Applying A Public Management Perspective To Anti-Corruption Policy Implementation. An Empirical Analysis On The Role Of Public Management For Effective Policy Implementation In The Healthcare Sector In Italy

APPLYING A PUBLIC MANAGEMENT

PERSPECTIVE TO ANTI-CORRUPTION

POLICY IMPLEMENTATION

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An Empirical Analysis On The Role of Public Management For

Effective Policy Implementation In The Healthcare Sector In Italy

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Donatella Casale

University of Pisa

Department of Economics & Management Doctoral Dissertation Academic Year 2014-2015

PhD Programme “Regionali Pegaso” in Business Administration and Management Advisor Prof. Dr. Riccardo Mussari

Key words: Italy, New Public Management, Anti-Corruption, Policy Implementation. Codes: SSD 13/B1; SECS-P/07, SSD 13/B2; SECS-P/08.

“Applying A Public Management Perspective To Anti-Corruption Policy Implementation. An Empirical Analysis On The Role Of Public Management For Effective Policy Implementation In The Healthcare Sector In Italy”

© 2015 Donatella Casale

University of Pisa Department of Economics & Management Doctoral Dissertation Academic Year 2014-2015 PhD Programme “Regionali Pegaso” in Business Administration and Management

PhD Advisor Prof. Dr. Riccardo Mussari Key words: Italy, New Public Management, Anti-Corruption, Policy Implementation.

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The dissertation investigates the process of anti-corruption policy implementation in Italian local health agencies from a public management perspective. At first, the author offers a theoretical examination of the relationship between New Public Management - a public management movement that, inspired by private sector practices, raised to challenge the formal bureaucratic authority structures to improve governmental performance and capacity- and anti-corruption. Then, the particular focus of her empirical analysis is placed on the healthcare sector, one of the sectors more affected by the problem of corruption since regional budgets in Italy are engaged with significant shares of health spending. In fact, Italian health service is based on decentralized means, that it is significantly variegated at the local level, both in terms of the efficiency, than respect to the organization of care facilities and public perceptions on the quality of services provided. As a result, even health care spending is diversified regionally. To this account, in the methods section the author empirically investigates the implementation of the anti-corruption policy in Italian Local Health Agencies by following a nested research design, which ends up with a controlled comparison of two Local Health Agencies in order to shed light on the process of implementation of a new anti-corruption regulation issued by the Italian Government in November 2012 after several recommendations coming from international bodies such as the Council of Europe’s anti-corruption monitoring body (GRECO). The model of anti-corruption delineated by this regulation takes place through a complex pattern of relationships between many actors with different roles, particularly articulated to translate in practice through a capillary system of responsibilities, plans and compliance. The risks of such a system are mainly represented by the increase of “red-tape”, ending up with the prevalence of procedural compliance instead of real understanding of the objectives of the policy and their factual implementation. Shifting from an approach to compliance towards an approach focused on commitment and managerial quality might constitute, on the one side, to widespread integrity culture and more ethical behavior in the public sector and to the achievement of the desired outputs of the implementation process, on the other. The perspective embraced by the author during the investigation is a public management perspective, that focusing on the achievement of the desired outputs of the implementation process in Italian Local Health Agencies aims at testing a “managerial quality hypothesis” as a tentative framework to investigate the ultimate role that public managers exert on the successful achievement of policy implementation and management. Various factors are controlled during the investigation, including relevant regional healthcare features and critical agencies’ features- e.g. the levels of healthcare spending per inhabitant, important regional Quality of Government indicators like the regional levels of perceived impartiality and corruption of healthcare, as well as particular agencies’ features like human resource and financial capacities. Finally, the

agencies and to provide insights for the improvement of anti-corruption policy implementation and management at a sub-national level of government in Italy.

The results of the study show that the complex system of accountability and punishment introduced by the law, however claims a bottom-up approach to the problem, such as reminded an holistic approach to the solving of the problem in question and the establishment of a common civil service culture more imbued with integrity and transparency and with clear chains of accountability. The core of the newly introduced policy is the prevention of corruption, instead of the suppression of it. To this account the emphasis is put on risk mapping and on the introduction of organizational instruments and procedures able to prevent wrongdoing. However, both managers interviewed express they feelings that the policy has a real potential to act on behaviors and that even if it has to introduce at first top-down measures such as norms and rules, they admit that the behaviors seem to e influenced by them and that top-down mechanisms are taking place to modify employees’ perceptions and are shifting employees attention on integrity issues that till the introduction of the policy were not among the first places of the employees agendas, as much as worries about parsimony in resource use and on the delivery of highest performances and standards with the constant pressure to “do more with less” that since 2009 seemed to be the main theme in Italian public administration; particularly after the introduction of a comprehensive reform on performance management (reform 150/2009 also known in Italy as the Brunetta Reform from the name of the Ministry for Public Administration at the time). Further attention should be placed on networking and on the communication of the policy results by the local health agencies to the exterior, such as through meeting with citizens and interest members of the civil society, in order to increase social capital and citizens’ trust in public administrations and on the presence of committed public managers which put their best efforts and their transferable skills to the service of citizens and for the delivery of high standard of services and for the construction of a culture of integrity within public sector organizations.

