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- Fernler, Karin, et al.
(författare)
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Democratic priority-setting? : Organizing multiple stakeholders to make decisions in the healthcare sector
- 2010
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Ingår i: Organizing Democracy: The Construction of Agency in Practice. - : Edward Elgar Publishing Ltd. - 9781848444287
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Ebba Sjögren and Karin Fernler This chapter focuses on efforts to enact stakeholder participation in decisionmaking processes, as illustrated by a comparison of two examples of priority setting in the Swedish healthcare sector. Healthcare priorities have historically been an indirect result of ordinary political budgetary processes, and the outcome of decision making by individual medical practitioners. Thus in contrast to Göran Sundström’s chapter on forest-sector objectives, institutionalized forms for stakeholder participation did not characterize these two examples. On the contrary, the value of broad stakeholder involvement is relatively new in the field of healthcare priorities. In recent years it has been increasingly argued that more systematic and transparent processes of priority setting should replace the more traditionally closed processes by which the healthcare sector has operated (Ham 1997, Daniels and Sabin 2002). The need for broad participation in setting healthcare priorities has been argued on several grounds: normative, substantive and instrumental (cf. Stirling 2005). Broad participation is a desirable value in democratically organized societies. In addition to this normative justification, broad participation is argued for on the grounds that one’s social knowledge, values and meanings should determine the outcome of prioritization decisions. To reflect societal values and thereby ensure substantially better outcomes requires the participation of a wide variety of actors. A third justification has been that broad participation is needed in order to gain a general understanding of and acceptance for the outcomes of priority-setting processes. In other words, the instrumental capacity to deliver socially credible...
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- Furusten, Staffan, et al.
(författare)
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Democracy, Governance and the Problem of the Modern Actor
- 2010
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Ingår i: Organizing Democracy: The Construction of Agency in Practice. - : Edward Elgar Publishing Ltd. - 9781848444287
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Göran Sundström, Staffan Furusten and Linda Soneryd It has often been said that modern democracies are becoming more complex, fragmented and multilayered. In recent decades we have witnessed decentralization in many organizations, increasingly complex social problems, accelerating internationalization, growing and more specialized public administration, increased demand for expertise, and rapid development of information and communication technologies. Several scholars have argued that with these changes power has slipped away from the political centre (the government) in several directions: upwards to international organizations (not least the European Union), downwards to local authorities and municipalities, inwards to semi-autonomous state agencies, and outwards to private organizations. As Rhodes (1994, 1997) would say, the state is ‘hollowing out’. In societies with hollowed-out states, decision-making processes have taken new forms, and “from government to governance” has become a catch phrase (see e.g. Rhodes 1997; PierreXX1Peters 2000; Kjær 2004; MarcussenXX1Torfing 2007). These changes mark a shift, or one could even say a displacement, from state-centred, authoritative and hierarchical to more society-centred, egalitarian and network-based forms of decision making; and they signal the dissolution of previously established boundaries between private and public organizations. The extent to which displacement has actually occurred is widely debated (HajerXX1Wagenaar 2003 p. 4). Yet it is clear that governance is an important concept in current research on state and public policies. We also believe that there is more governance today than was the case two or three decades ago, and that the focus on governance is increasing....
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- Soneryd, Linda, et al.
(författare)
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Democratic Values and the Organizing of Actors in Governance Structures
- 2010
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Ingår i: Organizing Democracy: The Construction of Agency in Practice. - : Edward Elgar Publishing Ltd. - 9781848444287
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Linda Soneryd, Staffan Furusten and Göran Sundström This book has addressed two questions. How are democratic values attended to in governance structures? And why is this done in a particular way? We argue that a number of organizational factors challenge the notion of agency assumed by a governance model. The governance model rests on the rational myth (Meyer and Rowan, 1977) and the assumption that democratic ideals can be translated to specified democratic values, which in turn can be adhered to by democratic agents. The model suggests that democratic ideals will be realized if these agents play their cards right. In contrast to this rational model, we argue that theories about organizing and the construction of agency can be used to explain how and why democratic values are attended to in governance structures. As we stated in Chapter 1, we have undertaken this task by focusing on a number of processes related to various policy fields in which governance ideas have been used as overall organizing principles. The processes were chosen because we expected certain democratic values to be regarded as problematic in governance structures. We also expected these cases to represent situations in which organizations were required to balance conflicting values in their performances. We expected the cases to be relevant, not only in their local settings, but also as representations of typical processes of organizing in the modern organizations of the Western world. As discussed in Chapter 1, responsibility for the realization of democratic values in...
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