Markets for Promoting Innovation in Health Care? A Market Practice Study of Public Procurement of Innovation (PPI)

This article critically analyzes public procurement of innovation (PPI) as an instance of using markets or market-like aspects as a means to resolve public concerns. It reports findings from a case of procuring radiation therapy equipment for a university hospital in Stockholm, Sweden. By extending a line of literature built on economic sociology as well as science and technology studies (STS), the study elaborates on public actors’ efforts in framing markets to promote innovation. The case illustrates how the participating actors constructed the notion of innovativeness to be introduced into health care as means of addressing various public concerns. It also reveals the intended—and unintended—consequences of PPI as manifested in various actors’ claims on the value of PPI realized in practice. The study suggests that it is extremely difficult to frame a market for the realization of innovation via procurement as a policy instrument because we cannot predict the ultimate impacts of devices and practices employed in such initiatives. By formulating a practice-based critique of PPI, our study invites important questions about the potentiality of such instruments for governing innovation without delimiting their consequences to the success-or-failure dichotomy as prescribed in predefined tools and strategies

Valuation studies: a collaborative valuation in practice

This discussion note provides a perspective on valuation studies by a group of PhD students. Based on impressions from the Valuation as Practice workshop at The University of Edinburgh in early 2014 we were inspired by the example of Kjellberg et al. (2013) to debate how we see, understand, and are inspired by the field of valuation studies. It is the hope of the editors that sharing the concerns of early-stage researchers starting out in a field in flux, may be of use to, and perhaps spur, senior contributors to further develop this emerging research landscape. Using the workshop experience as a springboard, we argue that the domain of valuation studies still relies heavily on influences from the study of economics, with a strong emphasis on processes of quantification and calculation. With apparent pragmatism within the field, concern as to what might be lost by this narrower perspective is raised. Additionally, we call for the exploration of the possibility of a common language of valuation, to better define shared features, and identify as well as manage conflicts within the field

Public E-services and Electronic Identification –A Comparative Implementation Study of Swedish Public Authorities

This thesis presents an implementation study on the handling of electronic identification in three public authorities in Sweden. Electronic identification is a complex but very topical policy domain, largely tied to the general policy aspirations of e-government development. Theories on policy action, logic of appropriateness, garbage cans, and the dialectics of institutions and technology are used. The result highlights that the policy process of electronic identification in the three studied authorities could not be adequately explained from a traditional policy-implementation dichotomy. The action imperative to develop e-services is very strong and explains why and how electronic identification has been developed within the three authorities. The three authorities have very different institutional capacity to implement e-services with electronic identification. The available technology on electronic identification is inscribed with certain logics of appropriateness, that doesn’t sit equally easy with the administrative logics of appropriateness in all three authorities

Public E-services and Electronic Identification –A Comparative Implementation Study of Swedish Public Authorities

This thesis presents an implementation study on the handling of electronic identification in three public authorities in Sweden. Electronic identification is a complex but very topical policy domain, largely tied to the general policy aspirations of e-government development. Theories on policy action, logic of appropriateness, garbage cans, and the dialectics of institutions and technology are used. The result highlights that the policy process of electronic identification in the three studied authorities could not be adequately explained from a traditional policy-implementation dichotomy. The action imperative to develop e-services is very strong and explains why and how electronic identification has been developed within the three authorities. The three authorities have very different institutional capacity to implement e-services with electronic identification. The available technology on electronic identification is inscribed with certain logics of appropriateness, that doesn’t sit equally easy with the administrative logics of appropriateness in all three authorities

Värdering på välfärdsmarknader : Regelböcker, whiteboardtavlor och snurrstolar i vårdvalsreform

This thesis takes an interest in how values attain a specific meaning in market reforms of welfare provision. The study builds on exploring how values are enacted rather than treating them as universal and stable. The aim of the thesis is to contribute conceptually to the understanding of how market-making activities in the welfare state bureaucracy handle the values at play in welfare reform. The empirical case is the governance of a so-called care choice system in a Swedish county council. The methodology for the study is “shadowing” of public officials working to formulate a so-called rulebook for care centres. The analysis describes how these officials handle a variety of values when designing the rulebook. How they choose to organize their work – the methods used to collect data about care centre performance, what governance tools they employ, how they arrange their work roles, and how they construct the rulebook – leads to value shifts and determines the meaning of values in practice. The officials’ work practice is political in the sense that it actively shapes the values enacted in the care choice reform. Therefore, it is of great importance to spur a broader debate about the organization of such governance practices, while there is a need to problematize simplistic images of what market reforms of welfare entails in practice. The thesis proposes that an “ecological” – i.e. a situated, reflexive, and malleable – approach to handling of contending values may contribute to such debates.Avhandlingen intresserar sig för hur värden får sin praktiska innebörd i marknadsreformer av välfärdstjänster. Studien bygger på att undersöka hur värden blir lokalt iscensatta snarare än att behandla dem som universella och stabila. Syftet med studien är att utveckla begrepp för att förstå hur marknadsskapande styrning av välfärd hanterar de motstridiga värden som står på spel i välfärdsreform. Det empiriska fallet utgörs av styrningen av det s.k. vårdvalet i ett svenskt landsting. Metoden är ”skuggning” av tjänstemän som jobbar med att formulera en s.k. regelbok för vårdcentraler. Analysen beskriver hur dessa tjänstemän arbetar med att hantera olika typer av värden när de konstruerar regelboken. Hur de väljer att organisera sitt arbete – vilka metoder de använder för att samla in data om vårdcentralernas prestationer, vilka verktyg de använder för styrning, hur de ordnar sina arbetsroller, samt hur de konstruerar regelboken – leder till värdeförskjutningar och styr vilka uttryck de olika värdena får i praktiken. Tjänstemännens arbete är politiskt såtillvida att det aktivt formar de värden som får utrymme i vårdvalsreformen. Därför är det av stor vikt att skapa en bredare debatt kring organisering av sådan styrning, samtidigt som det kräver att man problematiserar förenklade bilder av vad marknadsreformer i välfärden betyder i praktiken. Avhandlingen föreslår att ett ”ekologiskt” – dvs. ett situerat, reflexivt och föränderligt – perspektiv på hanteringen av motstridiga värden i marknadsreformer kan bidra till en sådan debatt

Vem vill ha rökavvänjning? : Att styra motivationen eller låta motivationen styra

Ersättningsmodeller har stor betydelse för vilka åtgärder som genomförs i vården. På initiativ från Leading Health Cares fokusgrupp för styrning av vård har vi studerat rökavvänjning i Landstinget Östergötland (LiÖ) och Västra Götalandsregionen (VGR). Skillnaderna i beteende som de olika ersättningsmodellerna leder till visar sig inte vara de vi kanske kan vänta. Vanor, yrkesroller och samarbetsformer över gränser gör snarare att likheterna kommer att överväga. En peng på en åtgärd som är svår att definiera innebär inte nödvändigtvis att vi uppnår önskade resultat

Vem vill ha rökavvänjning? : Att styra motivationen eller låta motivationen styra

Ersättningsmodeller har stor betydelse för vilka åtgärder som genomförs i vården. På initiativ från Leading Health Cares fokusgrupp för styrning av vård har vi studerat rökavvänjning i Landstinget Östergötland (LiÖ) och Västra Götalandsregionen (VGR). Skillnaderna i beteende som de olika ersättningsmodellerna leder till visar sig inte vara de vi kanske kan vänta. Vanor, yrkesroller och samarbetsformer över gränser gör snarare att likheterna kommer att överväga. En peng på en åtgärd som är svår att definiera innebär inte nödvändigtvis att vi uppnår önskade resultat