Abstract This article provides theoretical elaboration of the policy process underpinning the emergence of public sector reform. It reviews the three predominant models for understanding, namely the Advocacy Coalition Framework (ACF), Institutional Theory Approaches (ITA), and the Multiple Streams Framework (MSF). Rather than treating these frameworks as competing, the article identifies their complementary and interdependent contributions to explaining the policy process underpinning public sector reform, specifically the central driving role of ideas, institutions, and timing. The article provides a case for combining the three frameworks—and their identified drivers—to inform an integrated and elaborated model of public sector reform processes. The utility of the model is evidenced via an ex post analysis of the 10-year “NHS Plan,” which operated in the United Kingdom from 2000 to 2010. Discussion considers implications for key theoretical issues in researching and explaining the policy process underpinning public sector reform. Introduction Public sector reform has received long-standing policy and research attention. While the high tide of new public management has arguably passed, associated reforms have significantly changed the public sectors of many countries (Hammerschmid et al. 2016; Pollitt and Bouckaert 2017). Yet calls for substantive reform to core public services, including social welfare, education, and health care, continue across nations (OECD 2015a, 2015b). The rationale for deep reform, rather than incremental change and enhancement to efficiency, is premised on resource constraints combined with key policy issues and complex or “wicked problems” such as ageing populations, chronic disease, and climate change that require new policy responses and substantive change, yet be acceptable to multiple stakeholders. Such reform is likely to be systemic, in the sense of affecting an entire societal sector (e.g., health care, see Scott and Meyer 1991). Reflecting this, our focus is on the process by which paradigmatic policy reform (third-order change, see Hall 1993), rather than new policy instruments (second-order change), or the adaptation of policy tools (first-order change) is brought about. While of aligned interest, issues of policy design (Capano 2009) and implementation (Howlett 2014) go beyond the scope of our analysis. The article reflects our core concern with understanding the attainment of systemic and robust reforms, such as United Kingdom’s “The NHS Plan” considered as an illustrative case study later. A wide variety of perspectives on, and models explaining, the policy process underpinning public sector reform are evident in the literature (see Cairney and Heikkila 2014; Fisher, Miller, and Sidney 2007; Sabatier and Weible 2014, for an overview). However, three have largely dominated the debate about policy and public sector change processes since the 1980s (Dudley et al. 2000; Howlett, McConnell, and Perl 2017), namely the Advocacy Coalition Framework (ACF), Institutional Theory Approaches (ITA), and the Multiple Streams Framework (MSF). The ACF was developed by Sabatier (1988, 1991, 1998) and Sabatier and Jenkins-Smith (1993) and sees reform as emanating from a struggle between ideas, with each supported by a coalition of actors. In contrast, ITA frameworks (e.g., Barzelay and Gallego 2006; Ostrom 2011; Scott 2008) give insight into the impact of institutions—that is, deeply embedded rules, values, and cognitions—on processes of (non)reform. Last, the MSF, developed by Kingdon (1984, 1995), considers reform as a disordered process, with problems, policy proposals, and political developments circulating in multiple streams that only rarely connect—emphasizing the critical role of timing. Recent reviews reiterate that these three frameworks still predominate in explanations of (non)reform (see Béland and Howlett 2016; Jones et al. 2016; Ostrom 2011; Rawat and Morris 2016; Weible et al. 2011). However, despite their widespread utilization and impact, there is an ongoing struggle for supremacy between them (Howlett, McConnell, and Perl 2017). Indeed, “Although over three decades have passed, the dueling nature of these frameworks shows little sign of abating” (Howlett, McConnell, and Perl 2016, 274). Evidencing this, key texts and authors (e.g., Fisher, Miller, and Sidney 2007; Sabatier and Weible 2014) present them as competing rather than complementary (Dudley et al. 2000; Howlett, McConnell, and Perl 2017; see also the Policy Studies Journal series 2011/2). This is surprising as the frameworks can be “viewed as ‘variations on a theme’ rather than as entirely separate, stand-alone compositions” (Howlett, McConnell, and Perl 2016, 274). Despite this, to date, integrative attempts have been limited. Opportunities for linking two discrete models have been discussed, for example, ITA and MSF (Barzelay and Gallego 2006; Zahariadis 2016; Zohlnhöfer, Herweg, and Huß 2016). In addition, the similarities and differences across some models have been described including, for example, those between the ACF, MSF, and Punctuated Equilibrium Theory (PET) (John 2003; Real-Dato 2009), and between ACF, MSF, and the policy cycle model (Howlett, McConnell, and Perl 2017). Further, Cairney and Heikkila (2014) have provided a thorough overview of eight frameworks, evaluating key characteristics. Nonetheless, although progress has been made in comparing models and connecting some of their aspects, most previous attempts have focused on comparison rather than combination of frameworks, or limited their combination to the extension of one framework by using (some) aspects from another (e.g., Béland 2005; Howlett, McConnell, and Perl 2016, 2017; Zahariadis 2016; see also Cairney and Heikkila 2014). The absence of a more systematic synthesis is a deficit, particularly as “comparison reveals that each framework has promising components, but each remains short of providing a full explanation” (Schlager and Blomquist 1996, 651; see also Béland and Howlett 2016; Howlett, McConnell, and Perl 2016; John 2003), “in the sense that each one of them tends to favor a particular causal path” (Real-Dato 2009, 121; see also Barzelay and Gallego 2006; John 2003). As Cairney and Heikkila (2014, 363) argue, “The major theories and frameworks have generally been produced independently of each other.” Yet, the separate development of relevant frameworks over the past three decades has led to an “unwarranted theoretical diversity [that] often encourages the compartmentalization of perspectives which fail to enrich each other” (Capano and Howlett 2009, 1). As a result, Cairney and Heikkila (2014, 363) call for efforts to identify “their key concepts, when and how each is particularly useful, and the extent to which the insights of different theories can be combined.” Like others (Howlett, McConnell, and Perl 2017; John 2013), they conclude that “theoretical consolidation is in its infancy” (Cairney and Heikkila 2014, 383). In this article, we work to address this theoretical deficit by developing an integrated and consolidated model for understanding the emergence of public sector reform. Following suggestions in the literature (Cairney and Heikkila 2014; Howlett, McConnell, and Perl 2016, 274/5) that a focus on the common and complementary insights of different frameworks is more significant to public sector scholarship than a preoccupation with single models, our approach is informed by a rich amalgam of the three predominant frameworks (ACF, ITA, and MSF) and their core explanatory drivers of ideas, institutions, and timing. In the ensuing sections, we first elaborate the origins and explanatory orientations of each approach. We then evidence both complementarities and interdependencies between the approaches, and combine these to develop our integrated model of explaining the policy process underpinning public sector reform. To exemplify it, we use “The NHS Plan” (2000), a 10-year plan for radical change in a major public service, produced by the UK Government in the New Labour period. To close, we discuss implications for theory and the study of public sector reform. The Battle Between Frameworks The substantive literature on policy reform processes (see Cairney and Heikkila 2014; Fisher, Miller, and Sidney 2007; Sabatier and Weible 2014, for an overview) is characterized by rivalry between the three predominant frameworks (Dudley et al. 2000; Howlett, McConnell, and Perl 2017). In this section we introduce ACF, ITA, and MSF and highlight the frameworks’ basic assumptions and explanatory drivers. This provides a basis for identifying their respective strengths and shortcomings, as well as complementary aspects. ACF: Ideas and Actor Coalitions The ACF framework perceives “ideas,” together with the coalitions of actors supporting them, as the driving forces behind reform (Sabatier 1988; Sabatier and Jenkins-Smith 1993; see also Sabatier 1991, 1998). Specifically, reform results from three processes, underpinned by competing solutions, championed by different groups. First, the struggle between ideas continues until one acquires sufficient support by (groups of) actors who form a dominant advocacy coalition (from which ACF derives its name) and gain influence. The emergence of an advocacy coalition is premised upon the interaction of rival coalitions who share a set of basic beliefs and decide to work collectively (Sabatier 1988; Sabatier and Jenkins-Smith 1993). Second, external triggers (e.g., changing public expectations, socioeconomic conditions) may bolster or limit the influence of the coalition. Third, social structures and/or constitutional rules may further enable or constrain the power resources of coalitions (Sabatier and Jenkins-Smith 1993). Thus, in the ACF literature, change is a complex process, requiring the development of multi-stakeholder coalitions and the management of contextually embedded power dynamics (Weible et al. 2011). Further, even where this occurs, the ideas supported by the dominant advocacy coalition must meet three preconditions to influence the political agenda. Specifically, they must be supported by experts (e.g., academics, advisory boards, think tanks) to become viable; be politically feasible to allow for sufficient governmental support; and they ought to fit well with existing bureaucratic and implementation structures (Hall 1989; Sabatier and Jenkins-Smith 1993). Following these premises of the ACF, the ability of a political system to achieve decisions on major reforms is thus strongly related to its capacities to mobilize information (Jones and Baumgartner 2012), and generate support for ideas (Hall 1993). From an ACF perspective, as with the concept of punctuated equilibrium (Baumgartner and Jones 1993), reform usually develops incrementally (e.g., Hall’s first and second level), interspersed with short periods of radical reform (Hall’s third