__________________________________________________________________________________ List of Figures____________________________________________________________________9 List Of Tables____________________________________________________________________10 PART I INTRODUCTION TO THE DISSERTATION___________________________________13

1. Key Concepts And Research Rationale____________________________________________15 PART II REVIEW OF THE LITERATURE____________________________________________25

2. From Traditional Public Administration To New Public Management__________________27 2.1 Public Administration and Public Management: The Origins____________________________27 2.2 The Spread of the New Public Management Movement________________________________33 2.3 Understanding New Public Management and Beyond: A critic __________________________41

3. Corruption and Anti-Corruption Policies in Government: The Problem and the Cure_____49 3.1 Corruption: Theory and Evidence__________________________________________________49 3.2 The Supply And Demand Sides Of Administrative Corruption___________________________53 3.3 The Global Anti-Corruption Crusade_______________________________________________63 3.4 New Public Management and Administrative Corruption: The Debate_____________________66

PART III METHODS AND DATA___________________________________________________71 4. Background To The Data: Public Management, Regional Development And Anti-Corruption In Italy__________________________________________________________________________73 4.1 Italian Public Administration And Administrative Reforms Implementation Between

1990-2013_____________________________________________________________________73 4.2 Understanding Italian Regional Development And Healthcare System____________________80 4.3 Determinants And Effects Of Corruption in Italy: Focus On Regional Data________________84 4.4 Anti-Corruption Reform and Implementation in Italy: Preliminary Data___________________91

5. Research Design and Case Selection Criteria_______________________________________99 5.1 Applying A Public Management Perspective To Anti-Corruption Policy Implementation_____99 5.2 Research Questions and Design__________________________________________________103 5.3 Case Selection Criteria, Variables Of Interest, And Units of Analysis____________________108

6. Data Collection and Analysis____________________________________________________127 6.1 Descriptive Statistics: Secondary And Archival Sources Of Nested Data__________________127

6.3 Documentary Sources of Data____________________________________________________159 6.4 Interview Data________________________________________________________________160 6.5 Analyzing The Multiple Sources Of Data: Process Tracing_____________________________163

PART IV RESULTS AND CONCLUSIONS___________________________________________169

7. Results_______________________________________________________________________171 7.1 Documental Evidence__________________________________________________________171 7.2. Interview Results _____________________________________________________________186

8. Conclusions__________________________________________________________________197 8.1 Interpretation And Recommendations: How To Get Effective Anti-Corruption Policy

Implementation And Management ______________________________________________197 8.2 Limitations And Delimitations___________________________________________________211

8.

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1 Corruption between government and business 52

2 Drivers and effects of corruption of government officials by businesses 52 3 Contingency model on the supply and demand approaches to the study

of administrative corruption 62

4 NPM reform time-line 1990-2013 in Italy concerning: Organizational restructuring (OR), Human resorces related modernization (HRM), Process-innovation (PI) 76

5 Offenses for corruption per capita 1970-2009 in Italy 86

6 Offenses for corruption per capita 1980-2004 divided by macro-areas 87

7 Basic theoretical model 110

8 Extended theoretical model 111

9 Vectors of control’s diagram 125

10 Impartiality of public health care system from the EQI 2013 129 11 Perceived corruption of public health care system from the EQI 2013 130

12 Current regional health public spending in 2013 132

13 Current health public spending/inhabitant (Euro) 133

14 Variables 1-2-3 per region (data 2013) 135

15 Regional Health Care in Emilia-Romagna 138

16 Territorial organization of ULSS 1 Belluno 154

17 AUSL Parma territorial scope of competence through the sanitary districts 155

18 AUSL general organization chart 158

19 AUSL’s administrative directorate organization chart 158

20 General organization charts of ASLs’ administrative organization units 158

21 In-depth interviews topic guide 162

22 Causal diagram 164

LIST OF TABLES

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1 Components of NPM 36

2 Components of the so-called Post-NPM 45

3 Italian Regions 83

4 Corruption offenses per capita 1970-2004 in the regions Italian-average values

per 100,000 inhabitants 88

5 Corruption offenses per capita in Italy 2004-2009 - 88

6 Changes to the Italian criminal code after the Anti-corruption reform of 2012 94

7 Case study dataset diagram 112

8 Nested Matching Criteria And Variables Of Interest 113

9 Selection procedures diagram 114

10 Regional Vector of Control (1): Impartiality of public health care system 128 11 Regional Vector of Control (2): Perceived corruption of public healthcare

system in 2013 129

12 Regional Vector of Control (3): Current regional health public spending in 2013 131 13 Current health public spending/inhabitant (Euro) excluded Trento and Bolzano 132

