Producing Health Policy

Knowledge and Knowing in Government Policy Work

Jo Maybin

• Publisher: Palgrave Macmillan
• Year: 2016
• ISBN:
  9781349786541
• Topic: Politics & International Relations
• Subtopic: Social Policy
• Index: Politics & International Relations

In this book Jo Maybin draws on rare access to the inner-workings of England's Department of Health to explore what kinds of knowledge civil servants use when developing policy, how they use it and why. Combining ethnographic data with insights from psychology, socio-linguistics, sociology and philosophy, she demonstrates how civil servants engage in a wide range of knowledge practices in the course of their daily work. These include sharing personal anecdotes, thrashing-out ideas in meetings and creating simplified representations of phenomena, as well as conducting cost-benefit analyses and commissioning academic research. Maybin analyzes the different functions that these various practices serve, from developing personal understandings of issues, to making complex social problems 'thinkable', and meeting the ever-present need to make policies 'happen'. In doing so, she develops an original theory of policy-making as the work of building connections between a policy in developmentand powerful ideas, people, and instruments, and reveals the 'policy know-how' required by civil servants to be effective in their jobs.

1

Knowledge and Policy in the Literature

How have theorists conceived of the relationship between knowing and governing? What can past research tell us about how policy-makers might use knowledge in their work and, indeed, what ‘knowledge’ and ‘using it’ might constitute in this context? In this chapter I show how these questions were a central concern for foundational authors in the policy sciences, and how in the last three decades they have been taken up with renewed vigour by authors writing on the relationship between evidence and policy-making. Both of these literatures point to the limitations of technocratic accounts of policy-making, indicating instead the importance of attending to social interactions between policy-makers and researchers, and the context in which policy-makers operate, to understand how and why policy-makers use knowledge as they do.

But the evidence and policy literature itself seems to be stuck in something of an intellectual rut, and to pursue these themes further requires marshalling resources from other literatures. This chapter revisits some core concepts in the philosophy of knowledge and draws together more recent writing on the nature of knowledge in organisations and work, to sketch an alternative conceptualisation of what knowledge and knowing might comprise in the practice of policy-making. In this account knowledge is characterised as being underdetermined and is realised in activity, in interaction with others in a particular setting and in relation to a particular task.

Policy-making as a knowledge problem

In the pervasive conception of policy-making as a process of decision making, as ‘whatever a government chooses to do or not to do’ (Dye 1972, p. 2), public administrators are expected to draw on authoritative, expert knowledge claims to inform those decisions. In fact English civil servants are legally required to base their ‘advice and decisions on rigorous analysis of the evidence’ (Civil Service Commission 2012). And yet as early as the 1940s, writers in the policy sciences were pointing out the practical and political limitations of technocratic accounts of decision making. Herbert Simon’s work in this area emphasised the cognitive and contextual barriers to public administrators acting wholly rationally (Simon 1947). Writing against an image of ‘economic man’, who assesses all available options and chooses those which will most efficiently deliver some agreed objective, Simon describes the real ‘administrative man’ as limited by practicalities which mean only a few of these options ‘ever come to mind’ (Simon 1976, p. 81), and that he cannot have ‘a complex knowledge and anticipation of the consequences that will follow on each choice’ (Simon 1976, p. 81). In this state of ‘bounded rationality’, administrative work is driven by a logic of ‘satisficing’, rather than ‘maximising’ (Simon 1957, p. xxvi). The administrator accepts that ‘the world he perceives is a drastically simplified model of the buzzing, blooming confusion that constitutes the real world’, and is content to work with ‘a simple picture of the situation that takes into account just a few of the factors that he regards as most relevant and crucial’ (Simon 1957, pp. xxv–xxvi). Administrative man seeks a course of action that is ‘good enough’ (Simon 1957, pp. xxv–xxvi).

A similar conclusion was reached by Charles Lindblom, who identified the time, information, resource and intellectual constraints with which administrators worked, and the political and legal context for that work, as major barriers to ‘rational-comprehensive’ models of decision making (Lindblom 1959). In practice, he argued that administrators are engaged in ‘muddling through’, in which the ‘the test of a “good” policy is typically that various analysts find themselves directly agreeing on a policy (without their agreeing that it is the most appropriate means to an objective)’ (1959, p. 81). Taking up the subject 20 years later Lindblom advised policy-makers to abandon aspirations to ‘impossible feats of synopsis’ (1979, p. 518), and instead to develop more systematic versions of existing practices which involved making small incremental steps in policy, enabling administrators to gather ‘knowledge about the probable consequences of further, similar steps’ (1959, p. 86). Lindblom also argued that politics could be made more ‘intelligent’ through attention to improving (rather than curbing) ‘partisan analysis’ in which ‘participants make heavy use of persuasion to influence each other; hence they are constantly engaged in analysis designed to find grounds on which their political adversaries or indifferent participants might be converted to allies or acquiescents’ (1979, p. 524).

