bluuebunny/crossref_metadata_2025 huggingface dataset:
Privatizing road maintenance in developing countries
Authors: Larcher Paul
Published: July 2002

Over the past decade, there has been growing international interest in utilising private contractors to improve efficiency and reduce costs of road maintenance. In developing countries the existing private contracting sector is often too weak to take on this work. Accordingly projects to foster private sector involvement have been designed and implemented through international technical assistance, with a varying emphasis on financial, training and other support in order to achieve a workable market. This paper discusses case studies from five different countries which vary widely, in terms of social, cultural, contractual and organizational practices. While there are many different aspects to a construction development programme the paper discusses the issues of international assistance, training programmes, equipment provision, contracts and payments, programme objectives, contractor selection. Lessons are drawn from previous project experience in order to propose guidelines for future contractor development projects.
Barriers to transformation
Authors: Maddock Su , Morgan Glenn
Published: July 2002

The post‐1990 health reforms in health and social care have resulted in quasi‐markets, centralized funding and an acceptance of top‐down managerialism.The analysis of contracting within the public sector has focused on the extent to which the market has affected equity, access and choice for users ‐ but it has also had a tremendous impact on staff, staff morale and their relationships. Whilst policy makers demand joint practice in order to deliver continuous care, the market culture has resulted in competitive or depressed behaviour amongst professional managers and support staff. The bureaucratic public administrations were criticized for reinforcing rigid departmentalization and a stagnant culture ‐ the contracting environment and reductionist performance management (NPM and managerialism) appear to be having a similar blocking effect on those staff developing new relationships and working beyond establishment boundaries. This paper outlines what are perceived to be the barriers to social transformation in health and social care services, as relayed by those actively engaged in building bridges across professions and agencies. The research input is based on a mid‐stream ESRC Management Innovation Project.
Community identity in the twenty‐first century A postmodernist evaluation of local government structure
Authors: Barnett Neil J.
Published: July 2002

A key concern in debates about local government structure has centred around the competing claims for democracy, usually seen to require small units based on recognised communities of interest, and those of administrative efficiency or the instrumental requirements of the centre, usually seen to require larger units which can encompass socio‐geographical change and the functional requirements of large‐scale welfare provision. Britain provides perhaps the best example of this issue being settled in favour of the latter claim with structure being designed to reflect changing patterns of economic interaction between people and the technical requirements of service delivery. Although the various recommended changes in structure have recognised the importance of a sense of community to local government the dominant considerations have been those of economic rationality and the scale required for the delivery of services. Thus local government structure has been determined by functional requirement, with the economic welfare of communities being equated to total welfare. The adoption of a postmodernist stance however, provides the opportunity to reintroduce the concept of spiritual community and for claiming that the maximisation of economic welfare is not necessarily the same as the maximisation of total welfare. Postmodernist arguments are used in this paper to suggest local government structures which contain units of varying sizes. To define community in terms of welfare maximisation in this way would allow the combination of economic, social, physiological and psychological welfare. It is argued that such a definition would help the development of a local government structure which is not purely instrumental but which also promotes ownership and involvement. This approach is equally applicable not only where an instrumental attitude has prevailed, but also allows for the potential to re‐define “traditional” community bases for Local Government.
Integrated local service systems
Authors: Bacon Chris
Published: July 2002

Computer systems can support the delivery of services to many separate organizations and the provision of direct critizen access to local services. Discusses the options available for supplying the systems necessary to fulfill these functions. Adopting a middleware approach, allows for relevant information to be extracted from separate systems for display at the front end or enables information entered at the front end to be transferred to one or more of the back‐end applications.
Privatization of state enterprise: policy drivers and lessons learned
Authors: Wayne Taylor D. , Warrack Allan A.
Published: July 2002

Government’s continuum of policy instrument choices historically has included nationalization of enterprise. Today, the additional choice exists of the privatization of state enterprises. Canada is examined as a country in the process of switching from growing state enterprises (Crown corporation) to privatizing them. Although ideology, accountability, efficiency and/or financing were all reasons for creating state enterprise ‐ financing is the most prevalent driver of privatization.
Strategic management initiatives in the Civil Service: a cross‐cultural comparison
Authors: Green Sebastian
Published: July 2002

This paper presents some preliminary findings from a research project into strategic management initiatives in the Civil Services of four countries: Ireland, Northern Ireland, Australia, New Zealand, and three states within a fifth country, the USA. While often hailed as strategic management, what occurs in practice is a limited form of strategic planning. The paper explores the context to the introduction of such planning, describes some of its main content and process features, and compares it to private sector models of strategic management. The paper concludes that strategic planning in the Civil Service typically suffers from being a dressed up version of management‐by‐objectives, utilises an unnecessarily mechanistic and rationalist planning process and fails to address the development of new core competencies to ensure a continuing role in the twenty‐first century.
Problems of university governance in Britain
Authors: Ackroyd Pamela , Ackroyd Stephen
Published: July 2002

