École Nationale d'Administration Publique

CONTEXT: This article presents the main results from a large-scale analytical systematic review on knowledge exchange interventions at the organizational and policymaking levels. The review integrated two broad traditions, one roughly focused on the use of social science research results and the other focused on policymaking and lobbying processes. METHODS: Data collection was done using systematic snowball sampling. First, we used prospective snowballing to identify all documents citing any of a set of thirty-three seminal papers. This process identified 4,102 documents, 102 of which were retained for in-depth analysis. The bibliographies of these 102 documents were merged and used to identify retrospectively all articles cited five times or more and all books cited seven times or more. All together, 205 documents were analyzed. To develop an integrated model, the data were synthesized using an analytical approach. FINDINGS: This article developed integrated conceptualizations of the forms of collective knowledge exchange systems, the nature of the knowledge exchanged, and the definition of collective-level use. This literature synthesis is organized around three dimensions of context: level of polarization (politics), cost-sharing equilibrium (economics), and institutionalized structures of communication (social structuring). CONCLUSIONS: The model developed here suggests that research is unlikely to provide context-independent evidence for the intrinsic efficacy of knowledge exchange strategies. To design a knowledge exchange intervention to maximize knowledge use, a detailed analysis of the context could use the kind of framework developed here.

This paper reviews the literature on forms of leadership that in one way or other imply plurality: that is, the combined influence of multiple leaders in specific organizational situations. We identify four streams of scholarship on plural leadership, each focusing on somewhat different phenomena and adopting different epistemological and methodological assumptions. Specifically, these streams focus on sharing leadership in teams, on pooling leadership at the top of organizations, on spreading leadership across boundaries over time, and on producing leadership through interaction. The streams of research vary according to their representations of plural leadership as structured or emergent and as mutual or coalitional. We note tensions between perspectives that advocate pluralizing leadership in settings of concentrated authority and those concerned with channeling the forms of plurality naturally found in diffuse power settings such as professional organizations or inter-organizational partnerships. It is suggested that future research might pay more attention to social network perspectives, to the dynamics of plural leadership, to the role of power, and to critical perspectives on leadership discourse.

This paper reviews the literature on forms of leadership that in one way or other imply plurality: that is, the combined influence of multiple leaders in specific organizational situations. We identify four streams of scholarship on plural leadership, each focusing on somewhat different phenomena and adopting different epistemological and methodological assumptions. Specifically, these streams focus on sharing leadership in teams, on pooling leadership at the top of organizations, on spreading leadership across boundaries over time, and on producing leadership through interaction. The streams of research vary according to their representations of plural leadership as structured or emergent and as mutual or coalitional. We note tensions between perspectives that advocate pluralizing leadership in settings of concentrated authority and those concerned with channeling the forms of plurality naturally found in diffuse power settings such as professional organizations or inter-organizational partnerships. It is suggested that future research might pay more attention to social network perspectives, to the dynamics of plural leadership, to the role of power, and to critical perspectives on leadership discourse.

This article explores and extends the concept of hybridity to understand current changes in public services organizations, notably as seen from an organizational studies perspective. The notion of hybridity has become more important, given that the public sector increasingly blurs with other sectors and more social actors. Previous reliance on the use of ideal‐types in characterizing public services reforms has masked expanding heterogeneity. We here move beyond the (i) conventional focus on structural hybridity to consider (ii) institutional dynamics, (iii) social interactions, and (iv) new identities and roles in public services. Based on these four dimensions of hybridity, we review alternative theoretical frameworks. We suggest that bringing together work from the neighbouring disciplines of public administration and organization studies may improve our understanding of public services hybridity and outline a future research agenda.

This article proposes a cyclical theory of public entrepreneurship that is rooted in contextual conditions. The authors use material presented to the Institute of Public Administration of Canada for the annual innovation award, as well as an extensive literature review, to illustrate a new model for public entrepreneurship, arguing that today’s public entrepreneurs are teams and their actions are systemic. Public entrepreneurs do not create new artifacts, nor do they design grandiose projects, but they slowly reinvent their organizations and, in so doing, transform the systems that control government effectiveness and efficiency. The authors generalize and contextualize the idea of public entrepreneurship and structure the emergence of entrepreneurs into a cycle theory. The individual entrepreneur dominates when the organization is new or there is a need for novel activities. As the organization matures and the need for efficiency takes over, dominant individual entrepreneurship disappears, and with time, a new systemic entrepreneurship arises to tackle them.

