Coping With Public Value Conflicts

Introduction

In both academic and popular discourses, good governance has steadily received attention, albeit in a slightly broader fashion in the last two decades. Traditionally, the concept was associated with development issues and developing countries (De Graaf, 2013). Yet good governance is increasingly applied to modern nation-states struggling to find new (multi-actor and multi-level) approaches to public governance (Rhodes, 2007). It is this shift that may explain the recent growth of scholarly interest in a wider application of the good governance concept. As the traditional institutions of government no longer define “what works” and “what is right,” questions on the quality of governance automatically return to the center of public and academic attention. These questions touch on the effectiveness and efficiency of governance as well as aspects within ethics (integrity), democracy, and legitimacy.

As Kettl (1993) stated, government’s fundamental challenge in serving the public interest is to balance the pursuit of different, inevitably contradictory, standards (pp. 17-20). Trade-offs between valued principles are thus an ineluctable fact of any designing process (Le Grand, 2007). For instance, services that are fully responsive to the needs and wants of some individuals may not be very efficient in terms of the interests of the wider community. Besides, ideas of effective operational structures could be in breach of the law. Reflections on the concept of good governance may be helpful to interpret these trade-offs. In other words, good governance is about managing tensions between potentially conflicting public values.

Many governments have put together codes in which those public values are listed that should characterize the quality of governance in specific sectors. The idea of good governance is often given substance by normative statements about the public values a government should adhere to. Beck Jørgensen and Sørensen (2013) showed that the codes of good governance that have been developed in 14 countries all contain such a set of public values. When comparing the different codes, they conclude that there seems to be a list of universal public values mentioned in nearly every code: “It seems fair to conclude that we have identified a set of global values” (p. 85). Beck Jørgensen and Sørensen conclude that there are nine public values (e.g., effectiveness and transparency) that are supposed to form the basis of all governmental actions.

However, it remains unclear what the meaning of public values is for the daily practice of public administrators. Moreover, easy as it is to applaud specific values—who is against integrity, democracy or efficiency?—and set these values down on paper, in a code, it is much harder to subsequently act in line with all of them. In daily practice, multiple public values that are all desirable will conflict in such a way that choices have to be made (Huberts & Van Hout, 2011; Van der Wal, De Graaf, & Lawton, 2011).

The main research question consists of three parts—Which public value profiles do public administrators have, which value conflicts do they experience, and which coping strategies are used? Here, previous literature on public value conflicts is discussed first and linked to the literature on street-level bureaucrats and on coping strategies. Then, in the empirical part, the research strategy is presented, followed by two case studies: a Dutch municipality and a Dutch hospital (cf. De Graaf et al., 2013). The findings show six different value clusters that administrators adhere to, which value conflicts are typically experienced in various public sector organizations, and the different coping mechanisms that are used. The results show that using the perspective of (conflicting) public values to look at the daily work of those in the public sector offers important insights around topics such as good governance, street-level bureaucracy, and public professionalism.

Good Governance and Public Values

First, a few definitions of the central concepts are given. Governance has been attributed different meanings (see, for example, Kjaer, 2004; van Kersbergen & van Waarden, 2004). Here, it is defined as the process of agenda setting and rule enforcement by actors; in this article public actors—and therefore public governance. Values are defined as qualities appreciated for, contributing to, or constituting what is good, right, beautiful, or worthy of praise and admiration (De Graaf & Van der Wal, 2008). Public values are the important qualities of public governance. Even though Easton (1965) wrote the influential words that “public policies are the means through which politics allocate values” a long time ago, there is much confusion about what the concept of values in politics and public values entails (Van der Wal, Nabatchi, & De Graaf, 2014). It is important to note that the definition used here, differs from the work of Mark Moore, which centers on the creation of public value (Van der Wal et al., 2014); here, it is more similar to the way Veeneman, Dicke, and De Bruijne (2009) used the concept. Public values are conceived here as process values of governance, as they are conceptualized also in most codes of good governance. Norms are regulations prescribing proper general and situational conduct.