University governance has been in flux for some time. Examines the current situation, the legal framework and how power is distributed. Discusses the problems and concludes that effective goverance is most likely to be achieved when the constituent parts of the organization exist in creative tension, which could mean the need for less external control and not more.
Decoupling managerial audit
Authors: Kitchener Martin , Kirkpatrick Ian , Whipp Richard
Published: July 2002

Within discussions of the “new public management” (NPM) it is suggested that professionals increasingly face managerial initiatives that are designed to reduce their autonomy and monitor their work. This paper draws on study data from the local authority children’s homes sector to assess Power’s predictions regarding the “colonisation” and “decoupling” of management audits within professional state agencies. The findings suggest that the introduction of a managerial audit in children’s residential social work has involved a complex, negotiated and uneven process in which older patterns of autonomy have proved to be resilient. A key outcome has been the sometimes ritualistic and partial implementation of the audit process.
Understanding service quality in the new public sector
Authors: Williams Christine S. , Saunders Mark N.K. , Staughton Roy V.W.
Published: July 2002

Highlights the increasing emphasis on customers and service quality in the new public sector. Emphasises the bias towards hard, easily quantifiable data and a focus on external customers in the measurement of service quality. Explores relationships through which grants for social housing are bid for and allocated and the programme managed. Reviews measures of quality in relation to understanding such service relationships. Offers the Service Template Process within a process consultancy framework as an alternative. Findings emphasise the importance of partnership between the Housing Corporation, Local Authorities and Registered Social Landlords (Housing Associations) in ensuring quality in the funding of social housing and the need for longer time scales for joint planning activity. The suitability of the process to help highlight issues critical to a service relationship is also discussed.
Civil service reform in Tanzania
Authors: McGill Ronald
Published: July 2002

This paper establishes the link between institutional development (ID) and process consulting. It does so by recognising ID’s concern for client exploration and learning and process consulting’s focus on client ownership and increased capacity. In that context, the paper outlines the modalities for generating organisation and efficiency reforms in the Tanzanian civil service. It highlights the central role of middle‐ranking civil servants in the twin process of learning and the building of capacity. It looks at the resulting impact of the organisation and efficiency reforms. Finally, it reviews the process consulting experience in terms of the often elusive states of growing ownership and commitment to the reform process. Both are prerequisites for sustainability; an enduring challenge in the developing world.
Measuring performance in policy advice output: Australian developments
Authors: Di Francesco Michael
Published: July 2002

This paper is based on work undertaken for the Commonwealth Department of Finance and Administration and reports on recent developments within the Australian public sector of performance measurement in policy advice output. It outlines the role of performance information in an accrual‐based outcomes and outputs management framework, examines the merits of a model for developing criteria for “good” performance information and explores how these design principles might be applied to policy advice output. The paper identifies the key attributes of policy advice output from the perspective of both providers and clients and their linkage to proposed performance indicators, and concludes by surveying the political and accountability problems associated with specifying and measuring policy advice in government.
Financial Accounting Knowledge, Conceptual Framework
Projects and the Social Construction of the Accounting Profession
Authors: Hines Ruth D.
Published: July 2002

According to most authors, a body of (formal) knowledge is the
crucial trait of professions. It is the presumed existence of this
knowledge which legitimises claims to expertise, professional powers,
autonomy and control over work. The body of knowledge around which the
financial accounting professionalisation project has taken place is
described and it is shown that professionalisation took place around a
variety of personal qualities, such as honesty, independence and
respectability – skills not specific to “accountants”,
such as penmanship, arithmetic, work and knowledge, which at the time
were contestable as being the domain of the legal profession. It is
suggested that (not unlike other professions), the knowledge foundations
of the accounting profession are problematic and so in order to
reproduce and advance the accounting profession, members must counteract
threats to its legitimacy stemming from its underlying knowledge
foundations. It is also suggested that the frequently repeated search
for a conceptual framework represents a means of counteracting this
threat to the social legitimacy of the accounting profession, and that
conceptual framework projects are used as a political resource in the
profession‐alisation struggle during times of possible intervention by
the state and at times of competition from other (including accounting)
groups.
Agency, Auditing and the Unregulated Environment: Some
Further Historical Evidence
Authors: Mills Patti A.
Published: July 2002

