Institutions and nonlinear change in governance

• Published in: Journal of health organization and management 2008-08, Vol.22 (4), p.350-367
• Main Authors: Burau, Viola, Vrangbk, Karsten
• Format: Article
• Language: English
• Subjects: Europe; Governance; Health and medicine; Performance public administration
• ISSN: 1477-7266
• DOI: 10.1108/14777260810893953

Purpose The paper aims to account for the substance of nonlinear governance change by analysing the importance of sectorspecific institutions and the pathways of governing they create. Designmethodologyapproach The analysis uses recent reforms of the governance of medical performance in four European countries as a case, adopting an inductively oriented approach to comparison. The governance of medical performance is a good case as it is both, closely related to redistributive policies, where the influence of institutions tends to be pertinent, and is subject to considerable policy pressures. Findings The overall thrust of reforms is similar across countries, while there are important differences in relation to how individual forms of governance and the balance between different forms of governance are changing. More specifically, sectorspecific institutions can account for the specific ways in which reforms redefine hierarchy and professional selfregulation and for the extent to which reforms strengthen hierarchy and affect the balance with other forms of governance. Originalityvalue The recent literature on governance mainly focuses on mapping out the substance of nonlinear change, whereas the development of explanations of the substance of governance change is less systematic. In the present paper, therefore, it is suggested coupling the notion of nonlinear change with an analysis of sector specific institutions inspired by the historical institutionalist tradition to better account for the substance of nonlinear governance change. Further, the analysis offers interesting insights into the complexity of redrawing boundaries between the public and the private in health care.