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Why do some countries (often developing and emerging economies) adopt special laws on PPP, whilst in others PPPs are governed by the legislation on public procurement and related bylaws? This paper explains the above global discrepancies from an institutional perspective. In a contract-theoretical framework we demonstrate how PPPs can enable projects that are not feasible through standard public procurement arrangements. Incentives for private partners are created through extra benefits (often non-contractible) from their collaboration with the government (e.g. risk reduction, reputational gains, access to additional resources, lower bureaucratic burden, etc.). In a well-developed institutional environment these benefits are implicitly guaranteed, suggesting no need in a specialized PPP-enabling legislation. Otherwise, a PPP law should establish an institutional architecture to provide the above benefits.

The research analyzes good practices in health care “management experimentation models,” which fall within the broader range of the integrative public–private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the “management experimentation models” are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations.

In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC – Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies.

The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable.

The recognition of ISMETT’s good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

The public sector plays a critical role in the successful implementation of public–private partnership (PPP) projects. Thus, there is a need to holistically explore the public sector’s view on the implementation practices of PPP. This paper aims to explore and compare the public sector’s views on PPP practices in Ghana and Hong Kong.

Semi-structured interviews were conducted with PPP practitioners of senior authority in public institutions in both Ghana and Hong Kong. The interviews covered critical issues of PPP implementation practices such as motivations for engaging in PPP, success criteria/indicators, critical success factors (CSFs), external stakeholder management and training and education in PPPs.

The findings show that quick delivery of public projects and private sector efficiency are the reasons considered by both groups of interviewees. On the success criteria, interviewees from both jurisdictions mentioned user satisfaction, budget, time and quality. The CSFs mentioned by both groups include capacity building and training, project viability, proper planning and good feasibility studies. Sensitization programs, including open forums and community meetings, were mentioned by both groups as measures for managing external stakeholders. On the training and education, both groups mentioned international study tours and organizing courses and seminars.

The outputs of this study offer strategies that are very useful to international private developers who are interested in PPP practices in Africa and Asia. Further, the findings contribute to the knowledge on the international best practices for PPP.

Despite a growing literature on strategic partnerships, little attention has been paid to the way public‐private partnerships (PPPs) manage their relationships with their environments. Using a stakeholder approach, we specify how a large international public‐private partnership was able to endure over a period of 24 years in spite of a particularly challenging societal environment in a Latin American country. We identify sustainability mechanisms and discuss their implications for managing a PPP.

This research evaluates the value-for-money (VFM) obtained from public-private partnership (PPP) schools in Scotland, based on headteachers questionnaires, local authority interviews and Scottish School Estate Statistics. The period covered is 2000-2012, when 395 new schools were commissioned. The PPPs were better in building condition and maintenance standards and conventionally-financed schools were better in terms of teacher access and improvement in staff morale. There was transfer of knowledge whereby the high standards of the PPPs then became the new standards for the conventionally-financed schools. Concerns about PPP VFM relates to the high cost of unitary charges and contract inflexibilities. A higher percentage of headteachers of conventionally-financed schools (63.64%) considered their new schools resulted in good VFM compared to PPP schools (42.86%).

This paper aims to explore the perceptual differences on the factors that contribute to the successful management of public-private partnership (PPP) projects at the operational stage among stakeholders.

An international questionnaire survey was conducted with purposively sampled PPP experts from the private, public and academic sectors. Survey responses were analyzed using Kendall’s coefficient of concordance (W), mean score ranking analysis, Kruskal–Wallis test and Mann–Whitney U test.

The research findings show that each stakeholder group considers an efficient and well-structured payment mechanism as the most important operational management critical success factor (CSF). Moreover, the public sector considers open and constant communication among stakeholders as the second most important CSF, whereas the private and academic sectors consider effective operational risk management and well-structured legal dispute resolution mechanism, respectively. Further analysis using non-parametric tests (i.e. Kruskal–Wallis and Mann–Whitney U statistics) reveal significant differences in the importance of three operational management CSFs – “open and constant communication among stakeholders”, “effective changes of shareholdings in private consortium” and “stable macroeconomic indicators”.