An understanding of the legal environment is vitally important to
historical studies of accounting regulation, particularly those which
seek to clarify modern regulatory behaviour by comparisons with
premodern practices. In recent years historical comparisons of this type
have begun to enter the economics‐based literature on auditing
regulation. This research, however, generally neglects the wider
historical context of early audit activity. As a result, the picture it
conveys of accounting and the law in pre‐modern society misrepresents
the scope of legal intervention in early audit activity. The purpose of
this article is to provide some of the historical background necessary
to a fuller understanding of early regulatory behaviour and to comment
on the implications of this evidence for recent research. Among other
findings, it shows that the pre‐modern evidence is at present
insufficient to substantiate the claim that audits would exist without
any legal intervention beyond enforcement of contract.
The Function of Accounting: A Japanese Perspective
Authors: Jinnai Yoshiaki
Published: July 2002

The current functions of both financial and management accounting
in Japan are analysed. The critical views of the functions of accounting
that have been presented by Japanese researchers since the 1950s are
traced. In these views, the contemporary functions of accounting are to
accumulate capital through manipulation in financial disclosure in the
relation of capital ownership, and to pursue monopolist profits
by intensifying labour process and by reducing manufacturing costs in
the relation of production. The current use of accounting policy
changes by Japanese corporations is analysed in respect of the first of
these relations, and just‐in‐time production systems and other methods
of reducing manufacturing costs are examined in respect of the second
relation with particular attention directed to the relationship between
productive and accounting labour. Based on these considerations, some
new perspectives are offered on the functions of accounting not only in
the Japanese capitalist context, but in the context of capitalism
generally.
On Valuing Nature
Authors: Hines Ruth
Published: July 2002

The impersonal side of accounting for nature is discussed, where
accounting reduces the environment to mere monetary values. The cause of
personal interest in the beauty and worth of nature is pleaded and
weighed against the mercenary interests of sacrificing the environment
to industrial, national and professional self‐advancement in the name of
accounting, i.e. accountancy should be bound by the social contract and
eschew the destruction of the environment for financial gain.
Employer Equivocality and Union Heterogeneity as
Determinants of the Role of Accounting in Collective Bargaining
Authors: Amernic Joel , Craig Russell
Published: July 2002

Analyses the role of accounting data in collective bargaining in
not‐for‐profit organizations in four Canadian cases. Develops a model
upon the constructs of “employer equivocality” and
“union heterogeneity” to provide useful insights. Where
employer equivocality is low and union heterogeneity is high, the
analysis reveals that accounting data are not sought for their intrinsic
information value, but rather for their facilitative role in providing a
conduit, or an excuse, for continuing dialogue between the bargaining
parties. Analysis of other intersecting levels of employer equivocality
and union heterogeneity in bargaining settings characterized by
collective bargainers′ shared values are instructive regarding the role
of, and the extent of recourse to, accounting data.
Regulation of Accountancy and Accountants: A Comparative
Analysis of Accounting for Research and Development in Four Advanced
Capitalist Countries
Authors: Willmott Hugh C. , Puxty Anthony G. , Robson Keith , Cooper David J. , Lowe E. Anthony
Published: July 2002

Explores the development of regulations for “Accounting for
Research and Development” in four countries: USA, UK, Federal
Republic of Germany and Sweden. Seeks to illuminate the processes of
accounting regulation in the specific institutional contexts of each
advanced capitalist country, with reference to the particular mix of
organizing principles of dispersed competition, hierarchical control and
spontaneous solidarity.
The Rhetoric of Science and the Rhetoric of Revolt in the
“Story” of Positive Accounting Theory
Authors: Mouck Tom
Published: July 2002

Examines Watts and Zimmerman′s Positive Accounting Theory
as a literary narrative, as the “PAT story”, in an effort to
explain its success in light of the fact that it falls well short of
their professed methodological standards. Their use of the rhetoric of
science is examined, with special attention to their projection of a
“scientific persona”, their rhetorical construction of the
legitimate” boundaries of accounting research, their use of
metaphor and other literary devices, their rhetorical transport of
“scientific authority” from other disciplines, and the
circumstances that made their audience receptive to scientific rhetoric.
Their use of conservative political rhetoric (the rhetoric of revolt
against the interference of government in economic affairs) is also
examined, with special attention given to the devices used to convey a
normative message while maintaining a positive posture, and to the role
of sociohistorical circumstances (the Reagan era) that encouraged their
audience to overlook the story′s lack of scientific substance.
A Scale of Perceived Independence: New Evidence on an Old
Concept
Authors: Bartlett Roger W.
Published: July 2002

