Discretion and its effects: Analyzing the experiences of street-level bureaucrats during policy implementation

Transcription

1 Discrtion and its ffcts: Analyzing th xprincs of strt-lvl buraucrats during policy implmntation EGPA Confrnc Brgn, Norway, 5-8 Sptmbr 2012 PSG XIII: On Public Policy Chairs: Harald Sætrn and Ptr Hup Abstract Lars Tummrs and Victor Bkkrs Dpt. of Public Administration Erasmus Univrsity Rottrdam P.O. Box 1738 NL-3000 DR Rottrdam

2 Abstract Strt-lvl buraucrats implmnting public policis hav a crtain dgr of frdom or discrtion in thir work. Following th work of Lipsky, th concpt of discrtion has rcivd wid attntion in th policy implmntation litratur. Howvr, scholars hav not yt dvlopd thortical framworks rgarding th ffcts of discrtion, which wr subsquntly tstd ths using larg n sampls. In this study, w dvlop a thortical framwork rgarding two ffcts of discrtion (clint maningfulnss and willingnss to implmnt), in ordr to incras our undrstanding of th mchanisms at work. Th hypothsizd rlationships ar tstd using a Dutch nationwid survy among psychologists, psychiatrists and psychothrapists implmnting a nw rimbursmnt policy. Ths ar analysd using Confirmatory Factor Analysis (CFA) and Structural Equation Modlling (SEM). Th rsults firstly show a positiv ffct of discrtion on clint maningfulnss. Nxt to this, discrtion positivly affctd th willingnss to implmnt a policy, and this is partially mdiatd by clint maningfulnss. Hnc, whn strt-lvl buraucrats xprinc discrtion, this positivly influncs th valu thy can dlivr to clints, which in turn positivly influncs thir willingnss to implmnt a policy. Implications for policy implmntation rsarchrs ar discussd. Ky words: Discrtion Policy implmntation Rsistanc to chang Halthcar Quantitativ analysis 2

3 DISCRETION AND ITS EFFECTS: ANALYZING THE EXPERIENCES OF STREET-LEVEL BUREAUCRATS DURING POLICY IMPLEMENTATION 1 Introduction In his book Strt-lvl buraucracy: Dilmmas of th individual in public srvics, Michal Lipsky (1980) analysd th bhaviour of front-lin staff in policy dlivry agncis. Lipsky rfrs to ths frontlin workrs strt-lvl buraucrats. Ths ar public mploys who intract dirctly with citizns in th cours of thir jobs, and hav substantial discrtion in th xcution of thir work (1980:3). Exampls ar tachrs, polic officrs, and judgs. Ths strt-lvl buraucrats implmnt public policis. Howvr, thr ar intrinsic problms whn implmnting public policis: strt-lvl buraucrats hav to rspond to citizns with only a limitd amount of information or only a limitd amount of tim to mak a dcision. Morovr, vry oftn th ruls to implmnt dos not always corrspond to th spcific situation or contxt of th involvd citizn. In rspons, strt buraucrats dvlop coping mchanisms. Thy simplify th natur of thir job or dvlop routins so that thy fl thy ar doing thir job wll in som way. This is possibl as thy hav a crtain dgr of discrtion or autonomy - in thir work (1980:14). Following th work of Lipsky, th concpt of discrtion has rcivd wid attntion in th policy implmntation litratur. Spcial attntion in th litratur is rlatd to th apprciation of discrtion in trms of its significanc for th ffctivnss and lgitimacy of public policis. Howvr, although thr has bn substantial rsarch on th issu of discrtion, to undrstand th natur of discrtion, scholars hav not yt dvlopd thortical framworks rgarding th ffcts of discrtion, which wr subsquntly tstd ths using larg n sampls (s also O'Tool, 2000). This is in lin with argumnts of Wintr (2003:221) who nots that thr is a nd for mor thory dvlopmnt and tsting [in policy implmntation rsarch], and th dvlopmnt of partial thoris sms mor promising than continuing th sarch for th gnral implmntation thory or modl. In this study, w aim to dvlop a thortical framwork rgarding th ffcts of discrtion, in ordr to incras our undrstanding of th mchanisms at work. Mor it can b noticd that thr also sms to b bias in th discrtion litratur, bcaus much of th of th mpirical rsarch on polic, social srvic workrs, halth and safty inspctors, building inspctors and othr frontlin workrs (Myrs & Vorsangr, 2003). Satrn (2005) shows that - in gnral - thr is a lot of rsarch concrning policy implmntation in th halthcar sctor. Howvr, it sms that policy implmntation scholars hav paid not much attntion to th rol of mdical profssionals in front lin jobs, such as physicians, nurss or psychologists, working in th (smi)public sctor. On important ffct, which is oftn notd, is that a crtain amount of discrtion can mak it possibl to adjust th (gnral) policy to th spcific circumstancs and nds of th clint (Palumbo t al., 1984). For instanc, a social workr can adjust th policy to fit th spcific nds of th particular unmployd prson h is working with. Hnc, it is argud that, whn strt-lvl buraucrats hav a crtain dgr of discrtion, this will nhanc will mak th policy mor maningful for th clint. Clint maningfulnss can thus b considrd a potntial ffct of discrtion. 3

