IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v177y2017icp9-18.html
   My bibliography  Save this article

Street-level diplomacy? Communicative and adaptive work at the front line of implementing public health policies in primary care

Author

Listed:
  • Gale, Nicola
  • Dowswell, George
  • Greenfield, Sheila
  • Marshall, Tom

Abstract

Public services are increasingly operating through network governance, requiring those at all levels of the system to build collaborations and adapt their practice. Agent-focused implementation theories, such as ‘street-level bureaucracy’, tend to focus on decision-making and the potential of actors to subvert national policy at a local level. While it is acknowledged that network leaders need to be adaptable and to build trust, much less consideration has been given to the requirement for skills of ‘diplomacy’ needed by those at the front line of delivering public services. In this article, drawing on theoretical insights from international relations about the principles of ‘multi-track diplomacy’, we propose the concept of street level diplomacy, offer illustrative empirical evidence to support it in the context of the implementation of public health (preventative) policies within primary care (a traditionally responsive and curative service) in the English NHS and discuss the contribution and potential limitations of the new concept. The article draws on qualitative data from interviews conducted with those implementing case finding programmes for cardiovascular disease in the West Midlands. The importance of communication and adaptation in the everyday work of professionals, health workers and service managers emerged from the data. Using abductive reasoning, the theory of multi-track diplomacy was used to aid interpretation of the ‘street-level’ work that was being accomplished.