The generalizability of the research findings is limited considering the low sample size and non-participation of users/general public in the study. Hence, it is recommended that future research should be conducted in a specific country using both face-to-face and email questionnaire distribution approaches. This would likely increase the response rate and facilitate the inclusion of the general public/users.

The results of this study highlight and provide significant insights into how different PPP stakeholders perceive the critical conditions that are required to ensure the operational efficiency of PPP projects. This would, therefore, enable a better cooperation and collective effort from all stakeholders towards achieving the overall project success. In addition, the study offers new and additional CSFs which would enhance the comprehensiveness of the existing list of CSFs for the general implementation of PPP projects.

The increasing demand for public infrastructure has caused a rise in the global adoption of the public–private partnership (PPP) concept. However, over the past years, most of the developing countries have failed to attract more private investments as realised in the developed countries. This paper aims to investigate the critical factors that attract private investments in the PPP markets of developing countries.

An empirical questionnaire survey was conducted with targeted international PPP experts from the academic and industrial sectors. The inter-rater agreement analysis, mean score ranking and Mann–Whitney U test were used to analyse the survey responses.

Results indicate that the three most critical factors are political support and acceptability for PPPs, government positive attitude towards private sector investments and political stability. On the other hand, factors including government guarantees, competent PPP unit and tax rebate on imported equipment are of low importance. The Mann–Whitney U test reveals that experts from the academic and industrial sectors view the importance of three factors differently: adequate public sector experience in PPP, government providing guarantees and government providing tax rebate on imported equipment.

The research outputs contribute to the existing but limited knowledge on PPP practices in developing countries by providing empirical evidence and cross-cultural perceptions on the conditions that are critical to the expansion of PPP markets in developing countries. It is therefore expected that governments and policymakers seeking to adopt the PPP concept would take into consideration the results and implications to enhance PPP growth.

The purpose of this study is to provide a framework useful for identifying the elements that aim for success in the construction of collaborative governance and to investigate how international governance systems have characterized the international collaborative projects developed by the International Division of Gaslini Children Hospital in Genoa (Italy). Critical and successful factors in developing partnerships in the healthcare sector have been identified.

A total of 15 projects implemented by the Gaslini Hospital in collaboration with a global network of low and middle-income countries were examined using a content analysis of the project reports. Later, a conceptual framework proposed by Emerson and colleagues was used to design a theoretical map for investigating elements of international governance systems.

A matrix developed in two categories (health cooperation and training, and exchange of best practices) and three branches of medicine (oncology, paediatrics and cardiology) made it possible to cluster the research projects. However, details of the collaborative process often overlooked by research on public-private partnerships emerged from the framework.

The growing demand for higher quality health services in low- and middle-income countries has led to an increasing number of partnerships with industrialized countries to enable access to wider resources and technologies and develop useful skills to adapt to changes in society. Through the application of collaborative governance’s framework to healthcare collaboration, different elements of the collaborative process emerged which have been previously neglected.

Allocating risk in public–private partnership (PPP) projects based on public–private parties’ risk management (RM) capabilities is a condition for success of these projects. In practice, however, risks are allocated to these parties beyond their respective RM capabilities. Too much risk is often assigned to the private or public party, resulting in poor RM and costly contract renegotiations and terminations. This chapter proposes a methodology based on fuzzy set theory (FST) in which decision makers (DMs) use linguistic variables to assess and calculate RM capability values of public–private parties for risk events and to arrive at risk allocation (RA) decisions. The proposed methodology is based on integrating RA decision criteria, the Delphi method and the fuzzy synthetic evaluation (FSE) technique. The application of FSE allows for the introduction of linguistic variables that express DMs’ evaluations of RM capabilities. This provides a means to deal with the problems of qualitative, multi-criteria analysis, subjectivity and uncertainty that characterise decision-making in the construction domain. The methodology is outlined and demonstrated based on empirical data collected through a three-round Delphi survey. The public–private parties’ RM capability values for land acquisition risk are calculated using the proposed methodology. The methodology is helpful for performing fuzzy-based analysis in PPP projects, even in the event of limited or no data. This chapter makes the contribution of presenting a RA decision-making methodology that is easy to understand and use in PPP contracting and that enables DMs to track calculations of RM capability values.