The use of sustainable tourism indicators (STI) raises several issues, mainly because of the multiple interpretations of the concept of sustainable development, and by extension of the concept of sustainable tourism. It also brings to light incompatibilities between the needs and objectives of academics and policy-makers in developing a set of STI. The STI are then either scientifically relevant but too complex to be operational, or else they result from a political consensus, which could lead to conflicts of interest, such as in the destination branding strategy. In this paper, we argue that the trade-off between academic and policy-maker approaches to indicator development can be achieved through the development of core STI, based on the application of two sets of selection criteria to 507 expert-recognized indicators. The first set of criteria allows us to select 20 core STI, while the second set of criteria aims to match the selected indicators with a destination's policy framework in order to guarantee their usability. We illustrate the selection procedure using the Gaspésie region in Québec as a case study.

Drunks are accorded great social license in Oaxacan villages. They may shout insults, intrude uninvited into social gatherings, and behave in other normally unacceptable ways… [A]pparent inebriation serves to define a crucial role in village life: the licensed drunk pierces the elaborate information control devices of the community and provides the barefaced facts and opinions which normally go unspoken (Dennis 1975: 856, 862). As reflected in this epigraph, social license is not a new concept per se. In fact, social license has long been understood to play a vital function in society whereby social norms can precede and supersede legal rules.1 In this case, the community tolerates the drunk in exchange for his role in speaking truth to power. Alongside this older conception, however, over the past two decades an allied concept of social license to operate (SLO) has emerged, especially in the context of mining, oil and gas development, and other resource-related projects (Gehman et al. 2016; Raufflet et al. 2013). For instance, after mentioning the concept of social license in less than 10 articles a year from 1997 through 2002, news media mentioned social license in more than 1,000 articles a year from 2013 to 2015, and more than 2,000 articles in 2016.2 Given the increasing prominence of social media and Indigenous engagement, governments, journalists, and public administration scholars have become interested in the topic of social license to operate. Despite the term's growing popularity, however, the concept of social license to operate has so far had only tenuous scholarly footing. In this article, we attempt to remedy this problem by reviewing and analyzing existing literature, including journal articles, popular books, and reports from industry, consultants, and government. Rather than dismissing the concept, we aim to foster greater scholarly appreciation of the key concepts and diverse frameworks potentially implicated in discussions of social license to operate. Notably, our review identifies and synthesizes three different varieties of SLO. After highlighting some of the similarities and differences among these varieties, we investigate the linkages between SLO and legitimacy, paying attention to how the two concepts differ from and interrelate with one another. We then review methods that have been used to measure social license. Overall, our review demonstrates opportunities for more systematic and nuanced terminological use, while suggesting the need for further empirical and theoretical research. We close by discussing implications for stakeholder engagement, evolving models of regulation, and potential avenues for research. The first variety of social license, the pyramid model, was developed iteratively in a series of articles, papers, and presentations by mining industry consultants over the 14-year period from 2000 to 2013. Proponents credit James Cooney, then an executive at Canadian gold mining company Placer Dome, for inspiring the model (for reviews, see Black 2013; Boutilier 2014; Thomson and Boutilier 2011).3 In 1996, Placer Dome had been severely criticized after a tailings dam failed at one of its mines in the Philippines, releasing toxic mud into a river and burying a village (Boutilier 2014). More generally, mining was ranked the worst of 24 U.S. industries in a 1996 Roper opinion poll, behind even the tobacco industry (Thomson and Boutilier 2011). It was in this context in 1997 that Cooney reportedly characterized the industry's problems to World Bank officials as a matter of obtaining a “social license to operate.” World Bank personnel are said to have circulated the term at a May 1997 conference on mining and the community (Thomson and Boutilier 2011). A social license to operate exists when a mineral exploration or mining project is seen as having the approval, the broad acceptance of society to conduct its activities…Such acceptability must be achieved on many levels, but it must begin with, and be firmly grounded in, the social acceptance of the resource development by local communities (Joyce and Thomson 2000: 52). Usage in the industry became widespread thereafter. In a 2003 project sponsored by Newmont Mining Corporation, Business for Social Responsibility (BSR) published six case studies on social license in the mining industry, defining the concept as “gaining support for the project from concerned groups, or stakeholders, over and above meeting any legal requirements” (BSR 2003: 4). A convenience survey (n = 152) of mining industry participants conducted in 2005–2006 revealed that 78 per cent of respondents were familiar with the term “social license.”4 Whether previously familiar with the term or not, 81 per cent agreed that, intuitively, social license was an apt way to describe societal and community acceptance of the right to access and extract mineral resources; and 56 per cent reported that their organizations used the term or its underlying concepts (Nelsen 2007: 9–10). Looking back on these and other early efforts, scholars have concluded that the concept of social license to operate initially emerged as little more than a memorable turn of phrase, “a term largely invented by business, for business” (Morrison 2014: 14; see also Raufflet et al. 2013). Some years later, in an industry conference presentation, Thomson and Joyce (2008) expanded their definition of social license to operate to include three “normative components:” legitimacy, defined as “conforming to established norms…legal, social, cultural and both formal and informal;” credibility, defined as “the quality of being believed—the capacity or power to elicit belief;” and trust, defined as the “willingness to be vulnerable to risk or loss through the actions of another.”5 They further differentiated between project acceptance and approval, arguing that legitimacy is necessary for acceptance, but credibility and trust are necessary for approval. Boutilier (2014), also an industry consultant, credited Joyce and Thomson for: (a) being the first to define social license to operate in terms of legitimacy; and (b) proposing that social license to operate at the project level would promote reputation benefits at the corporate level.6 Thomson and Boutilier (2011; see also Boutilier and Thomson 2011; Thomson, Boutilier and Black 2011) later elaborated their definition into a multilevel pyramid model (see Figure 1). In this model, legitimacy distinguishes projects that have been rejected (that is, projects for which social license to operate has been withheld/withdrawn) from those that have been accepted by stakeholders through engagement with them according to the “rules of the game.” Credibility distinguishes projects that have been accepted from those that have been approved by stakeholders through formal negotiation, definition, and agreement on the roles and responsibilities of the company and stakeholders. Finally, trust distinguishes projects that have been approved from those for which stakeholders have adopted what they called a sense of co-ownership or psychological identification through collaborations, shared experiences, and vulnerabilities. More recently, the Australian Centre