INSTITUTIONAL LAYERING IN GOVERNING HEALTHCARE QUALITY

Since the 1980s, regulated markets and New Public Management have been introduced in the public sector across the world. How they have affected existing governance mechanisms such as self‐regulation and state regulation has remained largely unexplored, however. This article examines the origins and consequences of institutional layering in governing healthcare quality. Dutch health care, where a market‐based system has been introduced, is used as a case study. The results show that this market‐based system did not replace but modified existing institutional arrangements. As a result, hospitals have to deal with the fragmentation of quality demands. Using the concept of institutional layering, this study shows how different arrangements interact. As a consequence, the introduction of a certain policy reform will work out differently in different countries and policy sectors. Our ‘archaeological’ study in this layering can be seen as an example of how such incremental change can be studied in detail.     

Feminism,Art, Deleuze,and Darwin: An Interview with Elizabeth Grosz

Abstract

This discussion stresses that looking at countries on the margins of European colonial rule can be useful when considering the wider dynamics of the present, reflecting the persistence of colonial discourses and how racism “endures”. Iceland’s colonial experience was characterized by duality, in which the country was an object of colonialism, while actively participating in the racist discourses predominant in Europe at that time. This paper demonstrates how Iceland’s long association with the exotic and its gendered manifestations is currently being perpetuated by the tourist and state industries, under the influence of neo-liberal ideas about nation branding. When contextualized within the larger geopolitical environment, Iceland as an “exotic” destination unravels the racist and colonized narratives still at play within a wider geopolitical context.     

Silence and Articulation—Whiteness,Racialization and Feminist Memory Work

Racialization is a constant process of “doing race”. Critical whiteness studies make efforts to address the silencing of whiteness in mainstream white feminism. In this article memory work is explored as a possible method for studies of whiteness as an unmarked majority position. The focus is on methodological practices or “how‐to‐do” questions. Starting from feminist epistemology the author investigates ways of practising the epistemological standpoint of situated knowledges. Feminist epistemology, despite its disagreements, has pointed to the importance of positioning work for scientific knowledge production. The relationship between racialization as an analytical concept and whiteness as dominant majority position is complicated. Usually memory work is employed to address gender or more specifically femininity, but, as argued here, it is well suited to investigations of racialization, too. The analysis shows that silent avoidance of matters associated with whiteness helps keep the majority position in place; whiteness is co‐produced with silence through avoidance in concrete everyday situations. Despite a number of problematic aspects, memory work proved productive in bridging the gap between an epistemological standpoint and the nitty‐gritty work of doing empirical research. It helped clarify racialization as a relational phenomenon and shows how lack of attention to or awareness of race has implications for scientific knowledge production.     

"Transcending gynocentric space”: Spatial metaphorics in feminist theory and criticism

Many studies assert that there are new gender constructions among young Scandinavian girls, who seem to be more individualized than earlier generations. In this article questions are raised as to what effect these girls’ newly won status as subjects might have on their construction of bodily gender, especially the part referred to as generative femininity. A “loss” of the generative body is argued to be a general tendency in postmodern discourse, as well as a dilemma in the individual girl's striving for being both individual and gender. This dilemma and its tentative solution is illustrated through the analysis of an 18‐year‐old Norwegian girl, who was the subject of an in‐depth interview in a three‐generational study of gender in change.     

ONLY GOOD FENCES KEEP GOOD NEIGHBOURS! THE INSTITUTIONALIZATION OF MINISTRY–AGENCY RELATIONSHIPS AT THE SCIENCE–POLICY NEXUS IN GERMAN FOOD SAFETY POLICY

This article makes a further contribution to opening the ‘black box’ of micropractices in ministry–agency relationships. We argue that the mechanisms that come into play in the course of institutionalizing agencification reforms – such as renegotiating mutual roles and rules in ministry–agency interactions – are only poorly covered in the existing literature. To adequately address the negotiated and contingent nature of de facto agency autonomy and political control, we develop an interpretive approach based on the concept of ‘boundary work’. The empirical focus is on ministry–agency interactions at the science–policy nexus in the contested policy field of food safety. By studying actors' stories about the institutionalization processes following the fundamental reorganization of the German food safety administration in the wake of the BSE crisis from a longitudinal perspective, we show how actors manage boundary conflicts via increasingly differentiated backstage coordination.     

TRANSPARENCY IN PUBLIC–PRIVATE PARTNERSHIPS: NOT SO BAD AFTER ALL?

Scholars' criticism of transparency in public–private partnerships (PPPs) often focuses on ‘external’ transparency, that is, the extent to which internal information is visible to the outside world. However, to achieve external transparency, internal transparency – the availability and inferability of information for the public procurer and the private party – is crucial. In this article we analyse input, process, and output transparency from three different perspectives (institutional, cognitive, and strategic) in four PPPs in the Netherlands. We conclude that input transparency is high, but process and output transparency less so. Moreover, output transparency has gained importance in PPPs. Whether this is problematic depends on the PPPs' institutional environment. In some partnerships the desired output is uncontested and predetermined by clear standards in the institutional environment, whereas other PPPs deal with contested output norms, decreasing the partnerships' transparency. These results nuance the current debate on the lack of transparency in PPPs.     

Unfulfilled promises of the consultation approach: the limits to effective indigenous participation in Bolivia’s and Peru’s extractive industries

Indigenous peoples’ right to prior consultation and to informed consent represents the basis of the new global model shaping state–indigenous relations. Consultation processes promise to enable indigenous people to determine their own development and are especially promoted when extraction projects with significant socio-environmental impacts are planned on indigenous lands. In this article we draw on debates on participatory development in order to analyse the first state-led consultations in Bolivia’s and Peru’s hydrocarbon sectors (2007–14). The analysis shows that effective participation has been limited by (1) an absence of indigenous ownership of the processes; (2) indigenous groups’ difficulties defending or even articulating their own visions and demands; and (3) limited or very general outcomes. The study identifies real-life challenges, such as power asymmetries, a ‘communication hurdle’ and appropriate timing – as well as simplistic assumptions underlying the consultation approach – that account for the unfulfilled promises of this new model.     

Varieties of consumer credit data regimes: A regulatory governance approach

Credit markets are expanding, and with them also the automated, large‐scale commercialization of personal credit data. The increasing use of data and scores for commodified decision making lends greater urgency to the study of credit data regulatory regimes. This article promotes a comparative regulatory governance perspective as the basis for theory‐driven, multidimensional measurement. In order to measure consumer protection, we distinguish three different subregimes (collection, profiling, and use) and construct a two‐dimensional index of consumer protection (market restriction and user empowerment). We then assess the index and demonstrate its applicability and validity, building on empirical analysis of the regulatory regimes in the United States, France, Sweden, and Israel for the year 2019. Our approach points to a new direction in researching and measuring regulatory regimes in a comparative manner, which looks beyond national analysis toward an in‐depth understanding of other, equally important, levels of variation.