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Civic competence or national competitiveness? The framing of information literacy in the Finnish policy documents The study examines information literacy (IL) from a policy perspective with the objective of analyzing how IL is framed in Finnish policy documents. Three policy frames were identified using an analytical framework drawn upon research literature. IL was associated with continuous learning, national competitiveness and civic competence. Ensuring skilled workforce together with active and digital citizenship was emphasized in the policy objectives framing IL. The findings reveal IL as a fragmented concept in policy documents. Instead of incremental development, the promotion of IL is scattered across different policy areas and ministries. Therefore, the national policy lacks a shared and public problem definition about what makes IL a societal issue. As a conclusion, rather than focusing on separate skills and competencies,IL should be acknowledged as an ambiguous political concept including multiple definitions, interests and ways...

The article proposes a novel way of conceptualising knowledge management in public sector by highlighting the social process of knowledge formation, where knowledge for public policies emerges and takes shape. This approach aims to overcome three main criticisms levelled at knowledge management, namely its excessive internal focus, solving tame organisational problems, and focusing on data over meanings. We take knowledge formation to be a social process in which information is collected, interpreted, and shared. We expand and contribute to the ongoing debate on KM in public sector by integrating insights from administrative sciences, organisation studies, and political science. The suggested approach provides an opportunity to understand the diverse conceptions regarding the role of information and the nature of knowledge in organisational decision-making and policy-making that complements the organisation-centric and instrumentalist approach to KM. publishedVersion

Mitä hallintotieteellinen tutkimus on ja minkälaista se voisi olla? Miten yhteiskunnallinen kehitys ja hallinnon tutkimus ovat sidoksissa toisiinsa? Hallintotieteellinen tutkimus kohdistuu julkishallinnon toimintaan hallinnon ja politiikan välimaastossa. Siihen kytkeytyy kriittinen keskustelu demokratian murroskehityksestä, julkisorganisaatioiden muutosprosesseista ja johtamisesta, julkisen toiminnan kestävyydestä tai toimintapolitiikkojen vaikuttavuudesta. Hallinnon tutkimuksen tulevaisuus on 54 tutkijan kirjoittama monitieteinen teos, joka luo näkymiä tieteenalan muutokseen ja tulevaisuuteen. Hallintotieteellisellä tutkimuksella on vahva käytännön yhteys ja merkittävä rooli yhteiskunnallisen muutoksen tekijänä. Samanaikaisesti se on myös muutoksen kohteena. Teos jäsentää tätä kaksoisroolia. Teos soveltuu julkishallinnon muutoksesta, kehittämisestä ja tutkimuksesta kiinnostuneille lukijoille: tutkijoille, asiantuntijoille sekä opiskelijoille.

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Background The need for measuring the impact of health research more collaboratively and from multi-dimensional perspectives has been acknowledged. As part of a Collective Research Impact Framework (CRIF), a scorecard was developed that will engage stakeholders in measuring the impacts of health research and innovation. The purpose of this study is to describe the developmental process of the MULTI-ACT Master Scorecard and how it can be used as a practical tool for assessing future responsible research and innovation actions collectively. Methods Based on an extensive review of the health research impact literature and multi-stakeholder initiatives, a total of 1,556 impact indicators were collected into a database. The Master Scorecard was then co-created by engaging key stakeholders and conducting semi-structured interviews with experts in the field. Results The MULTI-ACT Master Scorecard consists of five accountability dimensions: the excellence, efficacy, economic, social and patient-reported dimensions. The tool includes 126 potential indicators classified into 52 measurement aspects that are considered the most relevant topics applicable to multi-stakeholder research and innovation initiatives in assessing their impact based on their mission and stakeholders’ interests. The MULTI-ACT Master Scorecard allows the strategic management of multi-stakeholder research initiatives to demonstrate their research impact on people and society. The value of the tool is that it is comprehensive, customizable and easy to use. Conclusions The MULTI-ACT Master Scorecard is an example of how the views of society can be taken into account in assessing research impacts in a more sustainable and balanced way. The engagement of patients and other stakeholders is an integral part of the CRIF, facilitating collaborative decision-making in the design of policies and research agendas. In policy-making, the collective approach allows extending the evaluation perspective to the needs of society and toward responsible research and innovation. Multi-dimensionality fosters research and innovations to be more responsive to systemic challenges and developing more equitable and sustainable health services.