for Corporate Social Responsibility (ACCSR) adopted the pyramid model of social license to operate. Notably, the centre's managing director, Leeora Black (2013), has promoted the pyramid model as a “management framework for complex times.” The Pyramid Model (Adapted From Boutilier and Thomson 2011: 1784) A second variety of social license, what we refer to as the three strand model, was developed in a series of interrelated publications in 2003 and 2004 (Gunningham, Kagan and Thornton 2003, 2004; Kagan, Gunningham and Thornton 2003; Thornton, Kagan and Gunningham 2003). Whereas the originators of the pyramid model conceived of “social license to operate” as something of a dependent variable, which was in need of explanation, Gunningham and colleagues (Gunningham, Kagan and Thornton 2003: 2) started with a series of research questions: “Why has corporate environmental performance improved over time? Despite this improvement, why are some firms better environmental performers than others? How, and to what extent, can corporations be motivated to go beyond compliance with existing environmental regulations?” Ultimately, these research questions resulted in the inductive emergence of social license as one part of a larger explanatory framework. In other words, social license to operate emerged as something of an independent variable critical to explaining why some companies went beyond merely complying with environmental regulations, while other companies fell short of regulatory compliance. To answer their research questions, these scholars conducted an in-depth study of the environmental performance of 14 pulp mills located in the United States, Canada, Australia and New Zealand. Based on their findings, the authors proposed that companies in “closely watched industries” depend upon a multi-stranded license to operate: legal license, or the regulatory permits and statutory obligations embodying the demands of regulators, legislators, and judges; social license, or the demands of local, national, and international environmental activists, local community groups, and sometimes the general public; and economic license, or the profitability demands of top managers, lenders, and investors. In addition to their direct effects, the authors proposed that these different strands have interactive effects. Environmental groups may seek to enforce social license directly (for example, through shaming and adverse publicity), but also may attempt to influence economic license (for example, by generating consumer boycotts of environmentally damaging products) and legal license (for example, through citizen lawsuits or political pressure for regulatory initiatives). More recently, John Morrison (2014), executive director of the Institute for Human Rights and Business, proposed a variant of the three strand model (see Figure 2) that substitutes political license (that is, the authority that the government gives to any other organization to undertake a particular activity) for economic license (see also Brueckner et al. 2014 on the close link between politics and economics in the context of SLO). Although this may seem like a significant difference, it may be of little consequence. According to Morrison, the only time political license is not driven by economic considerations is if “you live in North Korea” (Morrison 2014: 22). The Three Strand Model (Adapted From Morrison 2014) Over the past decade, the original three strand model (Gunningham, Kagan and Thornton 2003, 2004; Kagan, Gunningham and Thornton 2003; Thornton, Kagan and Gunningham 2003) has spawned a variety of follow-on work. Lynch-Wood and Williamson (2007) examined whether social license concerns are sufficient to entice smaller firms to go beyond regulatory compliance in their environmental performance. They identified five factors that comprise social license—environmental impact of the firm's products and processes; customer power; customer interest; corporate/brand visibility; and community pressure—and argued that at least two of these factors must be salient for a small and medium enterprise (SME) to go beyond compliance. They concluded that for most SMEs, none of these five factors are significant enough to encourage going beyond compliance, and therefore, regulators cannot depend on social license considerations to either incentivize or sanction these firms. Thornton, Gunningham, and Kagan corroborated this conclusion in two studies of the U.S. trucking sector (Thornton, Kagan and Gunningham 2003, 2009). In these works, social license was defined as pressure from communities, advocacy groups, employees, and the news media. They concluded that, due primarily to low social visibility, environmental decisions in small trucking firms are driven almost entirely by economic license, and that social license pressures faced by these firms are very weak. Howard-Grenville, Nash, and Coglianese (2008), contributed to this discussion by showing that organizational activities beyond compliance are not solely driven by external factors, such as social license concerns. They examined the impact of five internal factors (managerial incentives, organizational culture, organizational identity, organizational self-monitoring, and personal affiliations and commitments) in 10 companies, five of which were participating in the U.S. Environmental Protection Agency's voluntary National Environmental Performance Track program. The authors found that firms in the two groups differed on company identity, self-monitoring, and managerial incentives and concluded that along with external regulatory, social and economic factors, internal factors significantly influence a company's willingness to go beyond compliance. The third variant of social license, the triangle model, is based on the concept of social acceptance that emerged in the 1970s and 1980s amid the first concerted efforts to develop renewable energy policies. Whereas the pyramid model conceives of social license to operate as an outcome worthy of explanation and the three strand model conceives of social license as part of the explanation for environmental performance that goes beyond regulatory requirements, the triangle model conceives of social license as resulting from a threefold set of “acceptance processes.” Namely, these researchers conceived of social acceptance as building confidence, familiarity, and trust in environmentally-friendly, but unproven technologies. Social acceptance is considered necessary to generate policy maker support for the financial and regulatory incentives required to overcome entrenched interests and the path dependency of conventional fossil fuel energy systems. Initially, the problem of social acceptance was largely neglected, in part because public opinion surveys indicated very high levels of support for renewable energy options. However, Carlman (1984) showed that public opinion surveys did not necessarily translate into public, political, and regulatory acceptance of renewables, such as wind power. More recently, Wüstenhagen, Wolsink and Bürer (2007: 2683) highlighted social acceptance as “a powerful barrier to the achievement of renewable energy targets.” As shown in Figure 3, they distinguished three dimensions: socio-political acceptance, or the broadest, most general level of social acceptance of both policies and technologies by the public, key stakeholders (that is, employees) and policymakers (see also Jegen and Philion 2017); community acceptance, or “the specific acceptance of siting decisions and renewable energy projects by local stakeholders, particularly local residents and local authorities” (Wüstenhagen, Wolsink and Bürer 2007: 2685), which may vary over time; and market acceptance, or the process of widespread adoption of an innovation. In particular, energy projects are embedded in complex multisided infrastructures that involve consumers, investors, and producers. The Triangle Model (Adapted From Wüstenhagen, Wolsink and Bürer 2007) This three-pronged distinction continues to provide a useful point of departure for this literature. Public opinion polls tend to show that while the general public remains favourable to the idea of wind, solar, biomass, wave, geothermal, and other renewable energy technologies (socio-political acceptance), host communities