Making Wicked Problems Governable?

Ferlie, Ewan; Fitzgerald, Les; McGivern, Gerry; Dopson, Sue; Bennett, Colleen R.

doi:10.1093/acprof:oso/9780199603015.001.0001

Cited by 98 publications

(15 citation statements)

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“…This is exemplified by the therapeutic encounters of the ‘psy’ disciplines, which Rose (2007) sees as based upon informed consent, choice and empowerment. A number of studies use the concept to explain, for example, how university students are enrolled in systems of voluntary compliance ( Howley and Hartnett, 1992 ), how organisational standards are promoted within professional communities ( Bejerot and Hasselbladh, 2011 ; Ferlie et al, 2013 ; Waring and Martin, 2016 ); how ethical workplace behaviour is shaped by corporate leaders ( Bell and Taylor, 2003 ); and how self-governing patients are constituted through their interactions with health experts ( Holmes, 2002 ; Rose, 2007 ; Wilson, 2001 ). These studies often use the concept to account for particular forms of expert power, but there is little explanation of the relational practices of pastors when seeking to constitute self-governing subjects, or indeed the limits of their influence or scope for resistance.…”

Section: Foucault’s Pastoral Powermentioning

confidence: 99%

Of Shepherds, Sheep and Sheepdogs? Governing the Adherent Self through Complementary and Competing ‘Pastorates’

Waring

Latif

2017

Sociology

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Foucault’s concept of ‘pastoral power’ describes an important technique for constituting obedient subjects. Derived from his analysis of the Christian pastorate, he saw pastoral power as a prelude to contemporary technologies of governing ‘beyond the State’, where ‘experts’ shepherd self-governing subjects. However, the specific practices of modern pastorate have been little developed. This article examines the relational practices of pastoral power associated with the government of medicine use within the English healthcare system. The study shows how multiple pastors align their complementary and variegated practices to conduct behaviours, but also how pastors compete for legitimacy, and face resistance through the mobilisation of alternative discourses and the strategic exploitation of pastoral competition. The article offers a dynamic view of the modern pastorate within the contemporary assemblages of power.

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Section: Foucault’s Pastoral Powermentioning

confidence: 99%

Of Shepherds, Sheep and Sheepdogs? Governing the Adherent Self through Complementary and Competing ‘Pastorates’

Waring

Latif

2017

Sociology

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“…Although much is known about managing change in health care, including the challenges of dealing with complex, so-called 'wicked problems', there has been little focus on specific capabilities to use evidence. 96 Evidence use is only one aspect of any change process, however, so links between process outcomes and capabilities to use evidence are not direct and need to be treated with caution.…”

Section: Capabilities To Use Evidencementioning

confidence: 99%

Improving the capabilities of NHS organisations to use evidence: a qualitative study of redesign projects in Clinical Commissioning Groups

Swan

Gkeredakis

Manning

et al. 2017

Health Serv Deliv Res

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BackgroundInnovation driven by authoritative evidence is critical to the survival of England’s NHS. Clinical Commissioning Groups (CCGs) are central in NHS efforts to do more with less. Although decisions should be based on the ‘best available evidence’, this is often problematic, with frequent mismatches between the evidence ‘pushed’ by producers and that used in management work. Our concern, then, is to understand practices and conditions (which we term ‘capabilities’) that enable evidence use in commissioning work. We consider how research gets into CCGs (‘push’), how CCGs use evidence (‘pull’) and how this can be supported (toolkit development). We aim to contribute to evidence-based NHS innovation, and, more generally, to improved health-care service provision.MethodSupported by the National Institute for Health Research (NIHR), we conducted semistructured ethnographic interviews in eight CCGs. We also conducted observations of redesign meetings in two of the CCGs. We used inductive and deductive coding to identify evidence used and capabilities for use from the qualitative data. We then compared across cases to understand variations in outcomes as a function of capabilities. To help improvements in commissioning, we collated our findings into a toolkit for use by stakeholders. We also conducted a small-scale case study of the production of evidence-based guidance to understand evidence ‘push’.ResultsFieldwork indicated that different evidences inform CCG decision-making, which we categorise as ‘universal’, ‘local’, ‘expertise-based’ and ‘trans-local’. Fieldwork also indicated that certain practices and conditions (‘capabilities’) enable evidence use, including ‘sourcing and evaluating evidence’, ‘engaging experts’, ‘effective framing’, ‘managing roles and expectations’ and ‘managing expert collaboration’. Importantly, cases in which fewer capabilities were recorded tended to report more problems, relative to cases in which needed capabilities were applied. These latter cases were more likely to effectively use evidence, achieve objectives and maintain stakeholder satisfaction. We also found that various understandings of end-users are inscribed into products by evidence producers, which seems to reflect the evolving landscape of the production of authoritative evidence.ConclusionsThis was exploratory research on evidence use capabilities in commissioning decisions. The findings suggest that commissioning stakeholders need support to identify, understand and apply evidence. Support to develop capabilities for evidence may be one means of ensuring effective, evidence-based innovations in commissioning. Our work with evidence producers also shows variation in their perceptions of end users, which may inform the ‘push’/’pull’ gap between research and practice. There were also some limitations to our project, including a smaller than expected sample size and a time frame that did not allow us to capture full redesign projects in all CCGs.Future workWith these findings in mind, future work may look more closely at how information comes to be treated as evidence and at the relationships of capabilities to project outcomes. Going forward, knowledge, especially that related to generalisability, may be built by means of a longer time and the study of redesign projects in different settings.FundingThe NIHR Health Services and Delivery Research programme.

