Connecting governance and the front lines: How work pressure and autonomy matter for coping in different performance regimes

AuthorNina Mari van Loon,Mads Leth Jakobsen
DOIhttp://doi.org/10.1111/padm.12357
Published date01 September 2018
Date01 September 2018
ORIGINAL ARTICLE
Connecting governance and the front lines: How
work pressure and autonomy matter for coping
in different performance regimes
Nina Mari van Loon | Mads Leth Jakobsen
Department of Political Science, Aarhus
University, Denmark
Correspondence
Nina Mari van Loon, Department of Political
Science, Aarhus Universitet, Bartholins Alle
7, Aarhus 8000, Denmark.
Email: nina@ps.au.dk
Funding information
DEFACTUM, Central Denmark Region
How frontline employees cope with perceived work pressure may
be of direct influence on policy outcomes. This study contributes
to the street-level bureaucracy literature in several ways. First, we
study both passive client-oriented and active system-oriented cop-
ing. Second, we analyse how these coping behaviours relate to
work pressure and work autonomy. Finally, this article analyses
whether these relationships are conditioned by the performance
regime. Using a unique set-up of hospital employees (n= 979)
working in external and internal performance regimes, we find a
higher level of system-oriented active coping than client-oriented
passive coping. Moreover, we find that autonomy matters for
system-oriented coping and work pressure for client-oriented cop-
ing, and that these relationships are context-dependent.
1|INTRODUCTION
Frontline workers such as physicians, nurses, and teachers have an important role in shaping services such as health-
care and education. Through their decisions and actions, they enact the policies set by higher-level decision-makers.
However, conditions at the front line can be challenging as employees are exposed to various demands arising from
conflicting interests, limited resources, and high-performance expectations (Brodkin 2011; Hupe and Buffat 2014).
The literature on street-level bureaucracy (Lipsky 1980; Tummers et al. 2015) has shown that frontline workers try
to cope with perceived work pressure from such demands in various ways. Most notably, the literature finds that
frontline workers try to cope by applying what we call passive behaviours in their interaction with clients, like
creaming, rationing, and routinizing (Tummers et al. 2015).
However, the focus on the interaction with clients excludes other ways to cope with work pressure. Relating
back to Hirschman's (1970) concept of voice, some authors (Maynard-Moody and Musheno 2003; Hupe and Van
der Krogt 2013) have pointed out that frontline employees also cope by trying to change the underlying causes of
work pressure. This challenges beliefs that frontline employees have limited power to voice their concerns and lim-
ited capacity to create new solutions in ways that remove the causes of work pressure. At the same time, Brodkin
(2011) points out that the growth of performance regimes based on external goal setting and incentives has started
to squeeze outopportunities for such activecoping, as it becomes more difficult for frontline employees to affect
the causes of work pressure when these circumstances are determined externally.
DOI: 10.1111/padm.12357
Public Administration. 2018;96:435451. wileyonlinelibrary.com/journal/padm © 2017 John Wiley & Sons Ltd 435
The purpose of this article is to provide a more comprehensive understanding of frontline employees' use of
coping behaviours in the work context. Therefore, we study both passive client-oriented coping behaviours (aimed
at the interaction with the individual user without attempting to address the underlying causes of work pressure)
and active system-oriented coping behaviours (focused on the broader governance system and addressing the
underlying causes of work pressure). We aim to provide insight into how these coping behaviours relate to the gen-
eral level of work pressure and work autonomy. Moreover, we analyse whether these relationships differ between
performance regimes with a different emphasis on external goal setting and incentives.
The article thereby makes two contributions to our knowledge of frontline employees' use of coping beha-
viours. First, it sheds light on the relationship between different types of coping behaviours and their relationship
with the classical coping determinants of work autonomy and work pressure. To our knowledge, there have been
no such studies before. Second, we aim to identify how these relationships relate to performance regimes, which
are governance systems that rely on performance measurement practices (Moynihan et al. 2011). External and inter-
nal performance regimes differ in the degree to which goals and indicators are externally set and linked to incen-
tives (Pollitt et al. 2010; Jakobsen et al. 2017). As most coping studies (see overview in Tummers et al. 2015) do not
compare coping between performance regimes (Hupe and Hill 2007; Berkel and Knies 2016), there is a need for
such comparisons. Continual austerity and demographic developments (Lodge and Hood 2012; Kiefer et al. 2015)
will in the coming years create an efficiency pressure on public organizations that may increase the need for coping
(Winter 2002; Tummers and Rocco 2015; Berkel and Knies 2016).
Using survey data, we analyse the coping behaviours of frontline employees (n= 979) from 16 hospital wards
in Denmark that are embedded in either an external or an internal performance regime. We utilize a trial in which
nine hospital wards for a three-year period were exempted from the Diagnosis-Related Group (DRG) system, in
which each diagnosis is connected to specific remuneration (Busse et al. 2011). Instead, the trial wards were encour-
aged to develop new performance indicators and received a global budget (Søgaard et al. 2015).
In the following sections, we first introduce the literature on the coping behaviours of frontline employees and
the expected relationships between work pressure, work autonomy and coping. This is followed by the methods
section. Subsequently, we present the analysis and results. The final discussion and conclusion addresses the contri-
butions of this study and avenues for future research.
2|THEORETICAL FRAMEWORK
2.1 |Behavioural coping in public services
In his seminal work on street-level bureaucracy, Lipsky (1980) introduced a bottom-up approach to public adminis-
tration, arguing that the actions of those at the front lines of public service delivery are just as (or more) important
in shaping the outcomes of public policy as the decision-makers at the top. Frontline employees operate between
citizens and the state (Maynard-Moody and Musheno 2003) and must execute policies under challenging conditions
that can give rise to work pressure, such as conflicting expectations from multiple stakeholders and a gap between
the resources available and the expected quality of services (Brodkin 2011; Hupe and Buffat 2014). When these
conditions cause work pressure, frontline employees have to cope with it. Or, as formulated by Lipsky (1980,
pp. 8586, 142), coping is about the management of work stresses.
Despite the use of many different definitions of coping in the broader organizational and psychological litera-
ture (Lazarus 1991; Skinner et al. 2003), a common trait is to define coping as a reaction to work pressure.
1
Within
this broad conceptualization, there is a key distinction between emotional and behavioural coping behaviours. Tum-
mers et al. (2015, pp. 110102) have sought to make behavioural coping the key focus of public administration
1
Although there are many pressures that an individual can be exposed to outside of work, we focus here on the work situation and
pressures arising from work.
436 VAN LOON AND JAKOBSEN

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