Suggested Citation

  • Gale, Nicola & Dowswell, George & Greenfield, Sheila & Marshall, Tom, 2017. "Street-level diplomacy? Communicative and adaptive work at the front line of implementing public health policies in primary care," Social Science & Medicine, Elsevier, vol. 177(C), pages 9-18.
  • Handle: RePEc:eee:socmed:v:177:y:2017:i:c:p:9-18
    DOI: 10.1016/j.socscimed.2017.01.046
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953617300539
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2017.01.046?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Goddard, Maria & Mannion, Russell & Smith, Peter C., 1999. "Assessing the performance of NHS Hospital Trusts: the role of `hard' and `soft' information," Health Policy, Elsevier, vol. 48(2), pages 119-134, August.
    2. Bradbury-Jones, Caroline & Taylor, Julie & Herber, Oliver, 2014. "How theory is used and articulated in qualitative research: Development of a new typology," Social Science & Medicine, Elsevier, vol. 120(C), pages 135-141.
    3. McCONNELL, ALLAN, 2010. "Policy Success, Policy Failure and Grey Areas In-Between," Journal of Public Policy, Cambridge University Press, vol. 30(3), pages 345-362, December.
    4. Stephen R. Barley & Gideon Kunda, 2001. "Bringing Work Back In," Organization Science, INFORMS, vol. 12(1), pages 76-95, February.
    5. Pickard, Susan & Sheaff, Rod & Dowling, Bernard, 2006. "Exit, voice, governance and user-responsiveness: The case of English primary care trusts," Social Science & Medicine, Elsevier, vol. 63(2), pages 373-383, July.
    6. Ian Greener & Russell Mannion, 2009. "Patient choice in the NHS: what is the effect of choice policies on patients and relationships in health economies?," Public Money & Management, Taylor & Francis Journals, vol. 29(2), pages 95-100, March.
    7. Mark Exworthy & Martin Powell & John Mohan, 1999. "Markets, Bureaucracy and Public Management: The NHS: Quasi-market, Quasi-hierarchy and Quasi-network?," Public Money & Management, Taylor & Francis Journals, vol. 19(4), pages 15-22, October.
    8. Mats Alvesson & Hugh Willmott, 2002. "Identity Regulation as Organizational Control: Producing the Appropriate Individual," Journal of Management Studies, Wiley Blackwell, vol. 39(5), pages 619-644, July.
    9. Exworthy, Mark & Frosini, Francesca, 2008. "Room for manoeuvre?: Explaining local autonomy in the English National Health Service," Health Policy, Elsevier, vol. 86(2-3), pages 204-212, May.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Nicola K Gale & Manbinder S Sidhu, 2019. "Risk work or resilience work? A qualitative study with community health workers negotiating the tensions between biomedical and community-based forms of health promotion in the United Kingdom," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-19, July.
    2. Nunes, João & Lotta, Gabriela, 2019. "Discretion, power and the reproduction of inequality in health policy implementation: Practices, discursive styles and classifications of Brazil's community health workers," Social Science & Medicine, Elsevier, vol. 242(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Sirris, Stephen, 2019. "Coherent identities and roles? Hybrid professional managers’ prioritizing of coexisting institutional logics in differing contexts," Scandinavian Journal of Management, Elsevier, vol. 35(4).
    2. Jones, Lorelei & Exworthy, Mark & Frosini, Francesca, 2013. "Implementing market-based reforms in the English NHS: Bureaucratic coping strategies and social embeddedness," Health Policy, Elsevier, vol. 111(1), pages 52-59.
    3. Hammond, Jonathan & Lorne, Colin & Coleman, Anna & Allen, Pauline & Mays, Nicholas & Dam, Rinita & Mason, Thomas & Checkland, Kath, 2017. "The spatial politics of place and health policy: Exploring Sustainability and Transformation Plans in the English NHS," Social Science & Medicine, Elsevier, vol. 190(C), pages 217-226.
    4. Eveline Bruijn & Gail Whiteman, 2010. "That Which Doesn’t Break Us: Identity Work by Local Indigenous ‘Stakeholders’," Journal of Business Ethics, Springer, vol. 96(3), pages 479-495, October.
    5. Carlos Martin-Rios, 2016. "Innovative management control systems in knowledge work: a middle manager perspective," Journal of Management Control: Zeitschrift für Planung und Unternehmenssteuerung, Springer, vol. 27(2), pages 181-204, May.
    6. Minbaeva, Dana & Rabbiosi, Larissa & Stahl, Günter K., 2018. "Not walking the talk? How host country cultural orientations may buffer the damage of corporate values’ misalignment in multinational corporations," Journal of World Business, Elsevier, vol. 53(6), pages 880-895.
    7. Suzan Lewis & Deirdre Anderson & Clare Lyonette & Nicola Payne & Stephen Wood, 2017. "Public sector austerity cuts in Britain and the changing discourse of work–life balance," Work, Employment & Society, British Sociological Association, vol. 31(4), pages 586-604, August.
    8. Barrett, Michael & Cooper, David J. & Jamal, Karim, 2005. "Globalization and the coordinating of work in multinational audits," Accounting, Organizations and Society, Elsevier, vol. 30(1), pages 1-24, January.
    9. Claudiu CICEA, 2011. "Consideration Regarding Cost’S Evaluation In Healthcare Area," Business Excellence and Management, Faculty of Management, Academy of Economic Studies, Bucharest, Romania, vol. 1(1), pages 37-48, December.
    10. Namrata Malhotra & Timothy Morris, 2009. "Heterogeneity in Professional Service Firms," Journal of Management Studies, Wiley Blackwell, vol. 46(6), pages 895-922, September.
    11. Beth A. Bechky, 2006. "Gaffers, Gofers, and Grips: Role-Based Coordination in Temporary Organizations," Organization Science, INFORMS, vol. 17(1), pages 3-21, February.
    12. Sharon Koppman & Elisa Mattarelli & Amar Gupta, 2016. "Third-World “Sloggers” or Elite Global Professionals? Using Organizational Toolkits to Redefine Work Identity in Information Technology Offshore Outsourcing," Organization Science, INFORMS, vol. 27(4), pages 825-845, August.
    13. Merkel, Janet & Suwala, Lech, 2021. "Intermediaries, work and creativity in creative and innovative sectors. The case of Berlin," EconStor Open Access Book Chapters, in: Culture, Creativity and Economy. Collaborative practices, value creation and spaces of creativity., pages 56-69, ZBW - Leibniz Information Centre for Economics.
    14. Paul, Michael & Hennig-Thurau, Thorsten & Groth, Markus, 2015. "Tightening or loosening the “iron cage”? The impact of formal and informal display controls on service customers," Journal of Business Research, Elsevier, vol. 68(5), pages 1062-1073.
    15. Ricardo Azambuja & Gazi Islam, 2019. "Working at the boundaries: Middle managerial work as a source of emancipation and alienation," Grenoble Ecole de Management (Post-Print) halshs-01959107, HAL.
    16. FitzGerald Cathal & O’Malley Eoin & Broin Deiric Ó, 2019. "Policy success/policy failure: A framework for understanding policy choices," Administration, Sciendo, vol. 67(2), pages 1-24, May.
    17. Naylor, Mary D. & Hirschman, Karen B. & Toles, Mark P. & Jarrín, Olga F. & Shaid, Elizabeth & Pauly, Mark V., 2018. "Adaptations of the evidence-based Transitional Care Model in the U.S," Social Science & Medicine, Elsevier, vol. 213(C), pages 28-36.
    18. Richard A. Hunt & Mathew L. A. Hayward, 2018. "Value Creation Through Employer Loans: Evidence of Informal Lending to Employees at Small, Labor-Intensive Firms," Organization Science, INFORMS, vol. 29(2), pages 284-303, April.
    19. Andrea Nóblega Carriquiry & David Sauri & Hug March, 2020. "Community Involvement in the Implementation of Sustainable Urban Drainage Systems (SUDSs): The Case of Bon Pastor, Barcelona," Sustainability, MDPI, vol. 12(2), pages 1-19, January.
    20. Yves Gendron & Laura F. Spira, 2009. "What Went Wrong? The Downfall of Arthur Andersen and the Construction of Controllability Boundaries Surrounding Financial Auditing," Contemporary Accounting Research, John Wiley & Sons, vol. 26(4), pages 987-1027, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:177:y:2017:i:c:p:9-18. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.