level). Incremental reform arises from learning over time (Cairney and Heikkila 2014; John 2013; Weible et al. 2011), with actor coalitions following and amending strategies within a context of core values and beliefs that remain stable until disrupted by “events that are hard to explain” (John 2013, 6). The ACF therefore affords a significant role to external shocks as triggers for major reform (Sabatier and Jenkins-Smith 1993). Having detailed the drivers and dynamics of reform processes as conceptualized by ACF, we consider potential barriers. In particular, both cognitive and institutional friction may obstruct far-reaching reform (Baumgartner, Green-Pedersen, and Jones 2006). Cognitive friction is defined as “the unwillingness of major power-holders to recognize the need for change because of commitment to ideology or group benefits” (Baumgartner, Green-Pedersen, and Jones 2006, 962). In addition, resistance from institutions (institutional friction) may prove an important obstacle, as also noted by Surel (2000). His critical review identifies the interests of actors and the role of institutions as neglected variables within ACF. In summary, key strengths of the ACF include its focus on competing ideas; its recognition of stakeholder and power dynamics, including the need for coalitions of actors to work together in support of ideas; and the importance of a supportive context and alignment with the political system. However, some suggest that insufficient attention has been afforded to the role of institutions (cf. Cairney and Heikkila 2014; Surel 2000). This leads us to consider our second framework, premised on neo-institutional theory. ITA: The Impact of Institutions ITA is an umbrella for multiple substreams in institutional theory used to seek explanations of both institutional change and stability. Unlike ACF and MSF, which were explicitly developed to analyze and understand agenda setting and policy making, ITA has a broader scope. This is to progress understanding of the impact of institutions on the behavior of organizations and individuals—including in the context of processes underpinning public sector reform. From an ITA perspective, actors make choices within an institutional context of well-established social structures—rules, values, and cognitions—that guide their perceptions and behavior (Ostrom 2011; Scott 2008). Following Barzelay and Gallego (2006), we briefly discuss contributions within ITA from historical institutionalism, rational choice institutionalism, and sociological neo-institutionalism that are particularly relevant to understand the policy process underpinning public sector reform. Historical Institutionalism Traditionally, neo-institutional theory focused on explaining stability rather than change. This is best exemplified in the concept of “path dependency,” which implies that past decisions affect future choices, while an existing path or paradigm can offer advantageous returns on earlier investments in knowledge, position, and influence to dominant parties in a field (North 1990; Peters, Pierre, and King 2005; Pierson 2000a). While now subject to critique (Howlett and Rayner 2006; Kay 2005), path dependency has been used to explain the prevalence of incremental policy adjustments and a concomitant lack of sharp turns in policy trajectories and public sector reform (Yesilkagit and Christensen 2010). However, explanations of change have more latterly become a central concern in institutional theory. Empirically, this emanated from observation of long periods of stability interspersed with rapid periods of “big bang” or archetypal shifts, underpinned by changes in values, structures, and processes (cf. Greenwood and Hinings 1993). Such fundamental shifts are viewed as a response to functional, political, and social factors that may destabilize existing institutions (Oliver 1992). For example, poor policy performance, shifts in political power, and changing societal values can serve as prompts for substantial public sector reform (Boin and ‘t Hart 2000; Pollitt and Bouckaert 2017). Such factors can undermine the legitimacy of established structures, norms, and ideas (Scott 2008; Suchman 1995). In addition, actors dissatisfied with elements in their institutional context can create new institutions or transform existing ones (Greenwood et al. 2011; Scott 2008; Thornton, Ocasio, and Lounsbury 2012), changing the context in which policy making and reform will take place. Rational Choice Institutionalism This stream of institutional theory primarily views institutions as systems of rules and procedures that allow individuals or organizations to achieve their maximum utility (North 1990). Actors are considered as making rational choices given the set of collective, institutionalized, rules and procedures. The collective aspect means that the regulation of relationships between the various relevant actors is therefore central in this approach. The Institutional Analysis and Development Framework (Ostrom 2011) is a well-known representative of rational choice institutionalism. It uses three steps in explaining the potential outcomes of (different) sets of actors and institutions: identifying the unit of analysis (the so-called action situation), digging into the factors that affect the structure of the situation (e.g., the level of control over choice, or available information), and exploring how the outcomes from earlier times affect perceptions and strategies over time (Ostrom 2011). Sociological Neo-institutionalism In current debates within this large substream of ITA, institutional logics are a central explanatory device for stability and change. Institutional logics refer to the established values and norms that guide actors’ behavior (Thornton, Ocasio, and Lounsbury 2012). They can be based on state or market principles (e.g., equal treatment or competition), and also on those from family, religion, and professions (Friedland and Alford 1991). In many sectors, multiple institutional logics operate simultaneously, resulting in “institutional complexity” (Greenwood et al. 2011), that may produce tensions and create hybridity (Denis, Ferlie, and Van Gestel 2015). Competing logics provide opportunities and resources for actors to engage in political struggles within policy subsystems. For example, some authors have identified strategies used to deal with competing logics (see, e.g., Pache and Santos 2010, 2013; Reay and Hinings 2009) in ways that create and underpin the legitimacy of shifts in institutional arrangements (Greenwood et al. 2011). Key strengths of ITA include recognition of the importance of building legitimacy for reform in institutional contexts (Scott 2008; Suchman 1995). Its focus is on the interaction between sets of actors and institutions, producing outcomes that are often evaluated in terms of a trade-off among different values, like efficiency, fairness, and accountability (Cairney and Heikkila 2014). ITA brings insights into the constraining and enabling role of institutional factors in explaining reform (Van Gestel and Hillebrand 2011), attending to path dependency (Peters, Pierre, and King 2005; Pierson 2000a) as well as to destabilizing factors (Boin and ‘t Hart 2000; Oliver 1992), with recent studies particularly focused on (competing) institutional logics and complexity (Greenwood et al. 2011; Thornton, Ocasio, and Lounsbury 2012). Unlike the ACF, ITA does not discuss ideas or actor coalitions explicitly, but stresses the importance of shared values and norms that underpin the (re)production of rules, in this case for policy making and reform (Cairney and Heikkila 2014). Nonetheless, both ACF and ITA afford little recognition to the role of sequence and timing in change processes (Pierson 2000b; Thelen 2000). Although both ACF and ITA have been utilized in longitudinal studies of policy reform processes unfolding over a decade or more, consideration of time as an independent variable influencing such processes has been lacking (Pralle 2006). Therefore, we now consider the MSF, which focuses on the role of time and timing in pluralistic contexts, where opportunities for systemic change are perceived as scarce and hard to predict. MSF: The Role of Timing While the ACF emphasizes the importance of collaboration and coalitions in bringing ideas to fruition, and ITA draws attention to the importance of institutional legitimacy for public reforms, the MSF (Kingdon 1984, 1995) emphasizes uncertainty regarding actors’ preferences in resolving policy problems, as they operate under time pressure in ambiguous contexts. The MSF builds on Cohen, March, and Olsen’s (1972) comparison of the policy-making process to a garbage can, in which participants, problems, solutions, and opportunities for decision making are not necessarily connected. Although initially developed to understand agenda setting, use of the MSF has extended to encompass the whole policy making and reform process (Barzelay and Gallego (2006); John 2013). Kingdon (1984) distinguishes three relatively independent streams in volatile reform processes: the emergence of problems; the development of policy alternatives; and ongoing political events. He argues that political events, such as a new government taking office, or the emergence of a problem receiving large media attention, can enable “policy windows” to open, creating an opportunity to connect the different streams (e.g., problems and policy solutions). However, using such windows of opportunity requires policy proposals to be prepared in good time and: (1) be technically and financially feasible; (2) fit with the dominant value system of policy makers and politicians; and (3) be acceptable to the parliament and the wider public (Kingdon 1995). Only a small number of policy proposals will meet these criteria and thus afford an opportunity to produce policy change (Kingdon 1995; Zahariadis 2003). Moreover, while policy windows create opportunities to push forward policy proposals, they “open infrequently, and do not stay open long” (Kingdon 1995, 166). In practice, the coupling of multiple streams during a policy window requires skilled policy entrepreneurs (Capano 2009; Kingdon 1995). If a window closes before reform occurs, it can take a long time for another opportunity to arise (Howlett 1998; Kingdon 1995), causing Kingdon (1995, 170) to reflect that policy windows lend “powerful credence to the old saying, ‘Strike while the iron is hot.’” Historically, the theoretical potential of the MSF has been questioned (see, e.g., Dudley et al. 2000, 126). In particular, it has been critiqued for concentrating on temporal and situational factors to the neglect of structural factors, such as the role of institutions (Mucciaroni 1992). It has also been critiqued for affording little attention to (mutual) relationships between the three streams outside of the moment of policy change (Sabatier 1988; Van Gestel 1999, 