‘Real-world’ priority setting for service improvement in English primary care: a decentred approach

Kislov, Roman ORCID: https://orcid.org/0000-0003-2525-7673, Checkland, Kath, Wilson, Paul M and Howard, Susan J (2023) ‘Real-world’ priority setting for service improvement in English primary care: a decentred approach. Public Management Review, 25 (1). pp. 150-174. ISSN 1471-9037

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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.