4 Furthrmor, som authors not that, whn strt-lvl buraucrats ar givn a crtain amount of frdom in dcision making procss rgarding how to implmnt spcific policis, this will mak thm mor willing to implmnt a spcific policy program. Tummrs (2011) showd this whil studying 'policy alination', a nw concpt for undrstanding th idntification problms of strt-lvl buraucrats with nw policis (s also Tummrs t al., 2009). On mchanism undrlying this rlationship btwn discrtion and willingnss to implmnt sms to b that a crtain amount of discrtion incrass th maningfulnss for clints, which in turn nhancs thir willingnss to implmnt this policy (Hill & Hup, 2009; Lipsky, 1980). Hnc, th variabl clint maningfulnss could mdiat th rlationship btwn discrtion and willingnss to implmnt. This is oftn (implicitly) argud, but this particular mchanism hav not yt bn studid mpirically. Hnc, our cntral rsarch qustion is: How and why dos discrtion influnc th willingnss of strt lvl buraucrats to implmnt spcific policy programs and what rol dos clint maningfulnss play in it? In this articl, w dvlop and tst a modl rgarding th ffcts of discrtion. Aftr dvloping th thortical framwork, th hypothsizd rlationships ar tstd using a quantitativ approach, mploying data of a Dutch nationwid survy among psychologists, psychiatrists and psychothrapists implmnting a nw rimbursmnt policy. Structural Equation Modling is usd for tsting this framwork. Nxt to its thortical valu (dvloping a modl to study th ffcts of discrtion), a scond valu of this study lis thrfor in its quantitativ approach. To dat, most policy implmntation studis hav had a rathr qualitativ natur. Th qualitativ studis hav substantial valu, for instanc in providing a dp undrstanding on how and why strt-lvl buraucrats provid public srvics. Quantitativ rsarch can hlp in thory tsting and statistical gnralization. Although som valuabl quantitativ rsarch has bn takn plac (Brodkin & Majmundar, 2010; May & Wintr, 2009; Riccucci, 2005b), O Tool (2000:269) nots that th mov to multivariat xplanation and larg numbrs of cass xposs th [policy implmntation] spcialty to nw or rnwd challngs, which hav yt to b addrssd fully. (s also Hill & Hup, 2009; Wintr, 2007). W usd Confirmatory Factor Analysis (CFA), followd by Structural Equation Modling (SEM). Ths tchniqus fit th rsarch problm at hand and can b considrd vry novl for policy implmntation litratur (s also Sction 3) This brings us to th outlin of this articl. W will firstly dvlop a thortical framwork (Sction 2), which outlins th rlationships btwn discrtion, clint maningfulnss, and willingnss to implmnt. From th thortical framwork, w will dvlop a numbr of hypothss. Sction 3 dscribs th oprationalization of th concpts and th dsign of th rsarch projct. Following this, th rsults sction shows som dscriptiv statistics and discusss th analyss which tst th hypothss. W conclud by discussing th contribution of this articl to policy implmntation litratur, with a particular mphasis on discrtion of strt-lvl buraucrats. 4

5 2 Thortical framwork 2.1 Background on discrtion Th concpt of discrtion has bn usd in various ways. Som authors focus on th discrtion givn to stats for instanc to implmnt EU lgislation - or to agncis implmnting govrnmntal ruls (Oostrwaal t al., 2011; Thomson t al., 2007). In this study, w will focus on th discrtion during implmnting particular policis and discuss its ffcts on clint maningfulnss and willingnss to implmnt public policis. W must not that, givn th abundanc of litratur and th intrinsic difficultis with th discrtion concpt (such as th diffrnt intrprtations attachd to as wll as criticisms of ths intrprtations), w cannot provid a full analysis of th trm discrtion in this articl. Radrs intrstd in an laborat account on strt-lvl buraucracy and discrtion can rfr to a numbr of important books and book chaptrs which focus on this subjct (Davis, 1969; Evans, 2010; Hill & Hup, 2009; Lipsky, 1980; Myrs & Vorsangr, 2003; Wintr, 2007). In his book Profssional discrtion in wlfar srvics, Evans (2010) nots that for workrs, discrtion can b sn as th xtnt of frdom h or sh can xrcis in a spcific contxt. Rlatd to this, Davis (1969:4) nots that a public officr has discrtion whnvr th ffctiv limits on his powr lav him fr to mak a choic among possibl courss of action or inaction. In a similar vin, Vinzant and Crothrs (1998:37) dfin discrtion as th powr of fr dcision or latitud of choic within crtain lgal bounds (Davis, 1969)(Davis, 1969)(Davis, 1969). Lipsky (1980) focuss mor spcifically on th strt-lvl buraucrats, which implmnt policis and intract with clints whil doing this. H viws discrtion as th frdom which strt-lvl buraucrats hav in dtrmining th sort, quantity and quality of sanctions and rwards during policy implmntation (s also Hill & Hup, 2009; Tummrs, 2012). Following this, w viw discrtion as th frdom of strt-lvl buraucrats in making choics concrning th sort, quantity, and quality of sanctions and rwards on offr whn implmnting a policy. For instanc, to which xtnt can policmn thmslvs dcid whthr to giv an on-th-spot fin? To which xtnt can tachrs dcid what and how to tach studnts about th dvlopmnt of mankind, for instanc on volution or crationism (Brkman & Plutzr, 2010)? Whn discussing th notion of discrtion, it is important to not th discussion btwn th top-down and bottom-up prspctivs on policy implmntation. In th 1970s and 1980s, thr was an intns dbat on th corrct undrstanding of th phnomnon of policy implmntation (Rist, 1995) by lading authors such as Prssman and Wildavsky (1984) and Van Mtr and Van Horn (1975). Th arly implmntation scholars wr particularly concrnd with th rlationship btwn policy formation and policy implmntation. This ld to a dbat btwn th top-down and bottom-up prspctivs on policy implmntation (DLon & DLon, 2002; Hill & Hup, 2009). Basd on ths insights, mor nuancd approachs wr dvlopd (for xampl Goggin t al., 1990; Sabatir & Jnkins-Smith, 1993), although th distinction btwn top-down and bottom-up approachs rmains important (Hill & Hup, 2009). Top-down prspctivs (Hogwood & Gunn, 1984; Prssman & Wildavsky, 1984; Sabatir & Mazmanin, 1979) viw th implmntation of policy as basically a mchanistic procss which is compltly isolatd from policy formation. Implmntation is a rational procss that can b pr- 5