159–61). However, the MSF is now receiving enhanced recognition. As Barzelay and Gallego (2006, 540) note, “Kingdon’s (1984) situational, systemic, and contextual theory provides an excellent basis for what Renate Mayntz (2004) calls ‘causal reconstruction’ of policy-making episodes.” Others similarly argue that the MSF can shed light on the path-dependent policy reforms with which historical institutionalists typically struggle (Spohr 2016, see also Béland and Howlett 2016). As well as acting as a useful complementary to other perspectives, authors have suggested that Kingdon’s model has utility beyond its original focus on agenda setting, and its use has been extended to encompass additional stages of the reform cycle (e.g., Howlett, McConnell, and Perl 2016, 2017; Zohlnhöfer, Herweg, and Huß 2016). Others discuss how the MSF can be refined by, for example, more explicitly connecting the recognition of problems and ideas to political factors such as elections and party ideologies (Herweg, Huß, and Zohlnhöfer 2015). However, the MSF is not without shortcomings. The systematic incorporation of institutional factors remains lacking (Barzelay and Gallego 2006; Zohlnhöfer, Herweg, and Huß 2016). Integrating institutions into the policy stream is particularly important (Béland 2005, 8) as “national institutions and policy settings shape the role of policy experts” (see also Zohlnhöfer, Herweg, and Huß 2016, 247). Next, having detailed the origins, explanatory drivers (ideas and coalitions; institutions and legitimacy; policy streams and timing), strengths and shortcomings of each approach, we engage in systematic comparison of the three frameworks. Comparison of Contributions to Understanding Reform Thus far, the article has identified the core drivers of public sector reform accentuated by ACF, ITA, and MSF—ideas, institutions, and timing. Prior work has often presented these approaches as stand-alone and competing (Howlett, McConnell, and Perl 2016, 2017). In contrast here, to avoid amplification of difference and allow for identification of concordance, we consider their respective contributions to understanding each explanation of reform: conceptions of ideas and their supporting actors; institutions and the emergence of acceptability; and timing. This comparative analysis enables identification of similarities, differences and interdependencies across the approaches, and informs the development of an integrated framework in the ensuing section. Ideas This analytic category considers the mobilization of ideas. Ideas include beliefs, knowledge, worldviews, and shared definitions of problems (Cairney and Heikkila 2014). Actors work to enhance the profile of their preferred ideas, influencing reform through their actions and interaction. Actors can be individuals or collectives, and can range from interest groups, private companies, and advisory bodies, to political parties and government agencies (Cairney and Heikkila 2014). The ACF focuses on actors in a context of coalitions, where they operate in networks and subsystems to develop policy options of relevance to the interest groups with whom they consult and negotiate. The MSF similarly recognizes the activities of a range of actors and stakeholders participating in the three streams. These include government officials and “people outside of government closely associated with those officials” (Kingdon 1984, 3), that is, representatives of interest groups, journalists, consultants, academics, and other researchers. The MSF affords particular attention to the activities of policy entrepreneurs, who play a decisive role at the rare junctures connecting policy proposals (e.g., ideas) to problems under favorable political conditions (Capano 2009; Roberts and King 1991). Last, ITA views (individual and collective) actors as operating within an institutional context: it assumes that institutions can enable or obstruct the action of (groups of) different actors and affect their relative influence (Battilana 2006). Therefore, ITA affords particular attention to the—often competing—systemic logics and structures within which actors interpret their situation and choose between alternative ideas (Scott 2008; Thornton and Ocasio 2008). Thus, while ACF, ITA, and MSF all afford attention to ideas, and the role of actors and their interactions in bringing particular ones to the fore, they conceive their roles in policy making differently. Analysis using MSF has emphasized policy entrepreneurs combining stream developments (Cairney and Heikkila 2014; Capano 2009), ACF considers collectives of actors operating in networks and subsystems and the creation of coalitions supporting particular ideas, while ITA focuses on systemic analysis and takes account of the institutional context in terms of social structures or logics as constraints and/or enablers, explored further below. Together, the frameworks provide comprehensive consideration of the profile and uptake of ideas and the role of agency in supporting this, at multiple levels of analysis. Institutions This analytic category considers insights into what makes some policy options more acceptable than others in institutionalized contexts. Cairney and Heikkila (2014) believe that the selection of policy alternatives is based on a combination of ideas and institutions (suggesting interdependence between the core explanatory drivers of the ACF and ITA). Based on a 25-year review of empirical studies utilizing ACF, Weible et al. (2011) also deem ACF and ITA to be complementary perspectives. Of the three approaches, ITA pays most attention to the alignment of ideas with institutional context. In particular, it emphasizes the moral legitimacy of ideas for reform, relating to wider cultural accounts of whether a reform is “the right thing to do” (Suchman 1995, 579). ACF and MSF also recognize that reform is only viable if it fits into a dominant value system (Kingdon 1995; Sabatier and Jenkins-Smith 1993). However, they pay little attention to the variation in institutional logics that may lead to contradictions (Seo and Creed 2002) and institutional complexity (Greenwood et al. 2011) in plural contexts. Thus, ITA is particularly helpful in illuminating variation within institutional contexts (multiple, competing logics). However, ACF and MSF provide a complementary focus on cognitive and pragmatic alignment, respectively, in achieving public sector reform, noting the need for: political and parliamentary support, acceptance by the wider public, acceptance by experts, and the financial and pragmatic viability of policy proposals (Hall 1989; Kingdon 1984, 1995). Thus, the three frameworks provide complementary support in identifying the moral, cognitive, and pragmatic conditions for achieving agreement upon ideas, institutional alignment, and legitimacy for reform. Timing This category takes account of different conceptions of the reform process, and the resultant importance of timing. For ACF, reform is a rational and purposeful process within which actors choose between policy alternatives. In making such choices, ITA emphasizes that extant value systems as well as related rules, norms, and cognitions place constraints on actors’ choices and reform trajectories. In contrast, the MSF suggests that reform is substantively affected by ambiguity and disorder between objectives and events (Cairney 2013; Capano 2009). Thus, one major point of difference between the three frameworks relates to the (un)predictability of reform. However, each does recognize and take account of constrained behavior within policy processes, albeit to different degrees. Specifically, ITA emphasizes “bounded rationality.” ITA notes constraints such that actors make “choices within institutional environments that structure (or at least help explain) their behaviour” (Cairney and Heikkila 2014, 379–80; Ostrom 2011). ITA also recognizes ambiguity in institutional contexts, as evident in studies of competing institutional logics (Reay and Hinings 2009; Thornton, Ocasio, and Lounsbury 2012). Such ambiguity aligns with MSF’s emphasis on the uncertainty and “organized anarchy” in which actors operate in reform processes. Although Kingdon does focus on the organized rather than the anarchy (Kingdon 1984, 92; Van Gestel 1999), a key implication within the MSF is that timing and skill are pivotal in linking problems to policy alternatives when scarce policy windows open (Kingdon 1984). From this perspective, reform breakthroughs occur when “policy entrepreneurs”—persons with extraordinary negotiating skills and considerable authority (Roberts and King 1991)—are able to build a widely accepted compromise under time pressure. MSF’s early and central recognition of ambiguity in policy reform processes, and its ensuing emphasis on using opportunities generated by timing can be seen as a complement to ACF and ITA’s emphasis on bounded rationality and the creation of opportunities for reform over longer time frames, by gaining influence and shaping values. Thus, the approaches are complementary in their time frames of interest. MSF emphasizes short-term issues, focusing on current problems and context, and how to connect them. ACF focuses on the medium-term (Howlett and Cashore 2009): generating and using evidence, building relationships, and developing support for reform via coalitions. Last, ITA affords attention to longer-term historical facets of reform, shaping what is valued (Denis, Ferlie, and Van Gestel 2015). The former section of the article identified the purportedly distinct drivers of reform underpinning the ACF, ITA, and MSF prisms. Subsequently, this section has considered their complementary contributions to these three explanatory factors: ideas, institutions, and timing. Comparative analysis, summarized in table 1, has detailed the complementary insights provided by each approach, identified some points of interdependence, and has generated a rich elaboration of the possible reasons for and routes through which processes of public sector reform may emerge. The next section considers whether and how these insights might be integrated in an elaborated model of understanding the policy processes underpinning public sector reform. Table 1. Ideas, Institutions, and Timing: Comparison of the Three Predominant Frameworks for Explaining Public Sector Reform Key Drivers Explaining Reform ACF ITA MSF Ideas Uptake of ideas influenced by support from actor coalitions. Level: networks and subsystems. Uptake of ideas influenced by institutional constraints and competing logics that affect choice by individual and collective actors. Level: system/ organizational field. Focus on individual actors acting as policy entrepreneurs, coupling multiple streams (e.g., ideas and problems). Level: individual and system. Institutions Ideological acceptance of new ideas, political support, practicality. Cognitive and pragmatic legitimacy. Adjustment