Abstract
This chapter will outline the theoretical perspective of the book. Since it is politicians who will eventually decide about legislation and regulation on patient/user involvement, this is the field that needs to be focused on. Given structures, context variables, key actors, and their interplay need to be taken into account in order to arrive at the proper perspective. As any theoretical perspective, the approach pursued here needs to contribute to an explanation of the empirical observation in this exploratory study. Given the peculiarities and potential variances of the respective case studies, it also needs to be highly flexible and to cover a broad range of contexts and processes. In order to achieve that, the theoretical approach of this book rests on three pillars and combines historical institutionalism with actor-centred institutionalism and ideational approaches. Based on these theoretical approaches, it is possible to design an ideal-typical policy process and to theoretically follow the case of legislation of patient involvement from cradle to implementation.
[A] student [of sociology] who has difficulty thinking of at least three sensible explanations for any correlation that he is really interested in should probably choose another profession (Stinchcombe 1968 , p. 13)
On the Day of Judgement, when all laws are known, these may suffice to explain all phenomena. But in the meantime we do give explanations; and it is the job of science to tell us what kinds of explanations are admissible. (Cartwright 1983 , pp. 51–52)
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Notes
- 1.
This holds in particular true for what he calls ‘cumulative processes’ (Boudon 1981, chap. 6), which can be paraphrased as a ‘mutually conditional sequence of actions in a long(er)-term development process’. At the same time, his understanding can be perceived a forerunner of Coleman’s (1990) famous ‘bathtub model’, sometimes also called ‘boat model’: Effects on an aggregated level can very often be traced back to individual processes based on single (individual or collective) actors (for the application on the relation between health care provider and patients between macro- and micro-level cf. Groenewegen 1995, Symposium: ‘Medische sociologie: empirisch-theoretisch onderzoek’ te Utrecht). In sum, they shape macro processes. In addition, it bears, in part, reminiscence of Kuhn’s ‘scientific revolutions’ (Boudon 1981, p. 89; Kuhn 1976).
- 2.
‘Case studies may uncover or refine a theory about a particular causal mechanism—such as collective action dynamics—that is applicable to vast populations of cases, but usually the effects of such mechanisms differ from one case or context to another’. (George & Bennett 2005, p. 31).
- 3.
Beyond this consensus, Hedström and Swedberg and Elster are in disagreement on the actual goal. Whereas Elster states laws to be the goal (‘Although it is difficult to establish laws in the social sciences, that goal will always, for better or for worse, continue to guide scholars’. (Elster 1998, p. 62)), Hedström and Swedberg view laws in the social sciences as rather impossible, a stance, I would endorse.
- 4.
This holds true for any functionalist approach, too, as Rothgang et al. (2012, pp. 187–188) amongst many others rightly argue: Whereas functional deficits are sufficient for a description of change for many authors, they fail to address the mechanisms and time variable that can be of crucial value to the explanation of changes.
- 5.
While Mayntz and Scharpf (1995, pp. 60–65) argue for a number of more analytical options—abstraction from reality, network analysis, and game theory—a later version only deals with the lastmentioned (Scharpf 1997, pp. 69 et seq.). Due to the quality and kind of data, however, the structure of actor-centred institutionalism described so far needs to suffice, as the game theoretical reflections undertaken by Scharpf (1997) are impossible to conduct in this study.
- 6.
This also becomes apparent in the concepts used: The ideational approach knows its equivalent for ‘path dependency’, too, in that new ideas are still associated with higher costs and ‘need to prove its adequacy and suitability’ and that institutions help to form and change ideas (Hirschman 1991; Münnich 2011, pp. 490–491; Sikkink 1993, p. 26), is described as ‘incrementalism’ (Kingdon 2003, p. 79); or in that actors are described to be ‘rhetorically entrapped’ (Schmidt 2008, p. 312). ‘Path break’ or ‘path departure’ can be translated into ‘paradigm shift’. The ‘window of opportunity’, one of the standard concepts in institutional analysis, is called ‘policy window’ or substituted by highlighting the importance of timing (Kingdon 2003, pp. 166–169). Further similarities are that it is sometimes explicitly referred to the line of erratic, pragmatic, rationalistic, and institutional argumentation (Kingdon 2003, pp. 14–15). This includes a subjective perception, using arguments to the actors’ advantage, taking strategic considerations into account. The underlying claim, here, is that, similar to the rational choice reasoning, actors are goal-conscious about what they want to achieve (Maier 2003, p. 29). As will be shown in the subsequent section, the assumption, however, that the perception of actors and objective givens coincide will be challenged in this book (on that assumption cf. Maier 2003, p. 46).
- 7.
The solution hitherto applied—poor houses or poor relief to tackle poverty—was no longer perceived to be convincing, as sickness and illness were finally understood as one major cause of poverty. In consequence, the policy goal, instruments, and the self-image of the state changed: The state took the role of a regulator (as an early measure, for instance, set minimum quotas for physicians), an enabler, in some countries even as a provider of health care. This step from the state as the mere administrator of citizens and, specifically in times of war, user of citizens as a resource to a state that also takes care of its citizens occurred in various points in time for different countries and with slightly different reasons (cf. Cohn 1992:2, pp. 37, 89 et seq.; Immergut 1990, p. 394; Kuhnle 2000; Mathisen 1993, pp. 76, 129; Qvarsell 1991, p. 209; Ritter 1983, 1998; WHO 1996, p. 3).
- 8.
This is the more valid, since there are many issues that are left unclear regarding the change of policy paradigms: We do not get to know any hypotheses about the length of period of the process (is it a short event? can it stretch over several years?), the group of people (which group(s) of actors need to accept a shift of policy paradigms?), nor about their relative share that is needed to speak of a shift of paradigms (is it the acceptance by one key group or is a relative majority of groups or citizens needed?). A working suggestion is that similar to path dependency and path breaks the process of shifts might take a longer period of time, so that it is the final result that counts. As we are dealing with legislation processes, I would suggest that winning over the majority of decision makers is what counts, who, in turn, might be influenced by other actors. It might, however, be just as well argued that it is the societal reality which counts, which would imply that a bad implementation of involvement rights might not bring about a new paradigm in societal life or provoke a change in policy paradigms, when larger parts have shifted without a shift in the legal basis. It is, thus, a matter of what level and what group in society is focused on.
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Haarmann, A. (2018). A Theoretical Framework for the Study. In: The Evolution and Everyday Practice of Collective Patient Involvement in Europe. Springer, Cham. https://doi.org/10.1007/978-3-319-64595-7_3
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