Information sharing in public-private relationships: the role of boundary objects in contracts

ABSTRACT

The management of public-private relationships to deliver vital public products and services is crucial to ensure high performance. While extant public management studies have started to position contracts as vital in managing information exchange, these studies paid limited attention to unpack the elements within a contract, and their role and capacity, to support (or hinder) information sharing. Drawing on primary and secondary datasets, we examine three relationships between a pharmaceutical company and public healthcare organizations. While findings reveal that contracts can function as a common reference point, individual boundary objects differ both in their information processing and exchange capacities.

KEYWORDS:

• Boundary object
• contract
• information asymmetry
• public-private relationships
• information sharing

1. Introduction

With the increasing costs of and demands for developing new and maintaining existing public assets and services, governments around the world have increasingly partnered with private sector organizations in delivering and financing public infrastructure, products, and services (Warner and Hefetz 2008; Hodge, Greve, and Biygautane 2018). This trend towards the use of more long-term public-private relationships, as distinct from purely outsourcing public services to a private provider, in areas such as healthcare and transportation, brings about challenges for relationship management (Roehrich, Lewis, and George 2014; Hodge and Greve 2017). The relationships between public and private sector organizations are characterized by multiple participants with varying economic and social values (Caldwell, Roehrich, and George 2017; Torfing and Ansell 2017; Osborne 2018; Warsen et al. 2018). These differences between public and private partners reinforce the organizational boundaries that exist between them, with the potential to engender rigidity, inhibit responsiveness (Vangen and Winchester 2013), and yield high levels of information exchange demands for public-private relationships to achieve optimal performance (Kinder and Burgoyne 2013; Vangen, Hayes, and Cornforth 2015). Thus, it has been argued that ‘the public manager’s most formidable challenges are […] those related to working outside of the home organization in collaborative settings’ (Agranoff 2005, 18).

Difficulties of cooperation between public and private organizations are often underlined by information asymmetry stemming from, for instance, misaligned incentives, goals and payoffs, misconfiguration of resources, and activity interdependence, leading to possible opportunistic and self-interested behaviours (Kinder and Burgoyne 2013; Allen et al. 2016). This makes information processing and sharing – the gathering, interpreting, and exchange of information in the context of decision making (Tushman and Nadler 1978) – between partnering organizations critical to achieve relationship outcomes (Tihanyi and Thomas 2005). In public-private relationships, information, such as quality of service delivery, and how this is being measured and monitored, needs to be exchanged (e.g. Barlow and Köberle-Gaiser 2008; Brorström and Diedrich 2020). In order to manage private partners in the delivery of public assets, products, and/or services, contracts have become a common feature (Hughes et al. 2011; Isaksson, Blomqvist, and Winblad 2018; Howard et al. 2019). Prior public administration and contracting studies have considered the use of contracts to, for example, achieve value for money (VFM), appropriated risk transfer, and ensuring quality service delivery in public-private relationships (Ball, Heafey, and King 2003; Sanderson et al. 2018).

While some extant (public) management research has started to emphasize contracts as vital vehicles for information exchange (e.g. Hughes et al. 2013; Lumineau 2017), these studies have paid limited attention to unpacking the elements within a contract, and their role and capacity, to support (or hinder) information sharing. In order to address this vital gap for academia and practice, our study builds on prior public management and contract research concerning contracts and their functions (e.g. Petsoulas et al. 2011; Schepker et al. 2014) by unpacking the elements, such as timelines, nested within the contract. We build on extant studies which have focused on boundary-spanners (Williams 2002), and the facilitation of boundary-spanning behaviours (van Meerkerk and Edelenbos 2018). More specifically, we build on the concept of boundary objects (Sapsed and Salter 2004) within contracts in supporting boundary-spanning activity in public-private relationships. To manage the complexities and interdependencies across organizational boundaries, boundary-spanners construct boundary objects, such as reports, timelines, and presentations, to facilitate collaborations across organizational boundaries (Levina and Vaast 2005). Thus, boundary objects act as intermediaries that afford managers and organizations with the ability to manage and integrate multiple, divergent discourses, and practices across organizational boundaries (Carlile 2004).

We posit the following research question: How do different boundary objects in contracts address information asymmetry in public-private relationships? Our study focuses on three public-private relationships in the UK healthcare sector, constituting a sector with a high number and value of public-private relationships (Gov.UK 2018), and increasing reliance on private sector involvement (e.g. Allen 2009; Barlow, Roehrich, and Wright 2013). Our empirical research examines the relationships between the digital innovation centre of a multinational pharmaceutical company (PharmCo), and three different public healthcare organizations. A rich dataset was collected consisting of interviews, observations, archival data, and contracts.

We contribute to the management of public-private relationship and (public) contracting literature by positioning the contract and its nested boundary objects. First, we elaborate prior research on public-private relationships and contracts by assessing the nature of these relationships in terms of information asymmetry, before unpacking in detail the role of the contract in addressing information asymmetry. Our study shows how contracts: foster communication and shared understanding; align varying perspectives; delineate roles and responsibilities; help with monitoring and supervision; and coordinate resources and activities. Thus, contracts may act as a ‘common and negotiated frame of reference’ and a ‘shared space for action’, thus addressing information asymmetry.

Second, by unpacking the contract, the study reveals elements within the contract that act as boundary objects, namely timelines, processes, meetings and conferences. These elements have distinct characteristics in terms of information processing and sharing. More specifically, timelines help in achieving a joint interpretation of time and align different assumptions of time; processes may help to coordinate different interpretations of a project’s progress and processes; and meetings and conferences can help to build relationships and trust as well as ensure an equal representation of different perspectives. We argue that these elements in a contract may act as frames and filters that influence how organizations exchange and make sense of information to address information asymmetry, which is especially important in relationships without initial consensus and shared values. While the identified boundary objects, individually and in their interaction, may help to address information asymmetry in public-private relationships, these positive effects were not always realized. Where one partner is more dominant than the other, or where boundary objects are not used in the intended way, the elements may have a negative impact on information processing and sharing.