6 plannd and controlld by th policy formulators. Th rquirmnts of implmntation ar prsntd as a gnralizd list of conditions, which if mt, will nabl ffctiv implmntation. Bottom-up prspctivs (Barrtt & Fudg, 1981; Elmor, 1985; Hanf, 1982; Hjrn & Hull, 1982; Lipsky, 1980), on th othr hand, s policy implmntation in a much mor dynamic and intractiv procss. In thir viw, policy formulation and policy implmntation ar not strictly sparatd. Furthr, thy not that control ovr popl is not th way forward to ffctiv implmntation. Instad of rgarding human bings as chains in lin of command or cogs in a machin - policy formulators should raliz that policy is bst implmntd by what Elmor (1985) trmd backward mapping of policis, which involvs dfining succss in human or bhavioral trms and not in th compltion of a policy hypothsis. In both top-down and bottom-up approachs, th notion of discrtion is important. Both discuss th notion of discrtion, and oftn formulat normativ blifs. According to top-down scholars, discrtion is oftn not wlcomd (Davis, 1969; Polsky, 1993). First, too much discrtion might rsult in not raching th goals st by th policy hypothsis. Strt-lvl buraucrats can pursu thir own, privat goals, and might b shirking th policy or vn sabotaging it (Brhm & Gats, 1999). Th way forward is thn to control strt-lvl buraucrats. Scond, strt-lvl buraucrats ar not lctd officials, and th dmocratic lgitimacy of thm taking indpndnt, own dcisions is thrfor qustionabl (Lowi, 1993), although it must b notd that othr scholars argu that dlgating discrtion to strt-lvl buraucrats is not inconsistnt with dmocratic lgitimacy (Brkman & Plutzr, 2010; Dahl, 1989). On th othr hand, bottom-up scholars oftn mphasiz othr charactristics and ffcts of granting strt-lvl buraucrats discrtion. First, thy stat that discrtion is invitabl (Maynard- Moody & Mushno, 2000). Strt-lvl buraucrats ar facd with limitd rsourcs (tim, mony). In ths situations, strt-lvl buraucrats cannot possibly nforc all ruls and hnc nd discrtion. For instanc, polic officrs cannot arrst vryon thy s who mak infractions (Lipsky, 1980). Using thir discrtion, thy prioritiz which infractions ar most srious at th givn situation. Nxt to bing th notion that som discrtion is invitabl, mor discrtion can hav positiv ffcts. It might incras th clint maningfulnss, that is, th valu of th policy for clints. Many situations strtlvl buraucrats fac ar too complicatd to b rducd to programmatic formats. In ths circumstanc, discrtion maks it possibl to adapt th policy to th local nds of th citizns/clints, which incrass th maningfulnss of th policy for clints (Myrs & Vorsangr, 2003). Furthr, it sms that discrtion could positivly affct th strt-lvl buraucrats willingnss to implmnt th policy. In th policy implmntation litratur, it is suggstd that an important factor in th attituds of strt-lvl public srvants is th xtnt to which organizations dlgat dcision-making authority to th frontlin (Mir & O'Tool, 2002). This influnc may b particularly pronouncd in profssionals whos xpctations of discrtion and autonomy contradict notions of buraucratic control (DHart- Davis & Pandy, 2005). Concluding, it sms that discrtion can hav both positiv and ngativ ffcts. In his articl, w spcifically xamin two possibl positiv ffcts of discrtion: nhancd clint maningfulnss for clints and mor willingnss to implmnt th policy. Ths ffcts ar chosn givn thir dominant 6

7 rol in th policy implmntation dbat (Ewalt & Jnnings, 2004; Riccucci, 2005a; Simon, 1987; Tummrs t al., forthcoming 2012). Furthrmor, focusing on (mrly) two ffct nabls us to study th rlationship with discrtion mor in dtail. 2.2 Th ffcts on discrtion on clint maningfulnss and willingnss to implmnt W will now analys th rlationships btwn discrtion, clint maningfulnss and willingnss to implmnt. Givn th argumnts statd prviously, w firstly xpct that whn strt-lvl buraucrats xprinc high discrtion, this positivly influncs thir prcption of clint maningfulnss. Thy will hav th fling that thir frdom in making choics maks it possibl to adapt th policy to th spcific situation of thir clints, which incrass th valu of th policy for clints. For instanc, a social workr can us hr discrtion to adapt to th spcific wishs and circumstancs of th clint, which nabls hr to hlp th clint bttr, which will ultimatly nhancs th maningfulnss of th policy. Clint maningfulnss is closly rlatd to th social work narrativ as this is xprincd by frontlin workrs, who focus on hlping clints achiv long-trm succss (Maynard-Moody & Mushno, 2003). This amounts to th following first hypothsis: H1: Whn strt-lvl buraucrats xprinc mor discrtion, this positivly influncs thir xprincd clint maningfulnss of th policy Nxt, w xpct that whn strt-lvl buraucrats fl that thy do not hav nough discrtion, this ngativly influncs thir willingnss to implmnt a policy, as has bn discussd (s also Myrs & Vorsangr, 2003; Tummrs, 2011). Rlatd to this, in th chang managmnt litratur it is notd that mor autonomy of mploys rducs thir rsistanc to implmnt a chang (Eilam & Shamir, 2005; Pidrit, 2000). Furthrmor, w xpct that, whn strt-lvl buraucrats xprinc mor discrtion, this positivly influncs thir clint maningfulnss (H1), which in turn positivly influncs thir willingnss to implmnt a policy. Hnc, clint maningfulnss could influnc th willingnss to implmnt a policy. This is xpctd as strt-lvl buraucrats want to mak a diffrnc to thir clints livs whn implmnting a policy (Maynard-Moody & Mushno, 2000). May and Wintr (2009) found that if frontlin workrs prciv th instrumnts thy hav at thir disposal for implmnting a policy as inffctiv, in trms of dlivring to thir clints, this is likly to add to thir frustrations. Thy do not s how thir implmntation of th policy hlps thir clints, and so wondr why thy should implmnt it. Givn that th valuation of ffctivnss is likly to b basd on on-th-job xprinc, rootd in th circumstancs that profssionals ncountr in doing thir job, this aspct of attitud is likly to b particularly important whn it coms to dtrmining attituds and bhaviours (Myrs & Vorsangr, 2003). In mor tchnical trms, w xpct a mdiation ffct to occur. A mdiation ffct is an ffct of an indpndnt variabl (hr: discrtion) on a dpndnt variabl (willingnss to implmnt) via a mdiator variabl (clint maningfulnss)()(). Hnc, nxt to hypothsizing th dirct ffct of discrtion on willingnss to implmnt, w xpct that a part of this ffct is causd by mor clint 7

