NETWORKS AND PUBLICNETWORKS AND PUBLIC MANAGEMENTMANAGEMENT

Grahame ThompsonGrahame ThompsonThe Open UniversityThe Open University

NETWORKS IN THE NHS CONTEXTNETWORKS IN THE NHS CONTEXT

1.1. Means of Policy Formation (‘Policy Networks’)Means of Policy Formation (‘Policy Networks’)

2.2. Means of Policy Implementation Means of Policy Implementation

Care Delivery Mechanisms (‘Managed Clinical Networks’)Care Delivery Mechanisms (‘Managed Clinical Networks’)

3.3. Means of Knowledge ManagementMeans of Knowledge Management

Main issues are:Main issues are:

Strategic Strategic versus versus Operational considerationsOperational considerations

ATTRIBUTES OF TRADITIONAL FORMS OF CO-ORDINATION AND ATTRIBUTES OF TRADITIONAL FORMS OF CO-ORDINATION AND GOVERNANCE AS CONCEIVED FROM THE POINT OF VIEW OF GOVERNANCE AS CONCEIVED FROM THE POINT OF VIEW OF

PUBLIC POLICYPUBLIC POLICY

Hierarchies/BureaucraciesHierarchies/Bureaucraciescentralized power,centralized power,vertical command chainvertical command chaindecision making rulesdecision making rulesspecialized functionsspecialized functionsline-management proceduresline-management proceduresstrong reporting mechanismsstrong reporting mechanisms

(Quasi)-Markets(Quasi)-Marketsexchange processesexchange processesprice mechanism triggeredprice mechanism triggeredinteraction between supply and demand emphasisedinteraction between supply and demand emphasisedpayments for goods and servicespayments for goods and servicesoften (though not necessarily) operated in competitive often (though not necessarily) operated in competitive environmentenvironment

NetworksNetworksparties with common aims working togetherparties with common aims working togethertrust, altruism, solidarity, reciprocitytrust, altruism, solidarity, reciprocitycollaboration and cooperationcollaboration and cooperationpartnerships and joint workingpartnerships and joint workingjoint decision making between network partnersjoint decision making between network partners

NetworksNetworks(Quasi)-(Quasi)-MarketsMarkets

Hierarchies/ Hierarchies/ BureacraciesBureacracies

Homogenization and Homogenization and Centralization of Centralization of

ControlControl(‘tightness(‘tightness’)

‘Internal’Internal’controlcontrol

‘‘External’External’controlcontrol

HierarchyHierarchy Markets/ManagerialismMarkets/Managerialism

Legal/Legal/AdministrativeAdministrative EconomicEconomic

Self-regulationSelf-regulation Open-systemsOpen-systems

Moral & EthicalMoral & Ethical RelationalRelational

EMERGING FORMS OF PUBLIC EMERGING FORMS OF PUBLIC ORGANIZATIONAL COORDINATION ANDORGANIZATIONAL COORDINATION AND

GOVERNANCEGOVERNANCE

Differentiation and Differentiation and Flexibility of ControlFlexibility of Control

(‘looseness’)(‘looseness’)

THE AGENDA FOR REFORM ?THE AGENDA FOR REFORM ?

((DAPDAP MODEL (C. Pollitt 2004)) MODEL (C. Pollitt 2004))

DisaggregationDisaggregation of agencies from Ministries of agencies from Ministries

AutonomizationAutonomization of those agencies in terms of of those agencies in terms of greater managerial freedomgreater managerial freedom

DD

AA

practice of practice of PerformancePerformance contracting and contracting and monitoring based on targeting linked to resourcesmonitoring based on targeting linked to resources

PP

SOCIAL INTEGRATIONSOCIAL INTEGRATION

WEAKWEAK STRONGSTRONG

WW EE AA KK

SS TT RR OO NN GG

SOCIAL SOCIAL REGULATIONREGULATION

Isolated/Individualistic Isolated/Individualistic NetworksNetworks

opportunistic opportunistic behaviourbehaviour

individualized individualized incentiveincentive

suspicionsuspicion

Co-operativeCo-operativeNetworksNetworks

shared identitiesshared identities

collective behaviourscollective behaviours

informal tiesinformal ties

‘‘policy communitypolicy community’

Project/Enclave Project/Enclave NetworksNetworks

Periodic/ad-hoc Periodic/ad-hoc alliances & alliances & partnershipspartnerships

‘‘Issue networks’Issue networks’