Reports the results of research on the topic of perceived auditor
independence. Consistent with generally accepted auditing standards,
independence is defined as the absence of bias in audit decision making.
As a characteristic of individual auditors, independence is theorized as
having a continuum of values. A mail survey was distributed to random
samples of bankers and CPAs. Responses were received from 143 CPAs and
100 bankers. Results indicate that a continuum of independence exists;
that there are significant differences in the perceptions of
independence between bankers and CPAs in nine of the ten situations
presented; and a respondent′s knowledge of accounting had no significant
effect on evaluations of auditor independence. Discusses implications
for ethical and regulatory controls on CPAs and presents future research
opportunities.
From Financial Control to Strategic Management: The Changing Faces of Accountability in British Local Government
Authors: Cochrane Allan
Published: July 2002

In recent decades British local government has been the subject of
dramatic financial and political pressures. Explores the apparently
inexorable rise of approaches dominated by demands for tight financial
control and the discourse of “value for money”, before going
on to consider some of the ways in which these approaches have
themselves been challenged with the rise of different forms of
managerialism. Argues that the finance‐led changes of the 1980s helped
to undermine the position of traditional welfare professionals (at first
giving a more powerful role to local authority finance professionals),
but were themselves overtaken by new sets of arrangements for the 1990s.
The end result has been the creation of a system of complex and often
confusing channels of political and financial accountability.
Worrying about Accounting in Health Care
Authors: Fong Chua Wai , Preston Alistair
Published: July 2002

Aims to promote concern and debate about the penetration of accounting
and financial management in the health care sectors of several
Anglo‐Saxon countries – the United States, United Kingdom and New
Zealand. Questions may be raised in several ways. For example, by
highlighting how accounting concepts such as “costs” are not neutral
notions but rather are sites for struggles of divergent interests or by
commenting on how accounting may change or be changed by different
organizational and societal rationalities. Concern may also be raised by
questioning the effects of accounting change in terms wider than the
purely instrumental and thereby arguing that its global spread is
grounded more in faith than “factual” evidence regarding its efficacy.
Health management performance
Authors: Van Peursem K.A. , Prat M.J. , Lawrence S.R.
Published: July 2002

A bewildering variety of performance measures and indicators in
health management is evident in the literature and in practice. Reviews
measures useful for health management performance accountability, and
expands on the traditional notion of health performance measures to
incorporate nominal and ordinal measures. The research is performed in
the interest of stimulating discussion in the public domain and with the
intent of expanding current notions of the term “performance
indicator”. Develops a comprehensive framework from measurement
and accountability theory, and the medical management, accounting and
accountability literatures are reviewed. Highlights the importance of
using non‐ratio measures to capture outcomes, structure and processes
influenced by management; and suggests that disclosures which include
measures from all elements of the framework would most closely account
for management activity.
Readability of annual reports: Western versus Asian evidence ‐ a comment to contexualize
Authors: Jones Michael John
Published: July 2002

Contextualizes some of the issues raised by an article by Courtis in AAAJ 1995. Readability, which measures syntactical difficulty, should be distinguished from understandability, which measures comprehensibility. Courtis’s results, which are suggestive (but not conclusive) of a link between readability and profitability are consistent with several other recent readability studies. In addition, his results are consistent with several content analytic studies suggestive of a lack of neutrality in managements’ presentation of accounting narratives. Prior readability studies are shown to provide new information about inter‐country readability differences and the differential readability of differing sections of the annual report. Courtis’s research on English versions of Hong Kong corporate reports raises interesting questions on the use of such texts in countries where English is not the native language.
Propaganda, attitude change and uniform costing in the British printing industry, 1913‐1939
Authors: Walker Stephen P. , Mitchell Falconer
Published: July 2002

Analyses the attempt by a trade association (the British Federation of Master Printers) to secure the universal adoption by its members of a uniform costing system. It was envisaged that the industry‐wide application of a prescribed costing solution would secure the socio‐economic advancement of employer printers and ensure an improvement in their power relative to unionized labour and unorganized customers. Universal adherence to the uniform costing system depended on the trade association changing the prevailing negative attitudes of employers towards the twin ideals of scientific costing and organization. In order to achieve this a concerted campaign of persuasive communication was undertaken. Reveals that propaganda was conducted by utilizing a variety of distribution media and by employing a range of propagandist devices. The limited success achieved in converting employers to the costing cause is considered to have been the result of message, audience and contextual effects. The persistence of traditional attitudes among printers, the effects of war and adverse macro‐economic conditions were particularly important factors which induced resistance to attitudinal and behavioural change. Concludes that the uniform costing movement and the history of costing in artisan‐craft‐based industries merit deeper investigation.
Methodological themes
Authors: Parker Lee D. , Roffey Bet H.
Published: July 2002

