FROM RED TAPE TO WHICH PERFORMANCE RESULTS? EXPLORING THE RELATIONSHIP BETWEEN RED TAPE AND VARIOUS DIMENSIONS OF PERFORMANCE IN HEALTHCARE WORK UNITS
| Author | NINA M. VAN LOON |
| DOI | http://doi.org/10.1111/padm.12294 |
| Date | 01 March 2017 |
| Published date | 01 March 2017 |
doi : 10. 1111/p adm .12294
FROM RED TAPE TO WHICH PERFORMANCE RESULTS?
EXPLORING THE RELATIONSHIP BETWEEN RED TAPE
AND VARIOUS DIMENSIONS OF PERFORMANCE IN
HEALTHCARE WORK UNITS
NINA M. VAN LOON
Decades of research on red tape have still to provide nal answers as to whether red tape reduces
performance. This may be due to not distinguishing the different dimensions that public service
performance consists of. Shifting the focus to rules and their characteristics, this study analyses how
the degree of compliance burden and lack of functionality of rules relatesto overall and dimensional
public performance. Building upon the argument that red tape reduces resources and motivation
and by doing so inuences performance, hypotheses are put forward regarding the relationship to
performance. Using red tape reports from employees in 49 work units and performance rated by
the supervisor, this study shows that performance is at its lowest when the rules have a high com-
pliance burden and lack functionality. Moreover, the dimensional analyses show that compliance
burden may be most detrimental for output, whereas lack of functionality reduces responsiveness
and democratic outcomes.
INTRODUCTION
Reducing red tape is high on the agenda of policy-makers, based on the belief that red tape
is harmful to the performance of public organizations, and reducing it would increase
efciency (Gore 1993; Brewer and Walker 2010). Red tape can be described as rules that
entail a compliance burden but have no functionality for the purpose of the rule (Bozeman
1993). In practice this means that nurses may have to register redundant information on
patients or need to follow procedures that are not applicable to the patient at hand. Doing
these unnecessary acts may not only take up resources such as time, it may also demotivate
employees wanting to do their work well (Moynihan and Pandey 2007; Brewer and Walker
2010; Jacobsen and Jakobsen 2016), in the end leading to decreased performance.
However, an important gap in research remains as there is a lack of theory and evi-
dence on the relationship between red tape and performance. Twoissues are of particular
concern. First, the concept of red tape has been difcult to study empirically due to con-
ceptualizing red tape by its consequences by asking about rules that negatively affect
the organization’s effectiveness (Rainey et al. 1995; Scott and Pandey 2005; Borry 2016).
Disentangling red tape from its consequences on performance is a prerequisite to study-
ing any effect of red tape on performance. Feeney (2012), for instance, demonstrates that
when using a general red tape measure respondents tend to reect on rules that reduce
effectiveness, but do not consider other legitimate purposes of rules such as equity or
accountability.
In this study, red tape is conceptualized using Bozeman’s (1993) denition as a starting
point. Red tape is dened as rules that are (a) burdensome and (b) lack functionality for
the purpose of the rule (Van Loon et al. 2016). Rules regardingpatient registration may be
burdensome, but if they serve a purpose – such as ensuring equity or accountability – we
cannot conclude that they are red tape. Such a reconceptualization also means that the
Nina M. van Loon is at the Department of Political Science, Aarhus University,Denmark.
Public Administration Vol.95, No. 1, 2017 (60–77)
© 2016 John Wiley & Sons Ltd.
RED TAPE AND PERFORMANCE 61
rules are to a certain degree burdensome or lack functionality, as opposed to being red
tape or not. The empirical question then becomes whether a higher degree of these rule
characteristics leads to lower performance.
Second, the few studies that have aimed to provide more insight into the relationship
between red tape and performance are inconclusive. Studies using red tape and perfor-
mance as reported by the same respondents are at risk of common source bias (Jakobsen
and Jensen 2015). In addition, studies have barely accounted for the multidimensionality of
performance, whereas the notable exception showed that red tape had differentialrelation-
ships to dimensions of – self-reported – performance (Brewer and Walker2010). To Gore’s
(1993) ‘from red tape to results’ statement one could ask to which results, as these ndings
raise questions regarding the intricate relationship with various performance dimensions.
This study aims to ll this gap in knowledge by studying red tape’s relationship with
multiple dimensions of work unit performance as rated by supervisors. Using supervisor
ratings instead of employee self-reports substantially reduces risks of common source bias
(Jakobsen and Jensen 2015). Using survey data from 1,162 employees and 99 supervisors,
this study is able to analyse the complex relationships between red tape and performance
for 49 work units in one healthcare organization.
In the following, rst, the theoretical arguments are presented. Second, a description is
given of this study’s design and methods. Third, the results are shown, and nally these
results are discussed in light of current theory and their value for practice.
RED TAPE: A RECONCEPTUALIZATION
Red tape as a concept has received considerable attention from researchers and practi-
tioners alike due to its self-evident drawbacks. A pervasive image is that governments
are less efcient due to red tape, and that removing it will make governments function
better (Gore 1993). The concept has also appealed to street-level workers such as teach-
ers and nurses who feel that rules and regulations are interfering with handling complex
cases well (Lipsky 1980; Brodkin 2012). Despite its appeal, red tape has proven difcult to
study.
Red tape cannot be reduced to the mere presence of written and formalized rules (Pugh
et al. 1969; Bozeman and Scott 1996; Pandey and Scott 2002; Borry 2016). Instead, red tape
has a distinct negative connotation: it is seen as a normatively undesirable phenomenon
that negatively affects the performance of the organization (Bozeman and Feeney 2011).
One of the rst denitions, by Bozeman (1993), denes red tape as ‘rules, regulations,
and procedures that remain in force and entail a compliance burden for the organization
but have no efcacy for the rules’ functional object’ (p. 283). However, most conceptual-
izations speak directly of burdensome administrative rules that negatively inuence the
organization’s effectiveness (Rainey et al. 1995).
A major challenge in red tape research has been to separate the phenomenon from its
consequences for performance (Bozeman 2000; Bozeman and Feeney 2011). Including the
negative effect in the denition of red tape has made it difcult to accurately assess which
rules are red tape, as this is only possible after the consequences have followed: a rule
is/was red tape if the conclusion is that it has had a negative effect on performance. This
is highly problematic for empirical research on red tape needing to distinguish the concept
from its consequences.
An alternative approach is following Bozeman’s denition from 1993 as a starting point
(Van Loon et al. 2016). In this denition red tape is dened as rules that score high on two
Public Administration Vol.95, No. 1, 2017 (60–77)
© 2016 John Wiley& Sons Ltd.
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