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HYBRID HEALTHCARE GOVERNANCE FOR IMPROVEMENT? COMBINING TOP‐DOWN AND BOTTOM‐UP APPROACHES TO PUBLIC SECTOR REGULATION
Author(s) -
MCDERMOTT AOIFE M.,
HAMEL LAUREN M.,
STEEL DAVID,
FLOOD PATRICK C.,
MKEE LORNA
Publication year - 2015
Publication title -
public administration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.313
H-Index - 93
eISSN - 1467-9299
pISSN - 0033-3298
DOI - 10.1111/padm.12118
Subject(s) - accountability , hybridity , corporate governance , business , health care , process management , top down and bottom up design , psychological intervention , public relations , public administration , political science , sociology , computer science , medicine , nursing , finance , law , anthropology , software engineering
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.