The importance of social and political context to understanding how policy-makers use knowledge in their work is also emphasised in writing on ‘policy learning’ (Freeman 2006). In a seminal contribution to policy studies in the 1970s, Hugh Heclo sought to challenge dominant accounts of the policy process as one of conflict resolution, and to highlight the ‘political learning’ involved in governing by attending to how governments ‘puzzle’ as well as ‘power’ (1974, p. 303). For Heclo, learning is what governments do in response to changes in their environment; it is a process that comprises a ‘relatively enduring alteration in behavior that results from experience’ (1974, p. 306). It is shaped by three forces: (i) individuals; (ii) organisations and their inter-relationships (the administration, political parties, committees and interest groups); and (iii) past policies. In his study of the evolution of income maintenance policies in Britain and Sweden, Heclo identified the importance of civil servants in the learning process, as a permanent fixture on the scene, and also the actors to whom ‘has fallen the task of gathering, coding, storing and interpreting policy experience’ (1974, p. 303). These policy-makers puzzle on society’s behalf. He also emphasised the important role played by ‘networks of policy middle men’ (1974, p. 311), who are at the ‘interfaces of various groups’ and have ‘access to information, ideas, and positions outside the normal run of organisational actors’ (1974, p. 308). Notably, Heclo’s account incorporated learning about both the substance, and the process, of governing; policy-makers are concerned not just with what was done by past governments, or by foreign administrations, but also with how it was done.

In the 1980s and 1990s Peter Hall went on to develop a theory of ‘social learning’ as the ‘deliberate attempt to adjust the goals or techniques of policy in the light of the consequences of past policy and new information so as to better attain the ultimate objects of governance’ (Hall 1988, p. 6; cited in Bennett & Howlett 1992, p. 276). He illustrated his account with an analysis of the shift from Keynesianism to Monetarism in UK economic policy in the 1980s (Hall 1993). Here, Hall distinguishes three main orders of learning. Within the normal run of policy-making, there is first order change, which involves adjustments to the instruments of governing, and, less commonly, second order change, which involves selecting different policy instruments to reach a specified goal. Changing the goals of policy, and the way in which a problem itself is conceptualised, constitutes a third order change, which amounts to a paradigm shift (Hall 1993, pp. 278–80). The changes to macroeconomic policy he describes exemplify this third type of policy learning. Explicitly drawing on Thomas Kuhn’s theory of scientific paradigms, Hall posits that:

policymakers customarily work within a framework of ideas and standards that specifies not only the goals of policy and the kind of instruments that can be used to attain them, but also the very nature of the problems they are meant to be addressing. Like a Gestalt, this framework is embedded in the very terminology through which policymakers communicate about their work, and it is influential precisely because so much of it is taken for granted and unamenable to scrutiny as a whole.

(Hall 1993, p. 279)

According to Hall, significant paradigm shifts are more sociological than rational or scientific in character. Though such shifts might be prompted by the emergence of anomalies which cannot be explained within the existing policy paradigm, an apparently more important prerequisite for a shift in policy paradigm is a prior and significant change in the ‘locus of authority over policy’ (Hall 1993, p. 279). In Hall’s account, puzzling is not sufficient to account for what he termed third order change; there must be powering too.

Together these authors find that cognitive and practical limits to knowledge gathering and processing, including the political nature of policy-making as a social process, mean that rational technocratic models of policy-making are necessarily implausible and impracticable. Alternative forms of practice emerge, in which the process of policy development is more social than scientific, infused with politics and power and populated with multiple actors in addition to the politician, the administrator and the researcher or expert.

This work notwithstanding, the model of policy-making as a rational decision-making exercise based on expert knowledge has remained curiously persistent in the academy as well as government itself. This vision has underpinned successive efforts in Britain and elsewhere to improve the functioning of the civil service, and has provided the anchor point for an ever-burgeoning body of literature concerned with assessing the extent to which policy-making is indeed informed by evidence. The next section summarises the main themes from the ‘evidence and policy’ literature, and outlines how they have informed the design of this research study.

The evidence and policy literature

The extensive research and commentary in this field can be organised into two loose groups. The first, which begins with the assumption of a rational-instrumental relationship between research and policy-making, is concerned with how to better enable the flow of knowledge from one domain to the other. The second follows more closely in the tradition established by the policy scientists discussed in the previous section of this chapter by attending to the social nature of the knowledge–policy relationship, identifying the multiplicity of actors involved and describing the iterative, and socially mediated or constructed nature of their communication, as well as analysing the political character of evidence and evidence use.

Rational-instrumental models: Bridging the two communities

Early models of the evidence–policy relationship assume policy formulation to be a rational process in which research findings might be applied to help solve society’s problems. In this body of research, the distinction between empirical description and normative prescription is sometimes elided. After early empirical research found that linear, rational models of the way in which research moves into policy bear little resemblance to practice, subsequent authors in this tradition have concerned themselves with understanding the obstacles to such research use by policy-makers, and how these might be overcome.

