The Many Faces of Accountability: Comparing Reforms in Welfare, Hospitals and Migration

Abstract

Welfare reforms involve trade-off between different accountability types, such as political, administrative, legal and social accountability. This variety of accountability types is used to investigate consequences of reforms in three different welfare services in Norway; social services, hospitals and immigration. The study finds that more complex, dynamic and layered accountability forms are emerging, but that there are some differences across reform areas. The reforms in immigration seem to change accountability relations the most in hospitals, administrative and political accountability is up against professional accountability, and we see that politicians lack overall capacity and have to rely on administrative accountability in social services. In order to analyze how reforms affect accountability relations one has to study both the formal and informal changes, as well as the relationship between politics and professionalism.

Performance and Accountability—A Theoretical Discussion and an Empirical Assessment

“…In a study of the effects on accountability of the welfare administrative reform, a distinction is made between formal and actual change in accountability relationships (Table 1) (Byrkjeflot, Christensen and Laegreid 2012). Concerning political accountability there are two aspects involved, one related to ministerial accountability and one related to local selfgovernment.…”

“…The mandatory local welfare offices imply a change in and limitation of local self-government, and even though these offices imply that more central resources will potentially be made available to solve local problems, the overall feature is that the central government is the dominant partner in the local partnership. Source: Byrkjeflot, Christensen and Laegreid (2012), page 50.…”

“…Judicial accountability deals with questions of rule of law, rights and equal treatment, professional accountability relates to professional competence and norms, while social accountability is more connected to stake-holders in the environment, i.e. actors feel a moral obligation to justify their actions (Byrkjeflot, Christensen and Laegreid 2012).…”

“…The political leadership has also become passive towards the NAV agency, partly to avoid blame. At the same time, as the provider of the majority of services and resources in local partnership offices, the central level has strengthened its influence vis-à-vis the local political level (Byrkjeflot, Christensen and Laegreid 2012).…”

Acquired brain injury rehabilitation: dilemmas in neurological physiotherapy across healthcare settings

“…Limitations in service delivery combined with increased responsibility can lead to dilemmas, as the appropriate course of action cannot be achieved because of external barriers (34); this can create tension between political governance and the professional accountability of street-level bureaucrats (35). Recent studies show that influence of contextual factors and external circumstances such as economy, duration of stay, organization and culture affect physiotherapists' and other professionals' clinical reasoning and decision-making (36)(37)(38)(39)(40)(41).…”