14 Vectors of control cumulative standardized dataset 134

15 ASLs in Emilia-Romagna 138

16 Cumulative data on Emilia-Romagna’s Health Agencies Features 139

17 Veneto Region Regional Local Health Agencies 140

18 Cumulative data on Veneto’s Health Agencies Features 140

19 Cumulative dichotomized variables at an Agency Level in Emilia Romagna and Veneto 141 20 Main Job function of the Responsibles for the Prevention of Corruption in 2013 in Emilia

Romagna’s Local Health Agencies 145

20.1 Implementers’ gender in Emilia Romagna’s local health agencies 145 20.2 Education levels of the Responsibles for the Prevention of Corruption in 2013 in Emilia

Romagna’s Local Health Agencies 145

20.2bis Major of the Responsibles for the Prevention of Corruption in 2013 in Emilia Romagna’s

Local Health Agencies 146

20.3 Gross annual salary of the Responsibles for the Prevention of Corruption in 2013 in Emilia

Romagna’s Local Health Agencies 146

20.4 Years of service of the Responsibles for the Prevention of Corruption (data 2013) in Emilia

Romagna’s Local Health Agencies 146

21 Main Job function of the Responsibles for the Prevention of Corruption in 2013 in Veneto’s

21.2 Education levels of the Responsibles for the Prevention of Corruption in 2013

in Veneto’s Local Health Agencies 147

21.2bis Major of the Responsibles for the Prevention of Corruption in 2013 in Veneto’s

Local Health Agencies 147

21.3 Gross annual salary of the Responsibles for the Prevention of Corruption in 2013

in Veneto’s Local Health Agencies 148

21.4 Years of service of the Responsibles for the Prevention of Corruption in 2013

in Veneto’s Local Health Agencies 148

22 Cumulative dataset of the dichotomized variables of interest nested

PART I INTRODUCTION TO THE DISSERTATION __________________________________________________________________________________

The purpose of this section is to introduce the dissertation topic and to present the rationale for why the topic is important. To this account, Chapter 1 presents the background to the study, highlighting its significance to the present context. In addition, the main research objectives and outcomes will be presented, along with information on the organization of the dissertation.

CHAPTER 1

KEY CONCEPTS AND RESEARCH RATIONALE

__________________________________________________________________________________ Public policies are courses of actions linked one to another by a chain of cause and effect. The formal policy objectives embody the desired effects, although since policy actions are undertaken to alleviate complex social problems causality is not straightforward. Thus, at the hearth of the study of pulic policy is the scientific study of causality. The policy sciences, along with the study of public policy, raised in the US Federal Government during the Great Depression of the 1930s mainly through the practice of performing cost-benefit analyses. Then, during the Second World War and there-hence they constituted an established governmental practice, giving rise to evaluation departments in the Federal Government and a real “industry” of evaluators (deLeon 2006).

The applied nature of the policies sciences to the solving of societal problems, more than to their analysis per se, makes policy at the same time a science, an art, a craft (Smith and Larimer 2013). Which should be the ‘best’ methodological approach to the study of public policy is still disputed by positivists and post-positivist, even though a middle-ground has also appeared in the horizon of the policy sciences. Anyway, the best methodology should be defined by the context (deLeon 2006). Program evaluation (especially process evaluation) consistently overlaps with the study of policy implementation, which describes and analyzes the processes of implemented program activities such as management strategies, operations, costs, and interactions. In fact, public policy success or failure is often explained through the study of implementation (Wildavsky 1973). Government intentions and the real impact of public policies on the outcomes of interest are translated into reality by each executive branch agency and by the people responsible for their enforcement. However, issues related to coordination and ambiguity of law, inter alia, can leave space to interpretation, and what can occurr is a gap between intention and results (Kerwin and Furlong 2010; O’Toole 1995; Mazmanian and Sabatier 1983; Ferman 1990). Accounting for results, the quality of public managers responsibles for running governmental programs is considered a key element of success for the implementation of public policies (O’Toole and Meier 2011; Hicklin and Godwin 2009; Meier 1999; Sandfort and Moulton 2015).