More and more national governments and public organizations adopt a code of good governance (Beck Jørgensen & Sørensen, 2013), usually containing a list of public values which are specifically valued. The public values in most good governance codes are meant for all actors in public governance. Good governance codes generally state values for public governance, but of course not all values are similarly relevant to all public servants. Several scholars have reflected on the idea that particular values might be more important for those in some positions, while other values are more important for others. Beck Jørgensen and Bozeman (2007) developed a classification in which public values are connected to particular aspects of public administration or public organization. In their classification, a public value such as “user democracy” belongs to the category “transformation of interests to decisions.” Although they provide a figure showing the connections between the various aspects of public administration, it is not clear how they differ or overlap and how they can be distinguished empirically. Huberts (2014) argued that values can be connected with various phases in the public policy process. He states that, for instance, participation is of great importance during agenda setting and policy making but less so during implementation. Accountability is not a central value during the first two phases but is certainly important during decision making and implementation. Hendriks and Drosterij (2010) used a combined classification in which they connect values both to phases in the policy process and to particular aspects of public administration. They argue that we can distinguish between values that are mainly related to the input of the policy process (responsiveness as the central value), values that are mainly related to the output of the process (with effectiveness as the central value), values connected to the rule of law and values connected to the institutional system of governance (values such as resilience and checks and balances belong to the latter).

There are few empirical studies to be found which test whether various public values are indeed significantly more, or less, important for managers or civil servants holding different positions (notable exception: Vrangbæk, 2009); the empirical studies that have been conducted so far tend to focus more on the values that are found to be of general importance.

Value Pluralism and Conflicting Values

Most accounts of the policy process give little prominence to the role of values (Stewart, 2006, p. 183), and even less to the conflicts of values. Yet, there are indications those conflicts exists. Wagenaar (1999) claimed that “public programs are structured in such a way that they regularly confront the administrator with difficult value choices” (p. 444). According to Spicer (2001), there is good reason to assert that value conflicts are especially pervasive in public administration, where statutes and regulations that seek to reconcile multiple values often present administrators with conflicting signals. Yet empirical evidence on conflicting values is rare.

Furthermore, we know little of how administrators deal with public value conflict. And this cannot be an easy thing to do, if value pluralists are right. Perhaps the most famous definition of value pluralism was given by Isaiah Berlin (1982):

[T]here might exist ends—ends in themselves in terms of which alone everything else was justified—which were equally ultimate, but incompatible with one another, that there might exist no single universal overarching standard that would enable a man to choose rationally between them. (p. 69)

Values can first of all be incompatible. Value incompatibility, simply put, means that “the pursuit of certain values must inevitably comprise or limit our ability to pursue certain other values. The more we seek to attain some of these values the less able we are to attain the others” (Spicer, 2001, p. 509). The idea that values inherently conflict or are in some situations incompatible is hardly new; many social scientists have researched it (e.g., Brecht, 1959). From the standpoint of value pluralism, however, values can also be incommensurable. According to Lukes (1989) incommensurability means that,

There is no single currency or scale on which conflicting values can be measured, and that where a conflict occurs no rationally compelling appeal can be made to some value that will resolve it. Neither is superior to the other, nor are they equal in value. (p. 125)

This does not mean that agents cannot make choices or give reasons for them, “rather, it means that some of the reasons we might offer in support of making a particular choice are incommensurable with other reasons we might offer were we to make an alternative choice” (Spicer, 2001, p. 512).

Value pluralism seems

especially relevant to the experience of public administration where practitioners are often called upon to grapple with and make judgments about value conflicts when making policy decisions, and where their actions are often, either explicitly or implicitly, coercive in character and affect a large number of people. (Spicer, 2009, p. 539)

The pursuit of an important value in governance inevitably limits pursuing other values. For example, Okun (1975) showed in his classic work that equality and efficiency necessarily conflict with each other in public policies.