are not as supportive (community acceptance) (Devine-Wright 2011; Pasqualetti 2011). Findings show evidence of a “social gap” (Bell et al. 2013; Bell, Gray and Haggett 2005) between public support for the general goal of more wind energy and the level of local support for specific projects. Policymakers, renewable energy developers, and other experts tend to view those who oppose local renewable energy projects and adopt a not-in-my-backyard (NIMBY) position as ignorant and uninformed. Evidence indeed shows that some members of host communities take the NIMBY position (Walker, Baxter and Oulette 2014; Wolsink 2000, 2007). However, researchers strive to understand opponents on their own terms (Aitken 2010; Devine-Wright 2011), and some (for example, Cohen, Reichl and Schmidthaler 2014) have argued that NIMBY is a rational reaction that should be recognized and remedied through policies that compensate individuals for costs associated with living close to renewable energy projects. Batel et al. (2013) made important conceptual critiques of the term “social acceptance,” pointing out that scholars tend to erroneously conflate acceptance with support. They showed that residents react differently when asked if they would accept vs. support an energy project. “Acceptance” implies a more passive relationship to an energy project. Likewise, Walker and Cass (2007) observed that scholars (and policymakers) tend to view members of the public as falling on a spectrum between support for and opposition to such projects; however, members of the public also play other roles, as service users, investors, owners, lessors/lessees of land or buildings, captive consumers, protestors and more. The point is that acceptance and support implies a degree of agency that is not necessarily realistic. Due to decentralized energy distribution, a wind farm's operations involve thousands of disparate members of the public who may be totally unaware of their use of renewable sources of energy. In this sense, active “acceptance” is an imprecise term for the many forms of social relations that exist as renewables develop. Although only a few renewable energy scholars have adopted the term “social license” (for instance, see Corscadden, Wile and Yiridoe 2012; Hall and Jeanneret 2015), several have described local opposition as serving the necessary political function implied by the use of the legal/political term “license.” Barry and Ellis (2010) argued for new planning models that minimize the use of arbitrary authority to approve renewable energy generation facilities, and Ellis et al. (2009) noted that dissent serves an important purpose in democracies and that the critiques of renewable energy development can better inform societal decision-making. Thus, the social acceptance or social gap concept relates closely to social license through a shared emphasis on issues of legitimacy. Despite their very different origins, all three varieties of social license invoke legitimacy. This is perhaps not surprising, since the concept of legitimacy “dates back to the dawn of organization theory” (Deephouse and Suchman 2008: 49; see also Deephouse et al. 2017; Suddaby, Bitektine and Haack 2017). Max Weber (1978) is typically credited with introducing the term into social theory, and for linking legitimacy with conformity to social norms and formal laws. In their classic work, Dowling and distinguished three of organizational and “a purpose not necessarily resource resource necessarily in a society are with societal norms and these are apt to be (a) in the two may take at different (b) are in is a greater of in legal and may activities model many of the three varieties of social license, especially the three strand model and the triangle More recently, these in his is not a to be or but a cultural or with or However, it was Suchman who what has become perhaps the most definition of “a or that the actions of an are or some of and is on an organization when is, internal and external by organizational and support an and and legitimacy have been described as being an active of the and or a passive on from or other opinion with and Haack 2011). or products are most the of legitimacy stakeholders also can be as to whether they have based upon legal legal or in the and benefits by company and Looking these one is by the to which legitimacy has become a and concept the social one that a by diverse stakeholders. the of legitimacy also have been and differentiated legitimacy, or “the of a new from legitimacy, or “the process by which key stakeholders, the general public, key opinion or government officials accept a as and existing norms and this in resulting in three of and with one of his three In a Suchman proposed a of and legitimacy with two vs. and two actions vs. organizational resulting in legitimacy to issues of energy and resource development, and proposed the concept of corporate environmental legitimacy, defined as the or that a firm's corporate environmental performance is or Public administration scholars also have with the concept of legitimacy, in terms of and The emergence of social license a or a from and to a more 2013). this as from of the of policy as as from officials as the this “social which with of “social public administration scholars have observed that that are not in the sense that they are not to of legal review and and a definition of social license to operate by also the role of legitimacy. Notably, and defined social license to operate as a for the legitimacy of a company's specific or an or a or political by to the of all concerned with Looking these what is is the of of legitimacy and social license (see 1). it may be to that social license to operate is more than a new for the concept of legitimacy, are useful social license to operate is used to describe acceptance of a company or project to with its This to be a of a company by its stakeholders. the of legitimacy can be is used to of a it also can be the company's of its stakeholders, or of other (for example, and the pyramid model that social license is in a company acceptance by the then by with stakeholders, and then identification through building research into legitimacy building not a company not have then and then legitimacy with its stakeholders. may be in such a but not necessarily and Haack include of the of the and and and The credibility of (that is, regulators, can to on the of these while or can to the 2011; see also and the three strand and triangle models of social license stakeholders according to their interests in the company or project. acceptance is a function of the company's technologies and policies meeting or regulatory community acceptance on and and market acceptance on new technologies to economic how a company is along the of legitimacy is not necessarily a function of who is the can and a project according to of legitimacy, such understand what the company is they the this project for and they the We to these in our implications to how legitimacy research can SLO in the Canadian such the of stakeholders into and of in terms of shared or in the context of the of the in the social of to with the cultural with “the norms of in the larger social and 1975: that are accepted and a context are then said to be that context of established cultural that for and A of organizational actions as or some of and of an organization by social (Deephouse of the organization by its and social of acceptance, and level of social acceptability upon a set of activities or and degree to which view a company's activities as and because its with industry norms and societal and the approval, the broad acceptance of society to conduct its (Joyce and Thomson 2000: “social support for the project from concerned groups, or stakeholders, over and above meeting any legal requirements” (BSR 2003: The right of and other in and to their and of a project 2003: demands on and for a enterprise that from environmental groups, community and other of the (Gunningham, Kagan and Thornton 2003: idea that must with of regulators, local communities, and the public in to and Coglianese 2008: the local community and other (Thomson and Boutilier 2011: and political approval, widespread and to legal to and to community of social acceptance or a that company or project has a in the and