EnduringEnduringNetworksNetworks

Long-term/rule driven Long-term/rule driven compliancecompliance

‘‘hierarchical’ controlhierarchical’ control

TYPES OF NETWORKTYPES OF NETWORK

SOCIAL INTEGRATIONSOCIAL INTEGRATION

WEAKWEAK STRONGSTRONG

WW EE AA KK

SS TT RR OO NN GG

SO

CIA

L R

EG

UL

AT

ION

SO

CIA

L R

EG

UL

AT

ION

STRENGTHS AND WEAKNESSES OF TYPES STRENGTHS AND WEAKNESSES OF TYPES OF NETWORKOF NETWORK

Isolated/IndividualizedIsolated/Individualized

Harnesses self interest and Harnesses self interest and instrumental actioninstrumental actiondemonstrates competitive successdemonstrates competitive successsuits professionals and suits professionals and professionalizationprofessionalization

zero-sum competitionzero-sum competitionhigh transaction costshigh transaction costscan encourage perverse incentivescan encourage perverse incentiveslack of common bondslack of common bondspotential for corruptionpotential for corruptiondifficult to manage/needs goals anddifficult to manage/needs goals and targetstargets

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Co-operativeCo-operative

Enables coping and survivalEnables coping and survivalreduces exposure during reduces exposure during adversityadversitystrong on security, trust and strong on security, trust and goodwillgoodwillsome possibility of managingsome possibility of managing

limited collective actionlimited collective actiondifficult to get decision madedifficult to get decision madecan get too big and unwieldycan get too big and unwieldytime consuming and frustration time consuming and frustration can set incan set in

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Project/EnclaveProject/Enclave

Clear commitments and goalsClear commitments and goalspolicy focussedpolicy focussed

can lead to protectionismcan lead to protectionismclosed and difficult relationships closed and difficult relationships with outsiderswith outsidersschisms and burnoutsschisms and burnoutssome instabilitysome instabilitynot readily managednot readily managed

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EnduringEnduring

Enables collective action and complex Enables collective action and complex division of labourdivision of labourclarity of rules and norms/good clarity of rules and norms/good accountabilityaccountabilityreadily managedreadily managed

over centralized and regulatedover centralized and regulatedexcessive proceduralismexcessive proceduralismdemotivationdemotivationlacks flexibilitylacks flexibilityencourages patronageencourages patronage

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EGO FRAME

METHODOLOGIES AND NETWORK ANALYSIS

Stress: Contacts/relationsIndividualistic

Switching

FieldsStructural/’enriched individualistic’/embeddednessDynamic properties

Data setsStructural positioning (blocmodelling, structural equivalences/holes)

Methods & techniques:

EthnographicStories & narrativesInsiders & outsiders

Domain of operation:

‘Weave-like’Open-ended

‘Web-like’Boundaries/hierarchical

Macro Political Structures/Models Involving Macro Political Structures/Models Involving ‘Network Formations’ of Various Kinds That ‘Network Formations’ of Various Kinds That

Affect Policy MakingAffect Policy Making

Policy NetworksPolicy NetworksPolicy communityPolicy communityIssue networksIssue networks

Fragmentation of the policy making framework:Fragmentation of the policy making framework:sectoralization of policy making, organizational explosion, sectoralization of policy making, organizational explosion, increased scope for policy making, democratization/fragmentation increased scope for policy making, democratization/fragmentation of the state, blurring of boundaries between public and private, of the state, blurring of boundaries between public and private, overcrowded policy making (increase in ‘policy turnover rate’)overcrowded policy making (increase in ‘policy turnover rate’)

CorporatismCorporatismPrivate interest governancePrivate interest governanceLarge-scale interest groups/ ‘social partners’Large-scale interest groups/ ‘social partners’Macro-level network of policy governance operating in parallel to Macro-level network of policy governance operating in parallel to state apparatusesstate apparatusesReturn of ‘social compacts’Return of ‘social compacts’

AssociationalismAssociationalismPluralistic version of ‘corporatism’Pluralistic version of ‘corporatism’Political associations with ‘dispersed sovereignties’ Political associations with ‘dispersed sovereignties’ (commissions, churches, trusts, trade unions, friendly societies, (commissions, churches, trusts, trade unions, friendly societies, professional societies, places of work)professional societies, places of work)‘‘Negotiated state’Negotiated state’Normative mutualismNormative mutualism

NGOsNGOs of Dissent of Dissent

Similar to associationalism/private interest governanceSimilar to associationalism/private interest governanceCampaigning and propaganda for a particular purposeCampaigning and propaganda for a particular purposePersuasion, mobilization, pressure politicsPersuasion, mobilization, pressure politics‘‘Bottom-up’ rather than ‘top-down’ networksBottom-up’ rather than ‘top-down’ networks

