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Often linked to the New Public Management (NPM) doctrines, agencification has been on the priority list of policy makers for over two decades. This article proposes an analysis of the role of agencies in the French health system and the impact of government agency reform on physicians and the public.

The research analyzes the perceived implementation of a re-concentration of decision-making powers within public agencies as the declared goal of agencification at the French health care system, specifically primary care providers and hospitals. The assessment relies on secondary sources from ministerial bodies such as the Ministry of Health and Social Affairs, the Ministry of Labor, the Social Security and the General Accounting Office, and specialized French technical agencies.

Decentralization in France and the subsequent rise of public health care agencies had outcomes below expectations. Hence, a re-concentration of decision-making powers within the larger Regional Health Agencies; a streamlining of the public administration; and a re-appropriation of decision-making powers by the Ministry of Health are needed. The monitoring of health providers allows central health authorities to govern at a distance.

The analysis of health care agencies in France and of their use of efficiency-enhancing techniques may trigger a change of values within the medical profession.

The study compares the social services functioning in two local contexts, one urban and one rural, in the same Italian region, to understand how contextual features affect frontline workers' work.

By applying the framework of the street-level bureaucracy theory (SLB) and proposing a framing of the spatial contexts under analysis, the present study adopts a qualitative approach. In particular, semi-structured interviews were conducted among street-level workers, decision-makers and privileged witnesses.

The study shows how the typical features of the rural and urban Italian contexts analyzed impact differently on the working conditions of frontline workers, leading to substantive differences in the possibility of exercise their role at the street-level.

The article contributes to a wider understanding of social services provision in a highly fragmented system like the Italian one by taking into consideration contexts that are usually little investigated in SLB and welfare studies in the Mediterranean Europe area: those rural and, in particular, those belonging to the so-called “inner areas”.

The study compares how distinct mechanisms that connect pre-established policy objectives to professionals' practices, and the health policy implementation context influenced different approaches to frontline staff participation. The authors analysed 26 teams in six cities from two Brazilian states, during the last cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ).

About 172 in-depth interviews were conducted with frontliners – community health workers (78), nurses (37), doctors (30) – and managers (27). Interview guides were based on key issues identified in the implementation and pay-for-performance (P4P) literature. Drawing on thematic analysis and synthesis of the literature, three types of participation mechanisms were identified: relational, motivational and incremental learning. They were analysed considering distinct contexts at the local level to understand how they influenced different forms of participation: mere adherence, result-oriented and transformative.

Administrations with stronger institutional organizational structures were able to control work processes and reduce professional discretion. However, sustained participation was more likely where there was greater integration between management and frontline health care teams. Motivation based only on financial incentives could not bring about transformative participation. This depended on the degree of professional's ideational motivation towards primary care. Finally, contexts with unfavourable working conditions tend to demotivate professionals, but incremental learning helps teams cope with these obstacles.

The study overcomes gaps in the literature in relation to PMAQ's implementation process. Overall, the study delves into which/how mechanisms alter frontliners participation in performance-oriented health programs.

With the soaring rise in popularity of social media platforms in recent decades, the use of website posts for the expression of work-related views has also increased. Despite websites being extensively used, there has been no examination of the views and concerns expressed by frontline workers through website posts. The present research aims to contribute to the “voice literature” first by evaluating how frontline workers utilize anonymous media platforms to express their views and work-related concerns and, second, by demonstrating how anonymous voice systems can encourage frontline health workers in providing feedback and dissatisfaction.

The study utilizes the thematic analysis method to analyze the content of posts by psychologists on a collaborative consultation website administrated by Israel’s Ministry of Health, discussing their perceptions of work-related concerns.

The analysis identified three work-related themes through the employees' voices. These include insufficient support from management, conflicts and excessive occupational demands. The workers expressed their apprehension with regard to organizational pressures, deficient budget allocations, excessive workloads, lack of recognition and work–life imbalances.

