<p> Problem: The problem this study investigated is the phenomenon of a small but growing group of activist political leaders who are redefining public sector governance by reshaping the organizations they lead, thereby improving the institutional environments of hitherto moribund public agencies. The study explored the unique dispositions, skills, values, and/or behaviors of this class of leaders in order to provide an understanding of their emergence in terms of their development, decision-making and other personal leadership characteristics that evolved into their 'activist' nature. The purpose of this research was to develop a grounded theory regarding how the leadership competencies/qualities exhibited by this new breed of public sector leaders support the achievement of &lsquo;above-the-norm&rsquo; organizational performance in the public sector, despite the constraints of weak governance institutions within their specified contexts. The study has its conceptual framework drawn from the notions of effective leadership from a personal leadership perspective, as described in the works of Greenstein (1979) and, Mumford (2006). </p><p> Method: The method of investigation adopted for this study was a &lsquo;grounded theory&rsquo; approach (Strauss &amp; Corbin, 1994, p. 273), a general methodology of qualitative research designed to build substantive theory based on the systematic collection and analysis of data. Data collection was primarily by open ended narrative interviews with a purposive sample of seven public sector leaders who had been (a) identified by perceived improvement in organizational performance during their tenure in public office (b) their leadership activism as demonstrated in their use of public office to effect social change within their leadership context (c) held public sector leadership role for a minimum of three years (d) in leadership at national and/or sub-national levels and (e) validated by a subject matter expert. In addition, four (4) key informants were interviewed &ndash; who is either a past/present associate/subordinate of five (5) of the leader(s) interviewed in the study. </p><p> Results: Three major themes emerged from my interviews with the leaders: (a) their managerial and personal approach; (b.) their cognitive disposition to achieving good governance outcomes; and (c.) their pragmatic leadership approach to resolving leadership challenges of weak institutional contexts. These leaders are able to deliver effective leadership despite weak institutional/governance frameworks, not by using a specific leadership technique; but rather by manifesting their own personal convictions for achieving results&mdash;convictions that emerges from a matured conceptualization of their self-integration process. </p><p> Conclusion: The study concludes that leaders&rsquo; personal characteristics, understanding of self-concepts, and a pragmatic approach empower them to successfully create a compelling personal vision that has a clear ethical framework. They combine these with the capacity to use their social and emotional competencies to achieve results. The study further claims that producing leaders who successfully lead public organizations effectively is the responsibility of many parts of the &ldquo;ecosystem&rdquo; of public leadership.</p><p>

<p> This study explores whether and how government services originally designed to meet the needs for homeless veteran men are being modified to address the unique needs and circumstances facing the current population of homeless veteran women. (Abstract shortened by UMI.)</p>

<p> This dissertation contains three essays on state and local economic development incentives. The primary mission of state and local governments is to reduce unemployment and bolster tax revenues. One way in which governments accomplish these goals is by using economic development subsidies and policies at their disposal. States statutorily authorize a range of economic development incentives (e.g. tax abatements, tax increment financing, enterprise zones, etc.). Local governments are empowered to take advantage of this authorization and use these tools to attract firms and people as a means to grow their own economies. However, not all state governments authorize every type of economic development incentive. Additionally, local governments do not utilize each type of economic development incentive, even when authorized to do so by the state. What determines the usage of these policies at the local level has been the subject of much research; however, this literature has failed to account for state-level authorization. Therefore, what is known about the &ldquo;determinants&rdquo; of economic development incentive utilization at the local level is theoretically and empirically flawed. The first essay addresses this issue by restricting the analyses to only those local governments that have statutory authorization to make use of these incentives, and compares these findings to the full set of cases with and without state authorization as is characteristics of the previous literature. Differences in magnitudes and significance levels are highlighted.</p><p> Increasingly governments are interested in determining the economic impact of their policies. The second essay uses difference-in-differences and triple differences models to evaluate the employment, payroll, and establishment effects of state Earned Income Tax Credits (EITC) in metropolitan areas that span more than one state where one side of the border has an EITC and the other does not. Given that states decide whether, when, and at what level to authorize these credits, this variation across states allow for a test of the impact of these policies on local economic outcomes.</p><p> While a good deal is known about why state and local governments use economic development policies, and how to evaluate these policies, little is known about the factors that contribute to the abandonment of economic development policies at state and local levels of government. Essay three explores the characteristics and context for policy abandonment of economic development policies at both levels of government. Using Fuzzy Set Qualitative Comparative Analysis (fsQCA), and regression-based models, this essay estimates the impact that political, economic, and social factors have on the abandonment of these policies. Additional research within local governments highlights the relative importance of each of factor in determining the propensity for policy abandonment.</p>

