Vlerick Repository

ABSTRACTChange is inherent to public sector management, yet many change initiatives in public organizations fail due to a lack of relevant change capabilities within the organization. This article introduces a measurement scale designed specifically to assess the organizational change capability (OCC) of public organizations. Drawing on a literature search, expert review and empirical validation involving responses from 333 professionals across multiple military organizations in Belgium, this study constructs and tests a reliable and valid scale tailored to the unique operational, regulatory, and political landscapes of public organizations. The scale includes 77 items distributed across 15 identified components, highlighting the multidimensional nature of OCCs. Principal component analysis and reliability testing confirm the scale's robust psychometric properties. The OCC scale presented in this article deepens theoretical understanding of how public organizations manage and implement change and provides a foundation for future research in diverse public organizational contexts.

OBJECTIVES: The study aims to evaluate the cost of managing psoriasis and its comorbidities across multiple medical departments and to identify cost determinants based on patient, disease and treatment characteristics. Additionally, it compares the cost of care with reimbursements under the fee-for-service (FFS) system to assess how well they reflect patient-specific care needs. DESIGN: Seven-step, time-driven activity-based costing (TD-ABC) analysis based on direct observations and interviews to generate patient-level cost estimates over the full cycle of care for participants prospectively enrolled in a clinical trial. SETTING: An integrated practice unit (IPU) at a Belgian University Hospital, centred around the treatment of psoriasis, including the management of associated comorbidities. PARTICIPANTS: A total of 52 patients meeting the trial's inclusion criteria, enrolled between January 2023 and November 2023, undergoing treatment within the IPU. RESULTS: The individual cost of care over a 6-month period ranged from €169.78 to €1454.97, highlighting significant variability. Major cost drivers included mental health status and disease severity. Additionally, the presence of one or more comorbidities had a substantial impact on care costs, affecting not only expenses directly related to comorbidity management but often also those associated with dermatological care. Finally, a comparison between the TD-ABC cost variability and reimbursement tariffs variability revealed disparities, indicating that current tariffs do not sufficiently account for patient-specific cost differences. CONCLUSIONS: Healthcare delivery and costing studies often adopt a fragmented approach, limiting cost insights into the full cycle of care for a medical condition. The TD-ABC methodology can address this gap by generating detailed, patient-level cost estimates for both primary illness management and related comorbidities. Our findings underscore the importance of including comorbidity-related costs when discussing a condition's overall economic burden while also revealing significant cost variability among patients with the same disease. Notably, these variations are not sufficiently addressed by the current FFS reimbursement system. TRIAL REGISTRATION NUMBER: NCT05480917 (ClinicalTrials.gov).

How do people develop and leverage self-definitions of who and what they are not, or their “not-me” identities, to navigate their work lives? In contrast to dominant portrayals of not-me identities as negative or oppositional, we explore how they can serve as resources in identity work. Drawing on a grounded theory study of 80 interviews with independent workers and clients, we identify a process we call “identity filtering.” Through this process, individuals identify and disconfirm misaligned role or relational elements, cultivating not-me identity repertoires that serve as reference points for how they engage in and shape their role-relationships. We identify two distinct pathways: some individuals enact their not-me identities through setting boundaries and role screening, which in turn enhance their self-clarity. Others suppress their not-me identities by engaging in enmeshment, which generates emotional strain. These diverging paths emerge through distinct underlying mechanisms: self-worth and desire for control both enable enactment, while adaptability constrains it. By reconceptualizing not-me identities as resources, this study advances identity theory and deepens understanding of how (independent) workers navigate fluid role-relationships and uncertainty in contemporary work.