2. Theoretical background

2.1 Public-private relationships and information sharing in healthcare

The rising costs of maintaining and operating existing public assets and of developing new public assets, the need to cut costs and waste, and rising constraints on budgets and borrowing are stifling governments’ ability to make the required investments in public infrastructure and services (Warner and Hefetz 2008; Hodge, Greve, and Biygautane 2018). Thus, around the world, governments have increasingly turned to private organizations to deliver and finance public health infrastructure, products, and services (Roehrich, Lewis, and George 2014; Torchia, Calabrò, and Morner 2015). This trend is often considered to be part of the New Public Management (NPM) Reform (Boyne 2002). This has brought about a diversity of public-private relationships, such as public-private partnerships (PPPs) and Private Finance Initiatives (PFIs), to allow public and private organizations to work together closely over extended periods of time (Anderson 2012), but with varied degrees of private sector involvement and responsibility (Barlow, Roehrich, and Wright 2013). In the UK, for example, over 700 PPPs for hospitals, schools, bridges, and roads have been established since 1990, accounting for a value of around £60bn (Gov.UK, 2018). The most common model for private sector delivery of healthcare infrastructure and services is the so called DBFO model in which the private sector designs, builds, finances, and operates healthcare infrastructure and services (Roehrich, Lewis, and George 2014).

Prior studies have explored a myriad of benefits that help account for why public-private relationships may outperform either sector working alone, such as the value of collaboration (Doberstein 2016; Warsen et al. 2018), complementary resources (Madhok and Tallman 1998), and being able to address bigger societal agendas (Hodge and Greve 2017). However, these relationships are not without their challenges as they bring together public and private actors with often different objectives (Brinkerhoff and Brinkerhoff 2011; Osborne 2018). While private actors are considered to strive towards maximizing private benefits such as economic profits, public actors seek to maximize public benefits such as sustainable development, or the delivery of medical services (Roehrich, Lewis, and George 2014). These divergent objectives lead to a variety of challenges from a policy, strategic, and operational perspective, for example, in relation to risk allocation (Bing et al. 2005), VFM considerations (Ball, Heafey, and King 2003), and contractual and relational governance (Zheng, Roehrich, and Lewis 2008).

Our study is based in the UK healthcare sector, constituting the sector with the highest number and value of contracts, apart from transportation (Gov 2018), that brings together public and private organizations. The UK healthcare sector has gone through multiple restructurings and reforms to increase private sector involvement (e.g. Allen 2009), and constitutes a sector where key social values – such as operational efficiency in delivering medical services, care-giving, and hospital maintenance services – are created (Allen et al. 2016). The aim of healthcare public-private relationships is to achieve a higher efficiency level by drawing on expertise and managerial changes from the private sector while working with the private party in close and often long-term relationships (Hood 1995; Sanderson et al. 2018). Working closely with private sector firms allow public organizations to access idiosyncratic resources and capabilities which may bring about, for instance, more innovative responses and improved health service quality (e.g. Barlow, Roehrich, and Wright 2013; Lennon and Elmholdt 2019).

Difficulties of cooperation between public and private organizations are often underlined by information asymmetry stemming from, for instance, misaligned incentives, goals and payoffs, misconfiguration of resources leading to possible opportunistic and self-interested behaviours (Allen et al. 2016). Furthermore, the boundaries that exist between parties reinforce rigidity and inhibit responsiveness. This creates complexity and uncertainty, yielding high levels of information processing and sharing to address information asymmetries for the relationships to achieve optimal performance (Phillips, Roehrich, and Kapletia 2021). Moreover, public sector organizations often operate in constantly changing business and political environments (Doberstein 2015). The UK healthcare system, for instance, is characterized by high levels of complexity and uncertainty as evident at the organizational and task levels; manifested in high levels of demand, environmental uncertainty, and in the complexity observed in diagnostics and patient care pathways (Kinder and Burgoyne 2013). This makes information processing and sharing between public and private organizations critical to achieve relationship outcomes (Tihanyi and Thomas 2005).

Information processing has been defined as ‘the gathering, interpreting, and synthesis of information in the context of organizational decision making’ (Tushman and Nadler 1978, 614), and the sharing of information between organizations is considered essential to ‘bridge disagreement and diversity’ between partners (Daft and Lengel 1986, 556). Partners need to exchange information pertaining to, for instance, quality of service delivery and how this is being measured and monitored, payment terms and conditions, and ongoing operational issues (e.g. Barlow and Köberle-Gaiser 2008). Building on information processing theory (IPT; Galbraith 1974), information asymmetry stems from two underlying factors: uncertainty (lack of information), and equivocality (messiness of information). Whereas gathering more data may help mitigate information uncertainty, equivocality requires cognitive skills to make sense of data, including ordering and presenting it in a logical way (Aben et al. 2021). This is particularly important when the information required is ill structured and difficult to evaluate (Daft and Lengel 1986). The more uncertainty an organization or relationship encounters, the more information needs to be gathered, processed, and shared with partners to realize high performance (Kinder and Burgoyne 2013; Dahlmann and Roehrich 2019).

A main tenet of information processing, as informed by IPT, is that organizational mechanisms, such as contracts, not only have functional consequences, but they also fundamentally shape the way in which activities and problems are framed, understood, and ultimately handled (Tushman and Nadler 1978; Kinder and Burgoyne 2013). As such, public-private relationships may create public and private value if governed appropriately across the relationship lifecycle (Hodge and Greve 2007; Quelin, Kivleniece, and Lazzarini 2017). The importance of contracts in public-private relationships is recognized within the UK health sector (NHS England), and further supported by prior studies, which draw out the need for contracts to ensure quality and delivery of vital healthcare products/services (e.g. Allen et al. 2016).

2.2 Contracts to govern public-private relationships in healthcare

2.2.1 Contracts

Contracts have become a common feature of introducing market mechanisms and private partners into the delivery of public infrastructure, products, and/or services (Hughes et al. 2011; Isaksson, Blomqvist, and Winblad 2018). Establishing and maintaining contracts is viewed to be crucial for achieving value for money, appropriated risk transfer, ensuring quality service delivery, and supporting information exchange (Ball, Heafey, and King 2003; Hughes et al. 2013; Allen et al. 2016; Sanderson et al. 2018). Public and private partners typically face a lack of familiarity, a need to align divergent goals, and different organizational cultures, processes, and practices (Rufin 2004; Roehrich and Lewis 2014; Warsen et al. 2019). Thus, contracts are employed to coordinate activities and control behaviours (Hughes et al. 2011; Roehrich et al. 2020). Contracts refer to ‘explicit, formal and usually written’ documents, which are detailed, binding legal agreements that specify the obligations and roles of partnering organizations (Lyons and Mehta 1997, 240). Public and private organizations align their governance features of exchange relationships to match known exchange hazards, and information processing and sharing needs, as trust alone is considered unreliable to safeguard the relationship (e.g. Poppo and Zenger 2002; Zheng, Roehrich, and Lewis 2008; Kreye, Roehrich, and Lewis 2015).