The application of thematic analysis method to anonymous open-public data should be viewed as an effective, affordable, genuine and unique research method for data analysis. Anonymous platforms can generate unique insights that may not be possible through traditional means. This can provide practitioners with a comprehensive understanding of various issues and challenges and be a useful tool for identifying shortcomings within health settings.

Village health volunteers are community health volunteers in Thailand that have helped the government deliver public health services for many years, particularly during the coronavirus disease 2019 (COVID-19) pandemic. Though labeled as “volunteers,” the village health volunteers are recruited, trained and supervised in a manner similar to how a government agency recruits, trains and supervises its street-level bureaucrats (SLBs). This study examines the two factors that affect how these street-level quasi-bureaucrats use their professional discretion: transformational leadership and public service motivation (PSM). Transformational leadership means a leadership style that develops, shares and sustains a vision to elevate SLBs to higher levels of performance, while PSM is defined as an SLB’s predisposition to make a difference by working in the public sector with a sense of calling. This study attempts to analyze the mediating role of psychological empowerment in the relationship between transformational leadership, PSM and professional discretion.

The paper uses a three-wave survey-based quantitative method to avoid common method biases. This method provides evidence gathered from 105 subdistrict health promotion hospitals and 798 village health volunteers (VHVs) in five provinces in Thailand.

PSM and transformational leadership influence the village health volunteers' use of professional discretion indirectly through the psychological empowerment mechanisms that make them feel positive toward their village health volunteer role and responsibility. The authors' findings suggest that the hospital directors' transformational leadership induces the village health volunteers' use of professional discretion by making them feel competent to do their work and feel fulfilled and valuable about their work. Similarly, the village health volunteers' PSM leads them to use professional discretion by making them feel fulfilled and valuable and by convincing them of the social and community impact of their work.

While existing research focuses on VHVs' role in alleviating capacity constraints on the health care system, this study revealed an equally important role played by hospital directors. These directors' transformational leadership was instrumental in enhancing VHVs' psychological empowerment – particularly their perceptions of the meaning of their work and their competence – that ultimately enabled them to use professional discretion in their work. This study also highlighted the importance of VHVs' PSM, which leads to their use of professional discretion via the meaning and impact dimensions of psychological empowerment. Based on this study, PSM should also be incorporated into the community health volunteers' recruitment criteria. Also, public health agencies should consider including transformational leadership in the hospital directors' training programs and their promotion criteria.

As VHVs' high-PSM level was found to enhance their professional discretion, the process of recruiting ordinary citizens to serve as community health volunteers should incorporate assessment of the candidates' PSM. Also, the Ministry of Public Health should design and assign tasks that citizen volunteers, particularly VHVs, consider meaningful and at which they feel competent.

Aside from technical training, directors of the subdistrict health promotion hospitals should regularly receive soft skill training (i.e. leadership training) and transformational leadership characteristics should be included in the government criteria for promotion.

While past research has examined the impact of other leadership styles on psychological empowerment, this study took a further step by examining the mediating effects of psychological empowerment on the relationship between transformational leadership and professional discretion among VHVs. The authors analyzed the mechanism linking PSM to the VHVs' professional discretion. In addition, by examining the relative importance of different dimensions of psychological empowerment, this study offers a nuanced understanding of the psychological processes by which transformational leadership and PSM shape the SLBs' use of professional discretion in their work.

This study aims to identify the street-level approaches of professional workers in complex public social service organisations when attending to social assistance claimants.

The study employed a multifaceted approach comprising documentary analysis, semi-structured individual interviews (17) and focus group discussions (8) with qualified frontline social workers from primary care social services in Tarragona.

Social workers embodied three specific sets of cognitive, normative and emotional dispositions when attending to people with low incomes. First, the compassionate approach conceives clients as defensive regarding social services and emotionally vulnerable because of deprivation. Second, the instructional approach frames clients as being baffled by a new, precarious, institutional and economic context. They also lack information, abilities and the proper mindset to conceive of and attain available welfare and occupational resources. Third, the enforcement approach tends to define clients as suspicious, trying to obtain an excessive and unfair advantage of the welfare system that would eventually hamper their social opportunities.

