L Menzies

Abstract: Procurement in the UKs National Health Service (NHS) is facing its most significant financial challenge Despite the sheer scale and complexities of the public healthcare sector, the Government's solutions are all too often packaged as "collaborate more", "standardise products" and "leverage spend" Unfortunately, these over simplistic solutions take a myopic view of market drivers, conflate spend with potential savings and fail to deliver value Many contracts have already been commercially optimised yet the funding crisis continues to deepen New value-based procurement approaches are needed to drive longer-term innovation and cost reduction and to move debates from efficiencies to embrace effectiveness in integrated supply chains In this research, we adopt the resource-based view (RBV) as a lens to explore the extent to which NHS resources support the strategic adoption of value-based approaches An empirical case study on a regional cluster of six NHS Trusts in England, confirms the dominance of narrow price-based approaches that create barriers to moving towards longer-term, valuebased procurement The antecedent roots of price-based approaches are unpicked through a hermeneutic analysis of recent Government commissioned reports to show how these have set the tone, culture and priorities for healthcare procurement in the UK The analysis provides explanatory power to the case study by illustrating how Government reports have led to, and legitimised the dominance of price-based approaches and caused relational and resource-based barriers to adopting value-based procurement, despite stakeholder enthusiasm The findings provide unique insights into why public procurement has struggled to reach beyond its traditional cost orientated scope We contribute to an extended consideration of the RBV in public organisations through identifying the role of the policy environment in determining and legitimatising an organisation's strategic direction

Abstract: Drawing on prior research, the value of scenario planning as a methodology for researching the future of purchasing and supply management (PSM) is explored. Using three criteria of research quality – rigour, originality and significance – it is shown how developing scenarios and analysing their implications present new, important research opportunities for PSM academics, practitioners, and leaders of the profession. Researching the future of PSM supports the identification of uncertainties and anticipates change across many units and levels of analysis of interest to PSM scholars and practitioners, such as the profession/discipline, markets/sectors, or organisations. Scenarios are particularly effective for: considering how the complex interaction of macro-environmental factors affects the PSM context; avoiding incremental thinking; surfacing assumptions and revealing significant blind spots. PSM research using scenarios aligns with Corley and Gioia's (2011) call for prescience-oriented research in which academics aim for more impactful research, enhancing sense-giving potential and theoretical relevance to practice, to better perform their adaptive role in society.

Abstract: Drawing upon transformative service research and social tourism literature, this paper explores the relationship between respite care and childhood illness. It focuses specifically upon the short break opportunities attached to respite care offered in children's hospices in the United Kingdom. Pathographies (illness narratives), shared by patients, siblings and family (n = 23), provide unique insights into ways in which each participate in respite care. Participation prompts inclusivity and normality. It offers a break from illness, and contributes to uplifting feelings of optimism, escapism and new beginnings. Conclusions drawn argue the need for healthcare policy to move beyond ‘Dying Well’ narratives into ones which celebrate ‘Living Well with Dying’. Tourism participation has much to offer such a progressive healthcare policy.

Abstract: The ageing population in the UK is placing huge pressure on Health and Social Care, exacerbated by current economic pressures to cut costs. The British Government is politically driving integrated care, to encourage the different services that constitute the whole system of care to work together in order to reduce fragmentation and overlap in the system. However, methods for effective partnership working towards integrated care are not well researched. This thesis details an action research project to virtually integrate Housing into the whole system of care in Conwy in particular, concluding that the methods used provide an appropriate approach for partnership working towards integrated care, thus addressing this gap. Housing plays an important role in the whole system of care for older people as a person's home environment has a high impact on their wellbeing. Poor quality housing can negatively impact on health, and care can be provided in the home due to the government's emphasis on 'ageing in place'. However, whilst the importance of considering Housing's role in the whole system of care is identified in government policy, efforts towards achieving integrated care do not commonly include Housing departments or providers. The thesis concludes that only types of housing which inherently include care (e.g. extra care, care homes) are integrated into the system, despite the fact that residents can access care in any type of housing. Soft systems methodology (SSM) is used to identify the whole system of care in Conwy, Wales. A Steering Group was established to develop an Older Persons' Housing Strategy (OPHS) for Conwy, one of the aims of which was to integrate Housing into the whole system of care. The local authority act as the 'strategic enabler' in achieving this. Each Steering Group member was interviewed to establish their role within the system, and their worldviews on it. This enabled the Steering Group to develop a shared vision for the OPHS, which is a key feature of successful partnerships to achieve integrated care. Support is identified as an appropriate integrating function and examined to establish appropriate operations structures. Through a survey of support services in Wales, it is identified that support, provided by wardens in sheltered housing, is currently going through a transition period, due to changes to funding guidelines for support. Many local authorities in England are now using offsite support, but the impacts of this are not well researched. This research provides an evidence base for practitioners looking to change the structure of their warden service. This is based on a SWOT analysis of onsite and offsite support, conducted from the data gathered during the survey. Local authorities can capitalise on the changes being made to warden services, taking the opportunity to upskill wardens and using support to integrate Housing into the care system by signposting other services. Finally, focus groups were conducted with older people to ensure the OPHS met their needs. This also served to triangulate the findings of the SSM and the survey, demonstrating the effectiveness of combining these methods.

