INTERROGATING INSTITUTIONAL CHANGE: ACTORS' ATTITUDES TO COMPETITION AND COOPERATION IN COMMISSIONING HEALTH SERVICES IN ENGLAND

Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers' understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketization in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.     

Human–algorithm hybrids as (quasi-)organizations? On the accountability of digital collective actors

Models of individual accountability for algorithms’ actions fail when a human–algorithm association comes to be viewed as a collective actor. In some situations, human and algorithmic actions are so closely intertwined that there is no longer a linear connection between the emergent collectivity and the complex interactions of humans and algorithms. In such collective decision-making sequences, individual accountability can no longer be attributed. Therefore, a new perspective on human–algorithm associations that captures their emergent properties and organizational qualities is needed to develop appropriate models of collective accountability. This article seeks to answer a number of questions. How can the encounter between humans and algorithms within such a socio-technical configuration be adequately theorized? Can the configuration itself be understood as a hybrid collectivity? Can actions be attributed to the configuration as a personified collective actor? How will accountability be institutionalized for human–algorithm associations – in centralized or distributed collective forms?