Haldor Byrkeflot and Karsten Vrangbaek
The debate on accountability within the public sector has been lively in the past decade. Significant progress has been made in developing conceptual frameworks and typologies for characterizing different features and functions of accountability. However, there is a lack of sector specific adjustment of such frameworks. In this chapter we present a framework for analyzing accountability within health care. The chapter makes use of the concept of “accountability regime” to signify the combination of different accountability forms, directions and functions at any given point in time. We show that reforms can introduce new forms of accountability, change existing accountability relations or change the relative importance of different accountability forms. They may also change the dominant direction and shift the balance between different functions of accountability. The chapter further suggests that developments in accountability regimes are best analyzed with a combination of top-down and bottom up perspectives and that there is a need to develop research strategies to support this aim.
Every activity of a public administration has an informational and a communicative aspect. Therefore, it may be expected that the institutionalization of electronic information and communication technologies (ICTs) in public administration would have a fundamental impact on the way in which public administration functions. Although this basic assumption is generally adhered to, it is not uncontested. This article first presents the shifts in management attention during the early phases of ICT use within public administration. Second, some theoretical approaches to informatization are discussed. Third, the dominant focus of public managers on effectiveness, efficiency, and economy as the main purpose of the use of ICTs in the implementation of policies are highlighted. Fourth, the growing emphasis on service delivery with ICTs are commented upon. Fifth, the democratic possibilities of ICT applications are discussed. Finally, the main strategic challenges of e-Government for public management, in terms of the technical, organizational and institutional barriers that will have to be surmounted, are demonstrated.
The application of information and communication technology to support health care organization, management, and delivery is high on the health policy agenda in many countries, and its implementation has become a significant issue. Despite optimistic expectations and increasing investment in e-health, the anticipated benefits are often elusive. This chapter reviews the factors driving the development of e-health before introducing a conceptualization of e-health focused on the management and use of health care information at the point of care, between health care providers and, ultimately, by health care consumers. The chapter then explores a range of issues that render e-health implementation problematic. In particular, implementing e-health is both a complex and emergent process that requires consideration of local health care contexts, and a socio-technical problem involving changes in work processes, interactions, and behaviors.
Huw Davies, Alison Powell, and Sandra Nutley
This chapter uses “knowledge mobilization” as an umbrella term to cover activities aimed at collating and communicating research-based knowledge within the health care system and within health care organizations. It explores the nature, use and flow of knowledge, focusing in particular on the role of research-based knowledge and its interactions with other forms of knowing, and on the organizational and management arrangements for health care delivery rather than on evidence-based practice per se. The chapter is underpinned by the premise that knowledge flow in health care is often slow, intermittent and uncertain. Specific, active, knowledge mobilization strategies that take account of context, politics and the individuals and groups involved are therefore needed to help ensure that research-based knowledge informs policy and practice.