Abstract: The growing awareness of public procurement as an innovation policy tool has recently sparked the interest of both policy makers and researchers. While an increasing number of studies is being published every year, an overview of the field is missing. Researchers, practitioners, and policy makers are often using ambiguous wording and have not yet reached consensus on the terminology and concepts involved. This state of affairs leads to research fragmentation and lack of knowledge convergence. For the purpose of contributing to knowledge synthesis and consolidation, this article provides a structured review of the literature on innovation in public procurement. From categorizing publications based on innovation drivers, concepts, and research approaches, the emerging structure of the field is described and synthesized into a framework of innovation in public procurement. The proposed framework differentiates between literature streams on (1) innovations in the public procurement process, (2) innovation of public services by means of procurement, and (3) the use of public procurement as a tool for demand-side innovation policy-making. For each of these streams of literature, different focus areas as well as research gaps and opportunities for future research are identified. Based on analysis of existing research, the proposed framework provides an overview of state-of-the-art knowledge, a unified terminology, and a holistic understanding of innovation in public procurement. The framework is both a point of departure for future research and a source of knowledge for practitioners.

Abstract: Several studies suggest that, in practice, service procurement is more challenging than goods procurement. The underlying but largely implicit argument is that the procurement process for services involves higher buyer uncertainty and therefore requires extra efforts to mitigate this uncertainty. Drawing on Transaction Cost Economics, we use a database of information technology transactions to investigate the relationship between transaction characteristics and social embeddedness, and ex ante cost and ex post problems. We explore whether the same relationships hold across transactions that involve only goods versus transactions that also involve services. Our findings support conventional wisdom that managing the procurement process for transactions involving services is more challenging than for transactions involving goods. However, when controlling for typical transaction characteristics, there is no difference between transactions involving goods and transactions that also involve services.

Abstract: Objectives Procurement's important role in healthcare decision making has encouraged criticism and calls for greater collaboration with health technology assessment (HTA), and necessitates detailed analysis of how procurement approaches the decision task. Methods We reviewed tender documents that solicit medical technologies for patient care in Canada, focusing on request for proposal (RFP) tenders that assess quality and cost, supplemented by a census of all tender types. We extracted data to assess (i) use of group purchasing organizations (GPOs) as buyers, (ii) evaluation criteria and rubrics, and (iii) contract terms, as indicators of supplier type and market conditions. Results GPOs were dominant buyers for RFPs (54/97) and all tender types (120/226), and RFPs were the most common tender (92/226), with few price-only tenders (11/226). Evaluation criteria for quality were technical, including clinical or material specifications, as well as vendor experience and qualifications; "total cost" was frequently referenced (83/97), but inconsistently used. The most common (47/97) evaluative rubric was summed scores, or summed scores after excluding those below a mandatory minimum (22/97), with majority weight (64.1 percent, 62.9 percent) assigned to quality criteria. Where specified, expected contract lengths with successful suppliers were high (mean, 3.93 years; average renewal, 2.14 years), and most buyers (37/42) expected to award to a single supplier. Conclusions Procurement's evaluative approach is distinctive. While aiming to go beyond price in the acquisition of most medical technologies, it adopts a narrow approach to assessing quality and costs, but also attends to factors little considered by HTA, suggesting opportunities for mutual lesson learning.

Abstract: Increasing the effectiveness, efficiency, and compliance of public procurement (PP) has become an ongoing concern for governments. Public administrations at different levels are realising that – in order for PP to fulfil its mission – appropriate control and diagnostic systems must be put in place. This study aims to investigate the architecture of PP performance measurement systems (PP-PMSs) in local governments, drawing on four case studies from Italy and four from Wales. The theoretical background is provided by the emerging literature on procurement PMSs in the private context as well as the specific literature on the public sector. PP-PMSs are specifically analysed with respect to performance areas covered (i.e., cost, quality, time, compliance, innovation, sustainability). Results show that performance dimensions should be extended beyond traditional cost measures, with KPIs not limited to those imposed by national/regional regulation. Furthermore, we show that this is likely to happen where the procurement function is recognised as strategic in the public institution.

Abstract: Interest in public procurement's role in innovation has been reinforced by the directional turn in innovation policy, which highlights the social purpose of innovation. Procurement-induced innovation may often be a by-product of the pursuit of other policy goals, especially in sectors that are highly dependent on innovation, such as healthcare. Yet the tendency of innovation scholarship to focus at macro-levels, and on R&D-intensive innovation, means that the ways in which procurement routinely affects innovation – whether positively or negatively – are not fully understood. A particular scholarly lacuna relates to the role of the procurement office, which is often characterized as a more-or-less effective conduit for the knowledge and imperatives of others, notably users and vendors. Literature from innovation policy studies, which highlights the importance of implementation and administration for realizing innovation policy aims, alongside the burgeoning field of valuation studies, suggests that these offices may have a more substantive effect. We explored the role of the procurement office in innovation in the healthcare sector, which is highly dependent on innovation but retains the delivery of a high quality public service as its primary goal. We used an embedded case study design across four provinces in Canada, involving document review, ethnographic observation and key informant interviews (n=32). We first review how procurement offices engage and shape markets, then turn to the critical ways in which this market-shaping capacity is enabled through demand shaping activities that are negotiated within health systems. We argue that procurement offices act as professional intermediaries wielding calculative devices to set up the parameters of purchasing situations and to render certain measures of worth calculable through purchasing specifications. In doing so, they configure demand, conjure supply, and shape markets over time. Thus, they have a systemic impact on innovation. Yet while always present, the strength of the procurement office's impact is not unlimited, being constrained by powerful constituencies within health systems and cost-cutting pressures placed on public sector procurement more generally. We suggest that acknowledging the substantive importance of procurement offices in innovation may be an important first step in unleashing their capacity to support it.