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This chapter explores how hybrid organizations navigate the challenges (and opportunities) associated with advancing unconventional logic combinations. It draws from a study of the 180-year history of sheltered workshops in the United States. Sheltered workshops are hybrids that combine social and commercial logics to provide gainful employment to individuals with disabilities. This chapter theorizes a connection between the governance system – that is, country-based social norms and regulatory settlements – framing hybrids and the agency that allows them the discretion required to advance unconventional combinations. It introduces the term hybrid agency to describe this connection and identifies four types: upstream, midstream, downstream, and crosscurrent. Upstream agency draws from the entrepreneurial vision of charismatic founders. It allows hybrids the discretion to advance unconventional logic combinations in unsupportive times, but it also requires them to observe certain dominant cultural norms. Midstream agency draws from hybrids’ adaptation and advocacy skills and resources in periods of historical change. It allows access to resources and legitimacy for unconventional combinations. Downstream agency draws from organizational slack possible in supportive times. Slack eases tensions and tradeoffs between conflicting logics but may also fuel mission drift. Finally, crosscurrent agency also draws from hybrids’ adaptation and advocacy skills and resources. It provides hybrids with the opportunity to grapple with challenges in periods of contestation.

Contemporary categorizations of western-style welfare states distinguish a particular pattern of organizing social security mainly found in Scandinavian countries, and sometimes labeled as a “social democratic welfare regime.” This is characterized by general access of the population to a social security system organized and administered by public authorities. This categorization is widely acknowledged, but the Scandinavian “social democratic” model is rarely ever analyzed in detail.

While most health services are provided by public actors, it is often overlooked that health services in Scandinavian countries in certain fields are delivered to a substantial part by private actors. In Norwegian rehabilitation specialist health care, these private actors stand for more than 30% of all service delivery.

Based on a content analysis of publications of the Norwegian Ministry of Health and Care Services we look into the relation between public and private actors in rehabilitation and relate our findings to classifications of Scandinavian welfare states into an institutional, social democratic model.

The Vocational Rehabilitation (VR) Service System was created in 1973 in the United States as a way to help people with disabilities access necessary supports and services to return to work and live independently. The program receives federal funds and operates in all 50 states and territories. The program is designed to allow consumers to develop a rehabilitation plan in collaboration with a VR counselor and receive necessary services and supports in order to meet their rehabilitation goals. Unfortunately, there are serious issues with access to services and rehabilitation success for minority individuals in the program, particularly African Americans. The chapter will first provide a brief overview of the Rehabilitation Act and its purpose, then we will introduce some of the research that has been conducted to evaluate the program over the years, with particular emphasis on the outcomes for African Americans, and then will focus on a series of studies that have been conducted by the authors in the state of Illinois. The chapter will conclude with some suggestions about ways in which the system could be improved and ways to empower African Americans in pursue of their rehabilitation and independent living goals, including peer-support and supported employment.

The application of forecasting to health care is not new. A frequent issue in many Inpatient Rehabilitation Facilities (IRFs) is the fluctuating and unpredictable census. With scarce resources, particularly physical therapists and occupational therapists, this unpredictability makes appropriate scheduling of these resources challenging. This research addresses the issue of patient admissions in an inpatient rehabilitation facility attached to an 861 bed level-one trauma hospital. The goal is to develop a predictive model for the IRF's Census to assist in resource planning (e.g., labor, beds, and materials).

As sociologists we all try to make a contribution to our field. Having completed our comprehensives and dissertations we have read in depth in several areas, have focused on an area that interests us, and have learned the research process whether it uses quantitative or qualitative methodology. We all make our contributions available to the field, but occasionally one among us makes a startling discovery, has an unusual idea or a way to approach a problem, starts examining a new problem at just the right moment, or has an insight into a specific conceptual problem with unusual alacrity. A few among us combine all that skill and happenstance and lead the way into new sociological insights, new areas of research and provide a notable foundation or advancement to an area of knowledge. Saad Nagi is one of those contributors with vision, insight, and skill to see ahead of his time. This paper attempts to bring together in one place his major contributions to the disability knowledge base in sociology.

The approach used in this paper is an in depth review of all of Nagi’s published works in the area of disability. The published literature is grouped into the five areas in which Nagi made major contributions, including major research of the Social Security Disability Insurance process; development of a framework for the disability process; epidemiological definitions and research; development of a coherent set of disability measures; and an examination of the social problem, policy, and program process as developed and practiced in this country.

Nagi made a large and significant contribution in all the areas listed above and much of the measurement, and process examination is still relevant and useful in current research. His framework is still the basis for the very newest models of disability which dominate disability research today.

