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Complementary logics of target-setting: hierarchist and experimentalist governance in the Scottish National Health Service

Published online by Cambridge University Press:  20 June 2016

Laura Schang  and
Alec Morton
Laura Schang*
Affiliation:
Department of Management, London School of Economics and Political Science, England, UK
Alec Morton
Affiliation:
Department of Management Science, Strathclyde Business School, University of Strathclyde, Scotland, UK
*
*Correspondence to: Laura Schang, PhD, Department of Health Services Management, Munich School of Management, Ludwig-Maximilians-Universität München, Schackstraße 4, 80539 München, Germany. Email: [email protected]
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Abstract

Where policy ends are contested and means for change are ambiguous, imposing central targets on local organisations – what we call hierarchist governance – is problematic. The concept of experimentalist governance suggests that target-setting should rather be a learning process between central regulators and local organisations. However, the relationship between experimentalist and hierarchist governance remains unclear. Existing literature suggests that the learning-oriented experimentalist logic is hard to reconcile with a hierarchist logic focussed on accountability for results. We examine whether complementary use of hierarchist and experimentalist ideas is possible. Drawing on experiences from Scotland, we find that experimentalist and hierarchist logics can co-exist in the same performance management system. Each logic served distinct roles with respect to target-setting, implementation and accountability. The emphasis on experimentalism was stronger where ends and means were contested (the case of shifting the balance of care for older people) than where both ends and means seemed obvious initially (the case of health care-associated infections, where target-setting followed a more hierarchist logic). However, governance drifted towards experimentalism when rising rates of community-acquired infections decreased clarity about effective interventions. The nature of policy issues and changes therein over time appear to be important conditions for synergies between governance logics.

Type
Articles
Information
Health Economics, Policy and Law , Volume 12 , Issue 1 , January 2017 , pp. 21 - 41
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Copyright
© Cambridge University Press 2016 

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