In this article, we explore how public front‐line service organizations respond to contradictory demands for institutional reform and the types of hybridization this entails. Our research context is a major administrative welfare reform in Norway characterized by a dominant New Public Management (NPM) logic of uniform user service and central administrative control, and a subordinate post‐NPM logic of holistic user service and local organizational autonomy. We elucidate four types of responses by the front‐line organizations as they have incorporated these contradictory demands: ‘non‐hybridity’ (ignoring post‐NPM demands), ‘ad hoc hybridity’ (indecisive adherence to both demands), ‘negative hybridity’ (separation of the demands), and ‘positive hybridity’ (integration of both demands). On the basis of these findings, we argue that hybridization and agency are possible in fields of public reform characterized by a highly institutionalized NPM logic and explore the key organizational characteristics that facilitate hybridization in such fields.

In social policy discussions about activation or ALMP (Active Labour Market Policies), most attention is paid to supply-side approaches, directed towards jobless individuals. In these discussions, little attention is given to demand-side approaches aimed at activating employers, or combined workplace-oriented approaches that combine supply and demand-side elements. The aim of this article is to introduce demand-side and combined approaches developed within the fields of disability policy and vocational rehabilitation to scholarly discussions about activation and ALMP.By comparing these three approaches, we show that demand-side and combined approaches challenge key assumptions underlying the dominant supply-side approaches. They do so by representing different views of a) work – as a right instead of a duty; b) the problem of reduced work capacity – not as individual failure, but rather as a prejudice in attitudes among employers or as a gap between capacities and demands; c) the employers and the labour market – as transformable instead of fixed.Supply-side, demand-side and combined workplace-oriented approaches share the aim of labour market integration; however, their developments seem to have taken place largely in isolation from each other. We argue that when brought together they could form a more comprehensive base for further development of labour market integration.

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Policies of citizen involvement in health and social care have given rise to a variety of organisational forms, which address citizens in different capacities and differ in their demands as to the representativeness, performance and competence of those involved. Apparently, the policies draw on different institutional logics. Based on extant studies, partly the author's own research from Norway, this article sheds light on three purposefully selected cases of citizen involvement. Two models of democratic consultation encompass a dominant model of involvement in Norway (advisory bodies of service users) and a model more prevalent in UK (panels of the general public). These are both embedded within a logic of democracy. A third emergent model of involvement is one in which citizens with experience as service users are engaged as workers in service providing organisations. This model resembles an idea of co-production. However, when involvement is organised as user-employment and paid work, the model rather seems rooted within the logic of the market – the labour market of service workers. The rise of this model suggests a shift in institutional embedding of citizen involvement. The analysis of these models provides a framework of distinguishing dimensions between different models of involvement.

Sammendrag:Forbrukerens stemme i norsk helsepolitikk har aktivert pasienter til å vaere involvert i diskusjoner om profesjonsutøvelse. Prinsippene om åpenhet har blitt introdusert i tjenester som er bundet av profesjonell autonomi og skjønn. Denne artikkelen viser innflytelsen norske pasienter og deres representanter har vaert i stand til å ha på tjenestetilbudet for rehabilitering for hjerneskadde og innen psykisk helsevern.Omsorgsbiblioteket har ikke tilgang til å publisere dette dokumentet i fulltekst. Kanskje ditt lokale bibliotek kan hjelpe deg, eller kanskje du kommer videre med lenken nedenfor.Relevant lenke: http://dx

Background With the increase in user activism in the Western societies in recent years, there has also been an increase in promoting user involvement in research. Hence, is necessary to address the danger of tokenism, a false appearance of inclusiveness, in user involvement, as well as to explore methods for promoting active user involvement. Using a Norwegian research project on the rehabilitation processes following traumatic injuries organised via user involvement, this study reviews ways in which to avoid tokenism in user involvement and how to instead stimulate active user engagement in research. Methods The analysis employs an ethnographic approach using participant observations from real life settings involving user involvement during the five years research process. The empirical material includes 472 pages of transcribed audio recordings from meetings between researchers and collaborators discussing personal experiences with traumatic injuries, and 340 pages of documents on the project’s involvement process. This empirical material was examined by thematic analysis, involving processes such as decontextualising, flagging and re-contextualising. Results Two main categories of facilitation emerged as promoting non-tokenistic, active user involvement in research: 1) defining the collaborative arena, (i.e. the setting of collaboration) which entails preparing for participation and promoting active involvement, and 2) designing for research counselling, which involves gathering user perspectives and valuing criticism. Taking into account the existing asymmetric relationships between researchers and collaborators, enabling more evenly distributed power dynamics also proved to be essential. Conclusions To achieve active participation that is relevant to the collaborators, two interconnected yet analytically independent themes should be considered: the collaborative arena and counselling. Both prove crucial for curbing power imbalance and stimulating the involvement process. The study indicates that non-tokenistic involvement should be anchored in the respect for participants and their ability to make contributions. This analysis can help researchers who seek active engagement and non-tokenistic involvement in research to find methods for facilitating and organising participation in their fields.

Models or measures to strengthen the position of service users not only change the position of the users, they also alter the position of the professionals involved. However, different forms of involvement alter the position of professionals differently. The aim of this article is to present an analytical framework that allows for an examination of different, ideal types of involvement, and their implications for the positioning of professionals. Three basic forms of involvement are identified: involvement as a) self-determination and self-management, b) sharing of lived experience, and c) co-management and mediation of causes and concerns. Within each of these basic forms, different models or measures are classified according to the positions of patients and professionals respectively. The framework shows that professionals are repositioned as facilitators, not only therapists; as partners and co-workers, rather than sole experts; as learners, rather than experts and teachers; and as recipients rather than in the position of offering knowledge and skills. While detailed and long-term investigation is necessary to determine the impact of involvement in actual cases, the presence of models and measures to strengthen the position of the users in various ways transforms the context of professional work, as well as the classic meaning of professionalism.

Activation work -the complex task of motivating, compelling and assisting marginalized citizens into labour market participation -pinpoints critical issues of discretion and accountability in the welfare state. Investigating accountability measures aimed at ensuring qualified discretionary judgements is therefore important.In this article, I discuss the reformed Norwegian Labour and Welfare Service and the accountability measures aimed at discretionary judgements of frontline workers tasked with motivating, compelling and assisting marginalized citizens into labour market participation.The conclusion is that, because activation tasks in the Norwegian frontline service imply professional discretion more than administrative discretion, structural measures aimed at restricting the discretionary space of frontline workers seem to have only limited impact. This is because the knowledge necessary to perform means-end judgements is insufficient. Rather, there seems to be a need for epistemic measures aimed at improving the knowledge base for professional discretionary reasoning.