Background The need to more collaboratively measure the impact of health research and to do so from multidimensional perspectives has been acknowledged. A scorecard was developed as part of the Collective Research Impact Framework (CRIF), to engage stakeholders in the assessment of the impacts of health research and innovations. The purpose of this study was to describe the developmental process of the MULTI-ACT Master Scorecard (MSC) and how it can be used as a workable tool for collectively assessing future responsible research and innovation measures. Methods An extensive review of the health research impact literature and of multistakeholder initiatives resulted in a database of 1556 impact indicators. The MSC was then cocreated by engaging key stakeholders and conducting semi-structured interviews of experts in the field. Results The MSC consists of five accountability dimensions: excellence, efficacy, economic, social and patient-reported outcomes. The tool contains 125 potential indicators, classified into 53 impact measurement aspects that are considered the most relevant topics for multistakeholder research and innovation initiatives when assessing their impact on the basis of their mission and their stakeholders’ interests. The scorecard allows the strategic management of multistakeholder research initiatives to demonstrate their impact on people and society. The value of the tool is that it is comprehensive, customizable and easy to use. Conclusions The MSC is an example of how the views of society can be taken into account when research impacts are assessed in a more sustainable and balanced way. The engagement of patients and other stakeholders is an integral part of the CRIF, facilitating collaborative decision-making in the design of policies and research agendas. In policy making, the collective approach allows the evaluation perspective to be extended to the needs of society and towards responsible research and innovation. Multidimensionality makes research and innovations more responsive to systemic challenges, and developing more equitable and sustainable health services.

Value-based healthcare (VBHC) is a widely approved logic for financing services, using innovative care models and evaluating healthcare outcomes. It is consistent with the Triple Aim framework of simultaneously improving population health, patient experience and the costs of care. In Nordic countries, VBHC has been mainly implemented as a strategic concept in developing hospitals. Despite the evident interest in VBHC as a management trend in healthcare organisations, the studies concerning the implications of VBHC logics on health policies have been scant. This study aimed to fill this gap by building a conceptual bridge between national health policy and value-based care. Through the Triple Aim framework, we explored how VBHC goals have evolved in Finnish Government Programmes from 1995 to 2015 by using qualitative document analysis and interviews. The study addresses the evolution and national impacts of VBHC. Our results show that the goals of Triple Aim gradually become evident at the Finnish health policies. All three Triple Aim goals were present, though the equal prioritisation of these goals only emerged in 2015, also highlighting patient experience. We argue that VBHC logics have indeed affected Nordic welfare policies, not only at the organisational level but also concerning performance measurement and care delivery. This may imply that the diffusion of VBHC logics evolves from healthcare organisations to policymaking instead of top-down. Particularly in publicly financed systems, VBHC indicates a transformation to a new public governance ideology, accelerating policy goals that promote customer responsiveness and value creation for citizens. acceptedVersion

Traditionally, civil servants and public officials are highly educated and have strong administrative expertise. Public financial managers have been regarded as ‘guardians of the public purse’, who have solid budgeting, accounting and auditing skills. However, the development of ‘mega-trends’ such as digitalization and e-government affect the future of the public sector by challenging the traditional competencies of public managers. This paper examines an attempt to redefine the capabilities of future public financial managers as part of the curriculum development process at Tampere University, Finland. The study reflects the tensions and institutional pressures between what is traditionally taught and what will be needed in the public sector in the future. Although in our teaching we emphasise the constant changes happening in public administration, we may be failing to provide our students with the broader skills they will need for dealing with the dynamics of change in a complex working environment. publishedVersion