8 maningfulnss. This mans that w xpct a partially mdiatd ffct: part of th ffct of discrtion on willingnss to implmnt is mdiatd by clint maningfulnss (Baron & Knny, 1986). W do not xpct full mdiation. Som of th influnc of discrtion on willingnss to implmnt is xplaind by othr factors than incrasing clint maningfulnss, for instanc th intrinsic nd for autonomy of popl in thir work (Fridson, 2001; Wagnr III, 1994). This brings us to th following hypothss: H2: Th positiv influnc of discrtion on willingnss to implmnt is partially mdiatd by th lvl of clint maningfulnss H3: Whn strt-lvl buraucrats xprinc mor discrtion, this positivly and dirctly influncs thir willingnss to implmnt th policy This brings us to th following modl. In th following sctions, w discuss th mthods and rsults for tsting this modl. Figur 1 Proposd thortical modl + Discrtion Clint + + maningfulnss Willingnss to implmnt 3 Mthods 3.1 Cas To tst th proposd modl, w undrtook a survy of Dutch mntal halthcar profssionals implmnting a nw rimbursmnt policy. First, w provid a short ovrviw of this policy. In January 2008, th Dutch govrnmnt introducd Diagnoss Rlatd Groups in mntal halthcar. This was part of a procss to convrt th Dutch halthcar systm into on basd on a rgulatd markt. Th systm of Diagnosis Rlatd Groups (DRGs, in Dutch Diagnos Bhandling Combinatis, or DBC s) was dvlopd as a mans of dtrmining th lvl of financial xchang for mntal halthcar provision. Th DRG-policy diffrs significantly from th formr mthod, in which ach mdical action rsultd in a financial claim. This mant that, th mor sssions that a profssional cargivr (a psychologist, psychiatrist or psychothrapist) had with a patint, th mor rcompns that could b claimd. This formr systm was considrd by som to b infficint (Kimbrly t al., 2009). Th DRG-policy changd th situation by stipulating a standard rat for ach disordr. Th nw Law Halth Markt Organization and th associatd DRGs can b sn as th introduction of rgulatd 8

9 comptition into Dutch halthcar, a mov in lin with Nw Public Managmnt (NPM) idas. Mor spcifically, it can b sn as a shift to gratr comptition and mor fficint rsourc us (Hood, 1991:5). W chos th DRG policy as th discrtion of th strt-lvl buraucrats for implmnting this policy was highly dbatd. Profssionals hav to work in a mor vidnc-basd way, and ar rquird to account for thir cost dclarations in trms of th mntal halth DSM (Diagnostic Statistical Manual) classification systm. As a rsult, it bcoms hardr to us practics that ar difficult to standardiz and valuat, such as psychodynamic tratmnts. Discrtion rgarding th lngth of tratmnt is arguably also incrasingly limitd. Whras, in th formr systm, ach mdical action rsultd in a paymnt, undr th DRG policy a standard rat is dtrmind for ach disordr. This mans that it has bcom mor difficult to adjust th tratmnt to th spcific nds of a patint. It is intrsting to study to how much discrtion strt-lvl buraucrats rally xprincd, and which ffcts this has. As can b sn from th prvious paragraph, w focus on xprincd discrtion. This is basd on th notion of Lwin (1936): that popl bhav on th basis of thir prcptions of rality, not on th basis of rality itslf (S also Thomas thorm, Mrton, 1995). Strt-lvl buraucrats may xprinc diffrnt lvls of discrtion, for instanc bcaus som hav mor knowldg on (loophols) in th ruls, th way th policy is oprationalizd in th spcific organization and prsonality of th strt-lvl buraucrat (Brhm & Hamilton, 1996; Lipsky, 1984; Prottas, 1979). Hnc, also for th sam policy, som strt-lvl buraucrats will prciv mor discrtion than othrs. In lin with this, in th opn answrs of th survy, w saw that som profssionals flt that thy had substantial discrtion, whil othrs flt vry limitd in thir discrtion (s also Van Sambk t al., 2011). Illustrating quots from diffrnt rspondnts ar: Th DRG-policy dos not forc m into a crtain choics. I xamin th funding schm of th tratmnt only in scond instanc I do my work first and formost according to profssional standards and hraftr just attach a DRG-labl which I think fits but bst. With th DRG-policy, I am bing forcd into a straitjackt. You ar bound by th ruls. so that's a harnss. In our quantitativ rsults, ths diffrncs wr also vidnt, as on a 1-5 scals th scors indd rangd from 1-5, with a standard dviation of.90 (s rsults). 9