Restates the case for accounting and management research from a grounded theory perspective, and advocates its informed and more frequent application. Examines the intellectual foundations and key tenets of grounded theory in the context of researchers’ theoretical assumptions and methodological characteristics, discussed in relation to Laughlin’s (1995) classification schema. Pays particular attention to grounded theory assumptions and methods in relation to other interpretive paradigms such as symbolic interactionism, ethnomethodology and hermeneutics. Describes the basic principles and methods of grounded theory research, and presents potential applications to the accounting and management research arenas. Argues that rigorous grounded theory research can offer the accounting and management literatures unique understandings that provide additional perspectives to those already being offered by major schools of thought, and discusses implications of grounded theory for informing contemporary professional practice.
Struggling with the praxis of social accounting
Authors: Gray Rob , Dey Colin , Owen Dave , Evans Richard , Zadek Simon
Published: July 2002

Addresses three related, though not entirely congruent, aims. Seeks, first, to initiate moves towards a “normative theory” ‐ a conceptual framework ‐ for the developing of social accounting by organizations. Second, aims inductively to draw out best practice from a range of social accounting experiments, illustrated, in particular, by reference to two short cases from Traidcraft plc and Traidcraft Exchange. Third, draws from the conclusions reached in the exploration of the first two aims and attempts to identify any clear “social accounting standards” or “generally acceptable social accounting principles” which can be used to guide the new and emerging social accounting practice. Presents a number of subtexts which attempt to link back to the accounting literature’s more trenchant critiques of social accounting; to address the tension between academic theorizing and engaging with practice; to synthesize different approaches to social accounting practice; and to respond to the urgency that the recent upsurge in interest in social accounting places on the newly formed Institute of Social and Ethical Accountability. An ambitious paper which means that coverage of issues must be thinner than might typically be expected ‐ exploratory, rather than providing answer, offers a collective view from experience and encourage engagement with the rapidly evolving social accounting agenda.
The incidence of budgetary slack: a field study exploration
Authors: Dunk Alan S. , Perera Hector
Published: July 2002

Extends the investigation into the nature of the relation between participative budgeting and budgetary slack. The literature focusing on this association can be divided into two groups, the conclusions of which are inconsistent with one another. One camp argues that managers intentionally use participation to create slack, while the other argues that managers, through anticipation, reduce slack in their budgets. In attempting to reconcile these differences, it has been suggested that superiors’ evaluative styles and information asymmetry are two factors which may influence this relation. The mechanism, however, by which they may exert an influence is unclear, since the cross‐sectional evidence also conflicts regarding the nature of the impact of evaluative style and information asymmetry on the association between participation and slack. A field study was conducted to allow an in‐depth analysis to be made. The study proposes that the association between participation and slack arises from a complex process of interactions between the parties involved. Although managers were aware that participation provided them with the opportunity to build slack into their budgets, they did not necessarily attempt to do so for reasons that include moral, ethical and career advancement considerations.
Persuasion without numbers?
Authors: Froud Julie , Haslam Colin , Johal Sukhdev , Shaoul Jean , Williams Karel
Published: July 2002

Using the example of capital charging in UK hospitals, this paper shows how new public policy initiatives are justified through forms of persuasion without numbers and can be challenged with empirics. A reading of official and academic texts shows how the official problem definition focuses on poor asset utilisation. Hospital accounts are then reworked to show that, although poor asset utilisation was never a major problem, the introduction of capital charges could disrupt service provision. The conclusion is that the operation of NHS hospitals should be understood in terms of distributive conflict, rather than inefficiency. Through practical demonstration, the authors of this article aim to encourage accounting researchers to use numbers to challenge public policy definitions.
The state of public sector accounting research
Authors: Broadbent Jane
Published: July 2002

Looks at the papers presented at the APIRA Conference in the public sector accounting area. There were some international comparative studies. The conference highlighted the need to understand different cultural contexts; the widening of the idea of public sector to the not for profit sectors and different technologies
Benefits of an ISO 9001 certification – the case of a Swiss regional hospital
Authors: Staines Anthony
Published: July 2002

This paper reports the experience of a quality management project leading to an ISO 9001 certification in a Swiss regional hospital. It describes the motivations for the project, the process that was followed and the benefits of the approach. It also shows its limitations, problems encountered as well as costs and resources involved. The emphasis is on practical issues. Choices that were made are discussed and lessons are drawn.
Responding to diversity: the Primary Care Group in the NHS
Authors: Willcocks Stephen , Conway Antony
Published: July 2002

