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Hybrid healthcare governance for improvement? Combining top-down and bottom-up approaches to public sector regulation

McDermott, Aoife M. ORCID:, Hamel, Lauren M., Steel, David, Flood, Patrick C. and McKee, Lorna 2015. Hybrid healthcare governance for improvement? Combining top-down and bottom-up approaches to public sector regulation. Public Administration 93 (2) , pp. 324-344. 10.1111/padm.12118

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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 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 recreated, 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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Business (Including Economics)
Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
R Medicine > RA Public aspects of medicine
Additional Information: Pdf uploaded in accordance with the publisher’s policy at (accessed 02/12/2014)
Publisher: Wiley
ISSN: 0033-3298
Funders: Health Research Board
Date of First Compliant Deposit: 30 March 2016
Date of Acceptance: 29 April 2014
Last Modified: 07 Nov 2023 06:09

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