Introduction

Hupe, Peter; Hill, Michael D.; Buffat, Aurélien

doi:10.1332/policypress/9781447313267.003.0001

Cited by 10 publications

(13 citation statements)

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“…Hupe and van Kooten47 noted that despite an abundance of literature regarding public management, this tends not to focus on middle management or work supervisors. They suggested that in processing rules, public managers either formulate additional rules, pass on rules or buffer rules and that in this way first-line supervisors are also discretionary actors 47. Our findings support this claim in the case of stroke unit therapists, and this highlights a need for consideration of their role as clinical leaders.…”

Section: Discussionmentioning

confidence: 99%

How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study

2018

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ObjectivesOccupational therapy, physiotherapy and speech and language therapy are central to rehabilitation after a stroke. The UK has introduced an audited performance target: that 45 min of each therapy should be provided to patients deemed appropriate. We sought to understand how this has influenced delivery of stroke unit therapy.DesignEthnographic study, including observation and interviews. The theoretical framework drew on the work of Lipsky and Power, framing therapists as ‘street level bureaucrats’ in an ‘audit society’.SettingStroke units in three English hospitals.ParticipantsForty-three participants were interviewed, including patients, therapists and other staff.ResultsThere was wide variation in how therapy time was recorded and in decision-making regarding which patients were ‘appropriate for therapy’ or auditable. Therapists interpreted their roles differently in each stroke unit. Therapists doubted the validity of the audit results and did not believe their results reflected the quality of services they provided. Some assumed their audit results would inform commissioning decisions. Senior therapy leaders shaped priorities and practices in each therapy team. Patients were inactive outside therapy sessions. Patients differed regarding the quantity of therapy they felt they needed but consistently wanted to be more involved in decisions and treated as individuals.Conclusions and implicationsStroke unit therapy has different meanings in different hospitals. Measuring therapy time is problematic due to varied interpretations of ‘what counts’ and variation in reporting practices. Although stroke policy, guidelines and audit are potential tools of improvement, their benefits are not automatic. Their actual effects depend largely on the attitudes and values of local influential ‘street level leaders’. More work is needed to promote an integrated whole team approach to rehabilitation. Further research into contextual and human factors, including the roles and views of therapy leaders, would enable a better understanding of implementation of guidelines and service improvement.

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Section: Discussionmentioning

confidence: 99%

How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study

2018

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“…Since the seminal work of Lipsky (1980) and Pressman and Wildavsky (1984), there is general agreement among public policy scholars that the services provided at street level typically diverge from the intentions of policy-makers and that much of this deviation results from the discretion of street-level bureaucrats (Brodkin, 2013; Hupe et al , 2015; May and Winter, 2009; Meyers and Vorsanger, 2003; Riccucci, 2005). Autonomy involves the degree of freedom from organisational authority; for instance, the ability of street-level bureaucrats to provide a different type of service delivery from what is imposed by higher levels.…”

Section: Perspectives On Street-level Autonomymentioning

confidence: 99%

Modification of Public Policies by Street-Level Organisations: An Institutional Work Perspective

2016

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The literature on policy implementation is divided with regards to the impact of street-level bureaucrats on the implementation of public policies. In this paper, we aim to add to and nuance these debates by focusing on 'institutional work' -i.e. the creation, maintenance and disruption of institutions -undertaken by central authorities and street-level bureaucrats during public reform processes. On the basis of a case study of the organisational implementation of a retirement pension reform in the Norwegian Labor and Welfare Administration, we argue that institutional work is a useful heuristic device for conceptualising the variety of responses available to street-level bureaucrats during public reforms. We also argue that the responses demonstrate the impact of street-level bureaucrats in these reforms in the context of managerial control and regulation. Finally, we argue that the effectiveness of policy change is dependent on the institutional work of street-level bureaucrats and, in particular, on institutional work that supports the institutions created by politicians and public administrations.

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“…Dans cette perspective, les pratiques des agents de l'administration contribuent à définir le contenu de la politique qu'ils sont chargés d'appliquer. Les recherches sur la street-level bureaucracy, dans la continuité de l'ouvrage fondateur de Michael Lipsky (1980), ont mis en évidence le rôle de policy makers des agents de terrain qui repose sur le pouvoir discrétionnaire dont ils sont dépositaires (voir aussi : Brodkin, 1997 ;Evans et Harris, 2004 ;Hupe, 2013 ;Hupe et al, 2015). L'observation des pratiques des agents de terrain « aux guichets » des administrations permet ainsi de saisir non seulement comment l'action publique est faite, mais aussi certaines de ses caractéristiques structurelles (Spire, 2008 ;Dubois, 2010).…”

Section: Pour Une Analyse Des Politiques D'asile « Par Le Bas »unclassified

Le Droit et ses médiations

Miaz

2019

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Les travaux qui portent sur la mise en oeuvre des politiques publiques et, en particulier, sur lasreet-level bureaucracyappréhendent généralement la question du pouvoir discrétionnaire à un niveau individuel à partir de la liberté d’action dont disposeraient les agents de terrain. Sur la base d’une enquête ethnographique au sein de l’administration responsable du traitement des demandes d’asile en Suisse, cet article analyse la question sous un autre angle : à partir des médiations sociales, institutionnelles et juridiques à travers lesquelles le droit oriente les comportements des agents. L’analyse des médiations du droit révèle surtout l’importance d’un pouvoir normatifcollectifde l’administration, qui réside dans l’élaboration de « normes secondaires d’application » par les agents. Cet article montre aussi qu’il existe, au sein de l’institution, tout un travail à la fois juridique et social qui encadre, oriente et contraint les pratiques des agents.

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Introduction

Cited by 10 publications

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How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study

How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study

Modification of Public Policies by Street-Level Organisations: An Institutional Work Perspective

Le Droit et ses médiations

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