10 3.2 Sampling and rspons W usd a sampl of 5,199 mntal halthcar profssionals implmnting th DRG-policy, randomly slctd from th databass of two nationwid mntal halthcar associations. Using an mail and two rmindrs, w rcivd 1,317 rturns of our qustionnair; a rspons of 25%. Of th valid rspondnts, 36% wr mn and 64% womn. This balanc is consistnt with Dutch avrags for mntal halth car profssionals, whr on can find figurs as high as 69% of th workforc bing womn (Palm t al., 2008). Th rspondnts ags rangd from 23 to 91 yars (M = 48), which is a slightly oldr avrag than th Dutch national avrag for mntal halthcar profssionals (M = 44). Hnc, th rspondnts man ag and gndr-distribution ar quit similar to thos of th ovrall mntal halthcar sctor. To rul-out a possibl non-rspons bias, w conductd non-rspons rsarch whr w contactd th non-rspondrs for thir rasons for not participating. Common rasons for not participating wr a lack of tim, rtirmnt, chang of occupation or not working with th DRG policy (som organizations, including som hospitals, wr not yt working with this policy). Th larg numbr of rspondnts, thir charactristics in trms of gndr and ag and th rsults of th non-rspons rsarch indicat that our rspondnts ar quit a good rprsntation of th population. Nvrthlss, w cannot compltly rul out a non-rspons bias sinc th nonrspondnts may diffr from th rspondnts in trms of numrous othr (unxamind) charactristics. 3.3 Masurs This sction rport th masurmnt of th variabls. Unlss statd othrwis, th masurs wr formattd using fiv-point Likrt scals, ranging from strongly agr to strongly disagr. For th itms tapping discrtion, clint maningfulnss and willingnss to implmnt, w usd tmplats. Tmplats allow th rsarchr to spcify an itm by rplacing gnral phrass with mor spcific ons that bttr fit th rsarch contxt. For xampl, instad of stating th policy or profssionals, th rsarchr can rphras ths itms using th spcific policy and group of profssionals which ar bing xamind, hr th DRG policy and halthcar profssionals rplacd th tmplat trms. This maks it asir for profssionals to undrstand itms, as thy ar bttr tailord to thir contxt and this, in turn, incrass rliability and contnt validity (DVllis, 2003:62). Th itms of all masurs ar shown in th Appndix. Discrtion Discrtion concrns th prcivd frdom of th implmntr in trms of th typ, quantity and quality of sanctions and rwards dlivrd (Lipsky, 1980). Th scal is basd on th validatd masurmnt instrumnt of policy alination (Tummrs, 2012). It concrns th dimnsions oprational powrlssnss. Sampl itms wr for instanc Whn I work with th policy, I hav to adhr to tight procdurs (R) and Whil working with th policy, I can mak my own judgmnts. In total, thr itms wr usd, as this provd to work bst in th confirmatory factor analysis (s Sction 4). Th Cronbach alpha was

11 Clint maningfulnss. Clint maningfulnss (or maninglssnss) was also concptualizd as a dimnsion of policy alination (Tummrs, 2012). It rfrs to th prcption of profssionals about th bnfits of thm implmnting th DRG policy for thir own clints. For instanc, do thy prciv that thy ar rally hlping thir patints by implmnting this policy? Thr itms wr usd. Sampl itms wr: Th policy is contributing to th wlfar of my clints and With th policy I can bttr solv th problms of my clints. Th scal s alpha was.77. Willingnss to implmnt In ordr to masur willingnss to implmnt, w usd th validatd scal of Mtslaar (1997). Four itms wr usd. Sampl itms ar: I am willing to contribut to th introduction of th policy and I am willing to fr up tim to implmnt th policy. Th scal s Cronbach s alpha was.83 in this study. Control variabls W includd commonly usd individual charactristics: gndr, ag and whthr th rspondnt occupis a managmnt position (ys/no). W also distinguish btwn psychiatrists and othrs, bcaus th formr blong to th mdical profssion, whil th lattr (psychologists and psychothrapists) ar non-mdical profssionals, which could influnc thir prcptions. 3.4 Statistical mthods usd In ordr to mpirically study th thortical framwork of th ffcts of discrtion, w usd Confirmatory Factor Analysis (CFA), followd by Structural Equation Modling (SEM). Although SEM CFA and SEM ar usd in psychology rsarch, ths tchniqus ar quit novl to most public administration scholars (but s Wright t al., 2012; Yang, 2005). W thrfor discuss a numbr of thir charactristics in dtail. Confirmatory factor analysis is a tchniqu for tsting th factor structur of latnt constructs, basd on thory and prior rsarch xprinc. In our cas, this is appropriat, givn that prior analyss hav alrady xplord th variabls discrtion and clint maningfulnss (Tummrs, 2012) and willingnss to implmnt (Mtslaar, 1997). CFA has svral advantags ovr xploratory factor analysis, such as far mor stringnt psychomtric critria for accpting modls, thrby improving validity and rliability (Brown, 2006). Using CFA, a masurmnt modl is spcifid. Th masurmnt modl spcifis th numbr of factors and shows how th indicators (itms) rlat to th various factors (Brown, 2006:51). Hnc, it shows for instanc how th itms askd to masur discrtion rlat to th latnt construct of discrtion. This masurmnt modl is usd as a prcursor for th SEM-analysis. In th SEManalysis, a structural modl is constructd. This structural modl shows how th various latnt factors ar rlatd to ach othr. For instanc, it shows how discrtion is rlatd to willingnss to implmnt. An advantag ovr rgrssion analyss is that in th SEM-analyss, a total modl can b tstd whr variabls can b both dpndnt and indpndnt. As th variabl clint maningfulnss is 11