<p> The role of public school superintendent is complex, challenging, political, and sometimes volatile. A shortage of candidates has plagued California during the past 10 years, due to high turnover rates resulting from the fallout of the NCLB punitive reform measures, increasing baby boomer retirements, and a reluctance of district leaders to step up to this demanding position. This top leadership role is unlike any other in K-12 education, due to the responsibilities with outside constituents and the advisory relationship with the school board. The purpose of this qualitative study was to document and explore the experiences of California public school superintendents who participated in leadership or executive coaching as a form of professional development and support while serving in this position. Data was collected through interviews with superintendents who agreed to participate. These interviews were transcribed and coded through the lens of the eight AASA Professional Standards for the Superintendency. This study sought to determine the efficacy of coaching as a support tool for superintendents with respect to their ability to lead in their positions. The coded results of the interviews were focused on the eight standards that included: 1) Strategic Leadership and District Culture, 2) Policy and Governance, 3) Communications, 4) Leadership and Organizational Management and School Finance, 5) Curriculum Planning ad Development, 6) Instructional Management, 7) Staff Evaluation and Personnel Management, 8) Values and Ethics. The qualitative components of the study were gathered through purposive sampling. Email invitations to participate were sent to targeted superintendents in seven counties in California. Analysis of the data revealed that superintendents who participated in leadership or executive coaching received a blended model of coaching which included mentoring and coaching strategies. All of the superintendents in this study received support in more than one of the eight areas of the AASA Professional Standards for the Superintendency. The study revealed that coaching supported superintendents in all of the eight standard areas. Retired superintendents provided all of the coaching support, except in one case. Every superintendent had a positive experience with coaching support.</p>

<p> Over the past two decades, development assistance for health and government health expenditure have both increased substantially. Despite the rise in public attention and funding levels internationally, there has been little empirical exploration of budgetary trends in global health funding. Through the use of public budgeting and finance theories, these three studies in aim to increase understanding of the flow of health funds between and within donor and recipient countries through time. Application of Punctuated Equilibrium Theory (PET) to multiple datasets of national health financing data illustrates a leptokurtic distribution for both own domestic health (government health expenditure) and other health (development assistance for health) spending. The distribution of change in government health expenditure by 15 OECD donor countries was found to be less punctuated that their development assistance for health to developing countries from 1990-2012, suggesting smoother, more constant pressures for &ldquo;own health&rdquo; spending versus spending for global health. Comparison of country-level annual changes in government spending on domestic health for 145 countries between 1995 and 2012 illustrated that overall, and when grouped by income, the distributions of countries&rsquo; pooled annual changes in government health spending were leptokurtic. There was a greater departure from the normal distribution as country income decreased across the highest and two lowest income groups, and the proportion of annual changes that were positive decreased. However, the high-income non-OECD and upper-middle income groups diverged from this trend in interesting ways. Empirical exploration of the changing organizational composition of the field through the lens of population ecology provides greater context for the funding trends in global health with a particular focus on the emergence of public private partnerships. Application of the Herfindahl-Hirschman Index (HHI) found a decrease in concentration in the organizational field of global health between 1990 and 2000, followed by stability in the field despite the introduction of a new organizational form. Over this period, there were increases in &lsquo;market&rsquo; shares for non-profit organizations and PPPs within the global health organizational population. The grant making-behavior directed through PPPs by a significant US bilateral agency was explored to identify patterns in decision-making related to PPP lifespan, disease focus, program type, regional focus, implementing partner categories and financial commitment, as well as recession impact. The limited empirical research concerning actors in global health funding emphasizes the need for further exploration of this phenomenon.</p>

