Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture

Choice and judgement in developing models for health technology assessment; a qualitative study

Introduction: The role of models in supporting health policy decisions is reliant on model credibility. Credibility is fundamentally determined by the choices and judgements that people make in the process of developing a model. However, the method of uncovering choices and making judgements in model development is largely unreported and is not addressed by modelling methods guidance. Methods: This qualitative study was part of a project examining errors in health technology assessment models. In-depth interviews with academic and commercial modellers were used to obtain descriptions of the model development process. Data were analysed using framework analysis and interpreted in the context of the methodological literature. Results: The activities involved in developing models were characterised according to the themes; understanding the decision problem, conceptual modelling, model implementation, model checking, and engaging with the decision maker. Finding and using evidence was frequently mentioned across these themes. There was marked variation between practitioners in the extent to which conceptual modelling was recognised as an activity distinct from model implementation. Discussion: Methodological approaches to addressing model credibility described in the wider modelling literature highlight the necessity to disentangle the conceptual modelling and implementation activities. Whilst interviewees talked of judgements and choice making throughout model development, discussion indicated that these were based upon skills and experience with no discussion of formal approaches. Methods are required that provide for a systematic approach to uncovering choices, to generating a shared view of consensus and divergence, and for making judgements and choices in model development

Public officials and their institutional environment - an analytical model for assessing the impact of institutional change on public sector performance

To perform well, public officials must be confident enough about the future, to be able to see a relationship between their efforts, and an eventual outcome. Their expectations are shaped by their institutional environment. If the rules are not credible, or are unlikely to be enforced, of if they expect policies to be contradicted, or resources to flow unpredictably, results will be uncertain, so there is little point in working purposefully. The authors present an analytical framework, used to design a series of surveys of public officials'views of their institutional environment, and to analyze the information generated in fifteen countries. They describe how survey results help map public sector's strengths, and weaknesses, and offer an approach to identifying potential payoffs from reforms. The framework emphasizes how heterogeneous incentives, and institutional arrangements are within he public sector. It emphasizes how important it is for policymakers to base decisions on information (not generalizations) that suggests what is most likely to work, and where. In building on the premise that public officials'actions - and hence their organization's performance - depend on the institutional environment in which they find themselves, this framework avoids simplistic anti-government positions, bur doesn't defend poor performance. Some public officials perform poorly, and engage in rent seeking, but some selfless, and determined public officials, work hard under extremely difficult conditions. This framework offers an approach for understanding both bad performance, and good, and for presenting the results to policymakers in a format that leadsto more informed choices, about public sector reform. Types of reforms discussed include strengthening the credibility of rules for evaluation, for record management, for training, and for recruitment; ensuring that staff support government policy; preventing political interference, or micro-management; assuring staff that they will be treated fairly; and, making government policies consistent.Public Health Promotion,Decentralization,Educational Sciences,Enterprise Development&Reform,Health Monitoring&Evaluation,Educational Sciences,National Governance,Governance Indicators,Poverty Assessment,Health Monitoring&Evaluation

Research and Applications of the Processes of Performance Appraisal: A Bibliography of Recent Literature, 1981-1989

[Excerpt] There have been several recent reviews of different subtopics within the general performance appraisal literature. The reader of these reviews will find, however, that the accompanying citations may be of limited utility for one or more reasons. For example, the reference sections of these reviews are usually composed of citations which support a specific theory or practical approach to the evaluation of human performance. Consequently, the citation lists for these reviews are, as they must be, highly selective and do not include works that may have only a peripheral relationship to a given reviewer\u27s target concerns. Another problem is that the citations are out of date. That is, review articles frequently contain many citations that are fifteen or more years old. The generation of new studies and knowledge in this field occurs very rapidly. This creates a need for additional reference information solely devoted to identifying the wealth of new research, ideas, and writing that is changing the field

Meta-evaluation of the impacts and legacy of the London 2012 Olympic Games and Paralympic Games : Developing methods paper

