HYBRID HEALTHCARE GOVERNANCE FOR IMPROVEMENT? COMBINING TOP-DOWN AND BOTTOM-UP APPROACHES TO PUBLIC SECTOR REGULATION

• 成果类型: Article
• 署名作者: McDermott, Aoife M.; Hamel, Lauren M.; Steel, David; Flood, Patrick C.; McKee, Lorna
• 署名单位: Cardiff University; Wayne State University; University of Aberdeen; Dublin City University
• 刊物名称: PUBLIC ADMINISTRATION
• ISSN/ISSBN: 0033-3298
• DOI: 10.1111/padm.12118
• 发表日期: 2015
• 页码: 324-344
• 关键词: management

摘要

Improving healthcare governance is an enduring challenge for policy-makers. We consider two national healthcare regulators adopting novel 'hybrid' regulatory control strategies in pursuit of improvement. Hybrids combine elements usually found separately. Scotland's and Ireland's regulators combine: (1) top-down formal regulatory mechanisms deterring breaches of protocol and enacting penalties where they occur (e.g. standard-setting, monitoring, accountability); and (2) bottom-up capacity building and persuasive encouragement of adherence to guidance by professional self-determination, implementation, and improvement support (e.g. training, stimulating interventions). We identify socio-historical contextual factors constraining and enabling regulatory hybridity, whether and how it can be re-created, and circumstances when the approaches might be delivered separately. Using our findings, we develop a goal-oriented governance framework illustrating distinct, yet complementary, national and local organizational roles: (1) ensuring the adoption and implementation of best practice, (2) enabling and (3) empowering staff to adapt and add to national mandates, and (4) embedding cultures of improvement.