<p> This dissertation examined the literature of cutback management in the context of the Great Recession. Specifically, it studied the relationship between cutback management policies used by county governments during the recession and revenue changes. </p><p> The purpose of this dissertation was to test whether or not the percent change in revenue had an impact on the probability that cutback management policies were used in the recession. According to the cutback management literature developed in the 1970s and 1980s, there should be a relationship. </p><p> The theoretical framework used for this study was the rational-approach framework, which proposes that every expenditure reducing and revenue increasing policy is enacted based on the percent decrease in revenue the government faces. This suggests that the cutback management policies are a proportional response to revenue decline. The framework was operationalized by using a binary logistic regression that used policy enactment as the dependent variable and the percent change in revenue as the independent variable. Eighty-six counties were sampled and 7 years of each county&rsquo;s budget book were examined for policies and financial data. </p><p> The research found that eleven expenditure policies and three revenue policies had a statistically significant relationship with the percent change in revenues. This resulted in the conclusion that the framework and, therefore, the cutback management literature were useful in explaining primarily expenditure policies.</p>

<p> Since the inception of the U.S. Environmental Protection Agency (EPA), considerable emphasis has been placed on the use of prospective policy analysis tools that aim to inform environmental decisions, including cost-benefit analysis and risk assessment. However, compared to the prevalence of <i> ex ante</i> analysis at the EPA to inform decisions, relatively little evaluation of these same environmental policies is conducted after implementation, to inform future policy development or to modify existing policies. </p><p> This dissertation applied accountability, organizational learning, evaluation capacity, and institutionalism literature in consideration of processes and determinants that affect evaluation supply at the EPA. The dissertation relied on archival documents, semi-structured interviews, and three embedded case studies of EPA&rsquo;s ambient air, hazardous waste, and performance partnership programs. Ten key factors were identified across the three case studies in this research that affect EPA's production of program evaluation to inform decision-making, and a new emergent model of evaluation capacity was proposed for EPA given the agency's regulatory structure. This research concludes that evaluation has much to offer EPA decision-makers, and efforts to improve evaluation capacity will present organizational learning opportunities that can further support the agency's evidence-building practices, specifically improving the application and use of program evaluation at EPA.</p>

<p> Excessive college student drinking is a complex problem associated with a range of consequences including deaths, injuries, damage, health risks, legal difficulties, and academic problems. State governing boards, trustees and executives have enacted policies aimed at reducing the negative effects of excessive drinking. This study examined influences on university staff members responsible for implementation of alcohol-control policies. Deeper understanding of factors influencing alcohol-control policy implementation may help leaders improve policy making, implementation and attainment of policy objectives. </p><p> This mixed methods study utilized a sequential transformative mixed methods strategy with a quantitative survey, sequenced first, informing the prioritized qualitative multiple case study. Research was conducted at two public universities selected from a single state. In the quantitative phase students (n=1,252) completed a survey measuring student support for 33 alcohol-control measures. Staff (n=27) responsible for policy implementation completed a survey estimating student support for alcohol-control measures. Survey data informed development of the case study interview protocol. In the qualitative phase ten interviews were conducted at each case study site. </p><p> The study&rsquo;s theoretical and conceptual model was based upon Pressman and Wildavsky&rsquo;s (1973) implementation framework and Kotter&rsquo;s (1996) eight-stage process for leading change. Findings from the quantitative phase of the study revealed strong levels of support for alcohol-control policies at both campuses while staff members generally underestimated student support for alcohol-control policies. The key findings that emerged after coding case study data included the influences of: (a) executive leadership; (b) leadership transitions and policy saliency; (c) cognition and sensemaking; and, (d) anchoring changes in culture. Student support for alcohol-control policies was found to have no direct influence on staff members responsible for implementation of alcohol control policies.</p>