12 both dpndnt (it is hypothsizd to b influncd by discrtion) and indpndnt (it is hypothsizd to influnc willingnss to implmnt), this was appropriat for our modl. For mdiation modls (as is our modl), SEM is prfrrd ovr rgrssion analysis (Iacobucci t al., 2007). In ordr to tst th total modl, fit indics ar usd (s rsults). Th analyss ar don using th latnt variabl program Mplus (Muthén & Muthén, ). In contrast to SPSS it can handl CFA and SEM analyss. Mplus is wll-suitd for handling non-normally distributd data (which is oftn th cas whn mploying survys), whil both SPSS and AMOS hav limitd capabilitis in this rspct. As our data wr (mildly) non-normally distributd, this was an advantag. W usd Robust Maximum Liklihood, an stimator which works vry wll in ths circumstancs (Brown, 2006:379). Howvr, a drawback from Mplus is that th rsarchr rquirs knowldg of syntax. 3.5 Masurmnt modl Bfor analyzing th structural modl, w will firstly analyz th masurmnt modl. As th structural modl can b sn as th rsults of th analyss, this is shown in Sction 4 (Rsults). Basd on th rsults of th masurmnt modl, a numbr of modifications wr mad in ordr to improv th modl. Th only modifications wr that a numbr of itms for th latnt factors wr dltd (thr for discrtion, on for clint maningfulnss, on for willingnss to implmnt). This was basd on thortical grounds (fit of itm contnt with dfinition of concpt/latnt factor) and th minimization of th Akaik Information Critrion (AIC). This fit indx can b usd to compar compting modls. As suggstd by othr scholars, slctd th modl with th lowst AIC, thrby taking into account thortically plausibility (Schribr t al., 2006). Svral authors suggst to rport RMSEA, TLI and CFI whn dscribing modl fit (Schribr t al., 2006; van d Schoot t al., 2012). Th Root Man Squar Error Of Approximation (RMSEA) a widly rcommndd fit indx which tsts th absolut fit of th modl was.048. This indicats good fit, as Hu and Bntlr (1999) suggst that valus.06 indicat good fit (<.08 avrag fit). Th Tuckr- Lwis Indx (TLI) is a comparativ fit indx that compars th fit of th modl with th baslin modl. Th TLI in our study was.98, which is considrd xcllnt (.90, bttr.95). Th Comparativ Fit Indx is also a comparativ fit indx and was.98 in our final modl, which shows good fit (.90, bttr.95). In our final modl, ach itm loadd significantly on its appropriat latnt variabl. For instanc, an itm to tap discrtion loadd onto th variabl discrtion. Th valus of th standardizd factor loadings wr all rlativly high (min..51, max..91, avrag.75). This shows vidnc of convrgnt validity: itms which tap th sam latnt construct ar rlatd to ach othr (Klin, 2010). Bfor going to th rsults, w should discuss th possibility of common mthod varianc. Slf-rportd data basd on a singl application of a qustionnair can rsult in inflatd rlationships btwn variabls du to common mthod varianc, i.. varianc that is du to th masurmnt mthod rathr than th constructs thmslvs (Podsakoff & Organ, 1986). Although a rcnt study showd that in contrast to convntional wisdom, common mthod ffcts do not appar to b so larg as to pos a srious thrat to organizational rsarch (Lanc t al., 2010:450), w conductd a tst to 12

13 analys whthr common mthod bias was a major concrn hr. W compard th thr-factor structur (discrtion, clint maningfulnss and willingnss to implmnt) with a on-factor modl. Th fit indics show that th on-factor modl had a much poorr fit than th thr factor modl. Th AIC was highr, and th RMSEA (.16), CFI (.58) and TLI (.54) indicatd much poorr fit. Hnc, common mthod varianc dos not sm to b a major problm hr. 4 Rsults 4.1 Dscriptiv statistics Tabl 1 shows th mans, standard dviations and corrlations for th variabls. A numbr of intrsting rsults can b sn. First, many strt-lvl buraucrats ar psychiatrists (42%), and ths oftn occupy managmnt positions. Nxt, th avrag scor on discrtion is low, maning that th strt-lvl buraucrats do not fl that thy hav a lot of autonomy. This is also th cas for willingnss to implmnt (2.35) and vn strongr for clint maningfulnss (1.87). Furthrmor, w s that, all bivariat corrlations for th variabls linkd through our hypothss wr statistically significant and in th anticipatd dirction. For xampl, willingnss to implmnt was positivly rlatd to discrtion. Tabl 1 Dscriptiv statistics and corrlations for th variabls in th study Variabl Man SD Gndr.64 NA 1 2. Ag Psychiatrist.42 NA Managing.44 NA position 5. Discrtion NS NS Clint NS.28 1 maningfulnss 7. Willingnss to implmnt NS Not: NA = Not applicabl (standard dviations ar not applicabl to dummy variabls). NS = Not significant. All shown corrlation scors ar significant at p < Structural modl Th cntral goal of this articl is to undrstand th mchanisms at work in th rlationship btwn discrtion, clint maningfulnss and willingnss to implmnt. Th rsulting structural quation modl is shown in Figur 2. Tabl 2 shows th spcific rsults of th mpirical rsults, including control variabls. First, an ffct of discrtion on clint maningfulnss was found (standardizd cofficint.33, p<.01). This mans that whn a psychologists, psychothrapists or psychiatrists flt that h/sh had 13

