How healthcare states matter: Comparing the introduction of clinical standards in Britain and Germany

Abstract

Purpose

This paper aims to identify variation in the introduction of New Public Management reforms in healthcare and how this variation is related to country‐specific healthcare states.

Design/methodology/approach

The analysis uses the introduction of clinical standards in Britain and Germany as cases. The two countries are characterised by interesting differences in relation to the institutional set‐up of healthcare states and as such present ideal cases to explore the specific ways of how healthcare states filter clinical standards as tools of a generic managerialism.

Findings

Both countries have introduced clinical standards but, importantly, the substantive nature of clinical standards differs, reflecting differences in initial institutional conditions. More specifically, in Britain clinical standards have taken the form of two parallel policies, which strengthen hierarchy‐based governing and redefine professional self‐regulation. In Germany, by contrast, clinical standards come in one single policy, which strengthens the hybrid of network‐ and hierarchy‐based governing and to some extent also pure hierarchy‐based forms of governing.

Originality/value

First, with its cross‐country comparative focus, the analysis is able to identify systematic variations across healthcare states and the specific ways in which they impact on the introduction of New Public Management. Second, with its focus on clinical standards, the analysis deals with the governance of medical practice as one of the central areas of healthcare states.

Citation

Burau, V. and Fenton, L. (2009), "How healthcare states matter: Comparing the introduction of clinical standards in Britain and Germany", Journal of Health Organization and Management, Vol. 23 No. 3, pp. 289-303. https://doi.org/10.1108/14777260910966726