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

Professional impacts

As the professional impacts of informal relations hinged on communication and information exchange, information rules are the most logical rules to identify. Ostrom and Crawford observe that these rules authorize channels of communication, obligate, permit, or prohibit information exchange, and establish the form and the frequency of such an exchange (2005: 206). In the HCIWG, officials have a great deal of leeway in the application of information rules. While there are formal communication channels, the informal channels are ultimately created, maintained, or terminated at the discretion of working officials. While officials did not identify any one ‘information rule’ as governing this informal exchange, careful study of interview transcripts suggests two basic information rules. First, because formal channels are inadequate, government officials should communicate frequently with their counterparts so that they have the necessary information to move forward with their work. Second, government officials who communicate honestly and openly can expect reciprocation from their counterparts. While this second rule is arguably linked to the personal realm, it is also essential in ensuring a steady flow of information.

It may be observed that the previously noted rules dealt only with government officials. This was a deliberate choice, and raises a subsequent set of rules: boundary rules. As noted above, there are differences in how different people may participate in the HCIWG. While there are important differences between a minister and an official, I argue that the difference between governmental participants and external participants is even starker and relate to the boundary to entry. Government officials always have a seat at the IGR table. External stakeholders are only present at the invitation of government. Moreover, their participation continues to depend on the willingness of government to have them over time. This is evident in the HCIWG, which initially saw very active participation from external stakeholders in the first year, but less participation as time went on. Some officials, and most stakeholders, felt that this was a return to standard procedure. This can be formulated as the following boundary rule: as a default, there is no room for external participants in IGR.

The effects of this boundary rule on the professional impacts of informal relations are clear. External stakeholders are not default participants in IGR. Because the IGR framework is not built to accommodate external participants, establishing and maintaining productive communication takes extra effort. As time went on in the HCIWG, and stakeholder groups became disillusioned with the results of their efforts, their participation diminished, both as a result of their own disinterest and as a result of a lack of interest on the part of government. Maintaining a high level of participation for such external groups would have required an active effort, since it went against the norm of Canadian IGR. In the HCIWG, this appears not to have occurred.

The professional impacts of informal relations can be understood by referring to information rules and boundary rules. The inadequacy and slowness of formal channels require that information be exchanged through informal channels. However, these channels are more easily created at the level of officials. Informal relations in the HCIWG have the effect of speeding up communication because they have to, but this effect is largely limited to governmental participants.