Purpose The purpose of this paper is to shed light on the potential of organizational learning for developing effectiveness of care. Value-based healthcare measurement recognizes patient value as a driver for improving health outcomes at the societal and individual levels. By using the action learning method, this paper examines the phases of organizational learning in a private healthcare organization that has developed a novel Big Data screening tool for the treatment of patients with type 2 diabetes mellitus (DM2). Design/methodology/approach Relying on triple-loop learning as a conceptual framework and by applying the action learning method to case study design, this paper illustrates the phases of organizational learning and efforts to utilize value-based measurement in healthcare. Findings The case organization was able to identify patients at risk and to improve their care balance. Although the results for the measurement of patient outcomes led to questioning of previous care processes and practices in the organization, increasing value for all stakeholders by incorporating social needs to business opportunities remains under process. Originality/value With the focus on organizational learning and organizational value creation processes, this paper demonstrates incorporation of measuring patient outcomes in re-structuring care processes, enhancing organizational performance and improving effectiveness as well as quality of care.

Purpose – Poor access to healthcare and increasing demand for services represent a management dilemma how to balance between needs and costs. Scrutinising the concept of demand management and using a case study from Finnish primary care, the purpose of this paper is to examine the complexities of managing demand for health services. Design/methodology/approach – Convenience has explained the popularity of walk-in clinics (WIC), making it an attractive demand management tool. By analysing the quantitative service utilisation data of frequent attenders at WIC, the paper exemplifies what enhanced access to care means for demand management of public welfare services. Findings – High user rates and satisfaction indicate demand for this type of service; however, the establishment of WIC provided supplementary care for the high users of health services, most suffering chronic diseases. Research limitations/implications – Better understanding of the structure of service demand is needed in order to develop a more coordinated service system and to manage demand for public welfare services. Practical implications – The study demonstrates the importance of identifying service utilisation patterns in managing demand. Instead of single solutions, a wider system-level perspective is essential. Originality/value – Managing demand and facilitating access are core primary care attributes but there is little evidence about the impact of demand management strategies. The paper ties together important healthcare management issues: how to control demand and improve the access? Moreover, few studies have examined the frequent attendance at WIC. This paper presents a practical illustration of demand management tool and indicates some demand management problems to be considered in healthcare management.