14 sufficint discrtion whn implmnting th DRG-policy, thy also flt that thy could bttr hlp thir patints, tailoring th nds of th patints to th contnts of th policy. Hnc, w do not rjct Hypothsis 1. Nxt to this, th mpirical tsts show an cascading ffct from discrtion to willingnss to implmnt through th mdiating variabl clint maningfulnss. As notd, th ffct (standardizd cofficint) of discrtion on clint maningfulnss was.33 (p<.01). Furthrmor, th ffct from clint maningfulnss on willingnss to implmnt was.49 (p<.01), maning that whn a strt-lvl buraucrat flt that th policy was maningful for thir clints, thy indd flt mor willing to implmnt it. Th total indirct ffct was hnc.16 (33*.49, p<.01). Givn that this ffct is significant and positiv, w do not rjct hypothsis 2. Furthrmor, th dirct ffct of discrtion on willingnss to implmnt was also significant (β=.27, p<.01), thus not rjcting hypothsis 3. Th total ffct of discrtion on willingnss to implmnt is th sum of its dirct and indirct ffcts: =.43. This mans that all othr things bing qual that whn th prcivd discrtion of th strt-lvl buraucrat incrass by 1, th willingnss to implmnt incrass by.43 (Baron & Knny, 1986; Zhao t al., 2010). As thr is both a dirct and an indirct significant ffct, thr is vidnc of partial mdiation, which was also hypothsizd. This (partially mdiatd) modl provd to b a vry good fit of th data: RMSEA =.04 (critrion.08), CFI =.97 (critrion.90), TLI =.96 (critrion.90). To shd mor light on th mdiating mchanisms, w conductd additional SEM analyss to tst th validity of two altrnativ modls: a modl without mdiation and a modl with full mdiation. Th modl without mdiation did not fit as adquatly as th partially mdiatd modl, givn that th AIC was far highr compard to th partially mdiatd modl. Th fully mdiatd modl also had a highr AIC, although th diffrncs ar small. Furthrmor, w usd bootstrapping in ordr to tst th indirct ffct of discrtion on willingnss to implmnt via clint maningfulnss. Bootstrapping is th prfrrd mthod for tsting mdiatd ffcts (Prachr & Hays, 2004; Zhao t al., 2010). It prsnts stimats and confidnc intrvals so that w can tst th significanc of th mdiation ffct. Th 99% confidnc intrval for th standardizd indirct ffct (which was.16) is btwn.11 and.22, which mans that w can b for 99% crtain that th indirct ffct is not qual to (or lowr than) 0. 1 Hnc, it sms that a positiv mdiation ffct is clarly prsnt in our sampl. Givn ths rsults, w do not rjct hypothsis 1-3. In th discussion and conclusion, w discuss th implications of this for both thory and practic. 1 Bootstrap 5000 tims, Maximum Liklihood stimation is usd as Robust Maximum Liklihood is not availabl for bootstrapping. 14

15 Figur 2 Structural quation modl for rlationships btwn discrtion, clint maningfulnss and willingnss to implmnt (control variabls not shown).28 Discrtion Clint.33 maningfulnss.49 (R 2 =.14) Willingnss to implmnt (R 2 =.45) D1 D2 D3 C1 C2 C3 W1 W2 W3 W4 Tabl 2 Rsults From Structural Equation Modling Modl Maningfulnss for clints (standardizd scors) Maningfulnss for clints (unstandardizd scors) Willingnss to implmnt (standardizd scors) Willingnss to implmnt (unstandardizd scors) Control variabls Gndr NS NS NS NS Ag NS NS Managing position NS NS Psychiatrist NS NS NS NS Dirct influncs Discrtion Maningfulnss for clints Indirct influnc Discrtion via maningfulnss for clints R Not: NS = Not significant. All shown corrlation scors ar significant at p <.01 15

