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ObjectiveTo identify views and establish agreements of key stakeholders on the features of an effective system for declaring and managing conflicts of interest in healthcare.DesignA modified Delphi study consisting of two surveys and semi-structured interviews. Surveys included closed and free-text questions.Setting and participantsUK, purposefully and generally invited participants including academics, researchers, healthcare professionals, regulators, patients and citizens from 10 countries, during 25 August 2024 and 20 January 2025.Main outcome measuresQuantitative and qualitative analysis of two surveys and 21 interviews. Descriptive statistics were used to describe the sample and analyse closed survey questions. Thematic analysis was used to analyse free-text survey responses and interview data. Results were synthesised to describe the perceived importance and purposes of declaration of interest systems.ResultsIn the first survey round, 616 invitations were sent, along with social media advertisements. 237 questionnaires were returned and 200 full responses were analysable. 129 respondents consented to recontact on the online form. In the interview round, 37 invitations were sent and 21 interviews completed (response rate 59.5%). Invitations for the second survey were sent to all 129 participants who consented to recontact. 91 responses were received and 89 questionnaires were analysable (response rate 82%). Features of ideal systems to declare and manage the interests of healthcare professionals identified by participants were categorised under seven themes: regulatory issues, the healthcare environment, human vices, professional virtues, the use of judgement, features of a better system and patients and public. There was broad agreement on the need for transparency and clarity in declaration systems. The most agreed features were: clarity on what information was needed; it should be a centralised ‘deposit’ for all declarations; it should be publicly accessible, educating and informing people accessing and using the register. Having a lifelong personal identifier, some flexibility in declarations and some privacy features were also rated highly. Respondents were less concerned about scrutiny or a loss of trust. Small numbers of participants raised concerns about serious adverse effects, including loss of privacy, personal safety and the potential of information to contribute to conspiracy theories. There were also major disagreements between participants concerning whether or not healthcare professionals should work with industry, and whether conflicts of interest from working with industry can be safely managed. Individuals with each perspective felt they were acting ethically.ConclusionsWhile many agreements were identified, disagreements were also found. If improved declaration systems are to be accepted by professionals and useful to regulators, patients and citizens, the potential for benefit and harm from new declaration systems must be addressed.Registration detailsPrepublished, Open Science Framework https://osf.io/fbj5n.

This article examines the storytelling and narrative practices of an elite group of public administrators in the United Kingdom: local government chief executives. The authors do so through the lens of relationality, exploring the collective dimensions of leadership. The focus on leadership and stories embraces the narrative turn in public administration scholarship. It responds to calls for research examining the distinctive settings of everyday leadership action. The contribution to theory is a qualitative understanding of the relational ways in which stories and narratives are used in the practices of public administration leaders. The article analyzes four ways in which such leadership is accomplished: inviting an emotional connection and commitment to public service, making sense of organizational realities, provoking reflections on practices and assumptions, and managing relations with politicians. The authors offer an appreciation of how relational leadership influence can be generated by expressive narratives and storytelling rather than stemming from bureaucratic authority.

In this article we explore the dilemmas experienced by boundary-spanning actors working at the intersection of local government and the private sector. We suggest that these dilemmas are entwined with the disruption, transformation and reproduction of local government traditions. We utilise structuration theory to understand how agency is both constrained and enabled by traditions and how such agency in turn affects traditions. In drawing on the accounts of both public and private sector actors in one English region over a 10-year period, we decentre the public sector and reveal the flux inherent in working across different traditions of practice.

Developing greater cooperation between researchers and practitioners is a long-standing concern in social science. Academics and practitioners working together to coproduce research offers a number of potential gains for public administration scholorship, but it also raises some dilemmas. The benefits include bringing local knowledge to bear on the field, making better informed policy, and putting research to better use. However, coproduction of research also involves managing ambiguous loyalties, reconciling different interests, and negotiating competing goals. The authors reflect on their experience of coproducing a research project in the United Kingdom and discuss the challenges that coproducers of research confront. They situate the discussion within a consideration of traditions of public administration scholorship and debates about the role of the academy to understand better the politics of their joint practice. Thinking about the politics of coproduction is timely and enables the authors to become more attuned to the enefits and constraints of this mode of research.