According to the philosopher Stuart Hampshire, actors in public affairs have an “added responsibility” (Hampshire, 1978, p. 49) because, from the relationship of representation, specific deontologically natured duties and obligations follow. Because of this added responsibility, public governance actors cannot have a purely consequentialist or utilitarian morality. Yet to pursue goals, they sometimes have to violate an obligation. According to Walzer (1973), in the process of governance, a public actor can choose a course of action that is perfectly justified on utilitarian grounds but still leaves the actor guilty of a moral wrong. So, there are moral rules of the game: The “means” (or process values) specific to public governance that can conflict with the ends public actors pursue. For example, “Because transparency is an obligation resting on democratic government, there is a permanent danger that, in those areas of policy requiring secrecy as a necessary condition for successful execution (notably, foreign affairs), this obligation will be violated” (Nieuwenburg, 2004, p. 685).

Value Conflicts in the Literature

Looking at earlier studies in which the dilemmas of those in the public sector were a key issue, a good starting point is Lipsky’s (1980) classic work on street-level bureaucracy, in which he studied the dilemmas of the individual in public services. He concluded that with their actions, street-level bureaucrats (civil servants who have direct contact with clients and who have a certain discretionary authority) do not only implement but also constitute government policy. Lipsky showed how policy goals are translated into general policies that should guide individuals in our public administration. However, as they experience situations in which a rule conflicts with a higher goal, in which rules conflict with each other, or in which they have discretionary space, civil servants have to make choices.

Lipsky’s and others’ work on street-level bureaucrats (e.g., Maynard-Moody & Musheno, 2003) shed some first light on the value conflicts public administrators experience. Two key issues that street-level bureaucrats have to cope with are the constant pressure on budgets and the care with which they want to do their job. In terms of values, this can be framed as the classical dilemma between efficiency and effectiveness: Working in a more efficient manner might mean that the work is done less effectively (in terms of the quality of the work, for instance). Second, Lipsky and others describe the conflict between following general rules on one hand and creating customized solutions for clients on the other. Various values such as lawfulness, equality, professionalism, and effectiveness conflict in such situations.

Value conflicts have received more attention in the public governance literature since the turn of the century. Most of this (theoretical) work focuses on the bipolar conflict between acting in the right manner and managing to get good results; between process values (such as integrity, lawfulness, transparency, and participation) and output values (effectiveness and efficiency; De Graaf & Van der Wal, 2010). Weihe (2008) addressed the potential conflict between material and procedural values in public–private partnerships. Bovens, ‘t Hart, and Van Twist (2007) argued that there are more potential conflicts and that we should thus look further than the bipolar distinction between process and output values. Here, this argument is followed and conflicts are framed using three types of governance each of which focuses on a particular aspect of good governance. First, this is the idea of performing governance, which is related to values like effectiveness and efficiency. An emphasis on this aspect of good governance is in line with, for instance, ideas on New Public Management (Hood, 1991). A second type of governance is called proper governance. Key values of this type are integrity, lawfulness, and equality. Responsive governance is the third type of governance. Values related to this type are transparency, participation, legitimacy, and accountability. These are values that have become more important to Western democracies during the last decades, partly as a result of technological developments and a changing role for governments in societies (cf. Rhodes, 2007; van Kersbergen & van Waarden, 2004).

Coping Strategies

As soon as public actors do not treat values as commensurable, they find themselves in a value conflict. This in itself is not a problem; perhaps value conflicts bring forth change for the better through innovation and alertness. Plus—as can be learned from Lipsky’s study—value conflict is unavoidable, it is a fact of administrative life. Decisions in public governance involve contending with diverse and often conflicting values (O’Kelly & Dubnick, 2005, p. 394). “Public administrators are often faced with making difficult choices or judgments among incompatible and incommensurable values” (Spicer, 2009, p. 541). Wagenaar (1999) argued, “public programs are structured in such a way that they regularly confront the administrator with difficult value choices” (p. 444). Yet, there is a danger that value conflict leads to a state of paralysis. Coping strategies (or coping mechanisms as they are also called in the literature) should prevent a state of paralysis for those who face value conflicts. For example, Lipsky showed how civil servants sometimes routinize their actions. Doing so would make life easier as choices for a particular value have to be made only once, after which it becomes routine.

