PurposeThis study examines unexplored horizontal accountability types between public, private and third sector actors within a hybrid organization. The case organization was applying a novel alliance model to generate service paths for heterogeneous clientele consuming cultural, educational, health and social services. It was first to do so in Finland.Design/methodology/approachThis research is on a case study that used documents and interviews to examine the design of the horizontal accountability. The descriptive analysis focused on identifying what type of formal accountability system was designed (i.e. who is the account holder, and who is accountable and for what and why).FindingsAn imbalanced accountability system was identified because accountability obligations were unevenly distributed between public, private and third sector actors. The private sector was the most accountable for performance, and the third sector (i.e. voluntary sector) was the least accountable. As account holders, the public, private and third sector actors were judging their conduct as account providers. This created a biased horizontal accountability system. The hybrid's accountability system was dynamic because the contracts made to establish the hybrid included opportunities to change horizontal accountability if future changes to the external environment affect too drastically the potential to achieve the hybrid's goals.Originality/valueThree new concepts are proposed for studying dysfunctional accountability systems: dynamic, biased and horizontally imbalanced accountability.
This article analyses national policies, strategies, and programmes formulating knowledge management as a factor of national-level competitiveness. The article analyses a project, which aims to develop a service operator responsible for collecting and co-ordinating wellbeing data on the Finnish population. We present an in-depth analysis of an almost ten-year period in Finland, which is one of the leading societies in terms of public sector efficiency and governance. The article calls for a major shift in perspective and shows how hybridity of institutional logics significantly guides the perception of knowledge management, the measures taken and the development and selection of concrete methods and tools in knowledge management. We see the essence of public sector knowledge management in a combination of national-level knowledge governance and processes, where public institutions, private organisations and third-sector actors create, store and utilise a shared information base to convert knowledge into action in their everyday operations.
PurposeFragmentation can inhibit joint goals and performance measures. Therefore, the purpose of this study is to investigate the level of fragmentation between public, private and third sectors in a hybrid organization's performance management systems and the effects of this fragmentation to propose hypotheses and new research methods for future studies.Design/methodology/approachThe inductive research design was based on a mixed method approach. As empirical data, a survey, interviews and documents were used in this case study examining a hybrid organization called Welfare Alliance.FindingsThe results showed low-level fragmentation in the performance management system of the hybrid. Although the level of fragmentation was low-level, it affected the hybrid's ability to implement joint performance goals and measures. Performance management practices suffered as a consequence.Originality/valueAs a theoretical contribution to research addressing performance management in hybrids, the study proposes new concepts and theoretical hypotheses concerning fragmented performance management systems in hybrids. These theoretical hypotheses propose how performance goals and measures can become fragmented because they isolate service production units and activities from each other. The proposed hypotheses for future studies also attempt to provide explanations for how fragmentation can spread from one management function to another (i.e. from goal setting to performance measurement).
Value-based healthcare (VBHC) is a widely approved logic for financing services, using innovative care models and evaluating healthcare outcomes. It is consistent with the Triple Aim framework of simultaneously improving population health, patient experience and the costs of care. In Nordic countries, VBHC has been mainly implemented as a strategic concept in developing hospitals. Despite the evident interest in VBHC as a management trend in healthcare organisations, the studies concerning the implications of VBHC logics on health policies have been scant. This study aimed to fill this gap by building a conceptual bridge between national health policy and value-based care. Through the Triple Aim framework, we explored how VBHC goals have evolved in Finnish Government Programmes from 1995 to 2015 by using qualitative document analysis and interviews. The study addresses the evolution and national impacts of VBHC. Our results show that the goals of Triple Aim gradually become evident at the Finnish health policies. All three Triple Aim goals were present, though the equal prioritisation of these goals only emerged in 2015, also highlighting patient experience. We argue that VBHC logics have indeed affected Nordic welfare policies, not only at the organisational level but also concerning performance measurement and care delivery. This may imply that the diffusion of VBHC logics evolves from healthcare organisations to policymaking instead of top-down. Particularly in publicly financed systems, VBHC indicates a transformation to a new public governance ideology, accelerating policy goals that promote customer responsiveness and value creation for citizens.
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