Contracts often include a wide range of clauses to specify terms such as monitoring and information sharing processes, and sanctions for non-compliance (Hughes et al. 2013; Isaksson, Blomqvist, and Winblad 2018), thus acting as mechanisms to control and coordinate relationships. Contractual control is concerned with safeguarding from potential opportunism and non-compliance (Schepker et al. 2014), and is common in the English NHS via the use of financial penalties and incentives (Hughes et al. 2011). Contractual coordination is focused on the ‘deliberate and orderly alignment or adjustment of partners’ actions to achieve jointly determined goals’ (Gulati, Wohlgezogen, and Zhelyazkov 2012, 12), and seeks to foster information sharing to facilitate goal congruence (Macaulay 1963) and help manage inter-dependent tasks between organizations (Ryall and Sampson 2009), which are vital in public-private relationships (Singh and Prakash 2010).

While long-term contracts may encourage commitment and stability in relationships, they can be costly to draft and maintain contracts (Van Den Hurk and Verhoest 2016), they may lead to over-dependency and complacency, often lack flexibility (Dixon, Pottinger, and Jordan 2005), and can hinder innovation (Barlow and Köberle-Gaiser 2008). Other studies have drawn out challenges in specifying service quality ex ante, or in ensuring appropriate and measurable performance indicators that reward or penalize service providers on an on-going basis (Petsoulas et al. 2011). While prior research has drawn out the various functions and limitations of contracts, we are interested in the role contractual elements play in addressing information asymmetry. Thus, we build on prior contract and public management research concerning contracts and their functions (e.g. Petsoulas et al. 2011; Schepker et al. 2014)

2.2.2 Boundary objects in contracts

Public sector organizations need to tackle forces related to fragmentation due to specialization (Tushman and Scanlan 1981), but also additional challenges related to policy complexity and functional differentiation (Williams 2019). This is especially heightened for organizations delivering health services due to the volume and range of organizations involved (Sanderson et al. 2018), producing multiple, shifting organizational boundaries (van Meerkerk and Edelenbos 2014). To successfully work across these boundaries, organizations rely on ‘boundary-spanners’. These individuals act as the primary agents of change, brokering, and negotiating interactions between organizations (Williams 2002; van Meerkerk and Edelenbos 2014; Williams 2019).

To manage the complexities and interdependencies across organizational boundaries and smoothen any resulting conflict (Collien 20219), boundary-spanners construct objects, such as reports, timelines, and presentations, to facilitate cross-boundary collaborations (Levina and Vaast 2005; Torfing 2019). Such ‘boundary objects’ can be physical or digital, and their meaning is neither fixed nor stable, but changes as individuals on different sides of the boundary engage with these objects (Leonardi, Bailey, and Pierce 2019). Boundary objects have been described as artefacts that provide practical means for interacting across organizational boundaries through fulfiling a bridging function (Carlile 2002). They include the establishment of a shared syntax, offering ways for individuals and organizations to learn about their differences, and facilitate a process of sharing information to create a form of ‘common knowledge’ to support cooperation in a public-private relationship (Star 1989; Carlile 2004). The concept of boundary objects was developed in science and technology studies, and has been employed, for example, in studies of new product development where members of different functions – engineering, marketing, production – are required to coordinate activities across boundaries between different technical specialities (Carlile 2002, 2004). In public administration research, a few scholars have used the concept of boundary objects when looking at collaborative partnerships in health research (Kislov 2014), climate science research (Franklin et al. 2018), and their use by public managers to enact communities of participation (Feldman and Khademian 2007).

Elements nested in contracts such as timelines become boundary objects only if they are incorporated meaningfully into the practices of individuals or organizations (Star and Griesemer 1989; Yakura 2002). With a focus on the use of boundary objects nested in contracts, we aim to fill an existing gap in the public-private relationships literature by assessing their contribution to the collaborative creation of information exchange between organizations. Some scholars interested in public administration and contracting (e.g. Petsoulas et al. 2011; Flood et al. 2015) have investigated the use of certain contract mechanisms, such as incentives and penalties, to encourage quality improvement and allocate financial risks. We add to this prior work by highlighting other objects nested in the contract, and their role in supporting information exchange in public-private relationships.

Prior studies have noted that the effectiveness of a boundary object is not only determined by the type of object in question (i.e. a specific element nested in the contract), but by ‘how it is perceived’ by parties in the relationship (Naar, Nikolova, and Forsythe 2016, 691). In other words, boundary objects can be imbued with either positive or negative meanings. As bridges, they may support information processing which increases their effectiveness in aiding the collection, analysis, and sharing of information, spurring relationship collaboration (Carlile 2002), and serving as tools to reduce complexity in social exchanges (Petsoulas et al. 2011). As roadblocks, they act to hinder the movement of information between organizations, weakening ties, and reinforcing boundaries between organizations (Newell and Swan 2000).

In conclusion, while prior (public) management research has emphasized governance mechanisms, especially contracts, as important devices for information processing and exchange in inter-organizational relationships (e.g. Hughes et al. 2013; Lumineau 2017), prior studies have paid little attention to unpacking the elements within a contract, and their role and capacity to support (or hinder) information processing and sharing. While prior research has drawn out the various functions and limitations of contracts our study is particularly interested in the role elements included in the contract play in addressing information asymmetry and driving information sharing. Through this focus, we build on prior contract and public management research concerning contracts and their functions (e.g. Petsoulas et al. 2011; Schepker et al. 2014). The concept of boundary objects in contracts provides potential for novel theoretical contributions to extant public management and contracting literature. Thus, we posit the following research question: How do different boundary objects in contracts address information asymmetry in public-private relationships?

3. Methods

3.1 Research setting, design and case selection

Our research setting is the UK healthcare sector, a context characterized by high degrees of information asymmetry due to the uncertain nature of innovation projects, and divergent values in public-private relationships (Warsen et al. 2018). Consistent with our objective of identifying an explanation of a complex phenomenon in its natural context (Eisenhardt and Graebner 2007), we employed a multi-methods, multiple case study design to investigate the roles of boundary objects in contracts across three relationships between PharmCo’s digital innovation centre (private organization) and three NHS Trusts (public organizations; Appendix A).

In response to the increasing demand for digital health services, PharmCo established a digital health innovation centre focused on developing innovations along three clinical pathways: cardiac health rehabilitation (CAR); mental health rehabilitation (MEN); and orthopaedics rehabilitation (ORT). The cases represent three public-private relationships; one from each of these three clinical pathways. Cases were selected after conducting pilot interviews with key informants at PharmCo, and analysing initial secondary data. Our sampling logic was as follows: First, the cases were representative of the same phenomenon, having in place a contract to manage the relationship. All cases were in the early phase of the relationship (after contract signature) in which information exchange was vital to overcome information asymmetry between public and private partners. Second, the cases were comparable in terms of, for instance, industry characteristics and the existence of a public-private relationship. In particular, the outcomes sought in each case were similar – an improvement in patient outcomes – and required frequent and rich information processing via the contract in order to address information asymmetry. Third, the same private sector organization was involved in the three investigated public-private relationships. This helped to keep constant the type of contract used in the investigated cases. By selecting comparable cases, pattern matching was enabled, allowing for the identification of recurrent or contrasting themes.

