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Author: Duco Bannink

This chapter presents a theoretical framework in which modes of multilevel governance are outlined that differ in two dimensions, The following section discusses the regulatory context of decentralised integration of Dutch social policy. It then considers the outcomes of decentralised interaction in these social policy domains.

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Collaboration has become an imperative of many new healthcare policies; however, little attention has been paid to how system-level narratives in both policy documents and the media create boundaries that shape implementation processes. By using boundary work as a theoretical lens, this article critically analyses the discourse found in both policy documents and the media surrounding the 2015 Dutch LTC reform. This discourse analysis contributes, first, by revealing two separate narratives – one epic, one tragic – which we argue represent different rhetorical styles used to (de-)legitimise symbolic boundaries. Second, we contribute by unravelling boundary work in both the social and symbolic dimensions to show how the design of the 2015 reform led to a tension-ridden position for local actors: symbolic boundaries demanded integration, while social boundaries imposed differentiation. These findings have implications for literature on boundary work as well as for policy design and its local implementation.

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Street-level bureaucrats do their work in different contexts and these contexts pose different control challenges. This study distinguishes two context variables: complexity and ambiguity. When ambiguity and complexity are simultaneously high, managers face a double control challenge - achieving both the expertise to address high complexity and the alignment to overcome high ambiguity. Traditional control mechanisms, enforcement, incentives or competence control, fall short. Using evidence from a wide cross-section of street-level tasks (42 cases), this study provides support for the claim that the double control challenge in contexts of simultaneously high complexity and high ambiguity is important in street-level bureaucracies and that it is difficult to devise a response. Usually one of the challenges is simply ignored. Where a response to both control challenges is devised simultaneously, tensions occur because some of the mechanisms conflict with each other. We found very few organisations that have found appropriate solutions.

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