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

Framing informal relations

The issue of informality in intergovernmental relations is, in some sense, a return to the classic tension between structure and agency. As a result of this challenge, neo-institutionalist theories (which emphasize the role of institutions) were forced to try and bring agency into the picture. Rational choice institutionalism was one such attempt, and an offshoot of that was the Institutional Analysis and Development framework developed by Elinor Ostrom and others. The basic premise of IAD is that human interactions can be understood by breaking down their components and understanding exactly what purpose they serve. This is done in two steps.

The first comes through the ADICO framework. In a widely cited paper, Crawford and Ostrom (1995) suggest a way of understanding institutions (defined as “enduring regularities of human action in situations structured by rules, norms, and shared strategies, as well as by the physical world” [582]). They focus on ‘institutional statements’: “Institutional statement refers to a shared linguistic constraint or opportunity that prescribes, permits, or advises actions or outcomes for actors… Institutional statements are spoken, written, or tacitly understood in a form intelligible to actors in an empirical setting.” (Ibid: 583). This approach to looking at institutions encompasses rules, strategies and norms. If institutions are perceived as ‘statements’, then they can be broken down into their component parts in the same way that a sentence can be deconstructed into linguistic building blocks. To do so, Crawford and Ostrom suggest a ‘grammar of institutions’, which has five components: Attributes, Deontics, AIms, Conditions, and Or else (ADICO).