of rules, values, and cognitions on the basis of multiple, competing logics. Moral legitimacy. Practical feasibility; fit of reform proposals with dominant values of the political elite; technically and financially feasible reform. Cognitive and pragmatic legitimacy. Timing Reform is purposeful; driven by actors’ disputes about different reform ideas; less attentive to timing. Medium-term focus. Bounded rationality; expression of preferences within institutional context; awareness of ambiguity. Longer-term focus. Reform proceeds from ambiguity in objectives, relations and events; organized anarchy; important role of timing. Short-term focus. Key Drivers Explaining Reform ACF ITA MSF Ideas Uptake of ideas influenced by support from actor coalitions. Level: networks and subsystems. Uptake of ideas influenced by institutional constraints and competing logics that affect choice by individual and collective actors. Level: system/ organizational field. Focus on individual actors acting as policy entrepreneurs, coupling multiple streams (e.g., ideas and problems). Level: individual and system. Institutions Ideological acceptance of new ideas, political support, practicality. Cognitive and pragmatic legitimacy. Adjustment of rules, values, and cognitions on the basis of multiple, competing logics. Moral legitimacy. Practical feasibility; fit of reform proposals with dominant values of the political elite; technically and financially feasible reform. Cognitive and pragmatic legitimacy. Timing Reform is purposeful; driven by actors’ disputes about different reform ideas; less attentive to timing. Medium-term focus. Bounded rationality; expression of preferences within institutional context; awareness of ambiguity. Longer-term focus. Reform proceeds from ambiguity in objectives, relations and events; organized anarchy; important role of timing. Short-term focus. View Large Table 1. Ideas, Institutions, and Timing: Comparison of the Three Predominant Frameworks for Explaining Public Sector Reform Key Drivers Explaining Reform ACF ITA MSF Ideas Uptake of ideas influenced by support from actor coalitions. Level: networks and subsystems. Uptake of ideas influenced by institutional constraints and competing logics that affect choice by individual and collective actors. Level: system/ organizational field. Focus on individual actors acting as policy entrepreneurs, coupling multiple streams (e.g., ideas and problems). Level: individual and system. Institutions Ideological acceptance of new ideas, political support, practicality. Cognitive and pragmatic legitimacy. Adjustment of rules, values, and cognitions on the basis of multiple, competing logics. Moral legitimacy. Practical feasibility; fit of reform proposals with dominant values of the political elite; technically and financially feasible reform. Cognitive and pragmatic legitimacy. Timing Reform is purposeful; driven by actors’ disputes about different reform ideas; less attentive to timing. Medium-term focus. Bounded rationality; expression of preferences within institutional context; awareness of ambiguity. Longer-term focus. Reform proceeds from ambiguity in objectives, relations and events; organized anarchy; important role of timing. Short-term focus. Key Drivers Explaining Reform ACF ITA MSF Ideas Uptake of ideas influenced by support from actor coalitions. Level: networks and subsystems. Uptake of ideas influenced by institutional constraints and competing logics that affect choice by individual and collective actors. Level: system/ organizational field. Focus on individual actors acting as policy entrepreneurs, coupling multiple streams (e.g., ideas and problems). Level: individual and system. Institutions Ideological acceptance of new ideas, political support, practicality. Cognitive and pragmatic legitimacy. Adjustment of rules, values, and cognitions on the basis of multiple, competing logics. Moral legitimacy. Practical feasibility; fit of reform proposals with dominant values of the political elite; technically and financially feasible reform. Cognitive and pragmatic legitimacy. Timing Reform is purposeful; driven by actors’ disputes about different reform ideas; less attentive to timing. Medium-term focus. Bounded rationality; expression of preferences within institutional context; awareness of ambiguity. Longer-term focus. Reform proceeds from ambiguity in objectives, relations and events; organized anarchy; important role of timing. Short-term focus. View Large Combining Complementary Insights in an Integrative Model How can the three theoretical frameworks be best used for understanding the processes underpinning public sector reform? At the outset of the article we identified the core explanatory drivers of our considered approaches: ideas, institutions, and timing. However, comparative analysis indicates that each of ACF, ITA, and MSF speaks to these three drivers, albeit to different extents and with divergent emphases. To state this differently, while each approach emphasizes a core driver of reforms, they all afford at least some attention to all three. In avoiding an adversarial framing of the approaches, comparison has drawn out the subtleties of each and synergies between them. Cumulatively, therefore, the approaches have potential to contribute to a richer understanding of the emergence of reform. As a result, here we focus on integrating their complementary insights, to develop a comprehensive model of the policy processes underpinning public sector reform. As a precursor to presenting this, we note that each approach draws attention to the role of triggers in starting reform, emphasizing complementary—and some overlapping—aspects. All three perspectives recognize “events” as imperative for launching systemic reform. As Cairney and Heikkila (2014, 365) note, “Events can be routine and anticipated, such as elections that produce limited change or introduce new actors with different ideas. Or they can be unanticipated incidents, including social or natural crises or major scientific breakthroughs and technological changes.” Specifically, the ACF points to external events or shocks that may trigger reform, for example, socioeconomic changes, new actor coalitions, a shift in public opinion, or policy change in other domains (Sabatier and Jenkins-Smith 1993). The institutional perspective stresses functional, political, and social triggers that may lead to the decline of dominant templates, values, and structures (Boin and ‘t Hart 2000; Oliver 1992). Functional factors—such as underperformance—can cause dissatisfaction with existing policies. Political factors, such as elections, provide legitimacy to existing arrangements or may lead to demand for radical change, as with Brexit and the 2016 presidential elections in the United States. Social factors—like the entry of new people and organizations in a sector—can lead to questioning established rules and methods. As Baumgartner, Green-Pedersen, and Jones (2006, 961) note: “As new participants with fresh ideas break into the inner circle of policy-making, the system is jolted.” Last, MSF points to developments in the “problem stream” and/or the “political stream” as triggers for reform, such as a problem suddenly attracting substantive (e.g., media) attention or a swing in national mood/political climate (Kingdon 1984, 1995). ACF and ITA view these influences as external pressures. This aligns with “the new orthodoxy” (Howlett and Cashore 2009, 33) that the origin of profound change is exogenous. However, the MSF suggests that this may be too narrow a view (cf. Kingdon 1984, 1995). Socioeconomic developments, for example, are not independent from government policies and disappointing results may build a political climate for change (Van Gestel 1999). Reform triggers are captured in figure 1, as are the three drivers of reform, identified after individual and comparative consideration of the approaches, and recognition of the interdependence of the explanations proffered. Figure 1. View largeDownload slide An Integrated Model of the Policy Process Underpinning Public Sector Reform. Figure 1. View largeDownload slide An Integrated Model of the Policy Process Underpinning Public Sector Reform. First, figure 1 highlights the important role played by the translation of ideas into reform programs. ACF argues that when collective problems are ambiguous and problem-solving capacities are divided between many parties, coalition building is necessary to create reform (Sabatier and Weible 2014). In achieving this ACF emphasizes the importance of ideas and their framing in attracting people to support reform efforts, and in translating ideas into tangible policy programs supported by influential coalitions. In an aligned focus, MSF contributes to understanding “the individual’s role as a driver of change” (Capano 2009, 22), using opportunities to gain support for reform—by sharing and (re)shaping reform ideas in ways that gain support and influence. Reflecting this latter concern, ITA focuses on how actors can create legitimacy for ideas, given constrained institutional contexts. Thus, together, the three approaches draw attention to the importance of individuals and collectives creating ideas in response to problems, gaining influence in support of them and their operationalization, and working to make them legitimate in constrained institutional contexts. Second, figure 1 emphasizes the importance of building the acceptability of reforms (e.g., managing rules, values, and cognitions), which is particularly concerned with the alignment of institutions and the creation of legitimacy as per ITA. This occurs at a variety of levels. As evident in comparative studies of public sector reform, the wider context of a nation’s political system and juridical structure (i.e., Rechtstaat, executive government, culture of decision making) influences the emergence of public sector reform (Pollitt and Bouckaert 2017; Kickert 2008). In the integrated framework, this institutional context is indirectly taken into account in the ACF, by way of social and constitutional rules and structures; and in MSF by the pressure for reform to accord with the “national mood.” However, institutional factors are most explicitly accounted for in ITA, for example, in the attention afforded to the different contexts created by majoritarian versus consensus executive governments, the administrative culture and the channels through which policy advice derives (Barzelay and Gallego 2006). Reform includes not only the establishment or reinforcement of particular policy discourses which support a particular package but also the wider configuration of potentially competing institutional logics, necessary for (moral) legitimacy. Crucially, however, the content of reform packages is dependent on both the desirable and the feasible (Pollitt and Bouckaert 2017). As a result, the cognitive and pragmatic legitimacy