Let's work together? How red tape influences cooperation between public actors

This paper aims to provide insight in how red tape influences cooperation between actors. More specifically, this study focuses on the degree to which red tape is related to hospital employee perceptions... [ view full abstract ]

This paper aims to provide insight in how red tape influences cooperation between actors. More specifically, this study focuses on the degree to which red tape is related to hospital employee perceptions about cooperation with General Practitioners (GP’s), municipalities and other hospitals. Cooperation between these actors is of major importance for reaching public value: good healthcare does not only depend on the received care in the hospital, but also on the prevention, signaling and accurate patient transfer of GP’s, and the care provided in the municipality nursing home. In short, cooperation between agents in the public domain is necessary to achieve public value (Agranoff 2006; Kickert, Klijn & Koppenjan 1997; Stoker 2006).

Still, in many healthcare systems cooperation between different healthcare providers is not a given. Often mentioned problems are that GP’s provide too little information in referrals, that specialists provide reports to GP’s too late and inadequate, or that no reports are provided when a patient is discharged (Bodenheimer 2008). Patients being transferred from one hospital to another need to know that their new doctor is well informed, and health outcomes depend on a good alignment of hospital care and rehabilitation afterwards. Cooperation can be hindered by structural, cultural and personal factors (van Raak, Mur-Veeman, Hardy, Steenbergen 2003; Axelsson & Axelsson 2006). Structural factors can be rules or laws preventing organizations from cooperating, but there may also be cultural or professional barriers, for example when professionals have different commitments or values interfering with good cooperation. This study focused on the role of red tape in cooperation.

Bozeman (1993) defined red tape can as ‘rules, regulations and procedures that remain in force and entail a compliance burden for the organization but have no efficacy for the rules’ functional object’ (p.283). Some have approached red tape as an objective phenomenon, others argue that red tape is ‘in the eye of the beholder’ and see red tape as a subjective concept on which stakeholders have different views. This study focuses on employee perceptions of red tape. Although self-reported, employee perceptions of rules have real impact on employee behavior and performance (van Loon 2017; Jacobsen & Jakobsen 2017). If nurses experience a high administrative burden when trying to refer a patient to municipal elderly care, they may be less likely to be able to cooperate well. Likewise, if GPs experience the rules to be dysfunctional they may feel held back in trying to work closely with the hospital. This study provides over time empirical evidence of how red tape perceptions are related to cooperation between hospital employees and municipality, GPs and other hospitals.

The data was collected in three waves from 2014 to the end of 2016 amongst hospital employees and their managers. The study looks at both the relationship over time of employee red tape to cooperation and manager red tape and cooperation as reported by their employees. Using panel data and diff-in-diff analyses trends can be identified in how changes in red tape perceptions are related to cooperation with other actors.