Over the past few decades, the Swedish welfare system has undergone a process of marketization, characterized by the implementation of choice reforms. In order for citizens to be able to utilize their freedom of choice, a set of requirements have to be met. However, while it is argued in the literature that the conditions for choice reforms are worse in rural areas compared to urban areas, there is a lack of empirical studies examining these requirements in a rural Swedish context. Therefore, this study aims to investigate the market diversity requirement and the overproduction requirement in rural Swedish municipalities that have set up a system of choice for home care services in accordance with The Act on Systems of Choice (LOV). The results show that out of the sixteen municipalities included in the study, both requirements for functioning freedom of choice were fulfilled in four rural municipalities. Most commonly, the market diversity requirement was violated because of the absence of multiple established home care service providers. In some municipalities, the same requirement was also violated because providers failed to offer a variety of services. Further, the study shows that because some providers have restricted their operations to certain geographical areas within some municipalities, the ability for rural citizens to utilize their freedom of choice can differ within a municipality. All providers were able to accept new elderly clients, meaning that the overproduction requirement was fulfilled in all sixteen rural municipalities.

Dagens organisationer kontrolleras allt mer, där granskning och mätning tenderar att genomföras av all dokumentation som behandlats i offentlig verksamhet. I förlängningen är utredningar i offentlig verksamhet idag en vanligt förekommande arbetsuppgift för HR specialister och syftet med studien är att undersöka betydelsen av utredningar i kommuner. För att kunna utreda olika typer av ärenden som kan innefatta både arbetsrättsliga och arbetsmiljömässiga problem krävs vissa kunskaper. Mer specifikt innebär det att undersöka betydelsen av och kompetensförutsättningar för utredningar utförda i tre olika kommuner ur ett HR-perspektiv. Under tidigare forskning behandlas frågan om kontroll av medarbetares arbete, ansvarsutkrävning av professioner, värdeskapande organisationer, organisatoriskrättvisa samt, betydelsen av kunskap och New Public Management (NPM), en styrform som vunnit allt mer mark i offentlig verksamhet. Teorier som använts som grund för att analyserainsamlad empiri kring utredningar och dess betydelse är legitimitet, HR-transformation, ny institutionell teori, isomorfism och isärkoppling. För att kunna utreda olika typer av ärenden som kan innefatta både arbetsrättsliga och arbetsmiljömässiga problem krävs vissa kunskaper. Studiens resultat visar att HR-specialister anser att utredningar är betydelsefulla i offentlig verksamhet, både för de individer det berör men även för arbetsmiljön som helhet. De understryker vikten av kunskap i utredningsmetodik för att kunna genomföra utredningar av god kvalitet. Resultatet ger en indikation på att HR-specialister i offentlig verksamhet ser utredningar som värdefulla handlingar som kan bidra till en bättre arbetsmiljö. Dock saknas i organisationerna strukturer för återkoppling och uppföljning av genomförda utredningar, 3vilket innebär att det saknas en vetskap bland respondenterna om vad som sker efter en utfördutredning.