The field of policy implementation studies is traditionally divided into three generations (Goggin et al 1990), although a fourth one seemed to emerge thanks to the widespread attention on management and results in the public sector (Smith and Larimer 2013). The first generation of studies raised with Pressman and Wildavsky (1973), thus, right at the beginning of the start of the study of implementation. The major objective of the research carried out in this period was the systematic understanding of implementation. These studies highlighted the importance of this process, along with

its complexity, especially generated by the need of joint action amongst the different layers and agencies of government. A second generation of studies, more analytical and comparative was initiated across the end of the 1970s, and beginning of the 1980s aiming at building generalizable theories for implementation by identifying the factors that affected variation in the implementation of the policy programs in different governmental units. This stream of research identified some adverse effects in the implementation process, such as, the possibility of diversion of resources, the deflection of policy goals by the means of new programs aimed at reaching more preferred goals, resistance to control, and dispersion of personal and political energy by blocking progress of a program in an attempt to extract self-interested terms or concessions that may or may not be related to policy goals. This generation of studies contributed to the classification of behavioral patterns across governmental bureaucracies (Smith and Larimer 2013). On the one hand, implementers’ behavior is considered as the key explanatory target of the evolutionary process, taking place within the frameworks for implementation (Bardach 1977; Majone and Wildavsky, 1979). On the other hand, also the consideration of policy outputs and outcomes as key dependent variables of effective generalizable frameworks for implementation has successfully contributed to the study of policy implementation and its main features (see Mazmanian and Sabatier 1989). Indeed, recently, the growing development of public management as the study of public administrations and governmental institutions by emphasizing private sector’s management instruments gave rise to a fourth generation of studies (Smith and Larimer 2013). The pioneers of this stream of research have been Matland (1995) Lester and Goggin (1998) and Kenneth Meier (1999). This generation used both bottom-up and top-down perspectives. E.g. Lester and Goggin’s (1998) model focused on a bottom-up perspective, which considered governmental commitment and institutional capacity as key dependent variables. In contrast, Kenneth Meier (1999a), calling for the incorporation of elements coming from public administration and public management, emphasized the importance for implementation studies to keep the policy outcomes as key dependent variables in studies seeking to analyze the implementation process. Key questions were developed to examine how do policies are put in place or which are the affecting factors that may block or modify the desired changes to be brought by the policy.

It has been acknowledged that the new work in public management constitutes a generalizable dimension of implementation, amenable to manipulation by policymakers. Thus, its constituting features can be used to improve policy outcomes and to create cumulative knowledge (ibid). Generalizations from implementation research should be used in order to formulate new implementation plans (Kelman 1984) since implementation research raised with practical purposes, such as to highlight the complexity of the relationship between policy and action, as well as, to sensitize the public opinion on the importance and on the benefits deriving from the actions that characterize policy interventions (see O’ Toole, 1986).

Since the 1990s Italian public administration has been characterized by a series of policy cycles in public management (Ongaro 2009), and since then New Public Management spread in the country as a movement that, inspired by private sector practices, tried to challenge the formal

bureaucratic authority structures to improve governmental performance and capacity. Particularly, still during the 1990s Italian regions have been subject to a complete reorganization from the institutional and administrative points of view under the growing pressure of NPM. Their organizational structure has become increasingly flexible and horizontal, with responsibility for the results and performance allocated to healthcare managers. Anyway, Italy has about 8.060 municipalities, 20 regions, and 110 provinces, that make the country, and especially its sub-national level of government, a highly diversified research field due to cultural and territorial characteristics that prove differences between north, center, and south areas of the country. Regions in Italy do not play a role of active management, as they are responsible for functions of organization and coordination, while the most administrative functions are performed by other bodies that are constituted primarily by municipalities and provinces according to the principles of subsidiarity and adequacy. Although, there is no denying that from an organizational point of view regions still present themselves extremely varied with some regions that have implemented organizational reforms more slowly than others and still present hierarchical functional models. The current Italian regional healthcare system has been established in 1978 and the regions have the whole responsibility for the regulation and organization of the healthcare services, through Regional Local Health Authorities (Aziende Sanitarie Regionali) and hospitals. In fact, healthcare falls into one of three regional main areas of expertise together with regional economic development and production activities. For the exercise of their functions, and for the implementation of health policies, regions make use of forms of indirect administration by delegating policy implementation to regional institutions, companies and agencies. From an organizational viewpoint, health system management in Italy is a typical model of direction. In fact, it is a mixed private-public model characterized by universal coverage and tax funding and regional budgets are engaged with significant shares of health spending. The health sector is among those most vulnerable to corruption for reasons of financial order. On the one hand, this is one of the most important sectors in terms of public spending- the consistency of which has increased over the past two decades as evidenced by the significant increase in regional spending compared to that of the state and local government. On the other hand, health spending is characterized by a less rigid structure since it is largely marked by purchases of goods and services; especially if compared to other equally important areas in financial terms such as pensions, education and social security - where instead prevails spending for less flexible posts such as salaries and pensions. Therefore, regional healthcare sees large amounts of cash handled by administrative decisions, which as a common feature are constantly repeated; indeed also decision makers (such as directors general and managers), are exposed to high turnover rates. Thus, all in all, the sector is constantly exposed to potential attempts of illicit conditioning. Most widespread examples of malfeasance in healthcare in Italy are wasteful spending, no-bid contracts, races held illegally, illegal recruitment and coaching, forgery and irregularities in the prescription of drugs and the like, non-compliance and irregularities in the execution of works and supply of goods (Governo Italiano 2012). Indeed, particular attention ought to be placed on the