16 5 Conclusion How and why dos discrtion of strt lvl buraucrats influnc th willingnss to implmnt spcific policy programs and what rol dos clint maningfulnss play in it? This was th gnral rsarch qustion which laid bhind this articl. Our rsarch shows that th discrtion of strt-lvl buraucrats dos influnc th willingnss to implmnt in two ways. First, w s that discrtion influncs clint maningfulnss, bcaus strt-lvl buraucrats ar mor abl to tailor thir dcisions and th procdurs thy hav to follow to th spcific situations and nds of thir clints. In doing so, discrtion givs strt lvl buraucrats th possibility to apply thir own judgmnts whn daling with th nds and wishs of citizns. Whn strt-lvl buraucrats fl rlativly fr in thir implmnting of th policy, thy ar bttr abl to contribut to th wlfar of its clints, daling with th problms that his or hr clints hav in a mor satisfying way. At th sam tim, th positiv ffct that discrtion has on th buraucrat s prcption of clint maningfulnss can b sn as important condition for a willingnss to implmnt th policy, as this ffct is mdiatd through clint maningfulnss. Th rsarch shows that whn strt-lvl buraucrats prciv that thir work is maningful to his/hr clints, thy ar also mor willing to implmnt a spcific policy program, bcaus thy ar mor convincd of th goals and bnfits of this program. Hnc, w providd additional mpirical vidnc for th notion that strt-lvl buraucrats want to mak a diffrnc to thir clints livs whn implmnting a policy, and whn thy fl that thy cannot do this, this may lad thm to rsist th policy (s also May & Wintr, 2009; Maynard-Moody & Mushno, 2003). Howvr, our rsarch dos also anothr ffct, mor autonomous ffct. Discrtion sms to b inhrntly valud by strt-lvl buraucrats, thrby dirctly influncing thir willingnss to implmnt a spcific policy program. This is in lin with th litratur from th HRM, whr lading authors not that autonomy is an intrinsic nd for popl. On of th cntral tnts of this movmnt is that mploys hav a right to mak input into dcisions that affct thir livs (Dci & Ryan, 2004; McGrgor, 1960; Wagnr III, 1994). Givn ths outcoms w can stat that discrtion influncs th ffctivnss and lgitimacy of public policy programs in a positiv way, bcaus discrtion stimulats willingnss and rducs rsistanc. This has intrsting implications for th thory and practic of policy implmntation. From a thortical point of viw it contributs to this long lasting discussion about th validity of a mor top down and bottom-up prspctiv on policy implmntation. Discrtion sms to hav a positiv ffct on th ffctivnss of policy programs, thrby rducing rsistanc, whil at th sam tim it adds to th lgitimacy of th policy implmntation procss, bcaus it abl to mt th nds and wishs of citizns in a mor appropriat way (in this ys of th implmnting buraucrats). Morovr, th thortical implications of our findings ar also rlatd to th mpirical basis of our rsarch, givn larg sampl that is usd (1,317 rspondnts out of 5, 199 rspondnts that wr approachd). If w compar this to mpirical bas of th prdominantly qualitativ and a small numbr of cas studis that hav bn carrid whn studying th ffcts of discrtion, thn th mpirical validity of our findings add substantially to arlir mntiond top down/bottom up discussion. For th practic of public administration, it sms important, whn drafting policy program, it is important to giv th implmnting strt-lvl buraucrats som frdom to adjust th policy program 16

17 in ordr to b ffctiv and lgitimat. Hr, w not that th dgr of discrtion flt can vary within th sam policy, as among ls as a rsult of spcific organizational ruls and prfrncs, managrial prformanc and risk managmnt and prsonality charactristics of th strt-lvl buraucrat (Brhm & Hamilton, 1996; Eaton Bair t al., 1986; Lipsky, 1984; Prottas, 1979). Hnc, th study rsults for instanc hav important consquncs for th rol of prformanc managmnt and risk managmnt in th implmntation of ths programs, bcaus th cntral rol that dtaild prformanc indicators and risk rduction ruls play in th implmntation procss vry oftn lads to a broad varity of rathr dtaild norms and guidlins that hav to b obyd by th involvd strt lvl buraucrats. Concluding, our mpirical rsults show that car should b takn whn rducing th autonomy of th strt-lvl buraucrats implmnting th policy. W ar not saying that policymakrs and managrs should nvr rduc discrtion: discrtion can hav substantial downsids, such as mpir building and infficincy (Dakin, 1994; Lipsky, 1980). Rathr, w ar warning that diminishing th discrtion of strt-lvl buraucrats should b a dlibrat, informd choic, mad aftr balancing th possibl advantags and disadvantags in th spcific situation. This brings us to th limitations of this study. As with all studis, this study has limitations. On important limitation is cas w analyzd: psychologists, psychothrapists and psychiatrists working in (smi)public organizations and implmnting th govrnmntal policy DRGs. On th on hand this addrsss a group of strt-lvl buraucrats that hav not studid intnsivly in th discrtion litratur; on th othr hand it is rathr spcific group of highly traind profssionals which traditionally, du to thir profssional training, hav gaind a lot of profssional autonomy. Morovr, th psychologists and psychiatrist that wr approachd, although thy prform a vital rol in implmnting a spcific policy program, work outsid traditional govrnmnt organizations (such as municipalitis). Hnc, it would b intrsting to compar th rsults of this study with a similar study that addrsss othr groups of strt-lvl buraucrats who hav rcivd othr typs of profssional training or who ar a part of govrnmnt srvic buraucracy. A scond limitation is that w hav only xamin two, positiv, ffcts of discrtion: clint maningfulnss and willingnss to implmnt. Hnc, w wr primarily looking at prcivd positiv ffcts of discrtion, and thrfor largly ignord its ngativ sid. In futur studis, scholars could tak into account numrous (ngativ and positiv) ffcts, thrby dvloping a mor all-ncompassing modl considring th possibl ffcts of discrtion. Concluding, this study dvlops a thortical framwork rgarding two important ffcts of discrtion (clint maningfulnss and willingnss to implmnt). Th rsults firstly show a positiv ffct of discrtion on clint maningfulnss. Nxt to this, discrtion positivly affctd th willingnss to implmnt a policy, and this is partially mdiatd by clint maningfulnss. Hnc, whn strt-lvl buraucrats xprinc discrtion, this positivly influncs th valu thy can dlivr to clints, which in turn positivly influncs thir willingnss to implmnt a policy. 17

18 Masurs Appndix: Itms usd for scals Discrtion (basd on Tummrs, 2012) 1. Whn I work with th policy, I hav to adhr to tight procdurs (R) 2. Whil working with th policy, I cannot sufficintly tailor it to th nds of my clints (R) 3. Whil working with th policy, I can mak my own judgmnts Clint maningfulnss (basd on Tummrs, 2012) 1. Th policy is harmful for my clints privacy (R) 2. With th policy I can bttr solv th problms of my clints 3. Th policy is contributing to th wlfar of my clints Willingnss to implmnt (basd on Mtslaar, 1997) 1. I intnd to try to convinc mploys of th bnfits th policy will bring 2. I intnd to put ffort into achiving th goals of th policy 3. I intnd to rduc rsistanc among mploys rgarding th policy 4. I intnd to mak tim to implmnt th policy 18

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