Social care services in Croatia are provided by social care institutions, local and regional self-government authorities, associations, religious communities, other legal entities, natural persons, and foster families. Until the reform conducted in 2022, the system of social care institutions had consisted of 82 social care centres (with 56 branches, out of which 36 territorial branches and 20 family centres) and 68 centres for provision of services in community (with 18 branches), all founded as legal entities by the Republic of Croatia. In addition, there were 45 decentralized nursing homes, 360 other providers of social care services and more than 2.500 foster families. Still during the COVID-19 crises and in the middle in different scandals connected with social care provision, at the beginning of 2022, the system of social care institutions was reorganized despite strong disapproval of professional community. Social care centres were abolished as autonomous legal entities and one centralized institution (Croatian Social Work Institute; hereinafter: Institute) was founded. Former social care centres were transformed into internal organizational units of the Institute. The reorganization rests on two main elements: centralization and the loss of functional autonomy of the social care centres. As stated by the responsible ministry and the Government, main intention of reorganization was to eliminate different practices in service provision.

The aim of the study is to establish indicators for measuring the performance (input, output, outcome) of this reorganization (centralization and functional autonomy loss) and to provide pieces of evidence about its actual performance. To formulate indicators about the performance of the reorganization, the goal-oriented and theory-based approaches from the evaluation theory are being utilized. The goal-oriented approach is used to determine the formal goals expected by the Government when centralizing the system of social care. The theory-based approach is used to establish the input, output and outcome changes expected from centralization and functional autonomy loss from the theoretical perspective. The combination of these two approaches allows to formulate input, output, and outcome indicators. The measuring of the performance is done using the questionnaire that will be distributed to social workers thought the Croatian Chamber of Social workers in June 2023. The analysis of the results allows to have pieces of evidence that can be used for further evidence-based decision-making, especially in time of crisis.

Public service reforms worldwide have led to an increased engagement of professionals, such as doctors and teachers, in management. This process has resulted in a growing number of “hybrid managers”, who combine professional practice with responsibilities for staff development, planning and budgets (Kirkpatrick et al., 2022). Considerable research has been conducted on the roles of hybrid professionals, focusing in particular on identity concerns, their roles and the implications for the performance of organizations (Llewelyn, 2001; Noordegraf, 2007; Giacomelli, 2020). In this regard, a substantial body of has focused on the individual characteristics of hybrid managers. For instance, Kaiser et al. (2020), Sarto et al. (2019), De Harlez and Malagueno (2016) and Goodall (2011) have highlighted the positive impact that clinicians in leadership positions of publicly owned healthcare organisations can generate on service quality.

However, despite the mounting evidence on the contribution of hybrid professional managers on performance, we still know little in relation to their impact on the resilience of public sector organisations. Drawing from Turner (2022), resilient organisations are characterised by being adaptive, sustainable and transformative. They are better able to adapt to external shocks and can withstand their challenges by developing and assimilating new capabilities. Indeed, according to Wang et al. (2020), the Covid-19 pandemic has represented an environmental ‘shock’ that needed rapid adaptation to the planning and delivery of healthcare services. Thus, resilience has played a key role during the global pandemic and its complex, multifaceted challenges which have required the ability of public managers to face the disruptive event through flexible adaptation, agile modification, and pragmatic reorientation of governance solutions (Ansell et al., 2021).

To fill this gap, the study draws on Upper Echelons Theory (Hambrick and Manson, 1984), whose central premise posits that senior managers' experiences, values, personality and cognitive traits influence how they make sense of situations and their consequent choices. Essentially, the way organisations behave is mirroring the characteristics of their top managers. We, therefore, aim to identify the combination of individual demographic and background characteristics of hybrid professional managers that enable them to positively influence the resilience of their organisations in times of severe crisis.

To do so, we focus on a group of hybrid professional managers who have been deeply impacted by the Covid-19 pandemic: the directors of clinical laboratories of public hospitals in an Italian region, Veneto. These directors are typically doctors who have substantial decision-making power over the allocation of resources in these laboratories. The Italian case is particularly interesting as it was the first European country to face the impact of the pandemic in 2020. Moreover, since Italy has a regionally based National Healthcare System, the Veneto Region was chosen as it was one of the first regions to come to terms with the spread of the virus.

Secondary data referring to the organisational characteristics of laboratories were collected and provided by the Veneto Region, while information related to the characteristics of hybrid professional managers were collected by analysing the CVs of laboratory managers available on the websites of the relevant organisations. In total, the dataset covered 39 clinical laboratories in publicly owned hospitals and covers the years 2019-2020. The resilience of clinical laboratories was proxied by their ability to maintain high levels of efficiency during the global pandemic. This was calculated using the pure efficiency change index based on the Data Envelopment Analysis-Malmquist productivity index (Kohl et al., 2019). Moreover, fsQCA (Rihoux and Ragin, 2008) was used to identify configurations of directors’ demographic attributes and background characteristics associated with high/low levels of resilience of the clinical laboratories.