emphasized by ACF and MSF are important complements to the moral legitimacy of ITA. Third, figure 1 draws attention to the nature of the reform process, and the role of timing within this. This is an area in which the approaches initially appear to differ. Specifically, reconciling the purposeful reform process detailed by ACF, with the organized anarchy detailed by MSF is not necessarily intuitive. The latter draws particular attention to the role of timing and makes a strong case that this should be afforded particular attention. As Pralle (2006, 990) argues: “Timing and sequence not only influence the relative impact of events but also shape the strategic opportunities available to political actors.” Yet ACF’s focus on translating ideas into policy programs—and gaining support for these—is affected by timing. At the occurrence of a significant focusing event, venue change, or external shock, it matters how advocacy groups and coalitions are organized to influence political and policy developments (Pralle 2006). Moreover, as Kingdon (1984, 1995) emphasizes, attention to problems—and the opportunities that accompany this—is time-limited. Although an unexpected disaster or alarming incident may focus attention, events need interpretation and translation into a policy problem (Kingdon 1995; Van Gestel 1999). Timing is thus particularly relevant in ACF’s focal process of consensus building—gaining influence with key stakeholders. Timing is also of substantial relevance to the challenge of building legitimacy for key ideas—as per ITA—with different dynamics in the stream of policy proposals and the political stream (Van Gestel 1999). Reflecting this, Kingdon (1995) greatly values the process of “softening up”: policy entrepreneurs who prepare change by emphasizing the necessity of reform and presenting early stage reform ideas that allow for reformulation and adjustment. Another element of timing concerns the public opinion or “national mood” which is not only an “external pressure” for reform but also influenced by political messages and media behavior (Kingdon 1984, 1995), another influence on values, cognitions, and legitimacy. As Capano (2009, 27) argues: “Timing is an essential discriminatory factor with regard to the nature of change and the essence of the process of change.” Thus, figure 1 takes account of the important role of timing—predominantly informed by the MSF, but with evident relevance to the core drivers underpinning ACF and ITA. Figure 1 combines insights from the three frameworks. Understanding the complex policy process underpinning public sector reform requires attention to the core complementary concerns of ideas, institutions, timing, and the associated capacities of gaining influence, shaping values, and using opportunities. Specifically, new and desirable ideas need to be translated into feasible plans, supported by coalitions of actors with influence. Even where this occurs, reforms require legitimacy, with actors supporting reform that accords with extant or emergent (reshaped) institutional rules, values, and cognitions. Moreover, in realizing reform, timing—the ability to capitalize on chance to make and use opportunities for reform—plays an undervalued role. It is particularly important to seize opportunities within plural settings characterized by many stakeholders, multiple goals, and a diffuse distribution of power. Critically, integrative analysis underscores the complex and volatile course of reform, and evidences synergy and interdependence between the explanations proffered by ACF, ITA, and MSF. Thus, as per figure 1, we suggest that explanations of reform are likely to be most complete at the dynamic intersection of ideas, institutions, and timing. So how can we use this integrated model? Because the three predominant frameworks point to interdependent issues and explanations at multiple levels (see table 1), their explanatory capacity is enhanced when combined (Cairney 2013; John 2003, 2012). Departing from figure 1, empirical studies can therefore focus on examining the joint role of coalition building, legitimacy, and timing in understanding the policy process underpinning public sector reform. In the next section, we present an illustrative case of health care reform in England written up to demonstrate how the integrated framework allows for a richer understanding of reform processes. The case study was chosen for its relevance as a systemic rather than an incremental reform, its familiarity to the general reader, and the opportunity for a causal reconstruction of a highly relevant example of public sector reform with some distance in time—to allow for a balanced ex post analysis. Health Sector Reform in England: The Case of the NHS Plan “The NHS Plan” (Dept of Health 2000) was a 10-year plan for radical change in English health care, produced by a New Labour government. The United Kingdom has a majoritarian political system where the largest party usually forms a government. New Labour was elected with a big majority in 1997, governed as one party and did not need to form a multiparty coalition. It held office until 2010 so one party had an opportunity to provide long-term and stable political direction. The 2000 NHS Plan promised major new investment in publicly funded health care (6% or 7% growth annually above inflation), but in exchange for a program of service “modernization,” radical reform, and transformation (see Fairclough 2000 for a discursive analysis of New Labour policy texts), leading to more patient-centric services. Translating Ideas into a Reform Program: Assembling a Broad Advocacy Coalition and Gaining Influence At a macro ideological level, New Labour was attracted to the “third way” ideas (Giddens 1998), enabling it to triangulate between the Old Left and the New Right (Ferlie et al. 2011; Ferlie and McGivern 2013). Its rhetoric smoothed over controversial binaries (Fairclough 2000), preferring the term “social inclusion” to “poverty,” for example. It moved from the politics of the producer (even though the public sector trade unions were a key part of the Old Labour coalition), to that of the consumer (Blair 2011), including promoting more patient-centric services in the health care domain. The NHS Plan was not built on a report from a commission of enquiry, a research study, or a single policy-orientated text from a think tank. Some aspects of the Plan process were highly consistent with New Labour’s broader “network governance” ideas of public policy reform (Alvarez-Rosete and Mays 2008, 2014), strongly stressing networks, partnerships, social inclusion, the involvement of public sector professionals and civil society, and “soft” leadership within a project of modernization and reform (Newman 2001; Rhodes 2007). Reflecting these basic ideas, there was an extensive program of staff and public consultation undertaken during the preparation of the NHS Plan. Multisectoral and multilevel “Modernization Action Teams” (MATs) were set up. These focused on particular themes and enabled the incorporation of a wide range of key actors. A Modernization Board of the “great and the good” was appointed to provide oversight and build public legitimacy. In addition, a successful “Big Tent” strategy of coalition building was evident in the many influential bodies from different sectors that (literally) signed up for the plan in its preface. While a key theme was a shift of power to patients, health care professionals were compensated by: substantial extra funding; a promise to invest in NHS staff; and the strong quality orientation apparent in the text. It was thereby possible to build a “win-win” coalition across the many stakeholders and indeed strong political attention was paid to such coalition building. Building the Legitimacy and Acceptability of Reform: Balancing Multiple Logics and Shaping Values The Plan sat within a long period of political stability and economic prosperity so that it was not associated with any destabilizing crisis or radical shift in political institutions. While a short-term “winter pressures” crisis was instrumental in moving the NHS Plan up the political and policy agenda (see below), this “crisis” was relatively minor, and may even have been orchestrated by politicians. Although substantial new money was made available, the text of the Plan indicated that financial investment should be accompanied by radical reform. It appears that three different logics of reform were apparent in the text associated with key interest groups. These logics were both kept in equilibrium and at the same time subject to some attempted rebalancing. The first example was the clear expression of a professional logic (e.g., Chapter 5). Health service staff were set to benefit from commitments to more investment, better pay and conditions, and an emphasis on service quality as well as productivity. These commitments were likely to generate staff support. At the same time, a patient-centered logic (Chapter 10) was evident. This led to an attempt to empower patients and give them more roles and rights within the system. The foreword by the Secretary of State for Health (Dept of Health 2000, 18) suggests that the Plan represented an attempt to shift the balance of power toward patients: “the NHS is a 1940s system operating in a twenty first century world. This NHS Plan sets out the steps we now need to take to transform the toughest issues that have been ducked for too long.” The then Prime Minister, Tony Blair, had sensed that there were long-term societal trends evident whereby consumers/service users increasingly wanted to be “in the driving seat” (Blair 2011, 263) in the public as well as the private sectors. He did not reject these aspects of earlier Conservative reforms, recognizing that if the public services (including the NHS) continued to fail to respond to such trends, then they would lose public support and legitimacy. Therefore, the service user logic was seen as increasingly important and was here orchestrated by senior political leaders to add to the legitimacy of the plan. The third logic and interest group apparent in the text was a political/managerial one. Politicians had an interest in ensuring that the new money was not wasted and that electorally visible improvements came through quickly. Chapter 6 of the NHS Plan outlined new management systems which included a tiered performance management regime with strong interventions in those health care organizations assessed as failing. There was also a new central agency (NHS Modernization Agency) to advise nationally on change management and service improvement issues. This also had a remit to help tackle poor performance at local level. The legitimacy claim made here was that these new managerial systems would lever up quality standards and deal more effectively with the long-standing tail of poor performers at local level about which nothing had so far been