Almost Like a Play’: Discretion and the Health Care Innovation Working Group Emmet Collins



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What are the effects?



The effects of informal relations can be difficult to discern. Without direct access to negotiations over time, a researcher is forced to rely on other sources of information, namely, the accounts of the practitioners themselves. This has potential pitfalls, however, since practitioners may misremember events, or present skewed accounts. This applies when we consider the impacts that informal relations have on the working group writ large. Because informal relations are intangible, their effects are not evident. While certain interview subjects made statements such as “informal relations account for 50% of my work”, these were obviously meant as approximations.

Overcoming the issue of relying on a second hand account is possible if we consider a few separate questions. First, does the account match that of other participants? If many officials are making the same points, they likely have some basis in truth. Second, does the account have external corroboration? That is to say, is there other evidence to support it? This becomes important when we consider the tangible results of the HCIWG’s work. As we shall see, evidence (or a lack thereof) can make an important point about the impacts of informal relations. The impacts of informal relations can be categorized in three general ways. The first deals with the personal impacts, the second with professional impacts, and the third with policy impacts.




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