The preliminary results suggest that the hybrid professional managers who can successfully contribute to the resilience of their organisations are more likely to be women, have acquired high levels of experience in the organisation and, surprisingly, have low levels of managerial education. Consequently, it would appear that a more flexible and participative management style associated with being a female (Esteve et al., 2013) is crucial to successfully overcome the environmental shock. Additionally, there is an indication that organisation-specific knowledge (Hermann and Datta, 2006) plays an important role in achieving higher levels of organisational resilience. Furthermore, co-optation into the management sphere (Harrison, 2009; Freidson, 1994) seems to compromise their ability to draw from their clinical expertise.

References

Ansell, C., Sørensen, E., & Torfing, J. (2021). The COVID-19 pandemic as a game changer for public administration and leadership? The need for robust governance responses to turbulent problems. Public Management Review, 23(7), 949-960.

de Harlez, Y., & Malagueno, R. (2016). Examining the joint effects of strategic priorities, use of management control systems, and personal background on hospital performance. Management accounting research, 30, 2-17.

Eckhaus, E., Iholkina, V., & Shkolnik, E. (2022). The Impact of Healthcare Executive Seniority on Implementation of Innovative Methods of Diagnosis and Prevention. Health Policy.

Esteve, M., Boyne, G., Sierra, V., & Ysa, T. (2013). Organizational collaboration in the public sector: Do chief executives make a difference?. Journal of Public Administration Research and Theory, 23(4), 927-952.

Freidson, E. (1994). Professionalism reborn: Theory, prophecy, and policy. University of Chicago Press.

Giacomelli, G. (2020). The role of hybrid professionals in the public sector: a review and research synthesis. Public Management Review, 22(11), 1624-1651.

Goodall, A. H. (2011). Physician-leaders and hospital performance: is there an association?. Social science & medicine, 73(4), 535-539.

Hambrick, D. C., & Mason, P. A. (1984). Upper echelons: The organization as a reflection of its top managers. Academy of management review, 9(2), 193-206.

Harrison, S. (2009). Co‐optation, commodification and the medical model: Governing UK medicine since 1991. Public Administration, 87(2), 184-197.

Herrmann, P., & Datta, D. K. (2006). CEO experiences: Effects on the choice of FDI entry mode. Journal of management studies, 43(4), 755-778.

Kaiser, F., Schmid, A., & Schlüchtermann, J. (2020). Physician-leaders and hospital performance revisited. Social Science & Medicine, 249, 112831.

Kirkpatrick, I., Altanlar, A., & Veronesi, G. (2022). Hybrid professional managers in healthcare: an expanding or thwarted occupational interest?. Public Management Review, 1-20.

Kohl, S., Schoenfelder, J., Fügener, A., & Brunner, J. O. (2019). The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals. Health care management science, 22, 245-286.

Llewellyn, S. (2001). ““Two-way Windows”: Clinicians as Medical Managers.” Organization Studies 22(4), 593–623.

Noordegraaf, M. (2007). “From “pure” to “hybrid” Professionalism. Present-Day Professionalism in

Ambiguous Public Domains.” Administration & Society 39 (6), 761–785.

Rihoux, B., & Ragin, C. C. (2008). Configurational comparative methods: Qualitative comparative analysis (QCA) and related techniques. Sage Publications.

Sarto, F., Veronesi, G., & Kirkpatrick, I. (2019). Organizing professionals and their impact on performance: the case of public health doctors in the Italian SSN. Public Management Review, 21(7), 1029-1051.

Simon Turner (2022): ‘We are all vulnerable, we are all fragile’: COVID-19 as

opportunity for, or constraint on, health service resilience in Colombia?, Public Management

Review.

Wang, C, PW Horby, FG Hayden, and GF. Gao (2020). A Novel Coronavirus Outbreak of Global Health Concern. Lancet 395 (10223): 470–473.

Continuity and coordination of care leading to quality are global priorities for reorienting cooperation between health and care providers to meet the needs of people, especially for older persons with chronic or complex conditions. Sweden is particularly interesting from this perspective, with its decentralized non-hierarchical system based on collaboration between service providers operating at the same level for strategic internal monitor and review, carried out by coordination bodies, sharing the responsibility for local social services by 290 municipality councils and regional health care by 21 county councils. This horizontal model for cooperation between regional government health care and local government social eldercare providers in internally checked coordination bodies–implemented after the Community Care Reform (Ädelreformen) when the governance of eldercare was decentralized from county to municipal level in the early 1990s—is during the last decades increasingly challenged by centralization through vertical network, market and hierarchy coordination and external check. Yet, regardless of these three additional ways to improve performance of the Swedish collaborative model, a significant reduction in most of Sweden’s regions' and cooperating municipalities' quality of integrated care public health services for older persons has occurred during the last decade, indicated by increasing proportions of unplanned hospital re-admissions, followed by a collaborative governance and management failure to assess and improve public sector integrated care performance for older persons during the COVID19 pandemic.