selection and assignment of local regional health agencies directors general, along with the rules of conduct of staff and managers and on the system of controls and purchases and payments

Administrative corruption is a costly problem to control, and the various anti-corruption strategies implemented both in the private and in the public sectors have marginal benefits as well as marginal costs that must be taken into account (Rose-Ackerman 1997). Corruption is inevitable to some degree (Ogus 2003; Rose-Ackerman 1978), but the anti-corruption strategies must seek a reduction of the net costs. Conventional strategies to constrain corruption are recognized to be less effective in jurisdictions where corruption significantly infiltrates the criminal justice and law enforcement systems, the resources available for monitoring the conduct of officials are relatively modest, or the political will to adopt an effective approach to corruption is absent (Ogus 2003, p. 338). In Italy, administrative corruption is a pervasive and systemic phenomenon that affects society as a whole. In fact, Italian public administration is normally characterized by scholars as poorly designed and inefficient due to extensive use of political patronage - individualization of benefits that are usually allocated collectively. These practices were especially evident between 1948-1994, with a widespread increase of political corruption since the 1970s (Golden 2000). Emblematic is the data coming from Italian Local Health Authorities (Unità Socio-Sanitarie Locali-USLs), that since their establishment in 1978 were plagued by patronage and poor administration, known for “appointing individuals with little managerial competence, expertise, or understanding of cost controls, but a voracious appetite for the exercise of political patronage in purchasing and job-creation” (Hine 1993, p. 249 reported in Golden 2000). These practices contributed to create an extensively inept and inefficient public administration in Italy, where the majority of the workers came from the most underdeveloped areas of the country (namely the south) whom lacked the needed expertise or experience.

According to the Italian legal system, corruption is understood as an umbrella term that includes various offenses set out in the Criminal Code. About 17 types of offenses are presented in the code, ranging from abuse of office, fraud, bribery, misappropriation of European funds. Italian’s system of rules on corruption dates back to the Criminal Code of 1931 that still provides the bones of Italian current criminal code. This code had been issued during the Fascist period; in fact it is still referred as the “Rocco Code” by the name of Mussolini’s Government Keeper (Hinna and Marcantoni 2013). Thus, needless to point out that various international commissions such as the GRECO (2009; 2011) have pointed out that Italian regulatory framework regarding corruption should be updated. After about 60 years since the Rocco Code the legislation on corruption was slightly revised in the 1990s. However, the most substantial and notable changes date back to 2003 when the Ministry for Public Administration set it up a High Commissioner For Preventing And Combating Corruption. The High Commission suffered from two main weaknesses: 1) The large turnover of managers with an average of 11 months each, which did not allow a consolidation or experiences or relationships; and much worse 2) The commission lacked of independence of an authority responsible for overseeing corruption since it depended on the Prime Minister. Notwithstanding, the High Commission became