公共行政近年在外在資訊社會形成，和治理需求發展下面臨巨大的衝擊，民調顯示公民信任政府的程度每況愈下，許多學者主張正視制度效率與效能、更新政府流程、組織與程序再造的呼籲，各國政府也在新一波政府再造運動的推波助瀾下，不斷提出新公共管理的計畫，欲圖藉由政策的落實，提供人民新的治理形象，並達成最終信任政府，發展公民－政府間未來互信、合作的善治願景。 　　然而，新公共管理的理論，是否受制於私部門管理主義的利潤及購買行為之考量而有所侷限？公民信任復是否可與顧客忠誠度等量齊觀？無疑是新公共管理實踐的最大障礙，也有待以實證的角度發展相關研究，選取最適的計畫，驗證公民基礎績效、微觀績效等績效理論假設。 　　就此而言，電子化政府實為一理想的驗證個案，首先，其具有打破微觀以迄鉅視界線的體制，因其可超越平行與垂直單位劃分特質，避免微觀績效受限於以往政府信任是否「鉅視概念」之爭辯；其次，電子化政府的發展，在達成善治的階段性導引下，具有完備轉換行政模式的潛力，甚至形成制度性的替代；再者，電子化政府的服務考量向來是以公民中心為主體設計，其不僅可能從顧客滿意度角度監控其服務達成公民期望，也可以從人民對其回應性的認知了解其問責的能力，並從此二變項與公民信任相連結，建立信任的路徑。 　　是以，研究者針對較常使用我國電子化政府的網路公民，進行「服務品質」、「滿意度」、「回應性」、「公民信任」等認知的調查研究，發現服務品質、滿意度均係影響公民對電子化政府信任的正向要因，說明微觀績效的連結確實存在。而回應性雖亦確受到服務品質的影響，但其與公民信任之間的關係則甚為微弱，在概念上宜再深入討論。 　　基此，研究者認為，現階段電子化政府應重視前開以公民為中心，及契合階段性發展的設計，儲存公民信任，以電子化政府制度化的達成，促成未來真正打破官僚舊作的行政再生。 / In recent years, the high-speed shaping of information society and citizen’s wishing of good governance have made great impact on the governors and researchers of public administration. Public-opinion data showed that citizen’s trust in government dropped dramatically under enormous changes of external environment. For recovering citizen trust, many scholars claimed that the public authorities should pay much attention to make sure the whole system accountable, west governments also created New Public Management (NPM) programs to mold the trustworthy image of country’s administration. The NPM theory, backing up the movement of “Reinventing Government”, borrows a few conceptions from the field of business management. But the research workers still concern whether there existed conflicts of conception between the public and private value. To resolving this question, we have to examine the causality of NPM theory which links government performance and public trust to prove the validity of performance theories in the process of theory application. That is to say, we must know if citizen trust could result from “performance-satisfaction-loyalty” sequence just like the description of business marketing textbook. For the objective of affirming the connection of performance and citizen trust, I chose E-Government policy to be the study target and designed an inter-net investigation to analysis the public’s cognition. By path analysis, a quality research method, I found that the performance factors, including service quality and client satisfaction, indeed influenced citizen trust. Especially, service quality could produce direct and indirect effects on trust in the meantime. But the other independent factor, responsiveness, usually discussed in the political field, could not affect citizen trust. Importantly, this result supported the validity of NPM theory to construct the path of restoring citizen trust by reforming way of electronic governing institution.

Au Québec, depuis les 25 dernières années, l’enjeu de la privatisation dans le secteur de la santé revient constamment dans le débat public. Déjà dans les années 1980, lorsque le secteur de la santé a commencé à subir d’importantes pressions, faire participer davantage le privé était présenté comme une voie envisageable. Plus récemment, avec l’adoption de la loi 33 par le gouvernement libéral de Jean Charest, plusieurs groupes ont dénoncé la privatisation en santé. Ce qui frappe lorsque l’on s’intéresse à la privatisation en santé, c’est que plusieurs textes abordant cette question ne définissent pas clairement le concept. En se penchant plus particulièrement sur le cas du Québec, cette recherche vise dans un premier temps à rappeler comment a émergé et progressé l’idée de privatisation en santé. Cette idée est apparue dans les années 1980 alors que les programmes publics de soins de santé ont commencé à exercer d’importantes pressions sur les finances publiques des États ébranlés par la crise économique et qu’au même moment, l’idéologie néolibérale, qui remet en question le rôle de l’État dans la couverture sociale, éclipsait tranquillement le keynésianisme. Une nouvelle manière de gérer les programmes publics de soins de santé s’imposait comme étant la voie à adopter. Le nouveau management public et les techniques qu’il propose, dont la privatisation, sont apparus comme étant une solution à considérer. Ensuite, par le biais d’une revue de la littérature, cette recherche fait une analyse du concept de privatisation, tant sur le plan de la protection sociale en général que sur celui de la santé. Ce faisant, elle contribue à combler le flou conceptuel entourant la privatisation et à la définir de manière systématique. Ainsi, la