Home / Lectures / Aoife McDermott, Cardiff Business School
To punish or persuade? Combining top-down and bottom-up approaches to delivering change in healthcare

Aoife McDermott, Cardiff Business School
Description
Semester:
- Winter 2015
Speakers:
Lecture Time:
Fri, March 13, 2015 @ 1:30 pm to 3:00 pm
Lecture Location:
Room R1240, Ross School of Business
Speaker Webpage(s):
http://business.cardiff.ac.uk/people/staff/aoife-mcdermott
Introduced By:
No introduction available.
Abstract
Improving healthcare is an enduring challenge for policy-makers. Organization theory simultaneously draws attention to the potential merits of improvement through the adoption of standardized evidenced-based best practice, and to encouraging change recipients to adapt and add to change agendas, to fit local contextual demands. These two approaches lead to theoretical tension between considering non-acceptance behaviours as ‘resistance’, and encouraging change recipients to productively challenge and tailor change agendas. This tension is particularly salient in the public sector, due to the mandated nature of much public reform, and the professional composition of the workforce. This session will draw on an empirical study of two national approaches (Scotland and Ireland) to enhancing quality and safety in hospitals, to identify strategies to encourage change recipients to respond to change agendas in appropriate ways. These countries have adopted novel ‘hybrid’ regulatory control strategies in pursuit of improvement. Hybrids combine elements usually found separately. Scotland and Ireland’s healthcare 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 persuasive encouragement of adherence to guidance and capacity building to enable improvement and innovation (e.g. implementation and improvement support, training, stimulating interventions). Although international comparison draws attention to socio-historical contextual factors constraining and enabling regulatory hybridity, findings enable development of 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.
Recording & Additional Notes
Introduced by HSOP PhD student Dori Cross