operational in mid-2004 and then was abolished in 2008 due to spending reviews. The functions attributed to this Commission had been transferred to Department of Public Administration through a section called SAET (Anti-Corruption And Transparency Service). However, this anti-corruption authority either was an independent one. To remedy this situation another law - decree law n. 150/2009 commonly referred as “Brunetta Reform”- was passed to create an additional authority called CIVIT (Independent Commission For Assessment, Integrity And Transparency In Public Administrations). This new committee, albeit, proved to be weak in the fight against corruption since it was created to remedy the lack of independence through a reform that had little to do with anti-corruption. In fact, the reform mainly focused on increasing public sector performance. Therefore, the activity of this committee for the fight against corruption has been very limited (Hinna and Marcantoni 2013). it has been noted from several sources (e.g. GRECO 2009) that Italy does not had any coordinated anti-corruption policy, nor an adequate and organic set of rules on the prevention of corruption in the public sector or a methodology in force to estimate the efficiency of anti-corruption measures specifically addressed to the government. In addition, a Report by a Governmental Commission For The Study Of Corruption (Governo Italiano 2012) acknowledges about a metamorphosis in the quantity and quality of corruption in the country that also called for an adjustment and strengthening of the prevention measures in order to cope with the changed empirical-criminological context. A comparison of judicial data and data related to the perception of corruption suggests the existence of an inverse relationship between practiced corruption and sanctioned corruption (ibid, p. VII). As the Corruption Perception Index issued by Transparency International and the World Bank’s Rating Of Control Of Corruption (RCC) show Italy is placed among the most corrupted countries in Europe.

In order to overcome these weaknesses, Italian Council of Ministries issued a new anti-corruption reform through the means of a new legislation. In fact, Law 6 November 2012, n. 190 concerns the rules for the prevention and suppression of corruption and illegality in public administration. The law has introduced new corruption offenses and tougher prison sentences in Italian Criminal Code. Indeed, it also increased the accountability of the CIVIT and extended its responsibilities in the fight against corruption by attributing to the Commission the function of National Anti-corruption Authority for the Evaluation and Transparency of Public Administration (ANAC). After this transformation the Commission became responsible for both anti-corruption and performance of public administrations. Given the diffusivity and the systematic nature of the phenomenon of corruption in Italy, the new legislation is intended to introduce a policy to combat corruption in an integrated and coordinated manner, using mainly administrative measures that constitute a series of rules to govern sensitive areas, such as governmental land use, health, and public procurement among others. In general, the new reform aims at the implementation of recommendations and instructions in order to predict corruption in the public sector and in its interfaces with the private one. In particular, it requires the adoption by every single administrations of adequate internal plans to prevent the risk of administrative corruption. Every administration has to

identify and map the most risky areas, as well as, to be ready to implement appropriate organizational solutions aimed at breaking down or reduce such risks. An independent authority is deemed responsible for a national policy of prevention of corruption. Each administration has to identify a person responsible for the prevention of corruption. This figure acts as a single project manager at an organizational level, with a real disciplinary responsibility for anti-corruption prevention success. In fact, this person is accountable to the administration in the event of corrupt practices within the institution if not able to demonstrate the implementation of all the tools to prevent the occurrence.

The model of anti-corruption introduced by the new legislation of 2012 takes place through a complex pattern of relationships between many actors with different roles, particularly articulated to translate in practice. These subjects are, at a central level, an Interministerial Committee, the Government, the National Anti-Corruption Authority, the Court of Auditors, the Prefects. At a local level, the single administrations have to face a capillary system of responsibilities, plans and compliance. Anyway, this new framework does not seem to be in full conformity with the provisions of the Criminal Law Convention of the Council of Europe (1999) under which agents of crime are those who broadly "engaged in any capacity on behalf of private sector entities"; not just those related to the company by an employment contract but also consultants, agents, customers, partners.

This study aims at investigating the factors associated with the implementation of anti-corruption policies in Italian Local Health Agencies. Precisely, it aims at explaining the causal mechanisms underlying the process that occurred after the formal issuance of the policy intentions at a central level of government that take the form of a bill. Hence, we will analyze, on the one side, the degree of compliance with the mandated prescriptions and guidelines to be attained by regions in Italy which constitute the formal policy objectives. On the other how the managerial features at the base of the new public management style of direction in regional health agencies impact on such policy achievements. Particularly this study attempts to: (1) Explain how do managerial qualities such as public managers’ qualification, levels of salary and managerial stability affect the formal achievement of anti-corruption policy objectives. (2) Define what role do regional features and agency features play for the formal achievement of the anti-corruption policy objective; and finally (3) Assess if / explain how different administrations should address the problem of corruption in different ways on the base of the above mentioned characteristics and variables.