3.2 Data collection

Our study combined primary (interviews, observations during site visits), secondary (meeting notes, presentation slides, government and industry reports), and contract data sources, which we collected live during the ongoing relationship (Appendices B&C). We used a three-step recursive strategy. First, we gained initial insights into PharmCo’s activities and work with public organizations at a site visit to their UK head-office that included three pilot interviews. We were also provided with archival documents (including presentations, board papers), yielding an extensive background on PharmCo’s vision for the healthcare sector and innovation projects. Second, we collected publicly available sector and government data to understand better the key challenges. We also received detailed contract documents for the three cases. Third, we conducted and recorded 20 semi-structured interviews within PharmCo and the three NHS Trusts to unpack the usage of boundary objects (Appendix D).

To gather reliable and objective information from our informants (Alvesson 2003), we used an interview guide to interview stakeholders with different lengths of tenure in the collaborations, and in disparate hierarchical and functional roles (Appendix E). Interviewee sampling was purposive based on the following criteria: (i) involvement in the relationship for a substantial period of time; and (ii) use of the contract and its nested boundary objects. This allowed us to access diverse perspectives and to triangulate data (Golden 1992). Individual case reports were then checked by key informants for each individual relationship, and data gathering continued until theoretical saturation was achieved. We applied specific criteria and measures to ensure validity and reliability of our case study findings (Gibbert, Ruigrok, and Wicki 2008; Appendix F).

3.3 Data analysis

Data analysis was an iterative process moving between data and theoretical concepts. We then used NVivo, a data analysis software, for iterative coding of recurring themes while identifying similarities and differences regarding investigated cases. This step included identifying key boundary objects (e.g. meetings and presentations, timelines) used by the case organizations, and highlighted the prominent role of the contract in directing and shaping the relationships. A key part of this analysis was coding all the contracts. We first coded each contract separately to identify boundary objects contained within them, and any unique features of the contract regarding coordination, control, and information exchange. Then, data display tables were developed to compare findings across the cases. These were jointly discussed to identify any discrepancies in the interpretation, forcing 100% inter-coder reliability between the authors (Appendix G). After completing the contract analysis, we focused on the use of boundary objects in the investigated cases. At first, we read through all relevant secondary data, interview transcripts, and observational notes to develop a comprehensive timeline including key events for each case. Next, we coded for the use of boundary objects and their role in information exchange. Findings were collated in tables to highlight the various boundary objects and their roles (Table 1).

Table 1. The contract and boundary objects nested within.

Contract and boundary objects	Sub-theme [numbering as indicated in the manuscript’s text]	Exemplary quote	Brief description	Function
Contract	Communication & sharedunderstanding [1]	‘It was pretty easy to agree on the budget, because we used the standard NHS templates, the contract language was very standard, so there was very little disagreement’. (PM1, PharmCo, CAR)	Use of approved NHS contract templates ensures standardization across the healthcare system.	Increased coordination Reduced information asymmetry
	Alignment (coordinating varying perspectives) [2]	‘There was a contract to set the tone and made sure that everyone was talking about the same thing […] however, there was little about joint working and a lot was focused on controlling activities […] forcing to share information’. (PM, MEN Trust)	While contract may have increased the parties shared understanding, disagreements over its control provisions were pointed out.	Coordination & restrictive control Leading to increased information asymmetry
	Delineation of roles and responsibilities [3]	‘We were fairly clear on our responsibilities and deliverables in the contract. I think that our partner [NHS Trust] was clear on their responsibilities too as we jointly discussed them before signing the contract’. (PM2, MEN)	Collaborative and joint development of the contract between PharmCo and MEN minimizing potential future disagreements.	Increased coordination Reduced information asymmetry
	Monitoring & supervising [4]	‘All study materials including the Screening Log and Study Patient Log forms will be kept in a locked office on hospital premises at all times by the Chief Investigator’. (Study protocol, CAR)	Stringent requirements as regards to the access and storage of patient information.	Increased control Reduced information asymmetry
	Coordinating resources & activities [5]	‘The pilot will include 250 patients with diagnoses of: Schizophrenia, Schizoaffective disorders, Bi-polar disorders … The pilot will not exclude people with Dual Diagnosis’. (Joint Working Agreement (JWA), MEN)	Description of the terms of the pilot study, specifying eligibility, duration and numbers.	Increased coordination and control Reduced information asymmetry
Timelines	Varying interpretations of time [6]	‘There was significant delay in the trust signing anything. It was six to nine months before the trust would sign any piece of paper’. (PM1, PharmCo, MEN)	Differences in organizational culture as pertains adherence to stipulated timelines.	Decreased coordination & control Increased information asymmetry
	Misalignment due to different assumptions about time [7]	‘They are (PharmCo) driven with their deadlines … whereas when you’re in the NHS, you know, timescales and things like that are a bit harder to do’. (Head Nurse, ORT Trust)	Organizational cultural differences revealed with regard to synchronizing timelines.	Decreased coordination & control Increased information asymmetry
Processes	Coordination of differing interpretations of a project’s progress [8]	‘We had a separate protocol for the service valuation and the data and we also had a separate consenting process for the third party reminder service that we were funding. So there were quite a lot of processes in place’. (PM2, PharmCo, MEN)	Routines and procedures that facilitate cross-boundary coordination between PharmCo and MEN.	Increased coordination and control Reduced information asymmetry
	Varying interpretations of processes [9]	‘PharmCo were trying to push for the cardiac rehab to be a paperless system, but, as part of the NIHR and portfolio adoption process, you need a written informed consent piece of paper for patients to be recognized in that project’. (Research Nurse, CAR Trust)	Conflicting interpretation of processes due to organizational cultural differences between a private organization and a public healthcare organization.	Decreased coordination Leading to reduced information asymmetry
Meetings andconferences	Building relationships & trust [10]	‘It kind of matched our people with their people, the senior managers … our global lead for neuroscience; he came over and gave a talk … gave their organization higher understanding of the level of expertise within PharmCo globally … I think it built a lot of trust’. (Implementation Manager, PharmCo, ORT)	Face to face interaction via meetings was instrumental in reaching across organizational boundaries to build and maintain relationships as well as trust and understanding. They were also used to coordinate the sharing of resources between parties.	Increased coordination and subtle control Reduced information asymmetry
	Equal representation of perspectives [11]	‘The quorum for meetings will be at least one member from each party. Views from any team member not present at a meeting will be requested either prior to or after the meeting’. (JWA, CAR)	The contract specifies the requirements of team meetings between PharmCo and CAR to ensure views of both parties are adequately and equally represented.	Increased control Reduced information asymmetry

4. Findings

In this section, we present our analysis of the nature and formation of the public-private relationships. We then unpack the boundary objects in the contract, and their information exchange roles in the relationships.