Public sector organizations are under pressure to adopt private sector tools to sustain legitimacy despite uncertainty about the compatibility of the techniques with this context. We explore the consequences of the misfit between the theories underlying two widely adopted managerial techniques (strategic planning and quality management) and the pluralistic power structure and values of public hospitals. We identify four scenarios of adaptation and use qualitative data to examine their empirical prevalence. We suggest that when the compatibility gap is large, there is greater likelihood that formalized techniques will be captured by and integrated into existing organizational dynamics (corruption of the technique) than that the technique will change these dynamics in a way consistent with its objectives (transformation of the organization). We examine the implications of our observations for understanding the role of managerial techniques in organizational change.

Abstract Purpose The purpose of this paper is to introduce the special issue and outline its major themes and challenges, their relevance and the research opportunities the field presents. Design/methodology/approach The paper reviews prior literature and outline's the need to analyse challenges for corporate governance and accountability of state-owned enterprises (SOEs) as a precursor to introducing the contributions to this special issue. Findings Corporate governance, accounting and accountability of SOEs are crucial and growing topics in public management and other research disciplines. Public service provision and budget consolidation cannot be realized effectively and efficiently without powerful governance and management of SOEs. However there are significant corporate governance challenges and important empirical research gaps in comparison to other fields. Broader theoretical perspectives, methodological approaches, accountability mechanisms and sector/context are identified and discussed and encouraged in future research. Research limitations/implications This paper aims to stimulate interdisciplinary research on emerging issues affecting governance and accountability of SOEs considering their growing importance in the society and their changing nature. Practical implications Effective mechanisms and good practices may contribute to better performance of SOEs. Findings may help politicians, administrations, board members, auditors, consultants, scholars and the media striving for improvements around the world. Originality/value The paper condenses theoretical and empirical findings to highlight the relevance of this field and important research gaps. The special issue offers an empirical examination of interdisciplinary literature and innovative experiences of SOEs to strengthen public service motivation, board composition and roles, trust and control, transparency, public value and to enhance the ability to manage, steer and monitor contracts, performance and relationships.

