Purpose

The purpose of this paper is to study the links between contextual changes, contract arrangements and resultant problems when changes in outsourcing regulatory requirements are applied to complex pre-hospital services previously characterized by relational contracting.

Design/methodology/approach

The study deployed a qualitative design based on interviews with key informants and extensive studies of documents. It is a longitudinal study of a procurement process taking place in a regional health authority covering the period 2006 to 2017.

Findings

A complex and longitudinal public procurement process where pre-hospital (ambulance) services are transformed from relational and outsourced governance to more formal arrangements based on legal and transactional controls, is described in detail. After several years, the process collapsed due to challenges following public scrutiny, legal actions and administrative staff resignations. The public body lacked procurement competencies and the learning process following the regulations was lengthy. In the end, the services were in-sourced.

Research limitations/implications

This study is based on one case and it should, therefore, not be generalized without limitations.

Practical implications

One practical implication of this study is that transactional contracts are not optimal when core and complex services are produced in inter-organizational settings. In public sector health-care contexts, the role of informal and social controls based on relational exchanges are particularly applicable.

Social implications

Acute health-care services essential to citizens’ security and health imply high asset specificity, frequency and uncertainty. Such transactions should according to theory be produced in-house because of high agency costs in the procurement process.

Originality/value

The paper contributes to the understanding of how the public procurement process can itself be complex, as managerial challenges and solutions vary along several dimensions and are contingent upon external factors. In particular, the study increases knowledge of why the design and implementation of outsourcing models may create problems that impede and obstruct control in a particular public sector context.

中文翻译：

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公共采购绩效和服务复杂性挑战–院前医疗保健案例

目的

本文的目的是研究将外包监管要求的变更应用于以前以关系承包为特征的复杂院前服务时，环境变化，合同安排和由此产生的问题之间的联系。

设计/方法/方法

该研究基于对主要信息提供者的访谈和对文档的广泛研究，部署了定性设计。这是对区域卫生局在2006年至2017年期间进行的采购流程的纵向研究。

发现

详细描述了一个复杂的纵向公共采购流程，其中，院前（救护车）服务从关系和外包治理转变为基于法律和交易控制的更正式安排。几年后，由于公众审查，法律诉讼和行政人员辞职带来的挑战，该流程崩溃了。公共机构缺乏采购能力，遵循法规的学习过程很漫长。最后，这些服务是内包的。

研究局限/意义

这项研究基于一个案例，因此不应无限制地进行概括。

实际影响

这项研究的实际含义是，当在组织间环境中生成核心服务和复杂服务时，交易合同不是最佳的。在公共部门卫生保健方面，基于关系交流的非正式和社会控制的作用尤其适用。

社会影响

对公民的安全和健康至关重要的急性保健服务意味着资产的特殊性，频率和不确定性很高。根据理论，此类交易应在内部进行，因为采购过程中的代理成本很高。

创意/价值

本文有助于理解公共采购流程本身如何复杂，因为管理方面的挑战和解决方案在多个方面有所不同，并取决于外部因素。尤其是，该研究增加了关于为什么外包模型的设计和实施可能会产生在特定公共部门环境中阻碍和阻碍控制的问题的知识。