Hybrid healthcare governance for improvement?

Combining top-down and bottom-up approaches to public sector regulation

Aoife M. Mcdermott, Lauren M. Hamel, David Steel, Patrick C. Flood, Lorna McKee

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)324-344
Number of pages21
JournalPublic Administration
Volume93
Issue number2
Early online date19 Jan 2015
DOIs
Publication statusPublished - Jun 2015

Fingerprint

public sector
governance
regulation
self-determination
best practice
Ireland
penalty
monitoring
staff
responsibility

ASJC Scopus subject areas

  • Public Administration

Cite this

Hybrid healthcare governance for improvement? Combining top-down and bottom-up approaches to public sector regulation. / Mcdermott, Aoife M.; Hamel, Lauren M.; Steel, David; Flood, Patrick C.; McKee, Lorna.

In: Public Administration, Vol. 93, No. 2, 06.2015, p. 324-344.

Research output: Contribution to journalArticle

Mcdermott, Aoife M. ; Hamel, Lauren M. ; Steel, David ; Flood, Patrick C. ; McKee, Lorna. / Hybrid healthcare governance for improvement? Combining top-down and bottom-up approaches to public sector regulation. In: Public Administration. 2015 ; Vol. 93, No. 2. pp. 324-344.
@article{4a9ef8b625574f529daca1428aa26e20,
title = "Hybrid healthcare governance for improvement?: Combining top-down and bottom-up approaches to public sector regulation",
abstract = "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.",
author = "Mcdermott, {Aoife M.} and Hamel, {Lauren M.} and David Steel and Flood, {Patrick C.} and Lorna McKee",
year = "2015",
month = "6",
doi = "10.1111/padm.12118",
language = "English",
volume = "93",
pages = "324--344",
journal = "Public Administration",
issn = "0033-3298",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Hybrid healthcare governance for improvement?

T2 - Combining top-down and bottom-up approaches to public sector regulation

AU - Mcdermott, Aoife M.

AU - Hamel, Lauren M.

AU - Steel, David

AU - Flood, Patrick C.

AU - McKee, Lorna

PY - 2015/6

Y1 - 2015/6

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84930931877&partnerID=8YFLogxK

U2 - 10.1111/padm.12118

DO - 10.1111/padm.12118

M3 - Article

VL - 93

SP - 324

EP - 344

JO - Public Administration

JF - Public Administration

SN - 0033-3298

IS - 2

ER -