On the issue of how to deal with value conflicts in public governance, Thacher and Rein (2004) have made an important theoretical contribution. Thacher and Rein describe how value conflicts that are unsolved can lead to psychological stress and can paralyze public officials. Conventionally, Thacher and Rein argue, the response of public actors to value conflicts has been seen as either a matter of balancing competing goals or making a trade-off (famous examples: Le Grand, 1990; Okun, 1975). The archetype of trade-offs is the cost–benefit analysis: The public values are given a monetary value and the optimum is calculated. But as Lukes (1996) has shown, not all our choices are to be understood as trade-offs. Thacher and Rein developed an (empirically grounded) theoretical framework for understanding how policy actors cope with value ambiguity. They claim that actors do not treat conflicting values as commensurable but draw on a repertoire of alternative strategies which enable them to cope. (These public governance strategies should not be confused with the more psychological coping strategies mentioned in the literature for individual [frontline] workers to deal with stressful situations and deal with policy alienation; cf. Tummers, Bekkers, Vink, & Musheno, 2013.) Each strategy has its own advantages and disadvantages. Thacher and Rein name three coping strategies: firewalls, cycling, and casuistry. Stewart (2006) discussed—in the context of policy change—the three strategies of Thacher and Rein, which she calls processes, and adds three. The six coping strategies are as follows:

None of these strategies require commensurability, yet they avoid a paralyzing situation which is often the result of carefully weighing the relative importance of conflicting values (Millgram, 1997); in this article, they are used as conceptual lenses to study how conflicting values are dealt with in public governance.

Reflecting on the character of the various strategies, one notices that they differ conceptually. First of all, while some coping mechanisms are conscious reactions to experienced conflicts (like casuistry), others (like cycling) seem to originate from a series of choices made over time. As a result, it seems likely that one will only find cycling in a longitudinal study of a particular issue. Second, while some are more likely to be on the meso or organizational level (like creating firewalls), others are more likely to be on a micro or personal coping level (e.g., bias). This is important to be aware of, as it also means that multiple coping strategies might be used in response to a single value conflict. One can, for instance, imagine that creating firewalls on an organizational level results in a bias for the workers in one of the “firewalled” departments. Also, Stewart (2006), Thacher and Rein (2004), and Steenhuisen and van Eeten (2008) related the coping strategies mainly to policy decisions. Most examples they give concern cases in which different outcome values are conflicting (for instance, punctuality and safety of trains in the article of Steenhuisen & van Eeten, 2008). Here, we study process values: We do not focus on the content and goals of public policy—and the difficult choices they entail as we cannot achieve everything we want—but on public governance. Finally, it is important to note that Thacher and Rein identified their strategies inductively; they are not based on theoretical choices. The six strategies presented above thus can overlap and the list can certainly be expanded (Thacher & Rein, 2004, p. 464).

Method

This explorative study focuses on the value conflicts that are perceived by public administrators, and how they are dealt with. It was feasible to conduct two case studies, two organizations. As we are interested in the variety of value conflicts that occur in public organizations we chose to study one classic public organization and one semi-public organization. As both municipalities and hospitals have their own codes that express the public values that are desirable in both organizations, we chose these organizations as our cases.

As both our case study organizations are located in The Netherlands, the Dutch governance code for the public sector which was drafted by the Dutch Ministry of the Interior and Kingdom Relations in 2009 was examined first. This code lists seven principles of good governance, but on a closer look it becomes clear that some of these principles contain several values. In the end, 10 public values were central in our study (Table 1).

OPEN IN VIEWER

Table 1.