done. While these three logics all appear, there is also an attempt to ensure that relations between them are not conflictual but that they are all combined in the “Big Tent” of reform. The political language used by New Labour in the two political prefaces to the Plan is nonconfrontational and inclusive, using positive but also vague words such as: “modernization, investment, and reform.” Other key words evident in the prefaces are: consensus; national alliance; radical change; and transformation. There is strong support for a modern sounding commitment to radical organizational change as a policy instrument which can achieve reform. The Importance of High Level Political Timing: Creating and Using Opportunities High level political leadership and the careful timing of political decision making play a critical role in the case. This was evident not just at Minister of Health but at Prime Ministerial level. The preparation of the NHS Plan was triggered by the then Prime Minister’s decision to do a television interview on January 16, 2000, during which he unexpectedly announced that the United Kingdom would seek to move toward the EU average for health care funding. The announcement was made without consulting the Department of Health (Blair 2011; Klein 2010) or the then Finance Minister (Gordon Brown, Chancellor of the Exchequer) in advance. The announcement led to a fierce row or “tin helmet time” (Blair 2011, 265), as the Prime Minister had in essence decided to publicly impose a big funding increase for the NHS on the head of a reluctant Finance Minister, opposed to big funding increases for the NHS. The Department of Health was not seen by Blair as such a core player at this initial stage. What might explain Blair’s decision to do this television interview? Health care was always a politically salient issue in UK politics, and there had been intense negative media coverage of the government’s handling of the NHS throughout that winter, just as in previous winters (Klein 2010). In addition, there had been particularly poor press coverage the day before. Behind these short-term triggers or crises, as we have seen, sat Blair’s (2011, 262) broader political sense that there were long-term social trends at work where users expected higher levels of performance from public services such as health care. The civil servants at the Department of Health were seen by Blair to be “off the pace” in responding to these long-term societal trends (Blair 2011, 263). During 1999, he had been turning over these problems in his mind, coming to the view that there were two main obstacles to major reform: a major funding gap and a lack of engaged political leadership at Department of Health level. The television interview decisively dealt with the funding needs. At departmental level, political conditions were now right as a New Labour modernizer had been appointed as Minister for Health in 1999. Alan Milburn, who was “fully sympatico with the direction of change” (Blair 2011, 264), replaced a previous “Old Labour” incumbent (Frank Dopson) perceived as more resistant. Milburn worked with a small team of civil servants and special advisers (political appointees) to quickly put the Plan together. Implementation was monitored by a new “Delivery Unit” reporting to the Prime Minister and also by the Treasury, through its Public Service Agreement contract with the Department of Health (appended to the NHS Plan). Milburn can be seen as the prime political and also “institutional entrepreneur” in developing the NHS Plan (Alvarez-Rosete and Mays 2008, 2014). UK economic growth was buoyant in the early 2000s so that it became possible for the government to fund key political priorities (a position that ended dramatically in 2008 with the Global Financial Crisis). There was also a broader political sense (Blair 2011, 262) that although the first New Labour government (elected 1997) was now in midterm, it had yet to articulate a vision for the NHS and was potentially neglecting a core legacy issue. So, the short and midterm political conditions came together at the highest level to create a time-limited “policy window” for engaging in major health care reform. So the English NHS Plan case demonstrates various ‘propelling’ factors which came together: politically astute timing of reform at the top which built upon a long and stable period of political control, and changes to the underlying political and social values and preferences of median voters, and with the use of a short-term crisis to create a widespread and multi actor coalition for change. This was combined with the clear projection of core reform ideas, “Big Tent” coalition building, and attempts to enhance the acceptability of reform by addressing and balancing different logics and “compensating” key stakeholders—all aided by the substantial new money coming into the system which could “buy change.” It was unusually inclusive in its approach (e.g., MATs) for what is usually seen as a closed and top-down policy-making style in the United Kingdom, although combined with strong ministerial leadership (Alvarez-Rosete and Mays 2008). It enjoyed hands on political support at Prime Ministerial level. It managed to engage health professionals; while at the same time sought to rebalance power somewhat toward users (still a long-term work in progress). The rhetoric in the text around quality, ensuring standards and tackling poor performance was widely persuasive and went well beyond the UK conventional focus on cost compression and productivity increases. Cumulatively, this increased support for the reform, and enabled the translation of ideas into a planned program of reform, with aligned attempts to devise a coherent implementation strategy centrally to try to ensure “delivery.” Of course, there are arguments as to whether the major investment did in the end produce major change and service improvement. But examined from the point of view of a policy-making process, the preparation of the NHS Plan illustrates the interdependent role of ideas, institutions, and timing, the creation and use of opportunities, building of coalitions, and the development of legitimacy. Discussion and Conclusion Based on a review and comparison of three predominant models (ACF, ITA, and MSF), we have shown their contributions to be both complementary and interdependent, and synthesized the role of ideas, institutions, and timing within a comprehensive model of the policy process underpinning public sector reform. The model is developed with the intent of contributing specifically to understanding major policy shifts underpinning public sector reform, where the process of policy making includes manifold stakeholders with a diversity of roles, ideas, and interests. We have evidenced the richness and relevance of the model via an illustrative case example. Next, we detail associated implications for the study of policy processes underpinning public sector reform. Building on the combination of the key drivers of ACF, ITA, and MSF as described in our integrative model, our study contributes to the field of public management—and to understandings of public sector reform—in three ways. First, synthesizing key drivers from each of the three predominant models is premised on recognition that, while each emphasizes a core driver of reform, each also affords some degree of attention to the alternative explanations proffered. Shifting from an adversarial to a more subtle framing of the approaches enables synthesis, which compensates for their respective shortcomings. For example, while ITA pays substantive attention to the impact of resilient social structures on policy making (Barzelay and Gallego 2006; Scott 2008), MSF fails to sufficiently conceptualize the role of institutional structures (Zohlnhöfer, Herweg, and Huß 2016). Meanwhile, MSF provides a complementary account of the pivotal role of agency (Béland and Howlett 2016; Capano 2009)—in particular of policy makers and policy entrepreneurs in connecting streams at moments of opportunity. ACF also has more focus on agency than on structure; it particularly stresses how actors and coalitions interpret and respond to events, while “the role of institutions is addressed less directly than the other elements” (Cairney and Heikkila 2014, 379). Thus, the interplay of structure and agency is central to understanding stability and change (Capano 2009; Giddens 1998; John 2012). Our integrated framework helps to avoid too much structuralism, where individual choice is determined by institutionalized rules, patterns of behavior, cultures. It also evades “overemphasizing of the independence of agency, contingency and chance” (Capano 2009, 17)—which would overstate the openness and randomness of the policy process. To ensure a balanced account of both structure and agency, their nature and interplay (as defined within each approach) have been afforded attention within the article. This is particularly important as theory development has been hindered by a lack of clarity about central concepts closely related to agency and structure, such as ideas, belief systems, institutions, and policy entrepreneurs (Cairney 2011; Capano 2009). In summary, the combination of the three frameworks in our integrative model affords balanced attention to the role of structure and agency (individual and collective) in the emergence of public sector reform. A second contribution of our integrated model is the combination of a short-, medium-, and longer-term perspective in understanding the policy process underpinning reform. MSF contains a relatively short-term perspective, seeking explanations for public sector reform at the juncture between current problems, available policy proposals, and ongoing political realities. In contrast, ACF provides a medium-term perspective; it assumes that analysis of reform is historical, covering years or even decades (Howlett and Cashore 2009; Sabatier and Jenkins-Smith 1993). However, in practice empirical studies show large variation, and are more likely to focus on years (Weible et al. 2011). Last, ITA is known for its longer-term perspective, attending to the history and path dependence of reforms, and includes strategies for legitimacy in the context of multiple, competing value systems (Denis, Ferlie, and Van Gestel 2015). The integrated model thus allows for a more complete analysis of policy change and reform that takes short-, medium-, and longer-term time horizons into account. The model suggests that explaining the policy processes underpinning public sector reform needs to account for layers of time, such that short-term cross-linking of problems and solutions in a particular political context is only possible in a medium-term context of changing ideas and belief systems, leading to long-term impact and adaptation of institutions. Third, contextualizing policies relates to another salient debate, namely how to