4.1 The nature and formation of the public-private relationships

Before the formalization of the public-private relationships, findings revealed attempts made to create shared values between PharmCo and the three NHS Trusts. For example, before signing the contractual agreement, initial conversations and workshops between PharmCo and the MEN and CAR NHS Trusts provided the organizations with opportunities to work towards a shared vision: ‘We had several conversations and workshops where we presented our R&D agenda. Some of the comments were that, “Gosh, we had not realized how closely aligned we were as two organizations from a values perspective”. That was a really important turning point for the relationship’ (PM1, PharmCo, MEN). Early open and transparent communication between the partners – ‘they made it very clear from the beginning what they were going to bring’ (GM, Trust, CAR) – helped establish trust between organizations, underscoring their shared values. This allowed organizations to see the potential of creating a shared vision of their future, and facilitated their search for common ground by finding ‘a way of shaping up how we were going to work going forward’ (Clinical Lead, Trust, MEN).

Despite initial attempts to ‘get to know each other’, all three relationships were characterized by organizations with limited prior experience of working with each other. This lack of relationship history provided a limited basis for mutual trust, and as a result personal ties played a significant role in initiating the collaboration. In the very early relationship stages, these ties were essential in establishing interest and building consensus between parties. However, such ties were not sufficient to sustain long lasting and resilient public-private relationships because they ‘could be broken when people leave the organization’ (PL1, Trust, ORT) or in some cases, key individuals could act as obstacles: ‘A very influential man […] but because of the way he was, he also had quite a few doors being shut in his face’ (PL2, Trust, ORT). The transitory nature of personal ties and its adverse effect on trust was also pointed out by a NHS Trust project manager (PM2, MEN): ‘PharmCo’s senior leadership changed a lot, and the Trust’s senior leadership stayed the same. It was actually quite difficult to build trust’. To guard against the fragility arising from personnel changes and personal characteristics of key actors, contracts were therefore employed to ‘formalize the personal relationships’.

Organizational differences observed in the initial relationship phase, particularly in terms of how things were done and their underlying motives, highlighted the importance of establishing contracts to govern public-private relationships. In the CAR case, this was for instance triggered by unease about the true motives of PharmCo: ‘There was always that thing in the back of our minds […] about a commercial company coming into the NHS. The kind of attitude of “oh, be very careful of commercial companies, they are trying to sell you something”’ (GM, Trust, CAR). High profit margins in the pharmaceutical industry engender the belief by NHS personnel that the private partner is incentivized solely by the bottom-line not the general public’s health. For public health managers, contracts therefore presented an opportunity to articulate key indicators related to performance, risk, and quality because as one NHS Trust project manager noted: ‘Healthcare is quite a legal-conscious environment, and a contract is significant in establishing that relationship’ (PM1, Trust, MEN). As boundary objects, they served in part as a tool to allay fears of conflicting motives by establishing transparency and accountability. The established contracts were also seen as ‘reinforcing the level of trust’ (PM1, PharmCo, CAR) between parties, a critical element in managing collaborative interfaces, especially among partners with different organizational cultures, rules, processes, and goals.

4.2 The contract and its boundary objects

After the initial formation phase described in section 4.1, contracts were used to govern the relationships, and for the exchange of vital information related to product and service requirements, quality needs, timelines, and other emerging operational issues. The contract helped parties to specify their task provisions, codify the project timeline, delivery dates, and scope of services. Especially in early relationship phases, the contracts outlined and clarified the obligations of the project sponsors and managerial teams. In later phases, contracts were used mainly as instruments to exchange information regarding product and service requirements, and emerging operational issues. Sometimes, the contract was also seen as helping to control and safeguard against opportunism and reinforcing deadlines. The contract thus became an assemblage of project related knowledge transmitted and shared by parties across boundaries to create a common understanding regarding the project at hand (Bechky 2003a). A selection of further key evidence is shown in Table 1 (which is referred to throughout the text using numbering – e.g. [2]), outlining the functions of the contract, and its boundary objects in terms of information exchange

During the early phase, the contract served as a ‘guiding document’ (PM1, PharmCo, CAR), an instrument for coordination intended for aligning divergent expectations and behaviour [1,2]: ‘That is our bible […]. Work streams and the different buckets of activities were identified. Who was doing what?’ By comparing it to the ‘bible’, the PM alluded to the contract as an object whose language is universally understood by all. Contracts provided a ‘shared space for action’, enabling the sharing and translation of knowledge (e.g. project management and clinical) across PharmCo and the NHS Trusts, thus facilitating communication and coordination across the boundaries while maintaining the viewpoints and interests of each partner [1–5]. It acted as a translation device, interpreting the demands, expectations, and roles of PharmCo and CAR NHS Trust [3] (Star and Griesemer 1989). Jointly developed, it is a shared boundary object that seeks to establish common ground by helping parties transcribe disparate meanings they have inscribed onto the contract in order to build a shared understanding of the rules, assumptions, knowledge, and principles that will guide their work for the duration of the relationship [1,2]. Nevertheless, this understanding evolved as the relationship progressed, and the partners learned more about each other. Our observations and interview findings showed that a shared understanding between public and private organizations helped to reduce the need for more informal and continuous communication across boundaries. While parties continued to talk to each other on a ‘regular and informal basis’, the contract was considered helpful in reducing the risk of misinterpretation of information and each other’s values, thus decreasing information asymmetry in the relationship.