Asiakasresponsiivisuutta vaaditaan julkishallinnon reformipolitiikassa, jossa tavoitellaan asiakaslähtöisiä, asiakkaiden tarpeisiin vastaavia matalan kynnyksen palveluja. Tavoitteen operationalisointi julkispalveluissa on kuitenkin ongelmallista. Responsiivisuudella tarkoitetaan hallinnon kykyä vastata kansalaisten toiveisiin ja tarpeisiin, mutta rajallisien inhimillisten ja taloudellisten resurssien muutospaineessa periaatteen soveltaminen käytännön kehittämistyössä voi muotoutua toisenlaiseksi. Tämä tutkimus tuottaa tietoa responsiivisuuden ja taloudellisten voimavarojen hallinnan yhteensovittamisen jännitteistä päätöksenteossa. Terveyskioskikokeilujen avulla konkretisoin millaisia ongelmia asiakasresponsiivisuuden parantamisesta voi syntyä voimavarojen tehokkaalle hallinnalle. Julkispalvelujen asiakasorientaation kehittämisideologia näyttää tematisoituvan hallinnon tehottomuuden ongelmana. Uuden julkisjohtamisen doktriinissa on vaadittu, että julkispalvelujen tulisi tuottaa asiakkailleen enemmän vastinetta verorahoille. Kustannusten hallinnasta ja yksilön oikeuksista on hyvinvointivaltion talouskriisin myötä tullut keskeisiä argumentteja kansainvälisessä reformiretoriikassa. Tarkastelin julkispalvelujen asiakas- ja kustannusajattelun dilemmaa erityisesti perusterveydenhuollon kehittämisessä; kuinka vastata kansalaisten tarpeisiin helposta pääsystä ja silti hillitä kasvavia kustannuksia. Asiakasnäkökulmasta hoitoonpääsyn ongelmana ovat pitkät odotusajat ja hankala tavoitettavuus. Tutkimuskohteenani olivat terveyskioskit, jotka ovat esimerkki ennaltaehkäisevästä, matalan palvelukynnyksen toimintamallista. Terveyskioski toimi tutkimuksessa eräänlaisena ikkunana kehittämisen jännitteisiin. Artikkeleissani havainnollistin empiirisesti terveydenhuollon asiakasresponsiivisuuden ja kustannushallinnan problematiikkaa Tutkimukseni on luonteeltaan ymmärrystä avaavaa. Se perustuu neljään terveyskioskia käsittelevään osajulkaisuun ja tutkimuksen kokoavaan teoreettiseen johdantolukuun julkispalvelujen kehittämiseen sisältyvistä jännitteistä ja ristiriidoista. Julkishallinnon uudistuksilla etsitään ratkaisuja rajallisten voimavarojen tehokkaaseen hallintaan. Uudistamisen tavoitteiden, keinojen, kehittämispuheen ja -toiminnan välisten ristiriitojen ja monitulkintaisuuden esiin nostaminen auttaa ymmärtämään päätöksenteon rajoittunutta rationaalisuutta ja asiakasresponsiivisuuden parantamisesta syntyviä yllättäviäkin seurauksia. Uudistustarpeiden legitimoinnin retorinen tarkastelu kertoo siitä, miten poliittishallinnollisia ongelmia kehystetään ja perustellaan. Tulkinta asiakasresponsiivisuudesta kielellisenä ilmiönä kuvaa taustaolettamuksia, joihin idea julkishallinnon tehokkaasta hallinnasta perustuu. Osajulkaisujen perusteella hoitoon pääsyn helpottamisella oli välillisiä vaikutuksia palvelujen kustannusrakenteeseen ja voimavarojen allokaatioon. Asiakastyytyväisyys heijastui korkeana käyttöasteena, mutta palvelujen suurkäyttäjät ja pitkäaikaissairaat käyttivät kioskia lisäpalveluna, mikä suuntasi ennaltaehkäisevää toimintaa sairauksien hoitoon. Asiakasresponsiivisuuden parantamista ohjaa pikemminkin palvelujärjestelmän hallinnan kuin asiakkaiden tarpeiden näkökulma. Asiakasnäkökulmasta tarvetta on ennaltaehkäiseville, helppopääsyisille palveluille ja psykososiaaliselle tuelle, mutta kustannustehokkuuden paine voi ohittaa asiakasresponsiivisuuden ja johtaa palvelukynnysten korottamiseen. Voimavarojen hallinnan ja palvelujen toimivuuden kannalta terveydenhuollon järjestämismallia ratkaisevampaa on tunnistaa suurimmat hoitoonpääsyn esteet, paikalliset palvelutarpeet ja resurssit yli sektorirajojen. Tutkimukseni tekee näkyväksi päätöksenteossa syntyviä todellisia valintatilanteita. Tutkimuksen perusteella julkishallinnon päätöksentekoon ja erityisesti julkispalvelujen kehittämiseen liittyy epävarmuutta tavoitteiden ja keinojen suhteesta. Uudistamisen ideat eivät välttämättä muutu käytännön toiminnaksi. Tehokkuuden parantamisen ratkaisut ovat monitulkintaisia ja voivat johtaa uudenlaisiin ongelmiin tai kehittämistavoitteet korvataan uusilla päämäärillä. Julkispalvelujen kehittäminen tapahtuu niukkojen voimavarojen ja poliittisen päätöksenteon kehyksessä, jossa tehdään arvovalintoja ja kompromisseja palvelutason, tarpeisiin vastaamisen, kustannustehokkuuden ja poliittisen kannatuksen suhteen. Asiakasresponsiivisuus muuttaa perinteistä poliittista ja hallinnollista vastuukäsitystä horisontaalisemmaksi, jossa on yritettävä vastata sekä äänestäjien että asiakkaiden tarpeisiin. Toisin kuin liiketoiminnassa, verorahoitteisessa järjestelmässä päätöksentekoa ja responsiivisuutta määrittävät universalismin ja oikeudenmukaisuuden periaatteet. Yksilöllisiin tarpeisiin vastaaminen ja palvelujen segmentointi on ongelmallista, koska yhden ryhmän asiakasresponsiivisuuden parantaminen voi tarkoittaa asiantilan heikentämistä toisaalla. Tämä tutkimus osoittaa, että asiakasresponsiivisuus on kiistanalainen tavoite eikä vielä itsestään paranna julkisten palvelujen tehokkuutta, vaan sen toteutuminen edellyttää laajempien yhteiskunnallisten tavoitteiden ja pitkällä aikavälillä realisoituvien välillisten vaikutusten