Researchers need to go back to find Nagi books and articles written in the 60s, 70s, and 80s to ground their work in the originals rather than to take the interpretations of others on this material. The ICF and the Social Model did not originate in Europe alone, but much of the work began in the states in the early 60s with the work of Nagi, Haber, and others and should not be overlooked or ignored.

Purpose – This chapter examines the impact of technology on sustainable effectiveness by focusing on the dynamic synchronization between the technical and the social subsystems at the Villa Beretta Rehabilitation Hospital (VBRH) and illustrates that technology can trigger and enable sustainable health care organizations.

Design/methodology/approach – The case study of VBRH relies on several data sources. They include interviews with key informants (VBRH executives, health care professionals, and technology suppliers), follow-up e-mails and phone conversations, direct observations of actors’ behavior, and notes of processes in action and archival data, such as patient pathway protocols, technical information systems documentation, performance and managerial reports, and administrative guidelines.

Findings – VBRH was capable to dynamically synchronize the social subsystem with the continuous innovation of the technical subsystem. This capability enabled sustainable effectiveness in three main areas. First, the correct alignment between technology and professionals’ practices and behaviors improved triple-bottom-line performance by promoting a more conscious use of the environmental, social, and financial resources. Second, technology-based initiatives promoted research-oriented plans of action that nurtured a culture of change and continuous improvement. Third, technology facilitated the extension of the research and operation networks that generated new ideas and initiatives for achieving sustainable effectiveness. Additionally, evidence from VBRH demonstrated that organization design, change management, and learning mechanisms are essential when institutionalizing new technology that requires the disruption of current professional practices and individuals’ behavior.

Originality/value – Previous contributions about sustainable effectiveness in health care failed to unveil and frame the complexity of dynamic synchronization between the technical and the social subsystems that is at the core of the sustainability of health care delivery. This chapter provides new insights that pave the way for a deeper-level understanding of the role that technology plays in sustainable effectiveness dynamics and outcomes in health care delivery. The chapter illustrates how different groups of technology contribute to sustainable effectiveness and the mechanisms that make them work.

The “New Paradigm” of disability and the International Classification of Function Disability and Health both describe an ecological model of disability that has significantly influenced policy and law, and this model is frequently cited as a background in published research. Given the central role of “the environment” in this ecological model, we asked, what is the status of research on the environment and disability? Specifically, is a scoping review warranted in this area of research?

We conducted a “rapid scan” of the National Rehabilitation Information Center (NARIC) database for articles reporting studies of the environment – defined as the arranged or built environment. We also scanned Google Scholar to ascertain the frequency of articles that might report research into the environment.

NARIC archived 12,486 items published from January 2007 to June 2012; 530 (4.2%) of which contained the search term “environment.” Of the 530 items, 78 (14.7%) also included the terms architecture space, accessibility, and ICF. Over the same time period, Google Scholar returned 109,000 entries to search terms “disability and environment,” 349 (0.3%) of which also included the terms architecture space, accessibility, and ICF.

This application of a method for rapidly assessing the status of the literature suggests that research into some aspects of the environment and disability may be under-represented. A more complete review, requiring more resources, is warranted.

The landscape of the Probation Service in England and Wales continues to be challenged by issues of priorities, workload, and lack of meaningful relationships between offenders and practitioners. In this climate of uncertainty and ‘transformation’, vulnerable offenders on probation become the ones mostly affected due to management plans and license conditions that do not respond to the variability of their needs. This chapter explores the older individuals on probation and uses the framework of Multi-Agency Public Protection Arrangements (MAPPA) to examine the extent to which it may accommodate the needs of this group of offenders in an otherwise risk-based context. This study draws ideas from previous research of the author and aims to develop the existing limited academic attention that older offenders supervised under specialised probation contexts have received. The structure of the chapter remains doctrinal in nature as a response to the need for a more comprehensive and inclusive perception of the risk of reoffending later in life and its implications for bespoke community reintegration strategies. This approach also allows for theorisation of MAPPA’s multi-agency structure and its prospects for the rehabilitation of older offenders. This study finds that as MAPPA only manages violent and sexual offenders, the ‘older MAPPA offender’ becomes a special category for probation that may exhibit a variety of needs and life circumstances. It thereby becomes even more important for these offenders that a constructive working relationship between them and the probation officer is in place. This supports the latter in appreciating what factors lead the individual to offending later in life, and what interventions may be most effective to address their risk of reoffending as well as their needs in the community.