Quality-Adjusted Life-Years (QALYs) are central to healthcare decision-making in Britain and abroad, yet their history is poorly understood. In this paper, we argue that a more in-depth and political history of the QALY is needed to allow a critical evaluation of its current dominance. Exploiting rich data from archives and 44 semi-structured interviews conducted between 2015 and 2018, we employ Multiple Streams Analysis to construct a complex and dynamic picture of how the idea of QALYs emerged and was adopted within UK health policy. Through its historical and political approach, the paper illuminates the relative roles in the policy-making process of experts (especially economists) and politicians as ‘entrepreneurs’ in the development of new ideas; how these were influenced by negotiation within established and emerging institutional structures; and the role of serendipity and crisis.
The claim that evidence-based policy (EBP) produces better outcomes has gained increasing support over the last three decades. Knowledge brokering (KB) is seen as a way to achieve improved policymaking and governments worldwide are investing significant resources in KB initiatives. It is therefore important to understand the range of these activities and to investigate whether and how they facilitate EBP. This article critically reviews the extant literature on KB. It identifies six important limitations: the existence of multiple definitions of KB; a lack of theory-based empirical analysis; a neglect of knowledge brokering organisations; insufficient research on KB in social policy; limited analysis of impact and effectiveness; and a lack of attention to the role played by politics. The paper proposes an agenda for future research that bridges disciplinary boundaries in order to address these gaps and contribute new insights into the politics of evidence use.
The organisational change literature remains dominated by macro-and microexplanatory models which tend to exclude conflict, mess and power in favour of enumerating universalistic steps or, as is the subject of this article, leadership definitions and factors for successful change. In this article, I review and question some of the mainstream literature on leadership in organisational change, drawing on Laclau and Mouffe's political discourse theory and its mobilisation by critical leadership studies of organisational change. This article problematises change leadership as a set of multiple and changing practices, pragmatically deployed by organisational players. In exploring those avenues, I deploy a five-step 'logics of critical explanation' approach -specifically designed by Laclauian discourse theorists -characterising organisational change practices according to social (rules and norms), political (inclusions and exclusions) and fantasmatic (fears and hopes) logics. Rather than a set of factors or top-down causes and effects, I offer a situated and critical explanation of leadership in organisational change. This research contributes to critical explanations of organisational change politics by considering leadership as a set of changing discursive practices and by developing four situated dimensions of leadership, which build on concepts of empty and floating signifiers, to add to discussions of the role of individuals in organisational politics.
Evidence plays a growing role in public administration worldwide. We analyze the perceptions of policy actors, using Q methodology and a structured questionnaire, which reveals four types of profiles. Most policy actors did not fit neatly into an Evidence-Based Policy-Making (EBPM) group. Instead, they either had a pragmatic view where context and policy issues influence what counts as evidence, an inclusive position which emphasized the importance of considering a range of different types of evidence, or a political perspective where power relations and politics influence what counts as evidence. Our research also illustrates how different actors in the same community can have different perceptions of evidence, and how this can change over time due to experience and career trajectory.
This chapter contributes to ‘second-generation’ accounts of depoliticization through the critical assessment of the meta-governance of English local authorities under conditions of austerity. It draws on the grammar of post-structuralism to examine the case of a county council and how in the context of the 2010 public spending cuts, its corporate centre sought, but ultimately failed, to implement a system of ‘integrated commissioning’. The chapter focuses on the discursive and rhetorical strategies to de-contest this project of organizational change, foregrounding how the rhetoric of austerity was deployed to depoliticize proposals for change. Such strategies of depoliticization, as counter-attempts to decouple austerity from integrated commissioning demonstrates, are always open to contestation, such that the complex interactions of politicization and depoliticization strategies cannot be divorced from accounts of local agency and the politics of hegemony. This chapter thus concludes against hasty characterizations of the depoliticizing practices of neo-liberal meta-governance.
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