BACKGROUND: Workers tasked with specific responsibilities around patient and public involvement (PPI) are now routinely part of the organizational landscape for applied health research in the United Kingdom. Even as the National Institute for Health and Care Research (NIHR) has had a pioneering role in developing a robust PPI infrastructure for publicly funded health research in the United Kingdom, considerable barriers remain to embedding substantive and sustainable public input in the design and delivery of research. Notably, researchers and clinicians report a tension between funders\' orientation towards deliverables and the resources and labour required to embed public involvement in research. These and other tensions require further investigation.
METHODS: This was a qualitative study with participatory elements. Using purposive and snowball sampling and attending to regional and institutional diversity, we conducted 21 semi-structured interviews with individuals holding NIHR-funded formal PPI roles across England. Interviews were analysed through reflexive thematic analysis with coding and framing presented and adjusted through two workshops with study participants.
RESULTS: We generated five overarching themes which signal a growing tension between expectations put on staff in PPI roles and the structural limitations of these roles: (i) the instability of support; (ii) the production of invisible labour; (iii) PPI work as more than a job; (iv) accountability without control; and (v) delivering change without changing.
CONCLUSIONS: The NIHR PPI workforce has enabled considerable progress in embedding patient and public input in research activities. However, the role has led not to a resolution of the tension between performance management priorities and the labour of PPI, but rather to its displacement and - potentially - its intensification. We suggest that the expectation to \"deliver\" PPI hinges on a paradoxical demand to deliver a transformational intervention that is fundamentally divorced from any labour of transformation. We conclude that ongoing efforts to transform health research ecologies so as to better respond to the needs of patients will need to grapple with the force and consequences of this paradoxical demand.

In the last twenty years, France has gone through health policy changes that are perceived as paradigm shifts. After briefly describing the reforms driven by the new public management and the subsequent re-centralization of the French health system for budgetary purposes, it appears that those reforms had outcomes below expectations. The regrouping of policy decisions within the Regional Health Agencies and the rise of a French Welfare elite weakened the medical profession. Blame-shifting strategy, political dilution, and spatial inequality linger. The COVID-19 epidemic highlights those limitations. The negative societal and political impact of failed public reforms is increasingly evident.

The study examines former home care workers\' reasons for leaving their jobs from the perspective of reforms in public services and eldercare policies impacted by New Public Management (NPM) in Finland. Written narratives from former home care workers (n = 39) were collected online and analyzed using thematic content analysis. Former home care workers\' reasons for leaving their jobs were connected to four interconnecting themes: mismatch between needs and resources, measurement-driven practices, unbalancing work-life, and ethical burden. These reasons reflected critical changes in the organization of care work and the work environment in older adults\' home care. Contradictions between needs, resources, and values lead to ethical dilemmas and push away from the workforce in eldercare. To improve care workers\' willingness to remain in the eldercare sector, changes are needed in the resourcing and organization of home care, including managerial support in everyday care work.

New Public Management-inspired reforms in the Norwegian hospital sector have introduced several features from the private sector into a predominantly public healthcare system. Since the late 1990s, several reforms have been carried out with the intention of improving the utilization of resources. There is, however, limited knowledge about the long-term, and sector-wide effects of these reforms. In this study, using a panel data set of all public hospital trusts spanning nine years, we provide an analysis of the efficiency of hospital trusts using data envelopment analysis (DEA), as well as a Malmquist productivity index. Thereafter we use the efficiency scores as the dependent variable in a second-stage panel data regression analysis. We show that during the period between 2011 and 2019, on average, efficiency has increased over time. Further, in the second-stage analysis, we show that New Public Management features related to incentivization are associated with the level of hospital efficiency. We find no association between degree of competition and efficiency.

BACKGROUND: Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate \"healthcare entrepreneurship\", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer\'s disease.
METHODS: A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have.
RESULTS: The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship - two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level.
CONCLUSIONS: Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients\' mental disease and ultimate passing.

This article historicises practices called \'personalization\' in the UK. It presents data from interviews with practitioners to show how business leaders, public sector managers, policy analysts, activists and others have crafted their personalizing practices through commercial and governmental work over a 40-year period. These public histories are illuminated by professional biographies, which reveal common interests in the transfer and application of technology, data and data analytics. Yet they also illuminate attempts to reform bureaucracies in public and private sectors alike during the late 20th and early twenty-first century. The article asks how mobility - of professionals and their personalizing practices - has affected the pre-existing contrast between, and separation of, public and private organizations. This article contributes to commentaries on personalization that view it as an essentially private and privatizing process. What remains of such domains once they have been crossed, and from whose perspective? This UK history raises questions for comparative histories of personalization and its synonyms elsewhere.

The article highlights several outstanding features of French healthcare reforms in light of New Public Management (NPM). The paper exposes the economic, administrative, and social context of reforms. It investigates horizontal integration, as exemplified by the concentration of power within the Regional Health Organizations, the verticalization of the chain of command, and ensuing conflicts between the French welfare elite and the operating core (eg, the medical profession). Outcomes were below expectations in many areas. The NPM-endorsed fragmentation of public organizations has yet to take root in the French healthcare system. There was little consultation with the medical profession. Physicians\' autonomy and patients\' rights receded.

COVID-19 arrived in Chile amid social protests that questioned the State\'s ability to protect children\'s rights. Nevertheless, child policy workers continued working despite the drastic changes to their daily work generated by both the pandemic and conflicts within the child welfare system. In this article, we aim to understand how these workers have experienced and overcome these challenges. We show that they have continued doing interventions with children at the expense of their economic resources and well-being. Our findings highlight the need for the government to take immediate action, offering guidelines to improve child policy workers\' labor conditions.

We analyze the relationship between the party affiliation of politicians at different levels of government and the spatial distribution of funding for research, development and innovation projects. In particular, we are investigating whether more federal grants are being granted in Germany for projects in federal states whose government is led by the same political party as the responsible ministry at federal level. Our dataset contains detailed information on publicly funded projects in Germany in the period 2010-2019. Using a fixed-effects estimation approach, we find a link between grant allocation and party affiliation of funding for research, development and innovation projects, in particular smaller ones. For these projects, political alignment is associated with an average increase in public funding by almost 10,000 euro. Our results suggest that public funds for research, development and innovation projects could be used more efficiently than they are.

While New Public Management practices (NPM) have been adopted in academia and higher education over the past two decades, this paper is investigating their role in a specifically socio-philosophical way: The preeminent question is what organization of science is likely to make science and research work well in the context of a complex society. The starting point is an obvious intuition: that academia would be \"economized\" by NPM (basically, that something is coming from the outside and is disturbing the inside). Habermas provides a sophisticated theorization for this intuition. In contrast, the thesis advanced here is that we should consider NPM potentially problematic-but not for descending from economics or administration outside academia. It is because NPM often cannot help research and science to function well. In this (rather \"essayistic\" than strictly deductive) consideration, I will therefore tentatively discuss an alternative approach that takes up critical intuitions while transposing them into a different setting. If we understand science and research as a form of life, a different picture emerges that can still bring immanent standards to bear, but at the same time compose them more broadly. This outlines a socio-philosophical critique of NPM. Accordingly, the decisive factor is not NPM\'s provenance. What is decisive is that it addresses some organizational problems while at the same time creating new ones. At the end, an outlook is sketched on how the specific situation of NPM allows some hypotheses on academy\'s [by \"academy\", I am referring to the whole research community (like \"academia\")] future organization. Ex negativo, it seems likely that qualitative evaluation criteria and creative freedom will have to play a greater role.