Assessing outcome in collaboration : the impact of assessment on collaboration practice

• Today the concept of efficiency is a guiding light in public management. Increased efficiency is thought to control spending and provide better services. Two approaches to achieve this are through assessments such as evaluation and audits; and collaboration between different actors. Collaboration can imply e.g. networks or partnerships and vary in intensity and formality. Regardless of form, collaborative efforts are generally thought to achieve services better adapted to address complex social problems, and diminishing overlaps and unclear responsibilities caused by fragmentation. Assessments are used to determine whether or not a program or a service is efficient, but the act of assessment itself is also intended to increase efficiency. Thus, the act of assessment influences the practice it is assessing. Furthermore, in order to be assessed, a program or a service has to be “evaluable”, which may also influence practice. Collaboration is often a solution to previous sector failure, and at the same time it is perceived as difficult to both achieve and sustain. Assessments are used as a tool to determine whether or not collaborative advantage is achieved and if the investments in collaboration should be pursued.Assessments of collaboration are a challenge since it confronts the regular vertical forms of organizing and thereby the focus of assessment. The challenge can be boiled down to the question of what collaborative arrangements can, and should, be held accountable for.Based on an ethnographic study and two years of field work, this question is critically analyzed with an example from Sweden. The financial coordination of rehabilitation measures act came into effect in 2004, and regulates the construction of coordination associations. The foundation of an association is a pooled budget to which all members, four different public authorities in the field of vocational rehabilitation, contribute. An important condition behind the law was the notion that public services were not adapted to, and therefore had trouble handling, some groups with complex problems needing support from two or more organizations at the same time. The overall, and ultimate, aim with financial coordination is to improve the working ability in the target population. Though the objective of the associations is, according to the law, to support collaboration, finance efforts within the collected area of responsibility and evaluate these efforts. The financed efforts may be both operative and strategic, and should in some way complement the operations of the member organizations or aim at development of new knowledge or methods. The associations have no power to make decisions of authority in relation to the target population, which remains with the professionals in the member organizations. Following this, it may be argued that the first target group of the associations is the regular organizations and next, as a secondary target group; the individuals in the target population. This means also that the target population is not the associations’ own but the regular organizations’ target groups. The aim with the associations is thus to contribute to the regular organizations working better in relation to this group. The associations have no tools at their disposal to contribute to the overall goal but the pooled budget. Their responsibility is to construct the budget, distribute the resources and follow up.However, as the findings presented and discussed in this paper show, the associations are generally held accountable to more than that in the frequent assessments being performed on both the associations and the efforts they finance. First, the associations are generally seen by others as being the efforts they finance. This makes the view of them almost like a new organization or authority, even though the efforts actually are organizationally owned and performed by regular organizations. Second, they are held accountable to the aim of improved working ability of the target group, i.e. the overall policy goal. Their objective to support collaboration and the notion that the law was introduced in order to ensure that, through collaboration, those individuals in the intersection of different organizations get the needed help is thus overlooked and focus is turned to effects on individuals.This paper argues that the assessments have highly influenced practice in the associations, and has shifted focus from organizational outcomes such as increased equity and quality of services due to decreased fragmentation, to individual outcomes such as employment and dependency of benefits. These latter outcomes are easier to account for and are also in line with conventional more hierarchical assessments. Since many associations perceive themselves to be questioned due to lacking efficiency, they may start seek legitimacy and thereby behave in line with the focus of assessments and start to “produce” improved working ability instead of supporting collaboration. Furthermore, the assessments and their focus on individuals tend to treat the associations not as a collaborative structure between four actors with a supportive aim, but as a regular organization with authoritative power. When the associations are held accountable for a group’s outcome, this group has been “passed on” from ordinary organizations on to the associations. Organizational outcome related to collaboration is greatly overlooked, in line with the “common wisdom” that collaboration is not an end in itself, and an end in public management collaboration must thus be measured as individual benefit. Increased quality and equity in services are thus outcomes that are not only not being assessed but might also be at risk of being lost with the current assessment focus. Last, there is an evident risk that the narrow and vertical assessment focus increases, instead of decreases, horizontal fragmentation within the welfare system due to its impact on coordination association practice.

Ämnesord

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences (hsv//eng)

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