Following Mazmanian and Sabatier’s (1989) basic model on implementation in this study, I adopt a top-down perspective on policy implementation, but differently I add to such perspective several insights coming from public management and public administration ( see Meier and O’ Toole 2011; Sandfort and Moulton 2015). From this it flows that the prevalent perspective is in accordance with a rationalistic approach to policy analysis (De Leon 2006; Smith and Larimer 2013) that mainly focuses on policy implementation outcomes. Particularly appealing, to this account, seems the “managerial quality hypothesis” developed by Meier and O’Toole (2011, p. 100), which postulates on the importance of managerial influences on public organizational and program performances through the execution of the standard internal functions that comprise their responsibilities. According to this

approach, variables such as public managers’ qualifications and turnover are deemed as important influencing factors for policy “good” or “bad” implementation and for the empirical understanding of policy implementation (Meier and O’Toole 2011). Indeed, according to most public administration theory, the quality of public managers has an impact on success of failure in the delivery of public policy results, hence managerial quality and policy performance are strictly related concepts (Lynn 1984; Meier 1999a; Meier and O’Toole 2011; Smith and Larimer 2013; Hicklin and Godwin 2009). Several managerial aspects are intended as indicators of performance in terms of policy outputs, to this account I cite Smith and Larimer (2013, p. 159) that explaining Mazmanian and Sabatier 1983 model on policy implementation remind that “[a] good program with a realistic objective can still fail if its managers are incompetent, uninterested, or distracted by other priorities. Even committed and competent managers have a hard time achieving policy objectives that are resisted by the public”. Particularly, the concept of “performance” is here intended as “the achievements of public programs and organizations in terms of the outputs and outcomes that they produce” (Meier and O’Toole, 2013). Although, this concept of performance is for its own nature multidimensional. At the ends of this study I will focus on the effectiveness dimension of performance, which is related to the extent to which policy objectives are being achieved. Good management is a critical contributor to program success, hence following the NPM theory of managerial performance, managerial features are deemed as means for effective performance (ibid; Thompson and Jones 1994; Behn 1991).

In general, the present study attempts to: (1) Explain how do implementers’ managerial qualities affect the formal achievement of the anti-corruption policy objectives; (2) Clarify if / explain how the different administrations achieve the desired outputs of the implementation process and how do external stimuli and implementers’ perceptions about the policy features affect implementation; (3) Based on the research results, suggest ways to improve the process of anti-corruption policy implementation and management at a sub-national level of government in Italy. To the account of the above mentioned general research aims, I hereafter substanciate the main research questions guiding the, and unfolding from, this specific research design are aimed at assessing in which ways public managers’ qualifications, levels of salary, managerial stability affect implementers’ ability to perform their duties effectively and consistently with the policy interests and how do implementers’ perceptions in relation to the policy features (i.e. statutory coherence) and external stimuli (i.e. support and training) affect implementation. Indeed, the study will analyze the outputs of the policy implementation process in the selected agencies (i.e. the three year plan for the prevention of corruption in the agency; the codes of conduct for employees and ethical charters; the organizational norms to prevent and limit corruption damages) to trace its consistency with the policy mandated standards of implementation to develop normative knowledge, useful for the improvement of the process of implementation and management of the anti-corruption policy, along with its outcomes, in such environments.

The research design will unfold according to a nested model aimed at the controlled comparison of two most similar cases. These cases are ideally defined as comparable in all respects

except for the independent variables, whose variance may account for the cases having different outcomes on the dependent variable. In order to test a series of causal chains characterizing the implementation process till the achievement of the desired policy outputs of the implementing agencies, I will proceed to apply a theory driven process tracing technique of analysis (George 1979; George and Bennett 2005; Gerring 2007).

Starting from these premises, based on a set of theoretical assumptions-carefully detailed in the book- I have identified three orders of variables for control at a regional level and three others at an agency level. At a regional level, two indicators of quality of government (Rothstein and Teorell 2012; Rothstein and Holmerg 2012; Charron, Lapuente and Rothstein 2013) have been identified among: the levels of corruption and impartiality of healthcare at a regional level, and the current regional healthcare spending per inhabitant. While, at an agency level the variables that aim to control for the comparison refer to the agencies’ human resource and financial capacities. The rational behind these variables lays out from the basic efficiency assumptions (Goggin 1998; Mazmanian and Sabatier 1989), along with assumptions on the importance that QoG indicators exert on regional development. All the data is presented in chapter 5 under the form of a descriptive statistics aimed at explaining the most detailed indications of the path followed by the researcher for the selection of the cases. The research design of controlled comparison of most similar cases (George and Bennett 2005; Gerring 2007) aims to isolate the difference in the observed outcomes as due to the influence of variance in the single independent variables. Indeed, in order to face the limitations of this approach, mainly recognized in the problem of equifinality ( i.e. different causal explanations for similar outcomes), process tracing analysis has been applied to complement the comparison to help to assess whether differences other than those in the main variables of interest might account for the differences in the outcomes by providing the appropriate control and variation required by the research problem. To this account, the case selection strategy has been considered an integral part of the research strategy. Indeed, the theoretical model has been designed to capture and record the essentials of the causal account of the outcome in the case. In the results section, the description of variance has been linked to the theoretical framework as drawn in the method section. Indeed, the analysis of the cases has been accommodated to a detailed description aimed at the verification of the causal processes at work through the theory oriented to teest the theories in the context of the selected Local Health Agencies, where multiple interaction might confound the relationship between the independent and the dependent variable. The validity of the causal claims is supported by relevant generalizations for which a measure of validity can be claimed on the basis of the existing studies on the validity of the managerial hypothesis and on the effective integration of public management and policy implementation (see Meier and O’Toole 2011; Sandfort and Moulton 2015). Alternative explanations and research dilemmas faced during the analysis of the data will be also accounted. First of all the problem of achieving control in the comparison and the above mentioned equifinality to be accounted for in the comparative method of controlled comparison. One of the main limitations of this method is given by the multiplicity and complexity of causes of social phenomena (see Mill 1843). In order to

