IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this paper

A comparative analysis of quality incentives in healthcare systems in england and tuscany: ‘fiduciary reputation’ rather than ‘standards and sanctions’

Listed author(s):
  • Patrick Brown

    (School of Social Policy, Sociology and Social Research; University of Kent, UK.)

  • Michael Calnan

    (School of Social Policy, Sociology and Social Research; University of Kent, UK.)

  • Milena Vainieri


    (Laboratorio MeS, Scuola Superiore Sant’Anna, Pisa, Italy)

  • Anna Bonini


    (Laboratorio MeS, Scuola Superiore Sant’Anna, Pisa, Italy)

  • Sabina Nuti


    (Laboratorio MeS, Scuola Superiore Sant’Anna, Pisa, Italy)

Governance systems which are based on assumptions of purposive-rational action have received significant criticism. For example the quality and performance frameworks of the English NHS function on the basis of incentives and sanctions, and have been critiqued in terms of both the logic on which they are run as well as the lack of evidence for their success. Yet the limitation of much of these critical appraisals is the failure to propose concrete, empirically-grounded alternatives. Thus as a means of adding to the literature, this paper seeks to perform three functions. Firstly it reviews the theoretical and empirical literature around governance in the English NHS as a basis of understanding the limitations of this ‘standards and sanctions’ system. Secondly, it will set out a theoretically grounded alternative to purposive-rational approaches based on a more normative oriented understanding of human action and the ‘civilising processes’ of moral obligation. Thirdly it will present findings from research into the governance system applied in Tuscany, Italy as evidence of the effectiveness of using the reputation of professionals and departments as a basis of facilitating quality in the absence of sanctions. Implications – for the English NHS and governance more widely – are then discussed.

If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

File URL:
Download Restriction: no

Paper provided by Scuola Superiore Sant'Anna of Pisa, Laboratorio MeS in its series Working Papers with number 200901.

in new window

Date of creation: 01 Jan 2009
Handle: RePEc:ssf:wpaper:200901
Contact details of provider: Web page:

More information through EDIRC

No references listed on IDEAS
You can help add them by filling out this form.

This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

When requesting a correction, please mention this item's handle: RePEc:ssf:wpaper:200901. See general information about how to correct material in RePEc.

For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Gaetano Esposito)

If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

If references are entirely missing, you can add them using this form.

If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

Please note that corrections may take a couple of weeks to filter through the various RePEc services.

This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.