The 10 Values.

1. Openness. Acting transparently toward all stakeholders on procedures and decisions

2. Participation. Involving the environment and stakeholders in decision making

3. Accountability. Acting willingly to justify and explain actions to relevant stakeholders

4. Legitimacy. Acting with public support

5. Effectiveness. Acting to achieve the desired results

6. Efficiency. Acting to achieve results with minimal means

7. Integrity. Acting in accordance with relevant moral values and norms

8. Lawfulness. Acting in accordance with existing laws and rules

9. Professionalism. Acting with expertise, including learning from previous mistakes

10. Equality. Treating equal cases equally

To some extent there are many similarities with these 10 values and the “set of global public values” identified by Beck Jørgensen and Sørensen (2013). The main differences are that the Dutch code does not contain values (similar to) public interest and political loyalty. On the contrary, more “modern” values such as professionalism and participation are added.

To find the value conflicts experienced within the two organizations—the second part of the research question—respondents with a range of different roles and responsibilities were chosen (cf. Vrangbæk, 2009, p. 528). In the municipality, we interviewed the mayor, two aldermen, six managers, and ten civil servants. The managers and civil servants came from three different sectors: permit enforcement, social security, and neighborhood management. While the executers in the first two sectors are responsible for the implementation of policy, neighborhood managers also have a role in the process of agenda setting and policy making. In the hospital, we interviewed a total of 16 respondents. The sample in this case consisted of both of the two senior executives, doctors, nurses, managers, and supporting staff. All interviews lasted somewhere between 45 and 75 min. All the interviews were taped and transcribed literally. During the semi-open interviews, questions were asked on (a) perceptions of relevant values in their daily activities; (b) relevant concrete conflicts perceived, foreseen, or known; and (c) particular values: transparency, participation, legitimacy, accountability, lawfulness, integrity, equality, efficiency, effectiveness, and professionalism—their definition, role in governance, and conflicts between them. Many interviewees initially considered the role of values in governance to be abstract. They were, however, able to make the values more concrete—for themselves and the researchers—when actual value conflicts were discussed. The specific value conflicts that officials perceive is important here, as is how they justify (Boltanski & Thévenot, 1999, 2006) and frame (Schön & Rein, 1994) them. All interviews started with a general question about the toughest decisions the respondent faced; only later were the 10 values introduced and the dilemmas interpreted in terms of value concepts.

To find the different value profiles of administrators in both cases—the first part of the research question—Q-methodology was used (cf. de Graaf & Van Exel, 2009; Selden, Brewer, & Brudney, 1999). All respondents were asked at the end of the interview to rank the 10 values in a Q-sort, to get a first impression of the value profiles among the respondents and how these profiles relate to the roles and functions of the respondents (De Graaf & Van Exel, 2009). Q-methodology was deemed most suitable because Q-study results are clusters that are functional rather than logical. In other words, the clusters are not logically constructed by the researchers, they result from the empirical data; they are operant (De Graaf & Van Exel, 2009). Q-methodology can reveal a characteristic independently of the distribution of that characteristic relative to other characteristics in a population. Unlike surveys, which provide patterns of variables, Q-methodology provides patterns of persons, in this case, administrators and their value profiles. Q-methodology is a mixed qualitative–quantitative small-sample method that provides a scientific foundation for the systematic study of subjectivity, such as people’s opinions, attitudes, preferences, and so on (cf. Brown, 1980, 1993; De Graaf, 2011; Twijnstra & De Graaf, 2013; Watts & Stenner, 2005).

Coding and Research Heuristic

The individual Q-sorts were factor analyzed using PQMethod 2.11 (extraction method: centroid; rotation method: varimax) to reveal the distinct ways in which the values were rank-ordered. The analysis led to six factors—six value profiles.