Writing in 2001, John Landry and colleagues elaborated on Carol Weiss’s (1979) description of ‘knowledge-driven’ and ‘problem-solving’ models of research use in policy-making to characterise the two dominant, early models of the evidence–policy relationship. The problem-solving, ‘demand pull’ models identify policy-makers and other research users as more or less formal directors or commissioners of research (Landry et al. 2001, p. 335). Knowledge-driven or ‘science push’ models present advances in research as the principal stimulus for knowledge use by policy-makers and others, with authors focusing on how utilisation is effected by the particular attributes of the research (its ‘technical quality’, complexity, ‘divisibility’ and ‘applicability’ [2001, p. 334]). For Landry and his colleagues, the weakness of these approaches lies in their failure to focus on the process by which research is taken up by policy-makers, including the active role played by the actors who are involved in the transfer, and the translation work required to make the research findings ‘usable’. The authors build on the findings of existing empirical literature to argue that it is a lack of interaction between research producers and users that is the main cause of research being under-utilised.

A key characterisation, which is common to both of these models (knowledge-driven and problem-solving) and the call for greater interaction between policy-makers and researchers, was articulated by Nathan Caplan in the late 1970s as the ‘two communities’ thesis (Caplan 1979). In this account:

social scientists and policy makers live in separate worlds with different and often conflicting values, different reward systems, and different languages. The social scientist is concerned with ‘pure’ science and esoteric issues. By contrast, government policy makers are action-orientated, practical persons concerned with obvious and immediate issues.

(Caplan 1979, p. 459)

Variations on this set of assumptions can be found in much of the subsequent literature. Authors in this tradition have identified barriers to evidence use presented by the different priorities and values of policy-makers and academics respectively. They found that personal interaction between members of the two groups is the most important enabler of evidence use, and described or prescribed the importance of various bridging roles to serve as conduits between the two worlds.

For example, two systematic reviews of the factors influencing research use by health policy-makers published in the early 2000s found that, of the two dozen studies covered in each (with only a couple of overlaps), personal contact between researchers and policy-makers is the most cited enabler of evidence use, followed by the timeliness and relevance of research (Innvær et al. 2002; Hanney et al. 2003). Sandra Nutley and colleagues’ comprehensive review of the field published in 2007 also concluded that models which focus on the interaction between researchers and policy-makers ‘integrate our best current knowledge about the kinds of factors that seem to support the use of research’ (Nutley et al. 2007, p. 119). A systematic review published in 2014, which incorporates studies from across the world on a range of policy areas including health confirmed that ‘the quality of the relationship and collaboration between researchers and policy-makers’ was the single most cited factor influencing evidence use by policy-makers and other decision makers working in public policy (Oliver et al. 2014).

Work in this field has also drawn attention to the significance of ‘context’ for understanding how policy-makers use knowledge, which is by definition ‘difficult to include in a deductive theory of knowledge utilization’ (Landry et al. 2001, p. 346). The work of John Lavis and colleagues, also based in Canada, has called for greater attention to be paid to the type of policy under consideration, the different forms that ‘use’ takes, and the impact of research in the context of other influences on policy development (Lavis et al. 2002). Back in the United Kingdom, Sandra Nutley and colleagues’ 2007 review of the field also found that ‘context … seems to be the key to whether and how research gets used’ (2007, p. 89) concluding that:

Simple surveys of what seems to support or inhibit the use of research can only take our understanding of the research use process so far. This means we need to attend in more depth to the ways in which these different ‘factors affecting’ interact, in complex and dynamic ways, in complex and dynamic contexts.

(Nutley et al. 2007, p. 89)

Relatedly, Katherine Oliver and colleagues find in their recent systematic review that the relatively narrow set of methodological approaches deployed in this field (surveys or interviews, with a majority focusing on the perceptions of researchers rather than policy-makers) means that there have been ‘few studies exploring how, when and why different facilitators and barriers come into play during the policy-making process’ (Oliver et al. 2014).

So although this academic sub-field starts with simplified, rational models of research use, the conclusions of its more recent work prescribe attending to a multiplicity of actors, to the importance of interaction for research mobilisation, and to the significance of context in understanding how, why and when research is used. These authors set out an agenda for studying research use by policy-makers as a complex social process.

Research use as a social and political process

A second body of research, which has developed from and in parallel to the work described above, has been concerned with understanding the social structures and processes that shape research use by policy-makers. This work tends to be more critical and analytical than some of the early work on evidence in policy, often eschewing the rational assumptions and normative positions assumed by those authors. Instead of focusing on how to overcome obstacles to rational research use by policy-makers, these researchers have attended to the multiplicity of actors relevant to research mobilisation by policy-makers, and to querying the boundary between the ‘two communities’ of policy-makers and researchers narrowly conceived, to re-examining the form and qualities of the evidence that is the object of exchange, and to describing the various symbolic and polit...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of Illustrations
• Acknowledgements
• Introduction
• 1. Knowledge and Policy in the Literature
• 2. Knowledge Sources
• 3. Learning through Interaction
• 4. Analytical Practices
• 5. Articulating People, Ideas and Instruments
• 6. Forms of Knowledge and Knowing in Policy Work
• Appendix 1: The UK Department of Health, 2009–11
• Appendix 2: Studying Practices in Practice
• Notes
• References
• Index