Headline Evaluating service innovations in health care and public health requires flexibility, collaboration and pragmatism; this collection identifies robust, innovative and mixed methods to inform such evaluations.

AIM: To report on an analysis of the concept of the sustainability of healthcare innovations. BACKGROUND: While there have been significant empirical, theoretical and practical contributions made towards the development and implementation of healthcare innovations, there has been less attention paid to their sustainability. Yet many desired healthcare innovations are not sustained over the long term. There is a need to increase clarity around the concept of innovation sustainability to guide the advancement of knowledge on this topic. DESIGN: Concept analysis. DATA SOURCES: We included literature reviews, theoretical and empirical articles, books and grey literature obtained through database searching (ABI/INFORM, Academic Search Complete, Business Source Complete, CINAHL, Embase, MEDLINE and Web of Science) from 1996-May 2014, reference harvesting and citation searching. METHODS: We examined sources according to terms and definitions, characteristics, preconditions, outcomes and boundaries to evaluate the maturity of the concept. RESULTS: This concept is partially mature. Healthcare innovation sustainability remains a multi-dimensional, multi-factorial notion that is used inconsistently or ambiguously and takes on different meanings at different times in different contexts. We propose a broad conceptualization that consists of three characteristics: benefits, routinization or institutionalization, and development. We also suggest that sustained innovations are influenced by a variety of preconditions or factors, which are innovation-, context-, leadership- and process-related. CONCLUSION: Further conceptual development is essential to continue advancing our understanding of the sustainability of healthcare innovations, especially in nursing where this topic remains largely unexplored.