To compare isobaric lidocaine and mepivacaine in outpatient arthroscopic surgery. Prospective, randomized, double-blinded study. Ambulatory surgery center affiliated with an academic tertiary-care hospital. 84 adult, ASA physical status 1, 2, and 3 ambulatory patients, age 18-70 years, undergoing arthroscopic knee surgery. Patients were randomized to receive a combination spinal-epidural anesthetic using 80 mg of either isobaric 2% mepivacaine or isobaric 2% lidocaine. Patients also received a femoral 3-in-1 block with 0.5% bupivacaine applied to the affected extremity. Demographic data and level and duration of the block were recorded. The use of supplemental epidural anesthesia was noted along with frequency of bradycardia, hypotension, and episodes of nausea and vomiting. Duration of block and times to ambulation and voiding were recorded. Delayed variables, including fatigue, difficulty urinating, back pain, and transient neurologic symptoms (TNS) were obtained. No demographic differences were noted between groups, and surgical duration was similar. Satisfactory anesthesia was achieved in all cases, with no differences noted in hypotension, bradycardia, nausea, or vomiting. Onset of sensory and motor block was similar. Duration of block before epidural supplementation was 94 ± 21 minutes with lidocaine versus 122 ± 23 minutes for mepivacaine (P < 0.011). Times to ambulation and voiding were longer in patients receiving mepivacaine but did not affect PACU stay. Twenty-four and 48-hour recovery was similar with no TNS symptoms reported. No major differences were noted between lidocaine and mepivacaine spinal anesthesia. Time to ambulation and voiding were longer in patients who received mepivacaine as was time to first dose of epidural catheter. Neither group had TNS symptoms. Lidocaine and mepivacaine are both appropriate spinal anesthetics for ambulatory orthopedic lower extremity procedures.

Abstract Foundations are one of the oldest organizational forms globally; their number and resources, as well as their socio-political and economic importance, have steadily continued to grow. Yet, foundations’ attributes, activities, and actual achievements remain underexplored and poorly understood. This is particularly noticeable in the context of global policy and transnational administration, an area where foundations tend to be subliminal players, acting as a widely unrecognized socio-political undercurrent. Addressing the resulting need for better and alternative conceptualizations of foundations, our paper uses French pragmatic sociology of critique (FPSC), a non-structuralist, post-Bourdesian, approach to sociology, to theorize philanthropic foundations within the policy agora. Through FPSC, we present foundations as a composite setup of activity, where critically reflexive actors bring normative ideologies and knowledge to policy, providing a new avenue for how scholarship can interpret and critique foundations and their influence.

Purpose - The purpose of this paper is to offer a reflexive account of the co-production of a qualitative research project with the aim of illuminating the relationships between research participants.Design methodology approach - The paper draws upon personal experience of designing and conducting a research project into management learning, run jointly between an academic and a senior practitioner. The methodological issues involved and the reflexive dynamics of how the work of research collaboration is accomplished are considered.Findings - Engaging with radical reflexivity helps to produce insights about the co-production process.Originality value - This paper contributes to the field of reflexivity and is innovative in its context of academic-practitioner research.

This article sets out a new research agenda for decentered public leadership. Nested in the concept of decentered theory, it examines the messy and contested nature of public leadership practices in different contexts. Drawing on recent empirical studies that have adopted a decentered approach to examining public leadership, it sets out a future research agenda that places individuals, history and context at the heart of explanations for public leadership in action.

This research note argues that pragmatic sociology is a useful theoretical framework when researching the third sector during the uncertain times of COVID-19 and beyond. It begins by introducing pragmatic sociology, which describes how actors express their values through the 'orders of worth' framework, and then how they justify their practices during moments of conflict, through the process of 'tests'. This ultimately employs complex and fragile moments in history to uncover meaning making and, by extension, individual and organisational practice. This article then demonstrates useful research questions that pragmatic sociology can offer for the third sector during this uncertain time and how this theory's utility can be applied even after the pandemic, due to its embracement of organisational dynamism, nuance and a fresh approach to power relationships.

This article examines ideas of local government crisis in the UK aiming to apply macrolevel political economy debates to this sector. Two observations underpin its rationale. The first concerns structuralism's neglect of local government and the disconnection from its lively history of crisis discourses. Crisis discourses are a key frame through which local government actors have come to understand their environment. The second is that the fast-growing literature on crisis leadership says little about the underlying causes of crises. The article synthesises a political-sociological interest in crisis with the grounded focus of interpretivism to offer insights about context and practice.