The Impact of Context on Public Sector Implementation: Translating the Concept of Value Based Management into Health Care

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The contribution of this paper is a conceptualization of how organizational context impacts policy implementation. The theoretical framework is translation theory (Wedlin and Sahlin, 2008) providing an alternative to most implementation literature. This framework allows for investigating implementation as a process in which the involved actors rationalize the aims of a new concept to make it fit their local context. The actors translate the abstract concept into organizational practices and in this process they are guided by institutionalized values such as existing and emerging steering paradigms.
The empirical focus is the implementation of ‘value based management’. Creating public value has become an important focus in the public sector after decades of New Public Management emphasizing primarily organizational efficiency, and measuring performance by the amount of activities, services, and costs (Moore and Hartly, 2008). In health care the time has come to ask patients how the sector can make a profound difference in each patient’s life. However, although policy makers think highly of the value based management concept, they exhibit only little attention to its implementation process. This is critical, as research for long has shown that the implementation process is crucial for making policy effective.
More generally, the paper discusses the profound explicit and implicit assumptions in public sector implementation, that changes are best initiated top-down. Experience shows that organizational actors need room for maneuver in order to make sense of new concepts. Thus, the organizational context becomes important as not only a venue for change, but also as playing an active role in its outcome (Dopson, Fitzgerald and Ferlie, 2008).
The paper draws upon a qualitative case study of a midsize hospital in Denmark. The Danish national and regional governments have selected this hospital as a special ‘laboratory’ for experimenting with value base management. The analysis is carried out as a policy document analysis. The documents include national and regional policy reports, budget agreements, the hospital’s planning documents, and evaluation reports created by a national evaluation institute drawing upon statistics and interviews with involved actors.
The preliminary findings show that institutionalized values in a particular context and actors’ mobilization of these values are crucial for how policy is implemented and with what outcome. Well-known steering paradigms in the organizational context impact the actors’ rationalization of how the new concept of value based management is translated into organizational practices.
Original languageEnglish
Publication date2018
Publication statusPublished - 2018
EventThe 22nd Annual Conference of International Research Society for Public Management. IRSPM 2018 - University of Edinburgh Business School, Edinburgh, United Kingdom
Duration: 11 Apr 201813 Apr 2018
Conference number: 22


ConferenceThe 22nd Annual Conference of International Research Society for Public Management. IRSPM 2018
LocationUniversity of Edinburgh Business School
Country/TerritoryUnited Kingdom
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