Citizen participation in the decisions that affect their lives is an imperative

How can public officials be held accountable, and yet avoid the paradoxes and pathologies of the current mechanisms of accountability? The answer, claims Harmon (1995), is dialogue. But what exactly is dialogue, and how is it created? More importantly, how can dialogue ensure accountability? To address these questions, I begin with a brief description of dialogue and its basic features, distinguishing it from other forms of communication. An example illustrates how dialogue occurs in actual practice. Not only does dialogue demonstrate the intelligent management of contradictory motives and forces, it also supports Harmon’s claim that it can resolve the accountability paradox and avoid the atrophy of personal responsibility and political authority. I suggest that dialogue’s advantage outweighs its cost as a mechanism of accountability under a particular set of conditions: when public officials confront “wicked problems” that defy definition and solution, and when traditional problem–solving methods have failed, thus preventing any one group from imposing its definition of the problem or its solutions on others.

This article presents a conceptualframeworkofpublic entrepreneurship. Public entrepreneurship is defined as the generation ofa novel or innuuative idea and the design and implementation of the innovative idea into publicsector practice. The conceptualfiamework is used to distinguish between public entrepreneurs and other actors in the policy process, and to clarify the differences between policy, political, executive, and bureaucratic entrepreneurs. Taking a functionalist perspective, the article difmentintes between individual and coZkctiue entrepreneurship and ginezates pmpaitims to move us cher to a theory of public entrepreneurship. Copyright 1992 by The Policy Studies Organization.

General managers are expected to strive for organizational efficiency and effectiveness. Depending on their emphasis on efficiency and effectiveness, they produce four basic approaches to public sector general management: the directive approach, the reactive approach, the generative approach, and the adaptive approach. This paper explores the generative approach, in particular its use ofpublic deliberation as an alternative way to establish public policy and set bureau direction. Two case studies help distill the basic elements ofpublic deliberation. The first case documents the use ofpublic deliberation in significantly reducing a school district budget. The second case illustrates how public deliberation aided in crafting state educational policy. Although it is risky and expensive, public deliberation in these two cases illustrates how opening up policy-making to stakeholder participation can be highly successful. The paper concludes with implications for public management theory andpractice.General managers face two basic challenges in leading and managing their public bureaus. They are expected to strive for both organizational efficiency and organizational effectiveness. Webster's Third (1971, 725) defines efficiency as the "capacity to produce results with the minimum expenditure of energy, time, money, or materials" and effectiveness as "productive of results" (1971, 724). To achieve efficiencies, managers focus on doing things well. They attend to the internal organization and center their energies on routinizing, refining, formalizing, and elaborating on existing knowledge, and on making short-run improvements. "Efficiency thrives on focus, precision, repetition, analysis, sanity, discipline, and control" (March, 1995, 5). On the other hand, to achieve effectiveness, managers must be In the competition for scarce organizational resources, the natural processes of each tend to pit one against the other. Effectiveness thrives on exploration and experimentation, but efficiency attempts to drive them out (March, 1995, 5).Depending on their pursuit of efficiency and effectiveness, managers have developed four basic approaches to general management: the directive approach; the reactive approach, the generative approach, and the adaptive approach (Figure 1). After a brief overview of the four approaches, this paper will explore the generative approach in greater depth, especially its use of public deliberation as an alternative way to establish public policy and set bureau direction. Having observed several of these deliberations to establish public policy, my goal is to distill the essence of their structure and process for the purpose of both improving future practice and building better theory. To this end, two cases will be examined: budget deliberations in a local school district and public deliberations over state educational policy. Four Approaches to General ManagementGeneral managers employing the directive approach (the first quadrant of Figure 1) resolve the tension between efficiency and effectiv...

Seamless care is the desirable continuity of care delivered to a patient in the healthcare system across the spectrum of caregivers and their environments. Medication Reconciliation is one component of seamless pharmaceutical care. A randomized controlled trial, carried out over nine months with a six-month followup period, investigated the impact of a pharmacist-directed seamless care service. Intervention patients admitted to one of two general medicine units were subjected to a comprehensive seamless care discharge process as they were discharged from a regional, academically affiliated hospital in Moncton, NB. The number, type and potential clinical impact of drug-therapy problems for seamless monitoring (DTPsm) and drug-therapy inconsistencies and omissions (DTIOs) in hospital discharge medications were measured. A total of 253 patients, with 134 patients in the intervention group and 119 in the control group, completed the study. An average of 3.59 DTPsm per intervention patient, with 72.1% of these being scored as having a significant or very significant clinical impact level, were communicated to community pharmacists. Ninety-nine DTIOs were identified and resolved in intervention patients before discharge. A retrospective medical chart review demonstrated that the intervention resolved almost all DTIOs. In conclusion, a pharmacist-directed seamless care service had a significant impact on drug-related clinical outcomes and processes of care.