Such constraints of cooperation capacity are serious, both because of the alarming death rates among the old and frail during crises and continuity of quality in ageing, indicated by the declining quality of integrated care services for older frail persons living with multi-morbidity within most Swedish regions, except for one outlier region. Yet, previous research shows that cooperation size, time, and scope may constitute important keys for the significant implementation challenge of making integrated care equal and autonomous enough to (re)build the capacities needed to implement quality across and within regions and municipalities through participation characterized by dignity and respect for older persons. The purpose of the paper is to study cooperation capacity building between health and care providers represented in coordination bodies, which sustain or improve the public sector performance of integrated care services for older people, using readmission rates as a quality in ageing indicator. The questions are: (1) How has capacity building by the strategic coordination body—i.e. both its collaborative performance management and governance of integrating care—changed after each corresponding period of office? (2) Why has quality of integrated care services for older persons changed during the last decade? (3) How is cooperate capacity building related to sustained/improved public sector ageing quality performance: when, where, how, why does it succeed?

The analyses rely on The Swedish National Board of Health and Welfare's data on the proportion of unplanned hospital re-admissions within 30 days among frail older persons 2010-11 and 2018-19 in all 290 municipalities and 21 regions of Sweden, enabling the search for systematic patterns of explanation across 52 coordination bodies repeatedly surveyed three times on their collaborative performance management and governance of integrating care services for older persons in 17 regions for the 2011-14, 2015-18, and the 2019-22 terms of office. The data utilized to explain when, where, how, and why a coordination body succeeds (against all odds), in addition to (1) the similarly conducted surveys (evaluating fieldwork carried out in 2014-15, 2018-19 and 2022-23 by Statistics Sweden after each general election), include (2) all protocols of each surveyed coordination across the previous period of office (2019-22, before the 2022 general elections), and (3) interviews with five key leaders (administrative, political, professional) representing the only case (collaborating research partner) of successful performance (with decreasing readmission rates in a region among all its eight municipalities, going from worst to best performance 2001-11—2018-19). The aim is to find new ways of making integrated care work, after the 2019 decline in quality and after the pandemic.

This study examines the challenges and opportunities of integrating the principles and targets of the Agenda 2030 and the specific Sustainable Development Goals (SDGs) into the training and capacity-building programs in Public Administration. The study employs a comparative approach that includes Portugal, Spain, and Greece to identify best practices and strategies to maximize the impact of such programs in pursuing the SDGs.

Through an approach based on a diversified methodology that includes a comprehensive literature review, survey, and interviews with key stakeholders, the study highlights the key challenges and opportunities associated with integrating the SDGs into training and capacity-building programs. The study also intends to reveal the need for political commitment, resource allocation, and stakeholder engagement, while acknowledging the challenge for integration posed by the complexity of the SDGs.

The study suggests that addressing these challenges requires a multi-level approach that involves policy coherence, stakeholder engagement, capacity-building, and monitoring and evaluation. The study also highlights the importance of integrating the SDGs into the core functions and processes of the Public Administration, such as budgeting, planning, and procurement.

The findings of the study provide insights into the key challenges and opportunities of integrating the SDGs into training and capacity-building programs in Portugal, Spain, and Greece. The study offers practical recommendations for policymakers and practitioners to maximize the impact of these programs on the achievement of the SDGs. Overall, the study contributes to the growing body of literature on the integration of the SDGs into public administration and provides insights for policy and practice.

References:

Grainger-Brown, Jarrod, and Shirin Malekpour. (2019). Implementing the Sustainable Development Goals: A Review of Strategic Tools and Frameworks Available to Organisations. Sustainability 11, no. 5: 1381. https://doi.org/10.3390/su11051381.

European Commission. (2021) Supporting Public Administration in EU Member States to Deliver Reforms and Prepare for the Future; European Commission: Brussels, Belgium, 2021.

Meuleman, L. (2021). Public Administration and Governance for the SDGs: Navigating between Change and Stability. Sustainability, 13, 5914. https://doi.org/ 10.3390/su13115914.

United Nations Department of Economic and Social Affairs. (2021). Building the Capacity of Public Servants to Implement the 2030 Agenda. World Public Sector Report 2021, pp. 89-124. https://www.un-ilibrary.org/content/books/9789210057783c008

United Nations High-Level Political Forum on Sustainable Development. (2023) Countries Voluntary National Review 2022-2023. https://hlpf.un.org/countries. Accessed in 15.05.2023.