Using the software program ATLAS.ti, the interviews were coded in various steps as described by Boeije (2010). According to Eisenhardt (1989), the multiple case study design offers the researcher the opportunity for more accurate formulation of concepts than single case studies. To be more specific, the logic of our data analysis is the “retrospective comparison of cases” (Den Hertog & Wielinga, 1992, p. 104): an in-depth analysis of a large set of aspects in a number of cases. According to Eisenhardt, the advantage of this design is that it allows the researcher to recognize general patterns in different settings. The disadvantage of this design is, however, that every case, with its own context and contingencies, has to be reduced to a more abstract level, to make between-case comparisons possible (Dyer & Wilkins, 1991). Of course, the context of municipal government differs largely from a hospital.

After coding, the next step was to take a certain theme and read all the respondents’ answers on it. From this overview, first impressions of overall patterns were derived and were then juxtaposed with the empirical data. This inductive process is clearly not a matter of counting. Besides the fact that we did not randomly select our respondents and that 34 interviews are, for quantitative purposes, too small a number, the idea of our explorative study is to consider the nuances and context of every case. Thus, it is not just important that a respondent experienced a value conflict, but which one and how it was dealt with; how it was worded. The inductive analysis process was repeated many times before the final analysis was written.

The central idea is that researchers constantly compare theory with data-iterating toward a theory which closely fits the data. A close fit is important to building good theory because it takes advantage of the new insights possible from the data and yields an empirically valid theory. (Eisenhardt, 1989, p. 541)

Results

Value Conflicts in the Municipality

The fact that respondents in the municipality had different and to some extent opposing value profiles is also reflected in the large number of value conflicts that respondents perceived. Figure 1 shows the value conflicts that were mentioned by at least three respondents.

OPEN IN VIEWER

Figure 1.

Number of particular value conflicts in the municipality.

Most conflicts follow the division between performing, proper, and responsive governance.

Proper versus performing governance: Respondents in the municipality experience how adhering to legal and moral norms can conflict with norms for performance. Having full integrity might mean that one misses out on opportunities for the realization of specific policy goals. An alderman states that his colleagues and civil servants try to be on the safe side and thus stay away as far as possible from the boundaries of integrity. “But by staying very far away from those boundaries, you do not fully exploit the opportunities an organization has.” A second conflict arises when treating everyone equally might mean that one spends part of a budget on citizens that do not really need it. In the eyes of respondents, equality then conflicts with efficiency. Third—and most noticed by respondents—it can be hard to choose between following the rules and making sure that one achieves results quickly. In line with the argument of Maynard-Moody and Musheno (2003), civil servants can then choose between either strictly following the rules or seeking space to maneuver—based on their estimation of the particular case: “citizens should file a request for subsidy 6 weeks in advance. However, when they do it 1 week in advance and I believe it to be an important initiative, I will arrange it in 1 week.” Another civil servant gives the example of arranging the construction of parking spaces on a spot where they are not allowed according to the rules of the municipality: “Those citizens are very satisfied. But if you would do that by the book, then you would need to start this whole procedure.” This finding harks back to a study on the loyalties of different types of Dutch administrators:

Client loyalty seems to play a large role in the loyalty conceptions of street-level administrators, whereas loyalty to stakeholders in the policy field (the equivalent of client loyalty for top level administrators) plays a small role in the loyalty conceptions of top administrators. (De Graaf, 2011, p. 15)

And a conclusion of the earlier mentioned study in Denmark on value conflicts: “Public managers in regulative/administrative organizations think that rule abidance and balancing interests are more important, whereas public managers in service delivery organizations score higher on professionalism and user focus” (Bøgh Andersen, Beck Jørgensen, Mette Kjeldsen, Holm Pedersen, & Vrangbæk, 2012, p. 723).

Proper versus responsive governance: In the municipality, proper governance also conflicts with responsive governance—partly because one cannot be open about certain issues where the law prohibits it. More important, however, is the conflict between participation and lawfulness. Getting citizens involved and hearing what their opinion is might result in the fact that one has to choose between implementing general and lawful policy which was established by the city council (vertical democracy) or doing what citizens want you to do (horizontal democracy):

The city council is the representation of the people and when you start a participation process, a conflict can arise that leads to a situation in which you have to choose: are we going to follow the general policy or are we going to follow the wishes of this specific neighborhood?

