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

Conclusion
The Health Care Innovation Working group was established partly in response to federal unilateralism as a way of demonstrating the ability of the provinces and territories to work collaboratively. While it produced an initial set of recommendations in short order, and has since moved on to other areas, little has emerged from the HCIWG in the way of documents or results. In terms of the working level, the HCIWG represented a unique opportunity in its inclusion of external health stakeholders, at least initially. It also operated in an atmosphere of limited resources, limited time, and very little in the way of formal institutionalization, which created an atmosphere where informal relations were necessary. Simultaneously, however, it also operated under well-established political mandates, which limited the role of informal relations and the exercise of discretion.

The parameters of informal relations in the HCIWG fit the expectations of the research. Informal relations occurred in and around the formal aspects of IGR, which tended to revolve around written documents. In this regard, the HCIWG was apparently no different from other examples of Canadian IGR. The biggest difference with the working group was the inclusion of external stakeholders, but the effects of this inclusion were more obvious to those stakeholders than to government officials. Inclusion of external stakeholders required a concerted effort, and after an initial flurry of activity the working group returned to intergovernmental business-as-usual. This returned external health provider groups to the periphery of IGR negotiations, where they were consulted after the fact rather than being included in an ongoing manner.

The effects of informal relations on the Health Care Innovation Working Group, or rather the limits of these effects, can be understood by referring to the ‘rules of the game’ as suggested by the IAD framework. On the personal level, good interpersonal relations both resulted from ongoing informal relations and facilitated further informal relations. This was true at the level of officials and external provider groups. These good interpersonal relations were related to an informal ‘rule’ of open and honest information sharing. This was in turn related to the need for efficiency. Since ‘formal’ channels are inadequate, irregular and slow, officials often turn to informal channels to speed matters up by sharing or requesting information as necessary. Boundary rules come into effect here as well. Because IGR does not, by default, include room for external actors, their participation requires continued and deliberate effort on the part of government officials. Finally, the policy effects of informal relations at the level of officials are limited by the aggregation rules at work in Canadian federalism and, in a related way, by the position rules. Put simply, intergovernmental officials are representatives of their governments, and generally do not have the necessary influence to effect substantial policy change. Thus, informal relations are useful to the extent that they help a government achieve its goals, but they do not change those goals, at least in the case of the HCIWG.

This paper does not stand completely at odds with the work of Inwood et al (2011) or Dupré (1985), who argue that informal relations form a crucial part of IG work in Canada. This assessment is correct to an extent. However, it is an argument that needs to be supplemented by a broader understanding of IGR. Informal relations do matter. They speed up and, indeed, even enable the work being done by officials. That said, they are constrained by systemic factors. The centralization inherent in Canadian government and the drive to maintain autonomy create certain unavoidable realities for officials working in IGR. The network of informal relations in the HCIWG also appears to reflect the insularity of IGR work. Creating room for external participants requires concerted effort. In sum, informal relations ‘work’ within particular parameters. Changes to those parameters would likely change the effectiveness and the impacts of informal relations.