Behind Smoke and Mirrors. A Political Approach to Decoupling

Abstract

In this paper, we examine neglected dimensions of decoupling, i.e. its power and political aspects. We draw on an empirical study of the reaction of two hospital subunits and an external agency (the Regional Health Agency) to a policy implementation, to contribute to the recent renewed interest in decoupling. We first reconsider the distinction between internal and external actors, by investigating how they interact in their responses to the new policy implementation. Observing different decoupling forms, we show how power and politics allow to understand how these forms are articulated and related. Furthermore, we highlight that contexts characterised by institutional complexity are especially propitious for decoupling. Finally, we outline that how actors use logics to justify their claims might differ significantly from how they enact those logics. More broadly, this paper contributes by bringing back power and politics into the analysis of institutional processes.

Keywords: decoupling, healthcare management, power dependence theory, institutional theory, agency

JEL Classification: M49