A similar conflict was found in Bøgh Andersen et al. (2012) in Denmark:

In a similar vein, the negative correlation between “rule abidance” and “user focus” (implying a value conflict between hierarchy and market) also makes sense as satisfying users’ needs will often put public managers in a dilemma between (narrow) individual concerns and broader structural elements (exemplified by the plights and prerogatives which rules imply). (p. 723)

Responsive versus performing governance: Being responsive from time to time also conflicts with achieving results. Respondents notice first of all how accountability conflicts with efficiency. Sometimes the quest for accountability leads to inefficient procedures. On other occasions, civil servants decide to skip a form of accountability to save time that they can use to help another client. Second, transparency and effectiveness often conflict in the municipality. Sometimes it seems to be in the interest of the municipality not to make something public or to be completely open, but these are tough decisions to make. “I might be too open sometimes. Because if you are too open, that can sometimes harm the quality of the decision-making process in the interest of the municipality.” Finally, respondents argue that they have to make choices between an efficient decision-making process and allowing everyone to participate in the process. Moreover, doing the latter might also result in less effective policy as the process results in a consensus that nobody can really work with: “I believe that I’m doing things which I doubt are really effective.”

Three more conflicts were mentioned. First of all, a traditional value conflict between effectiveness and efficiency is provided: The pressure on civil servants to be more efficient can conflict with their views on how to do their job in an effective manner. “Efficiency can be at the expense of a careful handling of a specific case . . . There’s quite some pressure from the rest of the organization. We often hear others argue ‘you are always so careful.’” This is in line with earlier findings of Bøgh Andersen et al. (2012): “Once the budgeted resources are used, the public service provider faces a serious dilemma of either skimming on services or not being able to keep the budget” (p. 723). Second, two values that can both be seen as translations of responsive governance can conflict with each other: Stimulating participation might not always lead to more legitimacy. In the end, it can be difficult to ensure that a decision has widespread support in society when one asks citizens to participate in decision making. Finally, while client managers (as noted in the study) believe lawfulness is of the highest importance, they do sometimes feel that it conflicts with their own idea of fairness. This troubles them on a personal level.

Value Conflicts in the Hospital

Compared with the municipality, less value conflicts were mentioned in the case of the hospital (see Figure 2). This might have to do with the semi-public character of the hospital. Acting in a proper manner and being responsive to society are expected from both a municipality and a hospital, but are of less importance in the daily work of the latter. Instead, work in the hospital is all about treating patients in a professional manner. Most of the value conflicts that occur thus entail a conflict in which the effectiveness or efficiency of the treatment of patients is at stake.

OPEN IN VIEWER

Figure 2.

Number of particular value conflicts in the hospital.

A first important value conflict, experienced primarily by middle managers and nurses, is between effectiveness and efficiency. As we saw in the municipality, the pressure to save money or time, can conflict with one’s ideas on doing a careful job. In the eyes of some, the conflict between efficiency and effectiveness is primarily hypothetical. In the eyes of others it already occurs: “Then we have to compromise on the quality of our care . . . Too few nurses while there are too many patients.” Having enough time for high-quality care can also conflict with demands for accountability. It is mostly doctors who find both things important, but feel that the demand for accountability sometimes is at the expense of their time for delivering good care. “You used to write things down in a file and then you were done within 10 minutes. Now you are writing for almost half an hour for just one patient. That starts to become excessive.”

Another conflict—which is experienced by almost all respondents—is between transparency and effectiveness. Doctors and nurses find it important to be open to patients and their relatives, but also have to take into account whether this can damage the effectiveness of their treatment when their message might cause too much upset. On the level of the hospital as an institution, too, transparency and effectiveness conflict. Should the hospital be open about things that have gone wrong or should it save its reputation: “I don’t want to have any trouble, so I’d rather choose the safe way out. But that leads to discussion with our medical staff because they do not necessarily agree.”