privatisation dans le secteur de la santé transfère des responsabilités du public vers le privé dans certaines activités soit sur le plan: 1) de la gestion et de l’administration, 2) du financement, 3) de la provision et 4) de la propriété. De plus, la privatisation est un processus de changement et peut être initiée de manière active ou passive. La dernière partie de cette recherche se concentre sur le cas québécois et montre comment la privatisation a progressé dans le domaine de la santé au Québec et comment certains éléments du contexte institutionnel canadien ont influencé le processus de privatisation en santé dans le contexte québécois. Suite à une diminution dans le financement en matière de santé de la part du gouvernement fédéral à partir des années 1980, le gouvernement québécois a privatisé activement des services de santé complémentaires en les désassurant, mais a aussi mis en place la politique du virage ambulatoire qui a entraîné une privatisation passive du système de santé. Par cette politique, une nouvelle tendance dans la provision des soins, consistant à retourner plus rapidement les patients dans leur milieu de vie, s’est dessinée. La Loi canadienne sur la santé qui a déjà freiné la privatisation des soins ne représente pas un obstacle suffisant pour arrêter ce type de privatisation. Finalement, avec l’adoption de la loi 33, suite à l’affaire Chaoulli, le gouvernement du Québec a activement fait une plus grande place au privé dans trois activités du programme public de soins de santé soit dans : l’administration et la gestion, la provision et le financement. / For the last 25 years, the issue of health care privatization has frequently been a subject of public debate in Québec. Already during the 1980s, when the health sector was starting to be under pressure, the use of the private sector was presented as a possible alternative. More recently, with the adoption of bill 33 by the liberal government of Jean Charest, many groups in the civil society have denounced the privatization of health care. What is striking when we study health care privatization is that the concept is rarely clearly defined. Through a closer look at the Quebec case, this research first recalls how the idea of health care privatization has emerged and progressed. This idea appeared during the 1980s when health care public programs started to represent important pressures on the public finance of states that were also experiencing an economic crisis. At the same time, neoliberalism and its questioning of the welfare state was slowly eclipsing keynesianism. A new way of managing health care public programs seemed necessary. New public management and the techniques it proposes, privatization being one of them, appeared to be the solution to consider. Then, through a literature review, this research analyzes the concept of privatization, in the realm of social protection in general but also more specifically in health care. Through this process, the research clarifies the concept of privatization and defines it systematically. Thus, privatization in the health care sector transfers responsibility from the public to the private in different areas. These areas are: 1) management and administration, 2) financing, 3) provision, 4) ownership. Adding to this definition, privatization is a process of change and can be initiated actively or passively. The last part looks more particularly at the Québec case and shows how privatization has evolved in the Québec health care sector. It also highlights how some aspects of the Canadian institutional context have influenced health care privatization in the province. Québec has not been impervious to privatization. After the cuts in health care funding by the federal government that began in the 1980s, the Québec’s government reacted by actively privatizing some complementary health services through de-insurance. It has also put in place the ambulatory shift policy, which has lead to a passive privatization of health care. The ambulatory shift represented a new trend in health care provision that consists in sending patients home more quickly after their hospitalization. The Canadian Health Act, considered as an obstacle to privatization, does not limit this kind of privatization. Finally, with the passing of bill 33, after the Chaoulli case, the Québec’s government has actively opened the door to the private sector in three health care activities: administration and management, provision, and financing.