In the ORT case, the contract’s coordination function was also dominant, although its control provisions regarding data security were stringent. This was exemplified by the following quote: ‘All study materials including the Screening Log and Study Patient Log forms will be kept in a locked office on hospital premises at all times by the Chief Investigator. The Log forms will be kept for a period of 3 years after the study and will be subsequently destroyed according to the policy of the Trust’ (Study Protocol, CAR). This account underscores the extent to which the parties went to safeguard patient data against unauthorized access and use, and mitigate risk, by specifying surveillance and monitoring procedures for data access and storage as well as articulating provisions that seek to control the actions of the parties. In the ORT case, one of the NHS Trust’s Project Leads (PL2) noted that the contract’s main purpose was ‘risk management to ensure who was accountable for what. We wanted them to stick with our timescales but be realistic as to how much time we had to work with’. Here, they underline coordination-oriented provisions focused on mitigating the risk related to misunderstanding. Further, by referring to the NHS Trust’s timelines, he acknowledged the contract’s role for coordination with the capacity to connect and disconnect different organizational groups, structures, and cultures [5]. We now turn to a discussion of the specific boundary objects nested within the contract.

Timelines. As a boundary object, timelines are used to manage resources and activities visually over the relationship lifecycle (Barrett and Oborn 2010). Timelines are representations of time that facilitate different parties to negotiate their interpretations of time, allowing for the reconciliation of diverse temporal arrangements (Yakura 2002) across boundaries. In the public-private relationships, timelines existed both within and outside of the contract, nested within organizational structures.

Timelines were included in contractual agreements in all three cases. For instance, referring to the project’s timeline, the Joint Working Agreement (JWA) in the CAR case noted: ‘The agreement applies until the end of the Commercial Trial as defined above and for a maximum length of 2 years’. In the MEN case, the JWA provided a project plan for tracking the actions, due dates, success criteria, progress rating, and completed actions of both parties, and asserted that timelines were changeable albeit with consent of all parties. In these cases, timelines acted both as tools of coordination and control, facilitating the temporal coordination of different interpretations of activity’ progress while denoting consequences of non-adherence [6]. In the CAR and ORT cases, for instance, timelines were present as objects both nested within the contract, but in all cases were also present outside of and independent of the contract, strongly engrained in other structures of the partnering organizations: ‘We did have a slight falling out with [a NHS Trust doctor] on one occasion when he walked out and slammed the door. Their timelines are just so slow compared to PharmCo. There was a clash of culture at times, particularly around timings, and I think they felt a bit controlled by the contract’ (PM2, PharmCo, MEN). While timelines permit organizations with varying conceptions of time to negotiate a common understanding, interpretive flexibility of timelines can be detrimental, resulting instead in participants translating them from their own perspective (Yakura 2002). Consequently, in the MEN case, timelines failed as objects around which organizations could align their work. This generated asynchronization, which meant that the NHS Trust was always a step behind PharmCo [7]. Misaligned timelines and organizations not using the contractually specified timelines posed a threat to information symmetry within the relationship. It resulted in uncertainties between parties in terms of ‘which activities needed to be done when’. Furthermore, unlike in other instances where ‘timelines functioned effectively alongside face-to-face interaction’ (Research Nurse, Trust, CAR), underscoring the complementary way contracts were used with relational interactions and information exchange, in the MEN case such interactions were largely absent.

Processes. Cutting across the boundaries in the public-private relationships, processes, which included routines, practices, and standard operating procedures (Sapsed and Salter 2004) served as a coordination and information exchange function by enabling public and private organizations to transform and transfer domain-specific information. For example, in the CAR case, processes comprised routines and practices shared between parties with differing priorities with the goal of coordinating their activities and to pre-empt misunderstandings that could cause delays [8]: ‘We agreed to a process of completing key tasks and activities to ensure that the relationship would be a success story’ (PM1, PharmCo, CAR). As boundary objects, processes consisted of a collective knowledge (across public and private partners) regarding the performance of certain tasks and activities [8,9]. Their interpretive flexibility ensured that parties involved could interpret them based on their perspectives while simultaneously allowing their divergent interests to co-exist, yielding collaborative relations (Seidel and O’Mahoney 2014).

In some cases, however, NHS processes were roadblocks to the timely completion of activities. This was evident in the ORT case, where processes failed to synchronize project schedules causing frustration [9]: ‘We had some difficulty getting our IT department to give us authorization to sign the contract. They were nervous about the information governance. […] It was sort of frustrating and slow’ (PL1, Trust, ORT). This account revealed an interaction between two boundary objects (timelines and processes). While the ORT’s processes increased the capacity to process information, therefore initially reducing information asymmetry internally (by ensuring that the required routines were adhered to), issues with IT staff generated conflicts between the public and private organizations, and thus undermined the facilitative role of processes in information sharing and coordination of activities. In contrast, interactions between processes and meetings in the CAR case produced a positive outcome by enabling partnering organizations to clarify relationship-specific information in the early phases of their relationship, therefore avoiding delays and time pressures at later phases: ‘We discussed a lot with the Trust the various activities and processes. I think this discussion early on helped during later parts of the relationships. We could make decisions much quicker by referring to the processes specified in the contract’ (PM2, PharmCo, CAR). As ‘shared artefacts’ containing collective information and knowledge emerging from everyday activities of organizing, processes allowed individuals in the relationship to reconcile different processes across public and private organizations, and to create a common understanding of key activities and tasks in the public-private relationship [8].

Meetings and conferences. Similar to timelines, meetings and conferences had a dual manifestation as boundary objects, stipulated in the contract and externally, often nested in the organizational culture. They included both face-to-face and virtual meetings, events, and workshops to share information. This boundary object served as a ‘platform to address diverse perspectives’, supporting the development of more collaborative relationships, and were ‘an excellent opportunity to exchange information’, thus improving information symmetry as revealed by the following: ‘The Board will meet quarterly and make provision for extraordinary meetings and/or meetings in relation to the attainment of a specified milestone’ (Project Initiation Document, PharmCo, MEN).

In addition to board meetings, employees also regularly met during staff meetings, conference attendances, expert presentations, and joint NHS Trust site visits. Meetings, which were contractually stipulated to take place at regular intervals, offered both parties an arena to jointly make sense of (relationship-specific) information, reducing confusion about possible information (i.e. information equivocality). This enhanced the contextualization of shared problems, creating a common ground between public and private organizations [10]. For example, in the CAR case, meetings between personnel from both partners responsible for project implementation allowed them to build a trusting work relationship: ‘We had fortnightly meetings between me, my research nurse and [PharmCo’s manager]. It was for both sides to update each other on progress from their perspective and also to follow up from points from the previous meeting to make sure that activities kept moving forward and did not stall. We instantly understood the importance of regular meetings and why they need to be in the contract’ (Consultant Cardiologist, Trust, CAR). As boundary objects agreed to by both partners, meetings were valued across boundaries. They facilitated a reflexive process by offering individuals from partnering organizations a platform to develop their own perspectives, and assimilate those of others, transforming information into knowledge in the process [11]. As boundary objects, they also served as bridges by fostering the coordination and negotiation of diverse perspectives making it easier for organizational actors to keep the relationship ‘on track’. Furthermore, they provided the public-private relationships with an interface not only to gather additional relationship-specific information (thus reducing information uncertainty), but more often allowed a focus on the joint review of existing information as to enhance clarity and resolve misunderstandings between parties [10]. Meetings and conferences permitted clinical teams to continually test innovations and ideas enhancing implementation success: ‘That visit of [doctor’s name] to the clinicians mitigated some of the initial distrust and misunderstanding with key activities. You have to open the door, meet and send the message repeatedly. It was a continuous iterative cycle of reflection on what is working, what we can do better, taking to the Project Board, and getting some direction from them’. (Clinical Lead, Trust, MEN). As boundary objects, they facilitated interdependent interdisciplinary interaction across PharmCo and MEN Trust enabling the clinical team to: share information, debate suggestions, influence key actors, work towards achieving mutual goals, and build trust over time.

