Accepting Methadone: The Evolution of an Institutional Decision

This is a study of organisational decision making among senior civil servants in the Department of Health (DOH) in relation to the acceptance of methadone maintenance as a valid treatment modality for opiate misuse in Ireland. A qualitative strategy was adopted with an emergent design and grounded theory perspective. The data was collected using a naturalistic mode of inquiry and comprised of documentary analysis and semi-structured interviews. The aspects of decision making chosen for the study were: 1. Identifying the actors involved considering the heretofore dominant 'corporation sole' culture of the Irish public administration. 2. Identifying two (out of the myriad) processes involved in decision making. 3. Identifying what theoretical model(s) of decision making most closely approximates to this case. The findings were as follows: 1. Actors involved at all levels of the decision making could be identified, albeit with some difficulty. This as a result of the strategic management initiative. Previously, it may not have been possible. Stages or phases could not, in this case, be readily identified though limitations of this study may prove significant. 2. Both the processes selected in decision-making in this case were confirmed. Personal and professional support provided by peers and seniors is crucial to decision making. Decision making does occur within networks: these tend to be those that are formally appointed rather than informal ones. 3. The model closest to that of this case was that of incremental decision making within network settings.This resource was contributed by The National Documentation Centre on Drug Use.

Services standardization in the United-States and in Europe: an institutional analysis of private authority

This contribution explores the role of international standards in the rules governing the internationalisation of the service economy. It analyses on a cross-institutional basis patterns of authority in the institutional setting of service standards in the European and Amercian context. The entry into force of the World Trade Organisation (WTO) in 1995 gave international standards a major role in harmonising the technical specifications of goods and services traded on the global market Despite the careful wording of the WTO, a whole range of international bodies still have the capacity to define generic as well as detailed technical specifications affecting how swelling offshore services are expected to be traded on worldwide basis. The analysis relies on global political economy approaches to identify constitutive patterns of authority mediating between the political and the economic spheres on a transnational space. It extends to the area of service standards the assumption that the process of globalisation is not opposing states and markets, but a joint expression of both of them including new patterns and agents of structural change through formal and informal power and regulatory practices. The paper argues that service standards reflect the significant development of a form of transnational hybrid authority, that blurs the distinction between private and public actors, whose scope spread all along from physical measures to societal values, and which reinforces the deterritorialisation of regulatory practices in contemporary capitalism. It provides evidence of this argument by analysing the current European strategy regarding service standardization in response to several programming mandate of the European Commission and the American views on the future development of service standards.

Struggles for meaning and struggles for control: the diffusion of bandwagon technology in two institutional environments

In this thesis, I examine the diffusion process for a complex medical technology, the PET scanner, in two different health care systems, one of which is more market-oriented (Switzerland) and the other more centrally managed by a public agency (Quebec). The research draws on institutional and socio-political theories of the diffusion of innovations to examine how institutional contexts affect processes of diffusion. I find that diffusion proceeds more rapidly in Switzerland than in Quebec, but that processes in both jurisdictions are characterized by intense struggles among providers and between providers and public agencies. I show that the institutional environment influences these processes by determining the patterns of material resources and authority available to actors in their struggles to strategically control the technology, and by constituting the discursive resources or institutional logics on which actors may legitimately draw in their struggles to give meaning to the technology in line with their interests and values. This thesis illustrates how institutional structures and meanings manifest themselves in the context of specific decisions within an organizational field, and reveals the ways in which governance structures may be contested and realigned when they conflict with interests that are legitimized by dominant institutional logics. It is argued that this form of contestation and readjustment at the margins constitutes one mechanism by which institutional frameworks are tested, stretched and reproduced or redefined.