Research thus far has tended to define public social assistance programmes in Southern welfare state contexts as mostly inefficient and hardly relevant residual social policies. The street-level approach shows that social workers try to resist the mere administrative processing of benefits, which is a professionally troubling and organisationally unsustainable way to proceed. They attempt to help clients by providing inclusive content in order to implement their benefits.

This research addresses the professional logics of street-level managers (SLMs) and bureaucrats (SLBs) working in the Brazilian National Social Security Agency (INSS) through their perceptions of distributive justice and discretion. Since SLMs have the authority to influence SLBs' actions, we investigate whether these two groups hold similar viewpoints.

We integrate the administrative data and survey responses (n = 678) with earlier thematic content analysis (n = 350) in three stages: mean-testing, regression analyses and complementary qualitative analysis, integrated through a mixed-methods matrix.

Whilst no significant differences emerge in distributive justice ideas between groups, SLMs demand wider benefit-granting discretion, praising professionalism whilst adopting managerial posture and jargon.

The study adds to the theoretical discussions concerning SLM’s influence on SLB’s decision-making, suggesting that other factors outweigh it. The finding concerning the managers’ demand for wider discretion asks for further in-depth approaches.

Findings supply valuable insights for policymakers and managers steering administrative reforms, by questioning whether some roles SLMs play are limited to symbolic levels. Further, SLBs’ heterogenous formations might be more relevant to policy divergence than managerial influence and perhaps an underutilised source of innovation.

By approaching street-level management professional logics within a Global South welfare state through a mixed-methods approach, this study offers a holistic understanding of complex dynamics, providing novel insights for public sector management.

The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs).

The analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors.

Interpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically.

The study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality.

Following the ‘Sarkozy’ era (2007–2012), France has engaged in ‘zero-tolerance’ policies, which have brought an increasing number of people into the criminal justice system (CJS). In an already extremely impoverished CJS, these policies have led to serious financial problems and have made an already existing prison overcrowding problem worse. Consequently, the CJS has gradually opted for a McDonald (Ritzer, 2019; Robinson, 2019) type of offender processing, whether in prosecutor-led procedures (representing roughly half of all penal procedures: Ministry of Justice, 2019) or in the sentencing phase (Danet, 2013). A similar trend has been found in probation and in prisoner release (in French: ‘sentences’ management).

The prison and probation services, which merged in 1999, have since then been in a position to benefit from the 1958 French Republic Constitution, which places the executive in a dominant position and notably allows it to draft the bills presented to a rather passive legislative power (Rousseau, 2007) and even to enjoy its own set of normative powers (‘autonomous decrees’ – Hamon & Troper, 2019). By way of law reforming (2009, 2014, and 2019 laws), the prison and probation services have thus embraced the McDonaldisation ethos. Their main obsession has been to early release as many prisoners as possible in order to free space and to accommodate more sentenced people. To do so, the prison services have created a series of so-called ‘simplified’ early release procedures, where prisoners are neither prepared for nor supported through release, where they are deprived of agency and where due process and attorney advice are removed. Behind a pretend rehabilitative discourse, the executive is only interested in efficiently flushing people out of prison; not about re-entry efficacy. As Ritzer (2019) points out, McDonaldisation often leads to counter-productive or absurd consequences. In the case of early release, the stubborn reality is that one cannot bypass actually doing the rehabilitative and re-entry work. I shall additionally argue that not everything truly qualifies as an early release measure (Ostermann, 2013). Only measures which respect prisoners’ agency prepare them for their release, which support them once they are in the community, which address their socio-psychological and criminogenic needs, and which are pronounced in the context of due process and defence rights truly qualify as such. As it is, French ‘simplified’ release procedures amount to McRe-entry and mass nothingness.