In the process of delivering care, the participation of patients has become more and more important. Most respondents applaud this development, but in some situations, they feel that participation conflicts with their professionalism. The wishes of a patient might not always be what the doctor or nurse believes to be the best course of action. Finally, following procedures strictly is good in general, but can sometimes conflict with providing the best and most effective treatment. Sometimes because the procedures prescribe actions that are not the optimal solution for the specific case, on other occasions because the prescribed actions take a lot of time: “Officially only the doctor can request such an examination. By now, I regularly just do it myself. And most of the time, that is applauded afterwards.”

Conclusion and Discussion

While governance codes try to formulate the meaning of good governance by listing a number of desirable public values, this study confirms the idea that these values can and do conflict in reality. Neighborhood managers, counselors, inspectors, doctors, nurses, middle managers, and executive directors all experience situations in which various values—which are in themselves desirable—conflict. Which values they find most important (as shown in the value profiles in this study) and which value conflicts they experience, is to a large extent influenced by the context of their specific job. Some values are however more present in the perceived value conflicts. In the municipality, respondents struggle with the extent to which lawfulness is an absolute value: Is it “good” governance to bend rules for the sake of effectiveness, efficiency, or participation? And what is more important: The effectiveness of policy and efficiency of policy processes or transparency and accountability toward the public and a participation process in which all actors are involved? These public values are incommensurable. Middle managers and their personnel in both the municipality and the hospital struggle with the current pressure on efficiency: Saving time and money is desirable, but what to do if you feel the pressure for more efficiency damages the quality of your work? In the hospital, respondents throughout the organization also struggle with the conflict between the effectiveness of their care or the hospital in general and the importance of transparency and accountability: Is it “good” governance to be less transparent and pay less time to accountability processes if you believe it ensures better care for patients?

Some of the conflicts found here were described by Lipsky (1980). But some new value conflicts were also identified. The demand for responsive governance can conflict with ideas about proper and performing governance. Moreover, the current pressure on budgets and the need to work in a more efficient manner seems to make conflict concerning efficiency more prominent and intense. As it is unlikely this pressure will fade away in the near future, it is interesting to look at the various ways public administrators cope with these value conflicts.

This study distinguishes empirically two patterns of coping strategies. The first pattern starts with firewalls on an institutional level: Various departments are given the responsibility of pursuing the realization of different values (resulting in differences between the value profiles of employees in the different departments). This makes it easy for those in the departments as it is clear to them what they have to do, possibly because of a bias. However, in particular cases in which the various departments are all involved, the value conflict can resurface. This leads to an individual coping strategy called “escalating” here: The conflict returns to higher levels in the organization.

In the second pattern, the different values are not separated institutionally. Instead, it is left to the professional to come to a good solution in specific cases. The professional turns to “casuistry,” which allows for an optimal solution to be found in every case. As this puts more pressure on the professional, this strategy is combined with “support”: administrators ideally share their dilemmas with colleagues and find out whether there is support for their preferred course of action.

Case studies—as conducted here—offer the advantage of studying phenomenon within their context. The disadvantage is that they do not allow for statistical generalization. Eisenhardt and Graebner (Eisenhardt, 1989; Eisenhardt & Graebner, 2007) argue that case study research does allow for theoretical and analytical generalization. The purpose of the within-case analysis was to study the case as a unique entity which “allows the unique patterns of each case to emerge before investigators push to generalize patterns across cases” (Eisenhardt, 1989, p. 540). Future research in other public institutions comparing our findings, and more quantitative research which makes statistical generalizability possible, would be interesting. Also, given the fact that this specific study was conducted in the Netherlands only, generalizability of the results to other countries and cultural spheres is limited. It would be interesting to conduct a cross-country value comparison.