combine macro and micro levels of analysis. Often, policy reform is situated either at the macro level where it is perceived to result from economic and/or demographic trends and political competition, or at the micro level with in-depth reconstruction of a specific policy (Capano 2009; Hall 1993). The latter micro approach has the danger of “reductionism,” explaining policy reform without affording attention to the wider political, societal, economic, and historical context in which it is situated (Capano 2009). Macro studies, on the other hand, often fail to provide insight into the influence of processes, agency, and interaction on the emergence of reform. They may fail to explain why policy sectors or countries that face similar macro challenges and developments follow different paths (Pollitt and Bouckaert 2017). We follow Capano (2009, 16) in asserting that each level of analysis illuminates different aspects of reform and is valuable; therefore, a “co-evolutive” or “emergentist” perspective is most favorable. As previously detailed, the three frameworks that constitute our integrative model emphasize different levels of analysis (see table 1), where ACF has a stronger focus on the meso level of subsystems, ITA on macro level institutions, and MSF attends to individual participants and entrepreneurs in a context of system level dynamics in multiple streams. Using the complementary strengths of these three perspectives avoids reductionism and draws attention to the conjunctural nature of explanations for reform. Limitations and Future Research We have limited the building blocks of our integrative framework to three frameworks predominant in the literature since the mid-1980s. There will inevitably be arguments about some of the frameworks omitted, including, for example, the policy network approach with its attention to interest mediation that some believe forms “a useful complement and contrast with more value-based frameworks such as advocacy coalitions and multiple streams” (Dudley et al. 2000, 123). In contrast, John (2013) views the network approach as similar to ACF, although actor coalitions include a broader set of participants and processes than that suggested by the network metaphor. Specifically, an advocacy coalition is perceived as “an alliance of bodies holding the same ideas and interests for the purpose of arguing against other coalitions within the same policy sector” (John 2013, 5). Actor coalitions are not restricted to participants with a direct stake in network collaboration, but include journalists, policy analysts, and researchers as well as the more familiar bureaucrats, politicians, and interest-group representatives, who all play a role in the dissemination of ideas. Another approach is the PET, recognized as having resonance with ACF (Jones and Baumgartner 2012). As stressed by the founding fathers of PET: “PET is close to ACF in its focus on the human cognitive and emotional side of policy decision-making” (Jones and Baumgartner 2012, 4). They perceive the added value of PET is “based more on the allocation of attention and the heuristics that decision makers, and consequently organizations, use to allocate scarce attention” (Jones and Baumgartner 2012, 4). PET is supplementary to ACF in the way ideas are disseminated and—rarely but rapidly—can replace stability by instability (John 2013, 17). The mobilizing of attention as a condition for creating big policy shifts is however also key in MSF, and thus included in our integrated model. In this article, we developed an integrative and interdependent approach to understanding public sector reform, moving away from conceptualizations of three predominant frameworks as competing. As Cairney (2013, 17) points out, the tendency in the field is to “exaggerate their differences to mark out their identities and gain support.” Some may believe that this approach advances understanding, but others critique debates where authors “give each other straw men titles” (Cairney 2013, 17). Moreover, policies and reform are essentially multi-driven: “They are composed of several different factors: ideas, interests, institutions, actors, different types of rationalities, different individual motivations. Thus, combinative causality is unavoidable” (Capano 2009, 27). Reflecting this, in this article we have drawn attention to interdependencies among causal factors and their complementary value within an integrative framework of the policy process behind systemic policy reform. In so doing we have responded to Cairney’s (2013) plea for a more productive scholarly debate about how to explain the complex policy process underpinning public sector reform. References Alvarez-Rosete, Arturo, and Nicholas Mays. 2008. Reconciling two conflicting tales of the English health policy process since 1997. British Politics 3: 183– 203. Google Scholar CrossRef Search ADS ———. 2014. Understanding NHS policy making in England: The formulation of the NHS Plan 2000. The British Journal of Politics and International Relations 16: 624– 44. CrossRef Search ADS Battilana, Julie. 2006. Agency and institutions: The enabling role of individuals’ social position. Organization 13: 653– 76. Google Scholar CrossRef Search ADS Barzelay, Michael, and Raquel Gallego. 2006. From new institutionalism to institutional processualism: Advancing knowledge about public management policy change. Governance 19: 531– 57. Google Scholar CrossRef Search ADS Baumgartner, Frank R., and Bryan D. Jones. 1993. Agendas and instability in American politics . Chicago, IL: Univ. of Chicago Press. Baumgartner, Frank R., Christoffer Green-Pedersen, and Bryan D. Jones. 2006. Comparative studies of policy agendas. Journal of European Public Policy 13: 959– 74. Google Scholar CrossRef Search ADS Béland, Daniel. 2005. Ideas and social policy: An institutionalist perspective. Social Policy & Administration 39: 1– 18. Google Scholar CrossRef Search ADS Béland, Daniel, and Michael Howlett. 2016. The role and impact of the multiple-streams approach in comparative policy analysis. Journal of Comparative Policy Analysis: Research and Practice 18: 221– 7. Google Scholar CrossRef Search ADS Blair, Tony. 2011. A journey . London: Arrow. Boin, Arjen, and Paul ‘t Hart. 2000. Institutional crises and reforms in policy sectors. In Government institutions: Effects, changes and normative foundations , ed. Henk Wagenaar, 9– 32. Dordrecht, The Netherlands: Kluwer Academic Publishers. Google Scholar CrossRef Search ADS Cairney, Paul. 2013. Standing on the shoulders of giants: How do we combine the insights of multiple theories in public policy studies? The Policy Studies Journal 41: 1– 21. Google Scholar CrossRef Search ADS Cairney, Paul, and Tanya Heikkila. 2014. Comparing theories of the policy process. In Theories of the policy process , ed. Paul A. Sabatier and Christopher M. Weible, 363– 90. Boulder, CO: Westview Press. Capano, Giliberto. 2009. Understanding policy change as an epistemological and theoretical problem. Journal of Comparative Policy Analysis: Research and Practice 11: 7– 31. Google Scholar CrossRef Search ADS Capano, Giliberto, and Michael Howlett. 2009. Introduction: The Determinants of Policy Change: Advancing the Debate. Journal of Comparative Policy Analysis: Research and Practice 11: 1– 5. Google Scholar CrossRef Search ADS Cohen, Michael D., James G. March, and Johan P. Olsen. 1972. A garbage can model of organizational choice. Administrative Science Quarterly 17: 1– 25. Google Scholar CrossRef Search ADS Denis, Jean-Louis, Ewan Ferlie, and Nicolette Van Gestel. 2015. Understanding hybridity in public organisations. Public Administration 93: 273– 89. Google Scholar CrossRef Search ADS Department of Health, United Kingdom. 2000. NHS plan: A plan for investment; a plan for reform . London: Dept of Health, Cm 4818-1. Dudley, Geoffrey, Wayne Parsons, Claudio M. Radaelli, and Paul Sabatier. 2000. Symposium: Theories of the policy process. Journal of European Public Policy 7: 122– 40. Google Scholar CrossRef Search ADS Fairclough, Norman. 2000. New labour; new language? London: Routledge. Ferlie, Ewan, and Gerry McGivern. 2013. Bringing Anglo-governmentality into public management scholarship: The case of evidence-based medicine in UK health care. Journal of Public Administration Research and Theory 24: 59– 83. Google Scholar CrossRef Search ADS Ferlie, Ewan, Louise Fitzgerald, Gerry McGivern, Sue Dopson, and Chris Bennett. 2011. Public policy networks and ‘wicked problems’: A nascent solution? Public Administration 89: 307– 24. Google Scholar CrossRef Search ADS Fisher, Frank, Gerald J. Miller, and Mara S. Sidney, eds. 2007. Handbook of public policy analysis: Theory, politics and methods . Boca Raton: CRS Press. Friedland, Roger, and Robert F. Alford. 1991. Bringing society back in: Symbols, practices, and institutional contradictions. In The new institutionalism in organizational analysis , ed. Walter W. Powell and Paul J. DiMaggio, 232– 63. Chicago, IL: Univ. of Chicago Press. Giddens, Anthony. 1998. The third way . Cambridge: Polity Press. Greenwood, Royston, and C. R. (Bob) Hinings. 1993. Understanding strategic change: The contribution of archetypes. Academy of Management Journal 36: 1052– 81. Greenwood, Royston, Mia Raynard, Farah Kodeih, Evelyn R. Micelotta, and Michael Lounsbury. 2011. Institutional complexity and organizational responses. The Academy of Management Annals 5: 317– 71. Google Scholar CrossRef Search ADS Hall, Peter A., ed. 1989. The political power of economic ideas: Keynesianism across nations . Princeton, NJ: Princeton Univ. Press. Hall, Peter A. 1993. Policy paradigms, social learning and the state: The case of economic policymaking in Britain. Comparative Politics 25: 275– 96. Google Scholar CrossRef Search ADS Hammerschmid, Gerhard, Steven Van de Walle, Rhys Andrews, and Philippe Bezes, eds. 2016. Public administration reforms in Europe: The view from the top . Cheltenham, UK: Edward Elgar Publishing. Google Scholar CrossRef Search ADS Herweg, Nicole, Christian Huß, and Reimut Zohlnhöfer. 2015. Straightening the three streams: Theorising extensions of the multiple streams framework. European Journal of Political Research 54: 435– 49. Google Scholar CrossRef Search ADS Howlett, Michael. 1998. Predictable and unpredictable policy windows: Institutional and exogenous correlates of Canadian federal agenda-setting. Canadian Journal of Political Science 31: 495– 524. Google Scholar CrossRef Search ADS ———. 2014. From the ‘old’ to the ‘new’ policy design: Design thinking beyond markets and collaborative governance. Policy Sciences 47: 187– 207. CrossRef Search ADS Howlett, Michael, Allan McConnell, and Anthony Perl. 2016. Weaving the fabric of public policies: Comparing and integrating contemporary frameworks for the study of policy processes. Journal of Comparative Policy Analysis: Research and Practice 18: 273– 89. Google Scholar CrossRef Search ADS ———. 