Presentations by experts during conferences (contractually stipulated) also played a key role in addressing any doubts among employees in the MEN case, where one project manager (PM1, PharmCo) noted that it ‘helped to appeal to sceptics and to “softly” control project progress’. The conferences divulged scientific information related to the project to address information asymmetry between parties. This was an iterative process, reflected by the experts’ willingness to ‘send the message repeatedly’, while also making themselves available after the conference. Given the NHS Trusts’ suspicion that PharmCo may use the relationship as a ‘back-door way’ (PM2, Trust, MEN) to ‘help them sell products’ (Consultant Cardiologist, Trust, CAR), this joint engagement in conferences was critical to reduce boundaries between partnering organizations, and to further support information sharing. This boundary object was also often seen as vital in acting as a ‘first step’ to collect more information, and to then jointly discuss it, with any alternative views proffered transforming knowledge in the process. Here, meetings and conferences acted as platforms for the translation and transfer of information, as well as the transformation of information into knowledge for both partners. Bringing individuals from the public and private organizations together and serving as a ‘common referent’ around which they could interact and align their work ‘helped position what we are trying to do, which then improved our credibility’ (PL, PharmCo, CAR). As boundary objects, meetings and conferences were versatile enough to adapt to the needs of both partners, while remaining robust enough to maintain a common identity and reference point across the organizations that employed them [11].

5. Discussion

In this study, we sought to understand the role of contracts in addressing information asymmetry in public-private relationships. We analysed multiple data sources to identify the key boundary objects nested within the contracts, before investigating their information processing and sharing capacity. Our study sought to make both theoretical and practical contributions to the management of and contracting for public-private relationships.

5.1 Theoretical contributions

We contribute specifically to the public management and contract literature by unpacking the role of the contract and its elements in supporting information sharing in public-private relationships. Prior studies on governance and public-private relationships have largely neglected to explore the role of contracts in addressing information asymmetry (a notable exception is the study by Aben et al. 2021). In this regard, our study shows how contracts may provide a formalized ‘language’ which offers a ‘common and negotiated frame of reference’ and a ‘shared space for action’, resulting in a lowering of the risk of misinterpretation across boundaries, a reduction in the cost of information processing, and a decrease in information asymmetry between partners. As a result, contracts can play an important role in: fostering communication and shared understanding; aligning varying perspectives; delineating roles and responsibilities; aiding monitoring and supervision; and coordinating resources and activities.

Contracts thus not only have functional consequences, but they also fundamentally shape the way in which activities and problems are framed, understood, and ultimately handled (Tushman and Nadler 1978; Kinder and Burgoyne 2013). In order to ensure that the contract is effectively used to coordinate activities and resources across boundaries (Lumineau 2017; Isaksson, Blomqvist, and Winblad 2018), early relationship phases should be characterized by joint contract discussions to develop mutual understanding of not only the contract content, but also its use in later relationship phases in order to avoid disagreements. As evidenced in one of our cases, when contracts were not developed collaboratively, the contract did not provide a ‘common referent’ for parties, and thus it failed its brokering role in overcoming boundaries and reducing information equivocality.

While prior (public) management research has emphasized governance mechanisms, especially contracts, as important devices for information processing and exchange in inter-organizational relationships (e.g. Hughes et al. 2013; Lumineau 2017), little attention has been paid to unpacking the elements within a contract, and their role and capacity to support (or hinder) information processing and sharing. Building on insights from the boundary objects literature (Star 1989; Carlile 2004), we address this gap by unpacking the contract to reveal nested boundary objects with distinct characteristics in terms of information processing and capacities for addressing information asymmetry across boundaries. In line with IPT (Daft and Lengel 1986), we argue that the elements in a contract may act as frames and filters that influence how organizations exchange and make sense of information to address information asymmetry. This is particularly important in relationships without (initial) consensus, a lack of shared values and prior joint work experience, as often present in public-private relationships (Torfing and Sorensen 2021).

Across the cases, we identified three key boundary objects – timelines, processes, meetings and conferences – nested in the contract. ‘Timelines’ offer organizations a joint (and negotiated) understanding of their differing interpretations of time, and hence helped to align activities in a common project timeline. We evidenced that timelines in public-private relationships were vital to facilitate temporal coordination of diverging interpretations of how far activities had progressed and how long their completion should take. While timelines were changeable, our study found that this was only possible with the consent of both parties. This findings supports emerging research that recognizes the co-evolution of boundary objects (Leonardi et al. 2021). Our findings showed that timelines make time concrete and negotiable across public and private organizations. This is particularly important when public and private organizations work together to overcome a ‘clash of cultures’ in terms of different perceptions of time. Here, timelines permit organizations with varying conceptions and assumptions of time to negotiate a common understanding and manage time. If a common understanding regarding time and timelines was not present in the relationships, our findings showed that this resulted in poorly synchronized activities and information exchange between parties.

The boundary object of ‘processes’, including routines, practices, and standard operating procedures, served a coordination function. Jointly negotiated and agreed upon processes helped to codify and transfer knowledge across boundaries. In some of the cases, we witnessed an interaction between two boundary objects (e.g. timelines and processes; processes and meetings) in order to increase the capacity of information processing. However, while certain processes might be well understood by individuals within an organization, individuals from the partner organization might have different processes (and an understanding of them) in place. To avoid undermining the facilitative role of processes (and their interaction with other boundary objects) in information processing, clear negotiations and the development of jointly agreed and understood processes is vital.

