Barriers to Co‐Governance: Examining the “Chemistry” of Home‐Care Networks in Germany, England, and Quebec

Abstract

This article aims at studying the dynamics of organized home care and particular problems in the delivery of social services, analyzed against the background of the international recasting of welfare systems. Challenging an influential academic discourse on the advent of new forms of network governance thought to improve service provision, three jurisdictions-Germany, England, and Quebec-are compared with regard to how home-care networks are actually configured and the rationales which appear to shape the interaction between network members. The article argues that notwithstanding the extensive literature extolling the virtues of network governance or the possibility of reconciling different governance modes, home care operates through arrangements embracing conflicting rationales. Rather than providing for mutual adjustment and shared perspectives, contemporary home-care networks tend to produce tensions and outcome problems as a result of the "biased" interplay between various steering rationales within given institutional arrangements and different meta-governance regimes.

Do governance choices matter in health care networks?: an exploratory configuration study of health care networks

“…Lowndes and Skelcher [13], for instance, found in a study of UK urban regeneration partnerships that the three governance mechanisms (contracts, hierarchy, and relational) can exist in network forms of inter-organizational collaboration, and that these modes can co-exist and depend largely on the stage in the life-cycle of the network organization. Bode and Firbank [31] studied home-care networks for the elderly in various countries and found that such networks can have very different governance mechanisms, ranging from more bureaucratic to more market-oriented. Berbée et al [33] distinguish between contractual and relational governance mechanisms in health care exchange relationships and found in a Belgian health care institute that contractual and relational governance reinforce each other rather than be conflicting.…”

“…Governance mechanisms in health care networks are, therefore, based on hierarchical, contractual, or relational governance, or a combination of these three. Although relational governance is traditionally thought to be the primary governance mechanism in networks [20,29], the literature suggests that this might not always be the case, at least not in health care organizations [31]. …”

Towards Developing New Partnerships in Public Services: Users as Consumers, Citizens and/or Co‐producers in Health and Social Care in England and Sweden

“…But market pressures and the overall weakening of consensus building set clear limits to ‘democratic’ governance in its own ways as evidenced in home care for elderly for example (Bode 2006). Home care clearly operates through arrangements embracing conflicting rationales (Bode and Oscar 2009). Yet often, making money by capturing customers easily overrules the building of trust‐based relationships with users and public bodies (Bode 2007).…”

“…In this case co‐production might be closer to citizenship. Yet given the lessening of political influence by organizations grounded in their local communities (Bode 2006, 2007; Bode and Oscar 2009), it is hard to imagine that clients or their relatives are empowered truly to participate in the co‐production of care services. Finally, if pressures to promote independence are enforced because of potential cost saving, as may be the case for direct payments (Fyson 2009), this might lead to inequality of outcomes for service users and increase their vulnerability to abuse.…”

“…Following the earlier example of Sweden, the New Labour government in England in 2003 moved away from partnerships and collaborative arrangements between state agencies as the preferred model of governance, in favour of markets and the power of the consumer. The concept of the consumer has been extended to the idea of the user of public services and citizen controlling decisions concerning his/her community (Lin 2004; Clarke et al 2005; Richter and Cornford 2007; Jones and Needham 2008; Bode and Oscar 2009). The pressure now is on state bureaucracies to become more responsive by giving users the power of ‘exit’ over unresponsive providers while upholding the elements of ‘voice’ in the system (Hirschman 1970).…”