Cette thèse analyse la confrontation entre les réformes postales inspirées du nouveau management public, cristallisées dans la politique de rationalisation de l’activité de travail, et les pratiques professionnelles des salariés. Elle étudie les enjeux, les modalités et les limites de la définition normative du travail des conseillers financiers. Désignés par l’organisation comme des acteurs du changement, ces derniers doivent gérer la tension entre logique de marché et mission de service public, qui persiste à travers un double langage de La Poste. Sont ainsi mis en évidence des positionnements professionnels qui se construisent en décalage par rapport à la norme de référence du conseiller idéal portée par l’entreprise. Cette dernière mise donc sur ses jeunes recrues, supposées réceptives aux nouvelles logiques managériales. L’étude du processus de socialisation professionnelle de ces conseillers potentiels, inscrit dans les parcours individuels, permet d’interroger l’homogénéisation des pratiques et la persistance du modèle social postal. L’approche repose sur une comparaison territoriale (Méditerranée/Île-de-France) et générationnelle. La combinaison de plusieurs techniques d’investigation (observation participante au sein de la DRH de La Banque Postale, enquête longitudinale prospective par panel menée auprès d’apprentis conseillers financiers, monographie de bureaux de poste et exploitation de données statistiques) permet de croiser les parcours biographiques et les éléments structurels d’analyse des politiques d’emploi, de travail et de formation de La Poste. / This thesis analyses the confrontation between postal reforms inspired by the new public management, fulfilled in the rationalisation politics of the working activity, and employee professional practices. It studies the stakes, the modalities and the limits of the financial advisers normative work definition. Designated as change agents by the organisation, they must manage the dynamics between market logic and the public services mission which persists through a double language at La Poste. This puts into evidence the professional positioning that is constructed based on the referential norm of the ideal adviser portrayed by the organisation. The latest therefore counts on its young recruits, excepted to be receptive to the new managerial logics. The study of the socialisation process of its potential advisers, registered on individual career paths, allows questioning the homogenisation in the practices and persistence of the social postal model. The approach is based on a territorial comparison (Mediterranean/Parisian region) as well as generational. The combination of several investigation techniques (participative observation within the HR Direction at La Banque Postale, longitudinal panel survey conducted on financial adviser apprentices, monograph of post offices and exploitation of statistic data) allows crossing of biographical paths (personal and career) and the structural elements of employment politics analysis, work, and training at La Poste.

Syftet med denna uppsats är att undersöka förutsättningarna för implementeringen av tillitsbaserad styrning och ledning på Arbetsförmedlingen. Vidare ska intentionerna med tillitsbaserad styrning och ledning undersökas för att ställas gentemot tjänstemännens förutsättningar. Implementeringsproblematik är något som kan förekomma om rätt förutsättningar inte finns bland dem som ska implementera. Förutsättningarna har i uppsatsen undersökts med hjälp av Lundquists tre implementeringsvillkor – förstå, kan och vill. Semistrukturerade intervjuer har använts som metod och genomförts med tjänstemän på Arbetsförmedlingen och med organisationschefen för att besvara syftet och frågeställningarna. Uppsatsen redogör för den tidigare forskning som är relevant och går vidare in på det teoretiska ramverket som ligger till grund för studiens analys. Resultatet visar att tjänstemännen förstår vad som efterfrågas av dem och har kompetens för att genomföra arbetssättet. Deras motivation ökar vilket innebär att viljan finns där. Men det finns inte tillräckligt med resurser i form av tid, pengar och personal för att kunna genomföra deras uppdrag utifrån tillitsbaserad styrning och ledning.