This report brings together the interim findings from the Developing Meta-Evaluation Methods study, which is being undertaken in conjunction with the Meta-Evaluation of the Impacts and Legacy of the London 2012 Olympic Games and Paralympic Games. The work on methods is funded by the Economic and Social Research Council (ESRC). The aim of this paper is to review the existing evidence on conducting meta-evaluation, and provide guidance appropriate to the Meta Evaluation of the Games as well as other meta-evaluation studies

Developing Knowledge-Action Systems for Integrated Water Management in New Zealand

The development of agricultural productivity and the management of water along sustainable ecological, economic and social trajectories require an integrated approach. Integrated water management is knowledge intensive across multiple scales. As New Zealand moves to set limits on water quantity and quality and respond to changing environmental values, both of which have implications for agricultural productivity, it has become apparent that the links between knowledge, policy and on-ground action are often missing. As a potential means of reconnecting these missing connections, this paper outlines the theory and practice of knowledge-action systems and their potential role in the coproduction of knowledge and policy across organisational, knowledge and institutional boundaries.Environmental Economics and Policy, Land Economics/Use,

'The Disadvantage of Tying One's Hands': Towards an Understanding of the Controversial Nature of Europeanisation in the Area of British Monetary Policy

[Introduction]. What is it about the Europeanisation of British monetary policy that merits attention? From a superficial glance at the subject, one might conclude: ‘not a lot’. In policy terms, this Europeanisation process as represented by sterling’s membership of the European Exchange Rate Mechanism (ERM) appears to have lasted a mere two years. As is often the case, Britain joined late (October 1990), found the experiment an uncomfortable experience before crashing out spectacularly in September 1992. Since then, while paying lip-service to future membership of the euro, the Treasury, first under Lamont, then Clarke and now Brown, has gone about carefully constructing a domestic institutional framework for confronting issues and problems in this particular policy area. Most notable in this context has been the decision to grant operation independence to the Bank of England to control inflation, as well as the introduction of two fiscal rules designed to place explicit limits on government borrowing and public debt. Commentators who predicted that New Labour would join the Single Currency in its first term, have been forced to revise these arguments

Private experiments in global governance : primary commodity roundtables and the politics of deliberation

Emerging scholarship on global governance offers ever-more detailed analyses of private regulatory regimes. These regimes aim to regulate some area of social activity without a mandate from, or participation of, states or international organizations. While there are numerous empirical studies of these regimes, the normative theoretical literature has arguably struggled to keep pace with such developments. This is unfortunate, as the proliferation of private regulatory regimes raises important issues about legitimacy in global governance. The aim of this paper is to address some of these issues by elaborating a theoretical framework that can orientate normative investigation of these schemes. It does this through turning to the idea of experimentalist governance. It is argued that experimentalism can provide an important and provocative set of insights about the processes and logics of emerging governance schemes. The critical purchase of this theory is illustrated through an application to the case of primary commodities roundtables, part of ongoing attempts by NGOs, producers, and buyers to set sustainability criteria for commodity production across a range of sectors. The idea of experimentalist governance, we argue, can lend much needed theoretical structure to debates about the normative legitimacy of private regulatory regimes

Bridging the Gap Between Theory and Practice in Integrated Assessment

There is growing support for the use of integrated assessments (IAs)/sustainability impact assessments (SIAs), at different government levels and geographic scales of policy-making and planning, both nationally and internationally. However, delivering good quality IAs/SIAs, in the near future, could be challenging. This paper mainly focuses upon one area of concern, differences between research and other technical contributions intended to strengthen assessment methodologies and the types of assessment methods considered usable by practitioners. To help in addressing this concern, the development of a common assessment framework is proposed, which is based on a shared, practitioner-researcher-stakeholder understanding of what constitutes a satisfactory integrated/sustainability impact assessment. The paper outlines a possible structure for this framework, which contains three interconnected elements - the planning context in which the assessment is to be carried out; the process by which the assessment is to be undertaken and its findings used; and the methods, technical and consultative, by which impacts are to be assessed. It concludes with suggested "next steps", addressed to researchers, practitioners and other stakeholders, by which the assessment framework might be tested and improved, and its subsequent use supported.Research Methods/ Statistical Methods,