ABSTRACT

This article develops an analysis of population-level priority setting informed by Bevir’s decentred theory of governance and drawing on a qualitative study of priority setting for service improvement conducted in the complex multi-layered governance context of English primary care. We show how powerful actors, operating at the meso-level, utilize pluralistic and contradictory elements of complex governance networks to discursively construct, legitimize and enact service improvement priorities. Our analysis highlights the role of situated agency in integrating top-down, bottom-up and horizontal influences on priority setting, which leads to variation in local priorities despite the continuous presence of strong hierarchical influences.

摘要

本文根据 Bevir 的去中心化治理理论对人口层面的优先级设置进行了分析，并借鉴了在英国初级保健的复杂多层次治理背景下进行的服务改进优先级设置的定性研究。我们展示了在中观层面运作的强大参与者如何利用复杂治理网络的多元和矛盾元素来讨论构建、合法化和制定服务改进优先事项。我们的分析强调了情境机构在整合自上而下、自下而上和横向对优先级设置的影响中的作用，尽管持续存在强烈的等级影响，这导致当地优先级发生变化。