Abstract Background Occupational Burnout is one of the greatest challenges affecting the labour markets today. It is mainly caused by prolonged stress exposure due to the psychosocial work environment and is nowadays the fastest growing cause of long-term sick leave in Sweden. It therefor affects both the society, organisation and individual. It is thus a managerial concern to manage and structure the organisations in a sustainable way that maximises the use of human resources, rather than burning them out.    Purpose The aim of the thesis is to investigate the high level of sick-leave or burnout due to organisational and managerial factors in the Swedish educational sector, by focusing on the role leadership, organisational and psychosocial work environment plays in preventing/causing employees’ burnout. The authors attempt to contribute knowledge on why theory may not match reality in this case, as statistics of sickleave due to stressrelated illness remains high. Methods In this qualitative study principals, administrators, and teachers of four public compulsory schools in Jönköping and Öckerö are interviewed. Using semi-structured interviews, data is gathered, coded and analysed in relation to modern research literature on the topic of burnout as well as Swedish Work Environment Authority guidelines, to spot key elements of positive and negative factors which have affected the stress situations of the schools’ employees. Several factors from organizational and leadership perspective are examined to assist organizations to avoid or prevent burnout.   Results Prevalence of high burnout rates in schools in the cases studied, was associated with recent large reorganization of employees and administration; weak and inefficient leadership which did not strive to build relationships and open communication with teachers; low integration between sectors and working groups; lack of support and monitoring of stressed employees; low ability of employees to contribute to their workplace environments; the shortage of budgets issued by municipality.   Conclusions 1.The reason sick leave related to stress and burnout is high in the cases studied, is that implementation of research and policy guidelines is lacking behind in schools which suffer from employee stress related issues. As well as the current management model of the public sector may not benefit to prevent employee burnout.   2. It is possible to avoid employee burnout through adjusting the management and organizational structure, as adaptations toward dealing with employees’ stress are showing a positive sign on preventing the development of burnout.

Introdução: A gestão público-privada na saúde brasileira, fortalecida após a criação das Organizações Sociais (OSs) no País, em 1998, se intensifica também na rede de atenção primária da cidade de São Paulo. Segundo a Secretaria Municipal da Saúde, das 449 UBSs existentes na capital paulista em 2014, 280 (62,3%) eram administradas via contrato de gestão ou convênios com entidades sem fins lucrativos. Faltam, no entanto, estudos que explorem o impacto da adoção desse modelo nas unidades de atenção primária. Objetivos: Analisar estrutura, processo e resultado das unidades de atenção primária da cidade de São Paulo segundo a modalidade de gestão e a entidade gestora. Métodos: Foi adotado estudo descritivo e exploratório em que foram analisados três bancos de dados do segundo ciclo do Programa Nacional para Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB) referentes às Unidades Básicas de Saúde da cidade de São Paulo, o que significou uma amostra de 264 unidades/911 equipes. Foram escolhidos 28 indicadores para análise (um de estrutura, dez de processo e 17 de resultado). As UBSs e equipes de atenção primária foram classificadas de acordo com sua modalidade de gestão e entidade gestora e os resultados de cada grupo em cada um dos indicadores foram separados. Foram realizados testes estatísticos (quiquadrado e Anova) para verificar a significância das diferenças encontradas. Resultados: Dos 28 indicadores analisados, 10 registraram diferença significativa entre equipes com diferentes modalidades de gestão. Em oito deles, houve melhor desempenho das equipes de unidades com gestão público-privada. Já na análise por entidade gestora, 25 dos 28 indicadores analisados tiveram diferenças significativas, com diferenças importantes entre unidades de administração públicoprivada, mas com entidades gestoras diferentes. Conclusões: Os resultados indicam que a contratualização na atenção básica pode colaborar com o aumento do acesso e produtividade dos serviços. No entanto, as evidências não são fortes o suficiente para concluir que um modelo é superior ao outro. Ficou claro que a entidade gestora parece ter um peso maior no desempenho das unidades e equipes do que simplesmente a modalidade de gestão. / Introduction: Public-private management in Brazilian healthcare system, strengthened after the creation of Social Organizations (OSs) in the country in 1998, is also strong in the primary care services of the city of São Paulo. According to the Municipal Health Department, from the 449 primary care services of the state capital in 2014, 280 (62.3%) were administered by non-profit entities through agreements with the government. There are, however, few studies that explore the impact of adopting this model in the primary care services. Objectives: Analyze structure, process and outcomes of primary care services in the city of São Paulo according to the management modality and the management entity. Methods: A descriptive and exploratory study was carried out in which three databases of the second cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) were analyzed for the Basic Health Units of the city of São Paulo, Brazil. which meant a sample of 264 units / 911 teams. We selected 28 indicators for analysis (one of structure, ten of process and 17 of outcomes). The UBSs and primary care teams were classified according to their management modality and managing entity and the results of each group in each of the indicators were separated. Statistical tests (chisquare and Anova) were performed to verify the significance of the differences found. Results: From the 28 indicators analyzed, ten registered a significant difference between teams with different management modalities. In seven of them, there was better performance of the teams of units with public-private management. In the analysis by management entity, 25 of the 28 indicators analyzed had significant differences, with significant differences among public-private administration services with different management entities. Conclusions: The results indicate that contracting in primary care may contribute to increased access and productivity of services. However, the evidence is not strong enough to conclude that one model is superior to the other. It became clear that the management entity seems to have a greater weight in the performance of the services and teams than simply the management modality.