The paper attempts to examine the development of Primary Care Groups in the NHS, utilising a conceptual framework taken from relationship marketing. In particular, it looks at a framework representing the complex relationships between the Primary Care Group and a diverse range of internal and external stakeholders and the implications of these relationships. It reports the preliminary findings of an ongoing, in‐depth case study of two Primary Care Groups; with data collected from in‐depth interviews with a small number of key stakeholders. The results, so far, suggest the importance of developing and maintaining longer‐term relationships with a range of partners, both internal and external. It recommends that Primary Care Groups should develop strategies to work closely with these stakeholders, as an essential underpinning to developing continuous improvement in performance, quality and “user” retention.
Improving prescribing practice through pharmacy audit
Authors: Griffith D. , Diggory P. , Jones V. , Mehta A.
Published: July 2002

The classic audit cycle has been applied to the prescribing practice to improve aspects of the quality of prescribing in the setting of a department of health care for older people in a district general hospital. Details the methods used both to increase the appropriate prescribing of drugs of proven benefit, and also to restrict the use of drugs which may prove hazardous. The latter provides an example of risk management. Also discusses the dilemmas posed in treating older people with multiple pathologies, on the one hand, trying to avoid an ageist approach, on the other, attempting to minimise the pitfalls of polypharmacy.
Empirical evidence for “the nurse satisfaction, quality of care and patient satisfaction chain”
Authors: Newman Karin , Maylor Uvanney
Published: July 2002

The statistics and associated literature reveal a chronic shortage of nurses and midwives and difficulties in recruiting and retaining D and E grades, the main providers of hands‐on patient care. This qualitative exploratory study of nurse satisfaction, dissatisfaction and reasons for staying provides empirical support for a conceptual model “the nurse satisfaction, quality of care and patient satisfaction chain”. The in‐depth interviews reveal a spontaneous and explicit linking of organisational resources to nurses’ ability to provide the level of patient care commensurate with their desire and patients’ needs. Nurse job satisfaction derives from knowing that they have provided good care as well as the attributes of the job such as a career, skill acquisition and the “people I work with”. Job dissatisfaction stems primarily from staff shortages, the behaviour of patients and negative media comment. The interviews demonstrate the critical role of the “ability to give quality care” and the satisfaction derived from patients’ demonstration of their appreciation and the influence of this on nurse retention.
The Development of Clinical Audit:
Authors: Aukett James W.
Published: July 2002

If clinical audit revolves around concepts of quality, then there is
need to examine the basis of quality and thereby clinical audit as
traditionally defined by health‐care organizations. Basing quality on
patients’ stated needs is often insufficient. Gives an expanded view.
Health‐care consumers should not be confused with the term customers,
and professional staff should be ready to consider patients’ needs
before those of any organization. In order to handle this wider view of
quality in health care, describes the concept and construction of a
quality web. Suggests that either by constructing their own quality
web, or adapting the model given, clinical managers could adopt a
broader perspective to quality and audit in the service they provide.
Improving health service quality from within
Authors: Lewisohn Colin , Reynoso Javier
Published: July 2002

Illustrates how the implementation of the internal customer concept
has assisted United Leeds Teaching Hospitals NHS Trust to establish a
culture for quality. Explains the conceptual framework on which the
notion of the internal customer is derived. Describes how, from 1992 to
date, the Trust’s quality management approach was designed to apply
these management principles in a large teaching hospital setting.
Outlines how this quality management approach has been successful in
enabling departmental managers to recognize, develop and improve
internal customer/supplier relationships. Concludes by explaining that
business process re‐engineering is now being applied as a prime quality
tool to help deliver a major culture change throughout the organization.
An evaluation of TQM in primary care: in search of best practice
Authors: Zairi Mohamed , Matthew Ajit
Published: July 2002

Presents an evaluation of a TQM initiative which was designed to
help the general level of awareness and knowledge within general
practices and to encourage the implementation of TQM in primary care.
The purposes of the initiative were to assess the effectiveness of the
TQM approach used, not only in terms of tangible results but also in
terms of cost effectiveness suitability and workability; and to check
the transferability of the model used and its replicability with similar
levels of benefits in other general practices on a nationwide basis.
Total quality management as a health care corporate strategy
Authors: Johnson James A. , Omachonu Vincent K.
Published: July 2002

Total quality management (TQM) must become a part of corporate
strategy if it is to become a way of life in health care. TQM should be
understood in the context of a cultural transformation. The greatest
challenge for top management is to create an organization in which every
employee, department and function is linked inextricably to the
organization’s mission and vision. One of the key benefits of TQM is the
use of teams to work on and achieve organizational objectives. Health
care managers must understand motivation in order to carry the workforce
with them to attain those objectives.
Defining a quality strategy for learning disability services
Authors: Smith Gordon
Published: July 2002

