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Health policy and services, public administration, Organisation Theory
Public service reform in modern economies has placed an emphasis on effective planning and management of service delivery to the citizen-client. This paper draws on the concept of the Street Level Public Organization (SLPO) to examine the problem of government’s top down implementation of planning reform in the delivery of public services. It does so, by exploring the implementation of strategic planning in the health sector and drawing upon field work from such implementation in the health services in Ireland and Canada. The SLPO model (McKevitt 1998) is used as an explanatory tool to add to the public sector reform debate. One issue that emerged from this review was the lack of recognition of the complexity of the healthcare environment and the stakeholders within it, in attempting to implement planning reform. The approach to management of key stakeholders such as health professionals and their clients, according to Taylor and Kelly (2006) is bolstered by the belief that professional discretion is held to be an obstacle to public service reform. Thus, requiring top down systems and management to reduce the scope of such discretion, so as to standardize responses and control demand. However reform of the healthcare system cannot be reduced to a mechanical exercise which consists of implementing a rational plan to improve the effectiveness of resource use, but is a difficult process of negotiation between the key actors. This paper posits explanations for some of the difficulty in aligning strategy with responsive planning in public sector reform.
Byers V. (2012). Making Sense of Irish Health Care Management: the Street Level Public Organisation (SLPO). 11th World Congress of the International Federation of Scholarly Associations of Management, University of Limerick, Limerick, Ireland, June 26-29.