<p> From 2017 to 2019, the primary strategy to improve public schools in the U.S. was increasing competition through the expansion of charter schools and the promotion of vouchers to send public school students to private schools. The problem this presented was that key education leaders had not provided adequate input and feedback into this strategy. The purpose of this qualitative study was to gather the perspectives of accomplished education leaders on how Tiebout&rsquo;s theory of competition and the concept of the Ontario K-12 School Effectiveness Framework impacted quality, trust, and capacity. Data were collected using semistructured interviews with a purposeful sample of 15 accomplished education leaders from the charter/school choice community and traditional public schools. Data were analyzed using Bernauer&rsquo;s modified three-phase method. School and classroom leadership, meaningful and informative assessment that guides instruction, substantive student engagement, and a focus on a strong curriculum and effective teaching were the key themes that aligned with quality, trust, and capacity. Education leaders did not see Tiebout education as a key driver that would alone improve the quality of public education. Leaders believed that some schools improved in response to Tiebout competition but also shared cautions on the diminishing returns, collateral damage, and equity concerns because Tiebout competition created winners and losers. Social change may be impacted by the results of this study in that the results define and share examples of healthy and unhealthy competition in public education. The results of this study can help inform policy makers and educators as they create opportunities that will enhance the long term personal and economic success of all U.S. students.</p><p>

<p> Starting in late 2013, new direct-acting antiviral medicines (DAAs) offered the chance of a cure for chronic hepatitis C virus (HCV) infection. In clinical trials, DAAs helped more than 90% of patients achieve sustained viral response (SVR), commonly considered to be a cure that will stop progression of related liver disease and prevent transmission of the virus to others. Prices for these medicines are now around $20,000 per treatment after discounts from manufacturers, due to competition. </p><p> In late 2016, the medical director for D.C. Medicaid asked what it would take to eradicate hepatitis C in the city. This dissertation focused on that question for Medicaid alone, to inform policy discussions and identify next steps. I profiled beneficiaries with chronic HCV infection based on medical claims from 2014-2016; interviewed medical providers and policymakers to learn more about their decision-making processes and to identify opportunities to expand treatment, as well as potential barriers; and created an Excel-based Markov model that estimates outcomes and costs under different scenarios. </p><p> Only 799 individuals, about 10% of the D.C. Medicaid beneficiaries identified as having chronic HCV infection, received treatment with DAAs in 2014-2016. Providers and policymakers are committed to treating this population, but treatment rates remained low through 2018. I estimate that roughly 80% of Medicaid beneficiaries with chronic HCV had not been treated at the start of 2019. </p><p> Beneficiaries with chronic HCV infection often have other physical, mental, and behavioral health conditions that might keep them from seeking treatment for an often-asymptomatic HCV infection. They often miss scheduled appointments and/or are lost to follow-up. Most live east of the Anacostia River, where there are fewer providers. Even if they engage in care, government or health plan policies might discourage or prevent individuals with low levels of liver damage from getting prior authorization for treatment. </p><p> Broader use of DAAs in D.C. Medicaid will allow more people to achieve SVR, potentially decreasing future healthcare costs for some and saving lives. A moderate (50%) increase in treatment rates among those with low liver damage could enable about 300 additional patients to achieve SVR over 10 years, at a net cost of $6.1 million. A 50% increase in treatment rates among those with moderate liver damage could enable more than 500 additional patients to achieve SVR over 10 years, keep more than 160 from severe liver damage, and avoid 19 early deaths. The net cost of the second scenario is $6.5 million, a smaller increase per person achieving SVR because curing those with moderate liver damage is more likely to avoid high healthcare costs. </p><p> The District must weigh the upfront costs of expanding use of DAAs against uncertain long-term benefits and inherent budget limitations. I recommend that D.C. develop a more complete profile of Medicaid beneficiaries with HCV infection; work toward universal screening and sustained monitoring of at-risk populations; collaborate with key stakeholders to develop policies, practices, and tools to engage beneficiaries in care; and reduce prior authorization requirements that might deter or prevent treatment when beneficiaries and health care providers are ready.</p><p>