Over the past decade, Social Impact Investing (SII) has garnered increasing attention among public policy makers as a solution for multigenerational, complex, intractable social and environmental problems, or as some advocates like to say, ‘wicked’ problems. The growing interest in SII aligns with the expansion, since the 1980s, of a set of public sector reforms that make use of new public policy instruments to achieve public objectives. Neoliberal economists and New Public Management (NPM) theorists have long argued for these reforms to improve the effectiveness and efficiency of government bureaucracies. These reforms have led to a paradigm shift that Lester M. Salamon has labeled ‘New Governance’, characterized by public policies that make use of market mechanisms, partnerships with new actors, networks and flexible rules. Public administration scholars have suggested focusing on public policy instruments instead of the traditional focus on programs and institutions to gain an understanding of the dynamics of the ‘New Governance’ paradigm and to address important questions that go beyond the dimensions of effectiveness and efficiency. This dissertation draws on Lester M. Salamon’s framework for analyzing public policy instruments combined with a conceptual framework developed by the Organization for Economic Development and Cooperation (OECD). The thesis uses this framework to assess the SII market by examining three cases of Canadian federal public policy instruments designed and implemented to achieve socio-economic objectives. These policy instruments provide either a cash transfer or a tax incentive to create investment funds mandated to invest with a purpose of making a return and achieving a positive social outcome. The dissertation employs a qualitative research approach and case study method to explore questions of equity and effectiveness to produce findings and recommendations useful to pubic administration scholars who focus their research on public policy instruments and to public policy makers who are considering policy options for structuring and growing the SII market. Data was collected through an extensive document review and 19 semistructured interviews. A dimensional analysis, SII analysis and discourse analysis of the data were undertaken. The researcher made the choice of undertaking a discourse analysis in order to fill a gap in the public policy instrument literature and inform the debate on SII. This dissertation contributes to the body of knowledge on public policy instruments and SII by presenting the results of a comparative analysis of three public policy instruments that created investment funds mandated to produce socio-economic outcomes.

The bulk of the literature on the New Public Management (NPM) has been blind to the moral dimension of the market-oriented reforms of the public sector. However, this thesis studies the potential for institutional arrangements such as financial incentives and other market mechanisms to undermine intrinsic, moral motivation among both“producers” and “consumers” of tax-financed welfare services. The first paper demonstrates how the promotion of NPM-like ideas by various left-wing and right-wing agents after 1968 led to the erosion of a professional ethos among Swedish teachers. The second paper shows how an ill-conceived school voucher reform in Sweden, implemented under the banner of NPM, has encouraged moral hazard on the part of schools. The thesis demonstrates an ecumenism between the left and right that with few exceptions has been overlooked in political science. It also demonstrates that public administration systems that have adopted market-oriented reforms need morality in order to function in accordance with the principles underlying these institutions. / <p>The series name, <em>Linköping Studies in Arts and Science Thesis,</em> is incorrect. Correct series name is FiF-avhandling.</p>