Describes how Lifecare NHS Trust established core values and an ISO
9000 quality framework as the foundation for patient care quality
improvement. Discusses a procedural approach to ensure that Lifecare
defines clearly the requirements of the management of every aspect of
its care system. Presents a framework for total quality management and
process improvement of care delivery.
Patient‐focused care and its role in hospital process
re‐engineering
Authors: Nicholson Janice
Published: July 2002

Examines the concept of patient‐focused care and how it fits into
hospital process re‐engineering. Describes the project undertaken at the
Derbyshire Royal Infirmary, to implement patient‐focused care and care
pathway development in accident and emergency, and trauma and
orthopaedics. Concludes with an insight into how care pathways have been
used to improve hospital documentation, reduce duplication of
information and provide a rich source of data for effective clinical
audit.
Path.Finder: an interactive clinical information system
Authors: Buchan Iain E. , Kennedy Tom
Published: July 2002

Presents Path.Finder, a locally managed health care information
system built in response to the need for better communication of current
research evidence and clinical practice guidelines. Concludes that this
system will improve patient care by providing up‐to‐date, clinically
useful information which is relevant locally. The technology and the
information management system have been developed in parallel.
The evolution of quality in the US health care industry: an old wine in a new bottle
Authors: Asubonteng Patrick , McCleary Karl J. , Munchus George
Published: July 2002

Explores the evolution of the quality issue within the health care industry and also the significance of quality in the health industry along with the historical origins of quality management. Reviews applications of total quality management in the health care industry along with implementation issues. Concludes that a fundamental understanding of the process of total quality management is an absolute requirement.
Clinical benchmarking: results into practice
Authors: Maxwell Melanie , Kennedy Tom , Spours Alan
Published: July 2002

Describes the way benchmarking data are used in a district general hospital to influence clinical practice. Wirral Hospital Trust is a site for the Electronic Patient Record Project; as such there is a large amount of patient‐based data available for research and internal benchmarking. Includes working examples of internal benchmarking which have been used by both clinicians and hospital management to improve hospital effectiveness. Discusses the ways in which this information is being used to develop initiatives such as clinical pathway development.
Costs of the treatment of leg ulcers: initiating a quality assurance process
Authors: Faresjö Tomas , Frödin Thomas , Vahlquist Carin , Klevbrand Maria , Elfström Johan , Leszniewska Danuta , Larsson Alice
Published: July 2002

Reports on a study which aimed to initiate a quality assurance process among health care personnel in Sweden. An epidemiological survey concerning treatment of leg ulcers in a defined region in Sweden was conducted and the costs of treating leg ulcers at different levels of care were analysed. The epidemiological survey provided the data necessary to calculate the socio‐economic costs for the treatment of leg ulcers. The weekly cost was found to be about 24 times higher for hospital in‐patients than it was for patients treated at home. The quality assurance process has continued through an interdisciplinary regional consensus conference and the establishment of a consensus programme in the region, with targets and general suggestions for the care and treatment of leg ulcers. To maintain high quality in leg ulcer treatment in the region, an interdisciplinary reference group has been established with members from different clinics at the hospital and members from the primary health care.
Establishing and developing health promotion in an Acute Trust
Authors: Grice Helen , Kickham Noreen
Published: July 2002

Outlines the integration of “Health of the Nation” and quality assurance into a health promotion strategy and reports on its implementation in a UK Health Trust. Presents and discusses strengths and weaknesses of such a health promotion strategy.
Recent service evaluation research on people with learning difficulties
Authors: Cheung Chung Man
Published: July 2002

Substantial research on the evaluation of residential services for people with learning difficulties emerged over the last ten years in the UK. Reviews some of the major findings (N = 14). Their measures on the effectiveness of services were based on three components: the reduction of clients’ challenging behaviour; the level of engagement between staff and clients; and clients’ community involvement. An overall impression showed inconsistency and controversy in the first two components but a negative trend in the third. Discusses some methodological issues and suggests other components for service evaluation research.
Total partnership for primary health care provision: a proposed model ‐ part II
Authors: Aggarwal A.K. , Zairi Mohamed
Published: July 2002

