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We are highly cognisant of the challenges and opportunities this presents, not least of which is the evolution of a client business model toward long term value creation. Clean-tech and social investment research. Creating opportunities to become active in social and clean-tech venture investments that directly or indirectly support human flourishing. The second element of relational coordination necessary to create social value in a hybrid collaboration, is the need to align the goals of partners from different sectors Carlile, ; Gulati et al.
Yet predictably the partners enter the hybrid with outcome misalignment, which means that expectations regarding the product or service to be achieved are not shared across organizations. A private organization's goals can be defined in terms of continuing existence and exploiting some form of gains from the joint efforts of their individual members Puranam et al. Thus, professional healthcare staff will have an expectation for example that they deliver a service that is egalitarian, and that offers equality of access, and where speed is not a primary concern.
Public agents such as healthcare professionals are actively involved in hybrid arrangements to pursue broader societal goals Cabral et al. Temporal alignment is needed to ensure that phasing of efforts across public and private partners is understood across both partners.
Thus, private and public organizations should develop a clear understanding of each other's goals and develop mutual knowledge to drive value creation. The aim of the private sector is to appropriate created value via rents and the aim of public organizations is to create appropriable value for beneficiaries Klein et al.
Track 2: Services and Hybrid Value Creation
Thus, the ability of interdependent actors to coordinate actions stems from mutual knowledge and goal alignment. Relational coordination is vital to achieve task performance Gully et al. Hybrid relationships are characterized by professionals and their embeddedness — the structure of interconnection surrounding a relationship Chua et al.
In sectors such as healthcare, professionals in the form of doctors and nurses may offer a tacit understanding of the hybrid relationship's context which is needed to achieve task performance Erez and Kanfer, ; Harrison et al. Experience may help social value creation by effectively developing routines and processes Vural et al.
Treasury, The study investigates the UK healthcare sector as it constitutes the sector with the highest number and value of PPP contracts let apart from transportation H.
Added value that pays off
The healthcare sector is considered as suffering market failure McKee et al. The private organization is responsible for design and build of the hospital and subsequently delivers FM services including upgrades, catering, and cleaning throughout the operate phase. The majority of existing studies on social value creation offer limited analysis of the roles of relational coordination and professional embeddedness at a dyadic level. Project Director, PuP. For instance, you now have motorized maintenance equipment which helps to clean the hospital much faster and to a much higher standard.
One level for patients, one for clinical staff and one for visitors. I think this is very innovative. For example, they did not understand a particular disease and what is needed in the hospital. Their knowledge and understanding of the wider PPP market was crucial to, for example, cut down negotiation time to around 2.
The ceiling lighting was quite innovative, mimicking a night sky […] This was something driven by my colleagues because we thought about our young patients and how we could best treat them. As an example, the linking corridor was a great idea initiated by one of their medical teams. The investigated cases had a number of unique qualities that made them logical candidates for sampling. First, both PPPs are sampled based on their differences regarding approaches to, and outcomes of, social value. The research design and sampling logic followed Langley's recommendations, ensuring that both cases were set far enough apart in time roughly a decade to ensure the research picked up on strategic changes to PPPs.
Second, the same private sector organization delivered both hospitals, but working with two separate public organizations i. Third, primary and secondary datasets were collected by following both dyads over time, thus offering a unique opportunity to investigate social value. In General Hospital case, both public and private partners possessed very limited experience in contracting for and managing PPPs.
Both parties took nearly five years to negotiate a detailed agreement addressing multiple governance issues ranging from regular reporting and information sharing, performance measuring, auditing to dispute resolution procedures. There are accompanying agreements, such as equity and loan agreements that govern the multiplicity of different relationships with, for instance, banks, in the wider PPP network.
The Specialized Hospital SH , a children's hospital adjacent to a general hospital, was established in the early s. This hospital was governed by a centrally provided contract, customized via a 2. The private partner had in the meantime acquired substantial experience in delivering healthcare PPPs, having been successful in securing a number of other PPPs. Overall, interiew recording resulted in 1, pages of interview transcription. A network of organizations are involved in these PPPs including but not limited to the public and private organization, nurses, and consultants, calling for interviews involving different perspectives.
Each of the PPPs investigated spanned up to 14 years and interviews were guided by an interview protocol. For instance, these included: building the narrative from the account of diverse interviewees from public and private partnering organizations, different organizational hierarchy levels, multiple functional areas, and across a relationship's history. Also, the study relied on organizational documents and relevant secondary data from government sources, professional associations, and media.
Data collection and analysis processes were conducted in parallel based on how data matched existing or emerging understanding of the phenomena under study Strauss and Corbin, Initial findings were presented in two 30 page case reports which formed the basis for subsequent discussions with key informants to verify accuracy.
Our data analysis process followed recommendations by Strauss and Corbin Where this process identified differences, the researchers jointly worked on the discrepancies until finalizing a working scheme of codes to individually recode the first case and then code the second case. The researchers also added to the coding scheme practices that arose from the data analysis but which had not appeared in extant literature. Coding was not finalized until consensus had been reached on each construct and the process forced per cent interrater reliability.
The continuous reappearing of findings and verification of comprehension throughout the analysis stage signified that saturation was reached. As we analysed our data from the cases, repeatedly we found relational coordination, which impacts task performance and social value creation, but for relational coordination to be operational, two key factors, namely goal alignment and mutual knowledge, needed to be present Figure 1. Below we present our findings organized by the core themes please see further data examples in Table II.