ElitesElitesSmall groups with a particular access to powerSmall groups with a particular access to powerBased on common economic, political and cultural Based on common economic, political and cultural outlook/formationoutlook/formation‘‘Exclusive/top-down’ network.Exclusive/top-down’ network.Undemocratic and non-egalitarianUndemocratic and non-egalitarian

Multi-LevelMulti-Level Governance and ‘Comitology’ Governance and ‘Comitology’

Vertical networksVertical networksOMCOMCDistribution of jurisdictionsDistribution of jurisdictionsExpertsExperts

SOME ISSUES AND PROBLEMS SOME ISSUES AND PROBLEMS WITH POLICY NETWORKSWITH POLICY NETWORKS

ACCOUNTABILITYACCOUNTABILITY

DEMOCRATIC CHARACTERDEMOCRATIC CHARACTER

LEGITIMACYLEGITIMACY

GENUINE REFORM OR GENUINE REFORM OR RECONSOLIDATION?RECONSOLIDATION?

Open network system of genuine policy Open network system of genuine policy influence?influence?

OrOr

Recentralization? — ‘shadow of hierarchy’Recentralization? — ‘shadow of hierarchy’

Complete privatization? — ‘shadow of the Complete privatization? — ‘shadow of the market’market’

DILEMMAS OF ACCOUNTABILITYDILEMMAS OF ACCOUNTABILITY

Governmental ApparatusGovernmental ApparatusDepartment of HealthDepartment of Health

Strategic Health Authorities Strategic Health Authorities (SHAs)(SHAs)

‘‘PRINCIPALPRINCIPAL’’

Primary Health-Primary Health-Care TrustsCare Trusts

(PHCTs)(PHCTs)

PHCTPHCTasas

‘AGENT’‘AGENT’

PHCTPHCTasas

‘‘PRINCIPALPRINCIPAL’’

Local Local CommunityCommunity

GPs/Local Hospitals/Clinics/GPs/Local Hospitals/Clinics/Other Local ProvidersOther Local Providers

‘‘AGENT’AGENT’

EXPLAINING THE DYNAMICS OF NETWORK CHANGEEXPLAINING THE DYNAMICS OF NETWORK CHANGE

HybridizationHybridization

mixed systemsmixed systems

relatively stable combinations and outcomesrelatively stable combinations and outcomes

Continued DisequilibriumContinued Disequilibrium

tensions between participantstensions between participants

continual attention by those involved on the groundcontinual attention by those involved on the ground(‘intelligent policy and managerial disequlibrium’)(‘intelligent policy and managerial disequlibrium’)

Formulation and Reformulation of ‘Political’ Alliances Formulation and Reformulation of ‘Political’ Alliances

implicit and explicit alliancesimplicit and explicit alliances

incentives and performance seen as a consequence of incentives and performance seen as a consequence of different alliancesdifferent alliances

THE ROLE OF ‘ALLIANCES’ IN EXPLAINING CHANGETHE ROLE OF ‘ALLIANCES’ IN EXPLAINING CHANGE

In the NHSIn the NHS: : Consultants/Doctors + Patients Consultants/Doctors + Patients versusversus Managers + Private Managers + Private SuppliersSuppliers

In respect of Socio-economic OrganizationIn respect of Socio-economic Organization

1.1. 1960’s & 1970’s: Managers + Workers (implicit?)1960’s & 1970’s: Managers + Workers (implicit?)i) Stable and moderate wage increasesi) Stable and moderate wage increasesii) Productivity growthii) Productivity growthiii) Keeps managerial pay in checkiii) Keeps managerial pay in checkiv) Strong and good returns to shareholdersiv) Strong and good returns to shareholders

2.2. 1980s: Managers + Customers1980s: Managers + Customersii) Promise of ever cheaper products and services) Promise of ever cheaper products and servicesii) Downsizing of activitiesii) Downsizing of activitiesiii) Ruthless pruning of labouriii) Ruthless pruning of labouriv) Beginning of managerial pay hikeiv) Beginning of managerial pay hike

3.3. 1990s: (Greedy) Managers + Investors (financial institutions) + (support 1990s: (Greedy) Managers + Investors (financial institutions) + (support from) Consultants and Lawyersfrom) Consultants and Lawyersi) Escalating CEO payi) Escalating CEO payii) Shareholder activismii) Shareholder activismiii) ‘Formidable’ allianceiii) ‘Formidable’ alliance

4.4. 2010s?: Progressive Managers + Ethical investors + Ethical consumers2010s?: Progressive Managers + Ethical investors + Ethical consumers