Analysing the Micro Implementation of Health Care Reforms: A Decentred Approach

Abstract

The network governance narrativeNarratives of public managementManagement reform sponsored by post New Public ManagementNew Public Management (NPM) (NPM) authors (Pollitt and Bouckaert in Public management reform: A comparative analysis, 3rd ed. Oxford University Press, Oxford, 2011; Christensen and Lsgreid in Transcending new public management: The transformation of public sector reforms. Ashgate, Aldershot, 2007) promoted more integrated and systemic approaches to the delivery of public services designed to address the fragmenting effects of earlier NPMNew Public Management (NPM) reforms (Ferlie et al. in Health Services Management Research 30: 61–71, 2016). The different streams of governanceGovernance have created what Jones (Jones in Decentring health policy, Routledge, Oxon, 2018) terms a complex sedimented governanceSedimented governance architecture. While the NPM approach emphasises managerial authority and top-down implementationImplementation, network governance works through collaborationCollaboration and partnershipsPartnership. In this binary theoretical field, the decentred theoryDecentred theory of governanceGovernance offers a different perspective that focuses on how ‘people see the world’ (BevirBevir, Mark and Rhodes in A decentered theory of governance: Rational choice, institutionalism, and interpretation (UC Berkeley Working Papers), Berkeley, University of California, 2001). In this paper we use a bottom-up decentred lens to understand how local actors perceive reforms and use their agencyAgency to make sense of the changes in the delivery of stroke services.