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Hirschman contrasts exit and voice as 'recuperation' mechanisms for making organisations responsive to users. However, the emergence of health-care quasi-markets and of network governance structures since Hirschman necessitate revising his theory, for they complicate the relationships between governance structures and recuperation mechanisms. Using a case study of nine primary care trusts (PCTs), this paper analyses the recuperation mechanisms, governance structures and relations between them in primary care in England. User voice can be exercised through dedicated networks besides hierarchies. As well as the 'user exit' described by Hirschman, two new 'exit' mechanisms now exist in quasimarkets. Commissioner exit occurs when a third-party payer stops using a given provider. Professional proxy exit occurs when a general practitioner (GP) fund-holder (or analogous budget-holder) behaves similarly. Neither exit mechanism requires the existence of mechanisms for user exit from healthcare purchasers, provided strong voice mechanisms exist instead to make commissioners responsive to users' demands. Establishing such voice mechanisms is not straightforward, however, as the experience of English PCTs illustrates. Keywords: Exit; Voice; Governance; Primary care; England; Quasi-market; UK

Evidence-based adoption of organizational innovations requires explicit definition of the outcomes the innovations are intended to produce. Implementation theory, however, suggests that organizational innovations are often politicized in the sense that the prospect of implementing them provokes conflicts of interests among the parties affected. Then the intended outcomes of the innovation are liable to be formulated ambiguously, misleadingly or not at all, which makes evidence-based organizational innovation unattainable. Analysis of 61 organizational innovations in nine English NHS primary care trusts suggests that while the majority of innovations were not politicized in this way, a substantial minority were. Innovations whose adoption is motivated by evidence can therefore be differentiated from politicized innovations whose adoption is not so motivated, even when they nevertheless do have evidential support. [ABSTRACT FROM AUTHOR]

Organizations providing public welfare services typically have distinct accountabilities to several parties, and the accountability chains linking these parties are often administered through different governance structures. This article reveals that in primary care in England the accountability chains characterized by different governance structures result in inconsistent levels of accountability. [ABSTRACT FROM AUTHOR]

The establishment of partnerships has been a central feature of British social welfare policy since 1997 when the New Labour government came to power. Although the academic attention given to partnership working since then has grown considerably, there have been few attempts to link conceptual models of partnerships with existing forms. This paper addresses this gap and finds that, while there are links between actual and model partnerships, there is little evidence that actual partnerships have been designed or structured to meet their particular tasks. [ABSTRACT FROM PUBLISHER]

This paper evaluates the scheme of performance-related pay facing NHS managers, using both quantitative and qualitative date from a questionnaire survey. We find that the scheme is modestly successful. On the basis of self-reported data from managers covered by the scheme, there are clear indications that it has raised motivational levels, and induced more effort, albeit for only a minority of the managers. These results stand in some contrast to those from a number of earlier UK studies, and may show what happens in relatively mature PRP systems. In seeking to understand why the scheme was not more successful, we found that motivational and behavioural change was less likely among those who thought that certain aspects of the objective-setting process were done badly, or that assessments were conducted inappropriately, or that the subsequent rewards were unattractive. We finish by drawing out some implications for HR policy. [ABSTRACT FROM AUTHOR]