pohtimista. Customer responsiveness is emphasized in public management reform policy. The aim is to develop customer-oriented public services that respond to public demand in facilitating access. However, the operationalizing this objective is problematic. Responsiveness is understood as the ability of public administration to respond to the desires and needs of citizens. The pressure for change and the limited human and economic resources may complicate putting customer responsiveness into practice. This study provides information about the decision-making tensions between responsiveness and efficient management of resources while improving public services. Using walk-in clinics to demonstrate these tensions, I illustrate the problems that may arise from customer responsiveness to cost control. Customer orientation in public services is part of the management ideology, with the issue appearing to relate to public sector inefficiency. The New Public Management doctrine argues that public services should provide customers more value for their tax money. With the economic crisis of the welfare state, cost containment and individual rights have become the central arguments in international reform policy rhetoric. The tensions of customer responsiveness are examined in the context of developing primary care; the dilemma is how to facilitate access while controlling costs. From the customer perspective, the major barriers to primary care access are long waiting times and availability difficulties. The subject of the study is the novel walk-in clinics, an example of the preventative and easy accessible service model. The walk-in clinic as a case study exemplifies the tensions of development in practice. The articles empirically reflect the healthcare problems between improving customer responsiveness and cost containment. The study is interpretive in its nature. It consists of four sub-studies on walk-in clinics and the theoretical introduction to the tensions and contradictions of public services improvement. Reforms are efforts to search for solutions in managing scarce resources more efficiently. The aim is to understand the conflicts and ambiguity between the means and ends of reforms and between the reform rhetoric and action. Tensions bring understanding to the bounded rationality in decision-making and unintended consequences when improving customer responsiveness. A rhetorical analysis of reform arguments and their legitimization describes how political–administrative problems are framed and justified. Interpreting customer responsiveness as a linguistic phenomenon represents the underlying assumptions on which the idea of efficient public administration is based. The results show that facilitating access had indirect effects on service cost structure and resource allocation. Customer satisfaction indicated a high utilization. However, the frequent users of health services and patients with chronic diseases used a walk-in clinic as supplementary care, which directed the clinic’s preventative actions antithetically to the treatment of diseases. Responsiveness is promoted from the organizational perspective of service system rather than the perspective of the clients’ needs. From the customers’ viewpoint, there is a need for accessible, preventative services and psychosocial support. Instead of improving access, the pressure for cost efficiency may paradoxically lead to increased barriers in accessing these services. More critical than the healthcare organization model is identifying the main barriers to care access, local service needs, and resources across the welfare sectors in ensuring the efficient use of resources and the functionality of services. This study makes visible real-world decision-making situations. The study argues that the uncertainty about the means and ends is the distinctive feature of public administration decision-making, especially in public service development. Reform ideas do not necessarily turn into action. Solutions in improving efficiency are ambiguous and may cause new problems, and new development goals replace the original goals. Scarce resources and policy-making determine the development of public services, bringing value judgment and compromises among the desired service level, responsiveness, cost efficiency, and political support. The aim of customer responsiveness is to transform the traditional political and administrative accountability in a horizontal direction, satisfying both the voters and the customers. However, unlike in business, in the publicly funded system, the key principles of decision-making and responsiveness are universalism and equality. Responding to individual needs and segmenting services is problematic since improving responsiveness of one group might deteriorate the status quo of another group. This study demonstrates that customer responsiveness is a highly contested aim and does not yet improve the efficiency of public services. For this to materialize, the wider societal goals and the indirect effects of actions that would be realized in the long term should be acknowledged.

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