Agency at the Managerial Interface: Public Sector Reform as Institutional Work

Abstract

This article draws on recent developments in institutional theory to better understand the managerial efforts implicated in the implementation of government-led reforms in public sector services. Based on a longitudinal study of a massive reform effort aimed at transforming the province of Quebec’s publicly-funded healthcare system, the article applies the notion of institutional work to understand how managers responsible for newly formed healthcare organizations defined and carried out their individual missions while simultaneously clarifying and operationalizing the government’s reform mandate. We identify and describe the properties of four types of work implicated in this process and suggest that structural work, conceptual work, and operational work need to be underpinned by relational work to offer chances for successful policy reform. By showing the specific processes whereby top-down reform initiatives are taken up by managers and hybridized with existing institutionalized forms and practices, this article helps us better understand both the importance of managerial agency in enacting reform, and the dynamics that lead to policy slippage in complex reform contexts.

Clinical leadership in service redesign using Clinical Commissioning Groups: a mixed-methods study

“…It is not only clinicians who engage in institutional work when creating new forms or shoring up old ones, managers in health service redesign attempts are also heavily involved. 68 Whether or not the same kind of analysis of professional jurisdictions made in these mainly acute contexts can be transferred to the primary care setting is an open question. This is especially so in the case of CCGs, where the core institution is ostensibly a 'membership' organisation.…”

Towards a Cognitive Cultural Approach to Public Management Reform

“…Table 2. Qualitative empirical studies referencing Hood and Peters (2004) Article reference Method of data collection Almqvist, Catasús, and Skoog (2011) Da/Int Anderson and Klaassen (2012) Da/Int Azzone and Palermo (2011) Da/Int Baines, Charlesworth, and Cunningham (2014) Da/Int/Obs Baines, Charlesworth, Turner, and O'Neill (2014) Da/Int/Obs Cloutier, Denis, Langley, and Lamothe (2016) Int/Obs Gleeson and Knights (2008) Da/Int Goh, Elliott, and Richards (2015) Da/Int Grimaldi and Serpieri (2013) Da/Int Da/Int Hall and McGinity (2015) Int/Obs Kann-Rasmussen and Balling (2015) Int Kartalis, Tsamenyi, and Jayasinghe (2016) Da ISSN 2161-7104 2018 We first studied the way in which the content of the change was included. It appeared that some studies do not define this content at all, because they do not actually go into a concrete change process.…”

“…Examples are Baines, Charlesworth and Cunningham (2014), Grimaldi and Serpieri (2013) and Kann-Rasmussen and Balling (2015). Other articles study organizational change without explicating the actual change content (Hall & McGinity, 2015;Kinder, 2012), or they define a change initiative in rather abstract, mostly macro-level or political terms (Cloutier et al, 2016;Liguori, 2012;Mattison & Ramberg, 2015;Sacranie, 2012). Five studies appeared to define the change content in detail: Azzone and Palermo (2011), Gleeson and Knights (2008), Liff (2014), Schmid et al (2010) andSchultz Larsen (2015).…”

“…It appeared that context usually figures only in general terms; see, for example, Almqvist et al (2011) and Cloutier et al (2016). There were four exceptions: Ahlbä ck and Bringselius (2015); Anderson and Klaassen (2012); Azzone and Palermo (2011);Schultz Larsen (2015).…”

“…Using our CC research method could have similar effects if applied to the study undertaken by Cloutier et al (2016), who investigate the extent to which the four elements of the institutional work done by health care managers influence NPM reform implementations, and conclude that one of these elements, ‗relational work', is an underpinning and determining factor to effectuate change. Relational work is described as building linkage, trust and collaboration between people involved in the actual change.…”