills, and expertise demanded to excel in the clinical work. Consequently, taking on leadership positions in the future was relatively unattractive for the residents. In order to overcome such perceived conflict between professional skill development and leadership roles, top management of health care organizations must help residents overcome such beliefs, or other professional groups may increasingly populate leadership positions, a scenario not fully endorsed by the community of physicians.

The paper demonstrates how complementary or completing institutional logics are influencing debates and identities on the “shop floors” of organizations.

The purpose of this paper is to investigate how the complexity of the network governance setting affects accountability practices. The authors pay particular attention to the organizational characteristics that may enable a common understanding of multiple accountability relationships, or lead to problems in reconciling competing forms of accountability, thereby appearing as blame game-type behavior.

The authors conducted a case study with 31 semi-structured interviews in a Finnish health care organization (FHC) that offers basic public health care services. The organization represents a co-operative arrangement with the main city and three smaller municipalities. The FHC has faced difficulties in balancing budget constraints with the provision of statutory care to citizens. This case is analyzed with the help of theories relating to accountability, the blame game, and dialogue.

The authors found that in the FHC operating under austerity constraints, attempts to reconcile financial, professional, and democratic accountability were made but, instead of dialogue and consensus, the different stakeholder groups resorted to defensive tactics in order to protect their resources, position, or sense of professional obligation. The authors suggest that in a context of network governance, accompanied by an increasing emphasis on financial accountability, organizational practices are susceptible to conflicting accountabilities and behavior characterized in this paper as a blame game.

The study contributes to the empirical studies on accountability in the new public governance context by analyzing the complex accountability relations between stakeholder groups with different agendas. The authors suggest organizational characteristics that may exacerbate conflicts between different stakeholder groups and prevent constructive dialogue. Furthermore, the study analyzes the composition of democratic accountability within the studied organization.

The paper seeks to explore how universal welfare arrangements based on needs testing may change and assume different institutional forms. Drawing attention to Norwegian home care, the paper explores how established interpretations of needs and associated notions of equity among needs have been challenged by shifting modes of governance.

The study draws on policy documents, interviews and observation from three different case studies undertaken at different points in time representing different eras of governance. From this perspective, the study examines the role of professionals taking part in needs assessment.

The studies indicate that routines for needs assessment in home care are contingent on shifting logics of governance. A shift in policy of needs testing may be described as a shift from a personal situated approach encouraging “creative justice” towards a detached and impartial approach better equipped to ensure “proportional justice”. The latter approach has become more dominant as heightened attention has been paid to citizens' rights. It is, however, questionable to what extent it will improve the preconditions for treating citizens with equal concern and respect.

The case study approach underlying the study is incapable of providing generalised conclusions about the development in all Norwegian municipalities.

Universalism is often talked about as a stable feature of the Nordic welfare system. Drawing attention to the underlying and elusive notions of needs, the study makes explicit some unstable aspects of universalism.