Puzzling about problems the ambiguous search for

Authors: AnnCharlotte Nedlund Peter Garpenby

Publish Date: 2014/04/27

Volume: 47, Issue: 4, Pages: 367-386

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Abstract

This paper focuses on problem frame differences among actors members of an advisory body senior administrators and clinical unit managers who are concerned with the introduction of new health technology at the regional level in Sweden It explores issues related to problem framing puzzling powering participation and the various rationales articulated in the ambiguous search for an evidencebased strategy to handle the influx of new technologies The Health Technology Advisory Committee HTAC was established in one Swedish county council in 2004 with the intention of controlling both the introduction of health technology and supporting policy decision and clinical practice by promoting the use of best evidence The HTAC followed a scientific rationality dominated by one problem frame although the problematic situation as it was framed by all the actor groups was highly complex and not solely a matter of evidence This paper illustrates how problem frame differences shape the puzzling of a policy problem and how the different distinguishable policy styles are dependent on who is participating and who is not participating in the puzzlingThe article is based on research supported by the Vinnvård Research Program Grant no A2008017 INTEGRAL and by the County Council of Östergötland SwedenThe Informants are acknowledged with gratitude The authors also thank the organizers and the participants at the panel Evidence and Meaning in Policy Practice at the Interpretive Policy Analysis Conference 2012 in Tilburg as well as the three anonymous reviewers for helpful comments and suggestions on earlier drafts

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