International audience

SUMMARY Auditor independence, which has certainly been one of the most addressed topics in auditing literature, is a complex and ambiguous construct that can be analyzed along two dimensions. The first dimension, organizational independence, relates to auditors' willingness to act in accordance with professional standards and to report errors found during the audit. The second dimension, operational independence, relates to auditors' capability to work diligently and effectively in order to detect material anomalies. Surprisingly, “much of the debate has [so far] focused on the former,” while the latter has remained largely “under-discussed” (Power 1999, 132), if not ignored. In this paper, based on ethnographic data and semi-structured interviews, we examine the realities of auditors' operational independence and discuss the practical and theoretical implications of our findings. Our evidence suggests that auditors' operational independence is both unsettled in practice and impossible to achieve through institutional measures alone. This view may challenge orthodox and regulatory conceptions of audit, but the smooth conduct of an audit engagement largely depends on the auditees' desire to cooperate. In order to arouse and maintain this desire, audit team members resort to a number of relational strategies that aim at securing their capability to work with diligence and efficacy, but that can also undermine their willingness to take enforcement action when necessary. Audit, therefore, appears to be a complex balancing act between capability and willingness. Ultimately, it is shown that because official arrangements designed to guarantee operational independence are unlikely to be effective, the reality of auditor independence remains highly uncertain and needs to be constantly negotiated and renegotiated in the field.

This article draws on recent developments in institutional theory to better understand the managerial efforts implicated in the implementation of government-led reforms in public sector services. Based on a longitudinal study of a massive reform effort aimed at transforming the province of Quebec’s publicly-funded healthcare system, the article applies the notion of institutional work to understand how managers responsible for newly formed healthcare organizations defined and carried out their individual missions while simultaneously clarifying and operationalizing the government’s reform mandate. We identify and describe the properties of four types of work implicated in this process and suggest that structural work, conceptual work, and operational work need to be underpinned by relational work to offer chances for successful policy reform. By showing the specific processes whereby top-down reform initiatives are taken up by managers and hybridized with existing institutionalized forms and practices, this article helps us better understand both the importance of managerial agency in enacting reform, and the dynamics that lead to policy slippage in complex reform contexts.

Organizational evaluation capacity building has been a topic of increasing interest in recent years. However, the actual dimensions of evaluation capacity have not been clearly articulated through empirical research. This study sought to address this gap by identifying the key dimensions of evaluation capacity in Canadian federal government organizations. The methodology used, based on Leithwood and Montgomery’s Innovation Profile approach, featured semistructured interviews with evaluation experts and a validating exercise conducted in four government organizations. The framework developed as a result of the study identifies six main dimensions of evaluation capacity (human resources, organizational resources, evaluation planning and activities, evaluation literacy, organizational decision making, and learning benefits), each one broken down into further subdimensions. The evaluation capacity of organizations on each of these dimensions and subdimensions can be described using four levels: low, developing, intermediate, and exemplary. The study found that government organizations vary in terms of their capacity from one dimension to the next, and indeed, from one subdimension to the next.

BACKGROUND: Funding agencies constitute one essential pillar for policy makers, researchers and health service delivery institutions. Such agencies are increasingly providing support for science implementation. In this paper, we investigate health research funding agencies and how they support the integration of science into policy, and of science into practice, and vice versa. METHODS: We selected six countries: Australia, The Netherlands, France, Canada, England and the United States. For 13 funding agencies, we compared their intentions to support, their actions related to science integration into policy and practice, and the reported benefits of this integration. We did a qualitative content analysis of the reports and information provided on the funding agencies' websites. RESULTS: Most funding agencies emphasized the importance of science integration into policy and practice in their strategic orientation, and stated how this integration was structured. Their funding activities were embedded in the push, pull, or linkage/exchange knowledge transfer model. However, few program funding efforts were based on all three models. The agencies reported more often on the benefits of integration on practice, rather than on policy. External programs that were funded largely covered science integration into policy and practice at the end of grant stage, while overlooking the initial stages. Finally, external funding actions were more prominent than internally initiated bridging activities and training activities on such integration. CONCLUSIONS: This paper contributes to research on science implementation because it goes beyond the two community model of researchers versus end users, to include funding agencies. Users of knowledge may be end users in health organizations like hospitals; civil servants assigned to decision making positions within funding agencies; civil servants outside of the Ministry of Health, such as the Ministry of the Environment; politicians deciding on health-related legislation; or even university researchers whose work builds on previous research. This heterogeneous sample of users may require different user-specific mechanisms for research initiation, development and dissemination. This paper builds the foundation for further discussion on science implementation from the perspective of funding agencies in the health field. In general, case studies can help in identifying best practices for evidence-informed decision making.