The boundary object of ‘meetings and conferences’ offered the organizations a platform to address diverse perspectives, thus facilitating cooperation and information symmetry. They also enabled adaptive learning by the partners in their collaborative work (Hsiao, Tsai, and Lee 2012). Furthermore, meetings were also considered to be a boundary object which was versatile enough to adapt to the needs of each party, while remaining robust enough to maintain a common identity across public and private organizations. This boundary object offered public and private organizations an interface not only to gather additional relationship-specific information thus reducing uncertainty, but mainly to review jointly information to enhance clarity and resolve misunderstandings (reducing information equivocality). In contrast to the other two boundary objects, ‘meetings and conferences’ were commonly understood from the outset of the relationship. Further information collection (addressing information uncertainty) was undertaken via conferences (e.g. transmission of relevant (clinical) information), and then information was discussed in meetings to jointly make sense of that information.

While these three boundary objects, individually and in their interactions, may help to address information asymmetry in public-private relationships, these positive effects were not always realized. Our findings show that when the boundary objects were not developed in a collaborative manner at the outset of the relationship, and used in an agreed manner (i.e. to coordinate or control), boundary objects may add to rather than reduce information asymmetry. In these circumstances, boundary objects failed to act as shared objects to help information sharing. More specifically, while boundary objects addressed information uncertainty by offering, for instance, a timeline with key dates and deliverables, it often led to a further increase of information equivocality between partnering organizations. Here, parties interpreted boundary objects differently, as they did not possess a shared understanding (derived from the joint development and negotiation of the boundary objects). This is an under-explored topic in the boundary objects literature (Comi and Varra 2021), as the vast majority of this literature has focused on their integrative, rather than divisive, nature (Seidel and O’Mahoney 2014).

5.2 Practical implications

There are a number of implications for practice that emerge from the study. First, contracts are important to overcome possible organizational boundaries characterized by divergent values and knowledge. The contract, if discussed and agreed on by both parties early on in the relationship, can aid the development of mutual understanding in order to support collaboration, and avoid disagreements in later relationship phases. The contract can also provide the mechanism that allows parties to track activities and progress, and defines roles and responsibilities. We have identified a variety of such mechanisms, including timelines, processes, meetings and conferences, which are often nested within a contract. These intermediaries, or boundary objects, help to reduce information uncertainty and ambiguity among partners, through the collection and dispersion of relationship-specific information, allowing the contract to act as a knowledge repository and common point of reference for partners. As such, boundary objects have the potential to surface differences between partners, such that they can be explored and misunderstandings clarified, and as a result they can help provide a bridge between differing perspectives, and to minimize the impact of these differences between partners.

Information equivocality, however, cannot be mitigated by simply gathering more information, but only through the joint sensemaking of information, a process that our study found took place during regular (contractually stipulated) meetings and conferences between partners. Additionally, boundary objects such as timelines, processes, and meetings and conferences are vital to coordinate activities and control parties’ behaviour. For instance, timelines may facilitate the temporal coordination of differing interpretations of activities progress, and they may act to control behaviours by ensuring the efficacy of timelines while also denoting the consequences of non-adherence. Nevertheless, boundary objects can have a negative effect on information processing when not adhering to what was agreed, or when they are established by one party only without a negotiation process between both public and private partners. Indeed, in such circumstances, boundary objects can be employed to alter the power relations between partners, and/or consolidate the position of a dominant partner; as we show in our study, the mobilization of boundary objects in this way can create tensions between partners, and thus should be avoided.

5.3 Boundary conditions and further research

Although the findings of our study demonstrate the ways in which boundary objects in contracts may enable and support information sharing in public-private relationships, there was also some evidence that suggests that in some circumstances boundary objects may undermine relationships. In such circumstances, boundary objects may be mobilized to consolidate power imbalances, and even reinforce boundaries between partners. Future work would benefit from investigating these negative roles of boundary objects, which have also been revealed elsewhere (Bechky 2003b; Comi and Varra 2021). While our study closely examined public-private relationships in the early relationship phases and in the healthcare sector, we believe that our insights hold true in other relationship phases and sectors. Future research should also compare our findings to other types of inter-organizational relationships (e.g. different types of organizations) in other sectors (e.g. with different clock speed as this may impact how and why boundary objects are being developed). Guarneros-Meza and Martin (2016) noted that most studies of boundary-spanning in the public sector have focused on what they term ‘horizontal’ boundary-spanning, that is cross-sector or between different public service areas, rather than ‘vertical’ boundary-spanning, that is between different tiers of government in the provision of public services. This therefore provides an interesting opportunity for future research concerning the nature, use, and roles of boundary objects. We also encourage future research to consider other countries and those with less mature legal systems to explore the impact of the wider institutional and legal environment, and relational governance mechanisms on how and when boundary objects in the contract are used to address information asymmetry (Roehrich et al. 2021). We hope that our findings encourage future research to augment our understanding of how boundary objects in contracts can support or hinder the management of information asymmetry in public-private relationships.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed at https://doi.org/10.1080/14719037.2022.2065344

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Florence Karaba

Florence Karaba is a Research Associate in the Innovation, Decisions and Operations (IDO) Division at the School of Management, University of Bath, UK. Previously she worked in accounting for a large US building materials company. Her work has been published in the International Journal of Management Reviews.

Jens K. Roehrich

Jens K Roehrich is a Professor of Supply Chain Innovation at the University of Bath, School of Management, UK. Before joining the University of Bath, Jens worked at Imperial College Business School, Imperial College London, UK. Significant strands of his research agenda explore the long-term interplay of contractual and relational exchange governance mechanisms and the management of public-private relationships in the UK and across Europe. His research has been published in journals such as Journal of Management Studies, Public Management Review, British Journal of Management, Social Science & Medicine, Health Affairs, International Journal of Operations and Production Management, and Industrial Marketing Management, among others.

Steve Conway

Steve Conway is Associate Professor of Innovation and Associate Dean of Enterprise and External Relations (Internationalization) within the University of Leicester, School of Business. Previously, Steve has worked at Hewlett-Packard, Aston Business School, and the University of Bath, School of Management. Steve rejoined the University of Leicester in October 2014. His research is focused on the nature and role of social and organizational networks in innovation and entrepreneurship.

Jack Turner

Jack Turner is a Senior Healthcare Researcher and Program Manager at Janssen Pharmaceuticals. He has experience in the pharmaceutical sector, national NHS roles and management consulting. Jack’s work has covered topics such as workforce planning, service re-design, public-private partnerships, value based healthcare, outcomes commissioning and digital innovation within life-sciences. Jack is currently working with Janssen Pharmaceuticals exploring how emerging digital health technologies can be used to improve care pathway delivery. Jack holds a BSc in Business Management from the University of Cardiff, and an MBA from the University of Bath.