2017. Moving policy theory forward: Connecting multiple stream and advocacy coalition frameworks to policy cycle models of analysis. Australian Journal of Public Administration 76: 65– 79. CrossRef Search ADS Howlett, Michael, and Benjamin Cashore. 2009. The dependent variable problem in the study of policy change: Understanding policy change as a methodological problem. Journal of Comparative Policy Analysis: Research and Practice 11: 33– 46. Google Scholar CrossRef Search ADS Howlett, Michael, and Jeremy Rayner. 2006. Understanding the historical turn in the policy sciences: a critique of stochastic, narrative, path dependency and process-sequencing models of policy-making over time. Policy Sciences 39: 1– 18. Google Scholar CrossRef Search ADS John, Peter. 2003. Is there life after policy streams, advocacy coalitions, and punctuations: Using evolutionary theory to explain policy change? The Policy Studies Journal 31: 481– 98. Google Scholar CrossRef Search ADS ———. 2012. Analyzing public policy , 2nd ed. Abingdon, Oxon: Routledge. ———. 2013. New directions in public policy: Theories of policy change and variation reconsidered. Paper presented at the International Conference on Public Policy, Grenoble, June 26–28. Jones, Bryan D., and Frank R. Baumgartner. 2012. From there to here: Punctuated equilibrium to the general punctuation thesis to a theory of government information processing. The Policy Studies Journal 40: 1– 19. Jones, Michael D., Holly L. Peterson, Jonathan J. Pierce, Nicole Herweg, Amiel Bernal, Holly Lamberta Raney, and Nikolaos Zahariadis. 2016. A river runs through it: A multiple streams meta-review. The Policy Studies Journal 44: 13– 36. Google Scholar CrossRef Search ADS Kay, Adrian. 2005. A critique of the use of path dependency in policy studies. Public Administration 83: 553– 71. Google Scholar CrossRef Search ADS Kickert, Walter, ed. 2008. The study of public management in Europe and the US. A comparative analysis of national distinctiveness . London: Routledge. Kingdon, John W. 1995. Agendas, alternatives, and public policies , 2nd ed. New York: Harper Collins College Publishers (1st edition 1984, Boston: Little, Brown). Klein, R. 2010. The new politics of the NHS , 6th ed. Oxford: Radcliffe. Mucciaroni, G. 1992. The garbage can model and the study of policy making: A critique. Polity 24: 459– 82. Google Scholar CrossRef Search ADS Newman, Janet. 2001. Modernizing governance . London: Sage. North, Douglas C. 1990. Institutions, institutional change and economic performance . Cambridge: Cambridge Univ. Press. Google Scholar CrossRef Search ADS OECD. 2015a. Fiscal sustainability of health systems: Bridging health and finance perspectives . Paris: OECD Publishing. ———. 2015b. Education policy outlook 2015: Making reforms happen . Paris: OECD Publishing. Oliver, Christine. 1992. The antecedents of deinstitutionalization. Organization Studies 13: 563– 88. Google Scholar CrossRef Search ADS Ostrom, Elinor. 2011. Background on the institutional analysis and development framework. The Policy Studies Journal 39: 7– 27. Google Scholar CrossRef Search ADS Pache, Anne-Claire, and Felipe Santos. 2010. When worlds collide: The internal dynamics of organizational responses to conflicting institutional demands. Academy of Management Review 35: 455– 76. ———. 2013. Inside the hybrid organisation: Selective coupling as a response to competing institutional logics. Academy of Management Journal 56: 972– 1001. CrossRef Search ADS Peters, B. Guy, Jon Pierre, and Desmond S. King. 2005. The politics of path dependency: Political conflict in historical institutionalism. The Journal of Politics 67: 1275– 300. Google Scholar CrossRef Search ADS Pierson, Paul. 2000a. Increasing returns, path dependence, and the study of politics. The American Political Science Review 94: 251– 67. Google Scholar CrossRef Search ADS ———. 2000b. Not just what, but when: Timing and sequence in political processes. Studies in American Political Development 14: 72– 92. CrossRef Search ADS Pollitt, Christopher, and Geert Bouckaert. 2017. Public management reform. A comparative analysis—Into the age of austerity , 4th ed. Oxford: Oxford Univ. Press. Pralle, Sarah B. 2006. Timing and sequence in agenda setting and policy change: A comparative study of lawn care pesticide politics in Canada and the U.S. Journal of European Public Policy 13: 987– 1005. Google Scholar CrossRef Search ADS Rawat, Pragati, and John C. Morris. 2016. Kingdon’s streams model at thirty: Still relevant in the 21st century? Politics and Policy 44: 608– 38. Google Scholar CrossRef Search ADS Real-Dato, José. 2009. Mechanisms of policy change: A proposal for a synthetic explanatory framework. Journal of Comparative Policy Analysis: Research and Practice 11: 117– 43. Google Scholar CrossRef Search ADS Reay, Trish, and C. R. (Bob) Hinings. 2009. Managing the rivalry of competing institutional logics. Organization Studies 30: 629– 52 Google Scholar CrossRef Search ADS Rhodes, Rod A. 2007. Understanding governance: Ten years on. Organization Studies 28: 1243– 64. Google Scholar CrossRef Search ADS Roberts, N. C., and P. J. King. 1991. Policy entrepreneurs: Their activity structure and function in the policy process. Journal of Public Administration Research and Theory 1: 147– 75. Sabatier, Paul A. 1988. An advocacy coalition model of policy change and the role of policy orientated learning therein. Policy Sciences 21: 129– 68. Google Scholar CrossRef Search ADS ———. 1998. The advocacy coalition framework: Revisions and relevance for Europe. Journal of European Public Policy 5: 98– 130. CrossRef Search ADS ———. 1991. Toward better theories of the policy process. Political Science and Politics 24: 147– 56. CrossRef Search ADS Sabatier, Paul A., and C. M. Weible, eds. 2014. Theories of the policy process . Boulder, CO: Westview Press. Sabatier, Paul A., and Hank Jenkins-Smith. 1993. Policy change and learning: an advocacy coalition approach . New York: Westview Press. Schlager, Edella, and William Blomquist. 1996. A comparison of three emerging theories of the policy process. Political Research Quarterly 49: 651– 72. Google Scholar CrossRef Search ADS Scott, W. Richard. 2008. Institutions and organizations: Ideas and interests , 3rd ed. Thousand Oaks/London: Sage. Scott, W. Richard, and John W. Meyer. 1991. The organization of societal sectors: Propositions and early evidence. In The new institutionalism in organizational analysis , ed. Walter W. Powell and Paul J. DiMaggio, 108– 40. Chicago, IL: Univ. of Chicago Press. Seo, Myeong-Gu, and W. E. Douglas Creed. 2002. Institutional contradictions, praxis, and institutional change: A dialectical perspective. Academy of Management Review 27: 222– 47. Google Scholar CrossRef Search ADS Spohr, Florian. 2016. Explaining path dependency and deviation by combining multiple streams framework and historical institutionalism: A comparative analysis of German and Swedish labor market policies. Journal of Comparative Policy Analysis: Research and Practice 18: 257– 72. Google Scholar CrossRef Search ADS Suchman, Mark C. 1995. Managing legitimacy: Strategic and institutional approaches. The Academy of Management Review 20: 571– 610. Google Scholar CrossRef Search ADS Surel, Yves. 2000. The role of cognitive and normative frames in policy-making. Journal of European Public Policy 7: 495– 512. Google Scholar CrossRef Search ADS Thelen, Kathleen. 2000. Timing and temporality in the analysis of institutional evolution and change. Studies in American Political Development 14: 101– 8. Google Scholar CrossRef Search ADS Thornton, Patricia H., and William Ocasio. 2008. Institutional logics. In The SAGE handbook of organizational institutionalism , ed. Royston Greenwood, Christine Oliver, Kerstin Sahlin, and Roy Suddaby, 99– 129. London: Sage. Google Scholar CrossRef Search ADS Thornton, Patricia H., William Ocasio, and Michael Lounsbury. 2012. The institutional logics perspective: A new approach to culture, structure and process . New York: Oxford Univ. Press. Google Scholar CrossRef Search ADS Van Gestel, Nicolette. 1999. The right moment for governmental renewal. In Renewing government, innovative and inspiring visions , ed. Nico Nelissen, Marie-Louise Bemelmans-Videc, Arnold Godfroij, and Peter de Goede, 151– 69. Utrecht, The Netherlands: International Books. Van Gestel, Nicolette, and Bas Hillebrand. 2011. Explaining stability and change: The rise and fall of logics in pluralistic fields. Organization Studies 32: 231– 52. Google Scholar CrossRef Search ADS Weible, Christopher M., Paul A. Sabatier, Hank C. Jenkins-Smith, Daniel Nohrstedt, Adam Douglas Henry, and Peter deLeon. 2011. A quarter century of the advocacy coalition framework: An introduction to the special issue. The Policy Studies Journal 39: 349– 60. Google Scholar CrossRef Search ADS Yesilkagit, Kutsal, and Jørgen G. Christensen. 2010. Institutional design and formal autonomy: Political versus historical and cultural explanations. Journal of Public Administration Research and Theory 20: 53– 74. Google Scholar CrossRef Search ADS Zahariadis, Nikolaos. 2003. Ambiguity and choice in public policy: Political decision making in modern democracies . Washington, DC: Georgetown Univ. Press. ———. 2016. Delphic oracles: Ambiguity, institutions, and multiple streams. Policy Sciences 49: 3– 12. CrossRef Search ADS Zohlnhöfer, Reimut, Nicole Herweg, and Christian Huß. 2016. Bringing formal political institutions into the multiple streams framework: An analytical proposal for comparative policy analysis. Journal of Comparative Policy Analysis 18: 243– 56. Google Scholar CrossRef Search ADS © The Author(s) 2018. Published by Oxford University Press on behalf of the Public Management Research Association. All rights reserved. For permissions, please e-mail: email@example.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Perspectives on Public Management and Governance – Oxford University Press
Published: Jan 29, 2018
It’s your single place to instantly
discover and read the research
that matters to you.
Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.
All for just $49/month
Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly
Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.
Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.
Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.
All the latest content is available, no embargo periods.
“Hi guys, I cannot tell you how much I love this resource. Incredible. I really believe you've hit the nail on the head with this site in regards to solving the research-purchase issue.”Daniel C.
“Whoa! It’s like Spotify but for academic articles.”@Phil_Robichaud
“I must say, @deepdyve is a fabulous solution to the independent researcher's problem of #access to #information.”@deepthiw
“My last article couldn't be possible without the platform @deepdyve that makes journal papers cheaper.”@JoseServera