The public administration literature has consistently questioned the validity of satisfaction surveys as a measure of government performance, particularly in comparison with more objective official measures. The authors examine this objective-subjective debate using unique data from a large survey distributed to nearly 1 million parents of children in the New York City public schools along with officially reported measures of school performance for about 900 schools. Their results suggest that the official measures of school performance are significant and important predictors of aggregate parental satisfaction, even after controlling for school and student characteristics. They conclude that public school parents form their satisfaction judgment in ways that correspond fairly closely with officially measured school performance. The results can also be interpreted as suggesting that the official performance measures reflect, at least in part, aspects of public schooling that matter to parents.

BACKGROUND: While healthcare systems vary in their structure and available resources, it is widely recognized that medical doctors play a key role in their adaptation and performance. In this article, we examine recent government and organizational policies in two different health systems that aim to develop clinical leadership among the medical profession. Clinical leadership refers to the engagement and guiding role of physicians in health system improvement. Three dimensions are defined to conduct our analysis of engaging medical doctors in healthcare leadership: the position and status of medical doctors within the system; the broader institutional context of governmental and organizational policies to engage medical doctors in clinical leadership roles; and the main factors that may facilitate or limit achievements. METHODS: Our aim in this study is exploratory. We selected two contrasting cases according to their level of institutional pluralism: one national health insurance system, Canada, and one etatist social insurance system, the Netherlands. We documented the institutional dynamics of medical doctors' engagement and leadership through secondary sources, such as government websites, key policy reports, and scholarly literature on health policies in both countries. RESULTS: Initiatives across Canadian provinces signal that the medical profession and governments search for alternatives to involve doctors in health system improvement beyond the limitations imposed by their fundamental social contract and formal labour relations. These initiatives suggest an emerging trend toward more joint collaboration between governments and medical associations. In the Dutch system, organizational and legal attempts for integration over the past decades do not yet fit well with the ideas and interests of medical doctors. The engagement of medical doctors requires additional initiatives that are closer to their professional values and interests and that depart from an overly focus on top down performance indicators and competition. CONCLUSIONS: Different institutional contexts have different policy experiences regarding the engagement and leadership of medical doctors but seem to face similar policy challenges. Achieving alignment between soft (trust, collaboration) and hard (financial incentives) levers may require facilitative conditions at the level of the health system, like clarity and stability of broad policy orientations and openness to local experimentation.

Purpose – The purpose of this paper is to examine the challenges that health care organizations face in nurturing and sustaining cultures that ensure the delivery of continually improving, high quality and compassionate care for patients and other service users. Design/methodology/approach – Based on an extensive review of the literature, the authors examine the current and very challenging context of health care and highlight the core cultural elements needed to enable health care organizations to respond effectively to the challenges identified. Findings – The role of leadership is found to be critical for nurturing high-quality care cultures. In particular, the authors focus on the construct of collective leadership and examine how this type of leadership style ensures that all staff take responsibility for ensuring high-quality care for patients. Practical implications – Climates for quality and safety can be accomplished by the development of strategies that ensure leaders, leadership skills and leadership cultures are appropriate to meet the challenges health care organizations face in delivering continually improving, high quality, safe and compassionate patient care. Originality/value – This paper provides a comprehensive integration of research findings on how to foster quality and safety climates in healthcare organizations, synthesizing insights from academic literature, practitioner reports and policy documents to propose clear, timely and much needed practical guidelines for healthcare organizations both nationally and internationally.

Purpose The purpose of this paper is to synthesize insights from the emerging work in accounting on greenwashing and sustainability assurance and propose an agenda for future research in this area. Design/methodology/approach This article offers an original analysis of papers published on greenwashing and sustainability assurance research in the field of accounting. It adopts a systematic literature review and a narrative approach to analyse the dominant themes and key findings in this new and rapidly evolving field. From this overview, specific avenues for future research are identified. Findings In the past few years there has been a substantial spike in concern relating to greenwashing among academics, practitioners, regulators and society. This growing concern has only partly been reflected in the research literature. To date, research has primarily focused on: (1) the characteristics of firms adopting sustainability assurance, (2) the challenges facing sustainability auditors, (3) the development of appropriate assurance standards and regulations, and (4) capital market responses to greenwashing and sustainability auditing/assurance. Three key future research issues with respect to greenwashing are identified: (1) the future of standard-setter attempts to regulate greenwashing, (2) professional jockeying in sustainability reporting assurance, and (3) capital market opportunities and challenges relating to greenwashing and assurance. Originality/value Despite the profound economic and reputational impact of greenwashing and the rapid development of sustainability assurance services, research in accounting remains fragmented and emergent. This review identifies avenues offering considerable scope for inter-disciplinarity and bridging the divide between academia and practice.