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.

Performance regulation in a networked healthcare system: From cosmetic to institutionalized compliance

“…These insights contribute to scholarship on network accountability, which has often focused on the decreasing importance of regulators in governance networks and the regulatory failures resulting from accountability conflicts in networks (Osborne ). Thus, this study concurs with recent case studies of other successful regulatory action in networks (McDermott et al ; Mills et al ; Reynaers and Parrado ) to contribute to our understanding of how regulators can act as change agents in networks, especially in settings with heterogeneous, conflicting perspectives and motives of network participants.…”

Understanding Hybridity in Public Organizations

“…); higher education reforms in Sweden, the UK, and the Netherlands (Teelken ); and reforms in Scotland and Ireland (McDermott et al. ). A second group concerns public–private relationships.…”

Disaster Management Collaboration in Turkey: Assessing Progress and Challenges of Hybrid Network Governance

“…This article focuses on structural hybridity; while identity and role hybridity are also studied elsewhere, for example within the welfare and health sector (cf. Denis et al ; Fossestøl et al ; McDermott et al ). The growing literature on collaborative public management has tended to treat networks as distinct from hierarchies, but recent research has shown that when actors organize to reach policy goals in practice, traces from both organizing principles are present (McGuire ; McDermott et al ).…”