Findings indicated that a gap existed in mutual understanding between key professionals i. A constant theme of the interviews was the transient nature of the private sector employee roles — they were constantly being switched between the private partner's other PPPs — i. However, essentially the same comment — that the private partner's focus was always on the bigger picture i. A comment from the private partner confirms that the private partner had to rethink this high staff turnover. The private partner is only paid once the hospital is in operation, thus the speed at which the new infrastructure would be available was a core driver for the private actor.
Modularity helped to speed up construction and minimized disruptions in the construction phase which was especially important for SH as it was built adjacent to a fully operating hospital. Thus, the private partner wanted speed of construction, but the public partner's goal was the patient experience and that the work environment of the hospital supported healthcare delivery. Similar to a misalignment in outcomes, both cases highlighted temporal misalignments.
This temporal misalignment was recognized by PuP staff once the hospital opened. For instance, the private partner without consulting the public partner had included design for expansion by converting office space into additional ward space if required. What is apparent in the Specialized Hospital data is a much closer engagement between public and private partner. Key individuals met frequently to exchange information, address problems, and discuss future project milestones.
During the construction phase, we asked for their input. When SH opened, the Director of Business Development PrP, SH found that the porters were not at the entrance hall to guide patients and visitors and they were not answering phones. Basically, nurses were using porters to walk patients to different parts of the hospital for their treatments. This meant that porters were sometimes occupied for 30mins and nobody picked up the phone.
We also sat down with senior nurses to find more suitable ways of walking our patients across the hospital. These examples show a depth of engagement between the public and private partner. An example of design enhancement in the Specialized Hospital was a linking corridor designed to combat infection risks through different access levels for patients and their families, nurses and doctors, and service providers. This was really helpful as we are the ones delivering medical services to our patients. As the hospital treats susceptible young patients the linking corridor and its three different levels was a very successful innovation; it ensures that young patients are not unnecessarily exposed e.
Such openness and collaboration was unique to Specialized Hospital. In General Hospital proposals to improve task performance made solely by healthcare professionals, met resistance. You just do not get that, it is like pulling teeth. The hospital's long stretches of corridors are better serviced by these motorized cleaners. In the Specialized Hospital, medical staff worked alongside the private partner's project team.
A site visit by a couple of senior nurses to a children's hospital in the US led to replicating a ceiling lighting design that mimicked a night sky. It was not specified in the initial contract, but we saw the benefits of having this installed in a children's hospital. The ceiling attracted the attention of the media which the private partner leveraged to create demonstrable photo and PR friendly evidence for potential clients.
We observed that social value creation is impacted by organizational experience and ecosystem experience. In GH, the private partner's personnel came with some experience acquired through PPPs in other sectors transportation , and therefore a pragmatist's confidence that they knew what was needed and could get the job done.
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Most public partner personnel had never worked in a PPP. This was reflected in the finding that the GH PPP appeared to be run by the private partner, leading to information imbalances and thus that values in the PPP were not equitably distributed.
Efficiency examples | Schröder Hybrid
The wider PPP ecosystem evolved significantly between the investigated cases. The early GH carried the risk and uncertainty associated with pioneering. Working with healthcare professionals could exacerbate that risk, adding expense and creating further delay. Its main responsibilities were to standardize processes and train staff in public sector organizations how to manage PPPs; mitigating the public sector partner's limited experience and capabilities.
The standard contract form used in SH , initiated by the PFU, substantially reduced negotiation times in later PPPs, and helped setting up new hospitals faster and at a lower cost H. Access to accumulated ecosystem knowledge of how to contract for and manage PPPs was vital for both parties to coordinate exceeding within sector social value creation. In examining the two case studies, we have presented evidence for the role of relational coordination in task performance and social value creation. In this section, we draw out the identified relationships between core constructs Figure 1 and discuss the implications for theories of social value creation, hybrid collaborations and organizational design.
Developing mutual knowledge was also critically enabled by the private partner having finally acknowledged the corrosive impact on relationships of continual staff turnover by the time of the Specialized Hospital; directly addressing this divisive practice though a policy of maintaining a few key staff across all project phases. However, generating the management practice of an ability to communicate does not of itself create the content of management processes.
Our findings in Figure 1 position goal alignment in combination with developing mutual knowledge. The findings report on the lack of joint working, even of regular meetings in the early GH case, and of how the private organization saw only costs and little value in dialogue. Coordination was not a goal, the private organization's emphasis is on speed and completion, through prioritizing having the hospital finished, speed itself becomes a mechanism that the private partner uses to exclude the public partner. In the later SH case, we find relational coordination joint working and consultation, and examples of social value creation enabled by mutual knowledge and goal alignment.
The issue of engagement is a substantive difference between the two cases. Our model identifies the need for both communication and alignment; that neither would work alone, specialist knowledge would not be accessible without relational coordination Hoopes and Postrel, Only in Specialized Hospital are healthcare professionals providing their specialist knowledge and engaging with the private organization.
Our model then shows professional embeddedness as mediating how relational coordination will impact task performance — high embeddedness in SH resulting in healthcare professional led task performance like the children's ward night sky and an infection reducing linking corridor. In the GH case the private partner's reluctance to acknowledge and work with professionals eschewed a need for mutual knowledge Puranam et al. Given the private partner's initial use of speed in GH to mitigate collaboration, a key factor in achieving increased alignment of goals was the private partner feeling it was economically feasible to include ideas from the public partner.
In turn, healthcare professionals from the public partner felt that their expertise and professional knowledge Harrison et al. We observed mutual risk reduction then as a necessary enabler of professional embeddedness and its mediating effect on task performance.