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

Professional effects

The professional role of informality in intergovernmental relations is essential. The ‘professional’ role refers to the importance of informality in ensuring that civil servants are able to do their jobs quickly and efficiently. This speaks to the broader role of informality in bureaucracy. As Blau succinctly puts it, “…congenial informal relations between co-workers, and not completely detached ones, are a pre-requisite for efficient bureaucratic operations” (1963: 177). We can expect that one of the major effects of informal relations in the HCIWG is to allow for the speedy exchange of information, and, indeed, the above noted results of interviews with civil servants confirm this point.

All officials interviewed noted this ‘professional’ impact of informal relations. In the formal context, civil servants were constrained by their ‘official’ role as representatives of various governments or stakeholder organizations. This, in combination with the formal structure of an agenda and the time limits of official meetings, made formal meetings a poor setting for the exchange of information. It was only in informal settings that officials could relay the reasoning behind their government’s position, or could indicate how a proposal might be modified to be more acceptable, or were able to act as a go between for other jurisdictions, to name a few examples.

If the professional impact of informal relations can be summarized in word, it is speed. The speed with which the work could be accomplished was dependent on informal relations, according to officials. This was especially the case in the working group, because of its time-constrained nature. The report that emerged from the initial “hundred day challenge” would simply not happened: “If it had to be through a structured process, any kind of communication, we would not have achieved the outcomes that we achieved… So especially for time-sensitive items, where you’re under tight timelines, it’s quite important.” This was apparently the case in later work as well. Commenting on the work that was done on drug pricing, one official observed the importance of developing relationships with people working on pharmaceutical policy already:

“So, we don’t negotiate lower prices on pharmaceuticals. Our drug-plan departments do that, those folks, so building that really good, strong relationship with them, that’s critical… Because you can’t do that work by yourself, you don’t know. You don’t have that knowledge and expertise. So you can make that up, but then the program area comes up to you and says “What it this? This is nothing””

Interestingly, the development of informal relations seems to be a virtually mandatory impact of the HCIWG itself. In other words, the HCIWG would simply not function without informal relations, at least according to officials. This seems to be corroborated by the very existence of work such as From Innovation to Action. Creating that kind of document in such a short period of time required working outside the bounds of official weekly teleconferences. Personal impacts are secondary to the need for rapid, reliable exchanges of information. Informal relations turn on the issue of communication, and while happier interpersonal relationships are often the result, these are incidental.

As a result, we can conclude that, so far as the HCIWG was concerned, the impacts of informal relations on the professional component were significant. Work was accomplished and mandates were fulfilled because of the ability of civil servants to communicate efficiently and as needed. However, a consideration of informal relations inevitably brings us to the question of the broadest impact. If informality was necessary for accomplishing the work that was produced, did it have an impact on the substance of that work?