Extending the Role of Institutional Design in Lean Collaborative Governance under Extreme Conditions: Emergency Medical Service Provision in the UK

Process models of collaborative governance assume stages before and during the collaboration. The first stage of initial conditions (Bryson et al., 2006), also referred as problem setting processes (McCann, 1983), coalition building (Waddock, 1989), formation of partnerships (Selsky and Parker, 2005) and starting conditions (Ansell and Gash, 2007) influence significantly the relationship, the collaboration process and the outcomes. The absence of initial conditions as a distinct stage requires reconsidering the role of institutional design and its function as a tacit stage substituting for initial conditions. Setting up clear rules of participation, levels of inclusiveness/exclusiveness and transparency (Ansell and Gash, 2007) by design minimises the resource-intensive requirements of relationship building. With starting conditions absent and cases of high institutional diversity, shared understanding is largely assumed rather than gradually developed. Uncovering how the collaborative governance operates under such extreme conditions can provide significant insight to inform collaborative governance implementation across all policy areas.

Our study shows Emergency Medical Service (EMS) provision in the UK operates with shared ground rules that are part of the institutional design conditions (Ansell and Gash, 2007) with minimal or absent initial conditions. We focus our investigation on instances of cross-sector collaboration without starting conditions, representing maximum institutional diversity of collaborative governance. This includes diverse network of EMS provision covering services that operate on the 1) road, 2) sea, 3) air and 4) caves/mountains, and within public, non-profit and private sectors. By comparing cases (Yin, 2014) across the types of provision, we map complementarities and coordination failures in the delivery of collaborative outcomes within conditions of high institutional diversity. We examine the level of interdependence and coordination and the role of shared sector-based values as a way to align operational purpose.

Our research contributes to the study of collaborative governance a lean model that connects the collaboration process with the outcomes under minimum initial conditions and in situations of high institutional diversity where operational procedural legitimacy is critical. The research indicates best practices and important gaps in operational legitimacy due to assumptions about shared operational protocols. It also uncovers opportunities for institutionalising cross-sector collaboration in EMS in the UK by extending the scope of the collaboration to increase capacity. Mounting governance challenges in cases of emergencies and disasters suggest that operating on minimum assumptions and identifying cost-effective pathways for the delivery of public value can prove significant in saving resources and lives. Our study suggests that extension to the scope of collaborative governance on the basis of shared values and collaborative protocols that are inclusive and transparent may help.