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

Attributes are identified to distinguish participants by certain characteristics (e.g. being above the age of 18, holding a ministerial post). Deontics imply matters that are related to moral conduct or duty; in the ADICO approach, it implies three related verbs: may, must, and must not (Crawford and Ostrom 1995: 584, 2005). AIms describe the outcome of an institutional statement. As Schlüter and Theesfeld put it: “aims tell us what to do” (2010: 448). Conditions outline the circumstances in which the aim can take place. Crawford and Ostrom (Ibid) identify “where” and “when” as the key words, while Basurto et al (2010) add “if”. Finally, Or elses outline the potential punishment for not following the rules.

If informal relations constitute ‘structured behaviour’, IAD suggests we can understand them as institutional statements. Not all institutional statements are going to be obviously structured. In fact, very rarely will institutional rules be structured in this way, particularly when we take on informal institutions. Certain components may be explicitly evident, where others may be present but unstated. In fact, those who engage in these institutional statements do not necessarily need to be aware that they are doing it (Crawford and Ostrom 2005).

When we have uncovered the institutional statements at work in an action scenario, the second part of the IAD framework involves classifying rules in a way that allows for comparison of institutional statements, that uncovers universal categories, and allows for dialogue among scholars studying different institutions (Ostrom 2005: 175). If the grammar of institutions exists to distinguish between institutional statements, the subsequent classification exists to group rules according to their institutional function. There are seven basic rules types in this framework: boundary rules, position rules, choice rules, information rules, aggregation rules, payoff rules, and scope rules (Ostrom and Crawford 2005b). The rules are each tied to specific effects on the ‘action situation’ being studied (for our purposes, the HCIWG), but not every rule will apply to every situation: certain action situations will not feature payoff rules, for example. See figure 1 for a summary of the effects.

In the context of Canadian IGR, the classification of rules using this framework allows us to understand exactly what purpose the institutional statements being uncovered serve. We can use this framework to better understand the role of informal relations in Canadian IGR, for instance by arguing that informal relations are related to choice rules but not boundary rules. The application of the AID framework therefore operates in the following way. The grammar of institutions is used to uncover informal relations as institutional statements. The institutional statements are then used to sort them according to their effect on the ‘action situation’, or in our case the Health Care Innovation Working Group. For the sake of space, I provide only a brief summary of the rules which are relevant to this analysis (however, see Ostrom 2005 chapter 7 for a full description).