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“…Thus, the data we derive informs us as to how stakeholders may interact and to identify what values and behaviours they would need to express for the described situation to be realised [49]. In a successful networked model of care we would expect to see stakeholders exhibiting mutual self-interest, cross-boundary connectedness and interprofessional support [92], though we found the panellists questioning how deeply these characteristics are held or expressed by the sector's actors. This reveals an important aspect of scenario analysis; that it can act as a rehearsal of a policy's implementation, with the resulting commentaries providing service and workforce planners a further means to identify the policy implications for service outcomes, its workforces and wider stakeholders.…”

Section: Discussionmentioning

confidence: 99%

“…We chose this method for its ease of use and because as it accommodates non-normal or bi-modal data distributions that can be found in policy Delphi data. Due to the modest panel size, we set the response stability acceptability criterion at 20% as per Nelson [92], meaning that when the percentage change is less than 20% it is considered to be stable. It may take up to four or five rounds to achieve response stability, as panellist divisions tend to become more polarised in latter rounds [55].…”

Section: Panel Administrationmentioning

confidence: 99%

Rethinking workforce planning for integrated care: using scenario analysis to facilitate policy development

Rees

Crampton

Gauld

et al. 2020

BMC Health Serv Res

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Background: A goal of health workforce planning is to have the most appropriate workforce available to meet prevailing needs. However, this is a difficult task when considering integrated care, as future workforces may require different numbers, roles and skill mixes than those at present. With this uncertainty and large variations in what constitutes integrated care, current health workforce policy and planning processes are poorly placed to respond. In order to address this issue, we present a scenario-based workforce planning approach. Methods: We propose a novel mixed methods design, incorporating content analysis, scenario methods and scenario analysis through the use of a policy Delphi. The design prescribes that data be gathered from workforce documents and studies that are used to develop scenarios, which are then assessed by a panel of suitably qualified people. Assessment consists of evaluating scenario desirability, feasibility and validity and includes a process for indicating policy development opportunities. Results: We confirmed our method using data from New Zealand's Older Persons Health sector and its workforce. Three scenarios resulted, one that reflects a normative direction and two alternatives that reflect key sector workforce drivers and trends. One of these, based on alternative assumptions, was found to be more desirable by the policy Delphi panel. The panel also found a number of favourable policy proposals. Conclusions: The method shows that through applying techniques that have been developed to accommodate uncertainty, health workforce planning can benefit when confronting issues associated with integrated care. The method contributes to overcoming significant weaknesses of present health workforce planning approaches by identifying a wider range of plausible futures and thematic kernels for policy development. The use of scenarios provides a means to contemplate future situations and provides opportunities for policy rehearsal and reflection.

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Making Wicked Problems Governable?

Cited by 98 publications

References 0 publications

Of Shepherds, Sheep and Sheepdogs? Governing the Adherent Self through Complementary and Competing ‘Pastorates’

Of Shepherds, Sheep and Sheepdogs? Governing the Adherent Self through Complementary and Competing ‘Pastorates’

Improving the capabilities of NHS organisations to use evidence: a qualitative study of redesign projects in Clinical Commissioning Groups

Rethinking workforce planning for integrated care: using scenario analysis to facilitate policy development

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