This is the second part in a paper which studied the dynamics of primary health care provision. This paper examines external factors related to the management of general practices. The study revealed that there are major problems at GP/FHSA interfaces involving poor communications, needs evaluation and understanding, and the lack of teamwork. The paper argues that attempts by FHSAs in terms of initiatives are so far failing and have not effectively been able to build strong partnerships between the parties concerned. The paper concludes by proposing a Model of Total Partnership for effective primary health care provision. The model suggests that structures need to be modified in a horizontal way, focusing on patients and building a collaborative way between FHSAs and GPs in a seamless fashion. The model is based on Total Quality Management (TQM) principles and is represented by the building of a customer‐supplier chain, the spirit of continuous improvement and synergy through teamwork with the ultimate goal of Total Patient Satisfaction.
Private and public medicine: a comparison of quality perceptions
Authors: Angelopoulou Penelope , Kangis Peter , Babis George
Published: July 2002

How do physicians and patients perceive the quality of medical services offered? Is this perception the same in the private and public sector? On the basis of a survey conducted in Greece on a 2x2 design with 20 respondents in each cell, several interesting characteristics were identified. Patients in the public sector attribute greater importance to resources of a medical and technical nature and do not seem particularly concerned about the contextual or environmental features of a hospital. Private patients are expecting a more holistic approach to their treatment and expect some attention to be directed to their emotional needs. Private surgeons are worried about the limited basic resources in private hospitals and their inability to satisfy the non‐clinical needs of their patients. Important lessons may be drawn for policy makers in terms of priorities and resource allocation in relation to the quality of service both expected and provided in both the private and public sector hospitals.
Preliminary evaluation of the efficacy and implementation of the new NHS complaints procedure
Authors: McCrindle J. , Jones R.K.
Published: July 2002

The increase (28.8 per cent) in the number of complaints from pre‐New NHS Complaints Procedure to the implementation of the new procedures in 1996 is a matter of concern because it is estimated that the current figure represents only 40 per cent of the number of people with some dissatisfaction. The Wilson Report prompted Government initiatives in producing a new NHS Complaints Procedure. The new procedure allows for complaints to be dealt with at a local level, or in a minority of cases through Independent Review. The new procedures, which were introduced in April 1996, oblige Trusts, GP practices and Health Boards to establish a Written Local Resolution process for handling complaints, responsibility for implementation lying with individual trusts. A preliminary assessment of the New Procedures was carried out in Lothian. A qualitative approach was utilised and semi‐structured taped interviews lasting on average one hour ten minutes were administered to the six complaints officers. This study concentrates on how the six Lothian NHS Trusts are implementing the new procedure, the openness in complaints handling, and the awareness of how complaints can be used to improve standards. The conclusion is that Local Resolution 1 has been successful, and that complaints do receive a speedy response. The process is much simpler and easier for the lay population to access. Reservations remain, however, towards the Independent Review procedure.
The development of a quality model: measuring effective midwifery services (MEMS)
Authors: Martin‐Hirsch Julie , Wright Gillian
Published: July 2002

In a wider debate on defining and measuring quality in health care, there is a particular need for frameworks for understanding and managing quality in specific specialties. This article addresses the definition and measurement of quality in maternity care. It develops a pro forma for monitoring and hence managing midwifery quality.
Quality of care and patient satisfaction in budget‐holding clinics
Authors: Gross Revital , Nirel Nurit
Published: July 2002

A budget‐holding program was implemented in nine primary care clinics in the Negev district of Kupat Holim Clinic, Israel’s largest sick fund. This study, carried out from 1991 to 1994, evaluates the impact of this program on patient satisfaction and other selected indicators of quality of care, using a controlled case study methodology. Structured questionnaires were used in face‐to‐face interviews with a representative stratified sample of 523 patients registered in the clinics. Patient reports were used to measure patient satisfaction, accessibility of services, comprehensiveness of care, responsiveness to patients’ needs and performance of preventive medicine activities. Other research tools included staff surveys, in‐depth interviews and administrative data on transfer among sick funds. The findings counter fears that budgetary control and cost‐containment negatively affect quality of care and patient satisfaction. However, the program did not fulfill expectations regarding improvement in clinic services and patient satisfaction.
Organisational effectiveness within National Health Service (NHS) Trusts
Authors: Jackson Sue
Published: July 2002

In view of the dearth of information relating to organisational effectiveness of NHS Trusts in comparison with clinical effectiveness, a complex study was undertaken to determine whether overall effectiveness was a result of management processes, people, or a combination of both. The study incorporated two phases involving the distribution of a comprehensive questionnaire to identify the “whats” of organisational effectiveness, and a benchmarking exercise aimed at identifying the “hows”. In the main, the better performing trusts were found to be subscribing to the concepts of “keeping it simple”, innovation and attainment of highly efficient processes. A number of examples of better/best practices were observed which included visible leadership, a commitment towards stakeholder involvement and the practice of teamworking. Given the complexity of the study area, the findings were deemed valuable to managers practising within all areas of healthcare. However, a need for further research was identified in order to substantiate the results.