overcome this problem, the comparative method of controlled comparison has been complemented with theory-driven process tracing and the acquisition of data from multiple sources in order to reduce the dangers of false positives and false negatives by applying a detailed narrative of causal analysis of the two selected cases aimed at the testing of the theoretical claims to ultimately answer the main research questions (George and Bennett 2005).

The results of this study are aimed to provide insights for the implementation and management of anti-corruption policies in the selected environments and hopefully will contribute to further understanding of the relationship between quality of government and of public managers involved in running governmental programs and the effective implementation and manageent of anti-corruption policies in such environments.The model of anti-corruption delineated by this regulation takes place through a complex pattern of relationships between many actors with different roles, particularly articulated to translate in practice through a capillary system of responsibilities, plans and compliance. The risks of such a system are mainly represented by the increase of “red-tape”, ending up with the prevalence of procedural compliance instead of real understanding of the objectives of the policy and their factual implementation. Shifting from an approach to compliance towards an approach focused on commitment and managerial quality might contribute: on the one side, to widespread integrity culture and more ethical behavior in the public sector; on the other side, to the achievement of the desired outputs of the implementation process.

The very nature is that of a qualitative investigation of a small number of cases. This approach has at the same time many advantages and as many limitations. The advantages reside in the delivery of insightful theoretically oriented narratives and process-tracing able to contribute in finding regularities and to address important questions about processes (Laitin 2002; Collier 1993). However, the limitations of such approaches rest on the general power of generalization of case study explanations. Albeit, case study explanations, and especially process-tracing, are deemed as “relevant, verifiable, causal stories resting in different chains of cause-effect relations whose efficacy can be demonstrated independently of those stories” (Tilly 1997, p. 48 quoted by George and Bennett 2005), case explanations have a provisional character, since they may be challenged by other scholars for having overlooked relevant data or misunderstood its significance, or indeed having failed to consider some important rival hypotheses. Thus, as a result the theoretical conclusions drawn from case study findings ought to be always considered as provisional too (George and Bennett 2005, pp. 90-91). This study, indeed, is not immune to such monitors, anyway I do not claim to attach the theoretical conclusions of this controlled comparison to all the local administrations in Italy, not to all the Italian Local Health Agencies, since such generalizations are the result of a focused and in-depth analysis of two particular cases, that -even if carefully selected to provide control for several variables- are still bounded in space and time and their outcomes might be still mainly attached to the particular contextual characteristics of the environments where the study has been conducted. Nevertheless, the results of this study about anti-corruption policy implementation and public management in Italy, ought to be considered to have an exploratory nature. Especially, considering that the new anti-corruption policy under investigation is of relatively new implementation in Italy. Moreover, to our

features in the Italian public sector has not been debated yet, nor by public management or public administration scholars in the country, nothwithstanding the extensive managerial challenges that it poses to the performance of public administrations-as emerged by the analysis. Thus, in-depth analyses of public management and anti-corruption policy implementation in such managerial environments as Local Public Administrations in Italy, are still lacking. Hence, the value that ought to be attached to the two analytic narratives offered in this study, and to the causal accounts that constitute the outcomes of such narratives is that of an exploratory study of the particular policy in object, in the particular and variegated environment constituted by the sub-national level of government in Italy.

The dissertation is organized as follows. Part II provides a review of the literature on NPM and corruption. The purpose of this review section is to provide an understanding of the previous research in this area, as well as providing a rationale for the choice of predictor variables in the present study. Part III includes the methods and data section. The purpose of this section is to present the methods used in this study to collect and to analyze the data that will constitute the original dataset for the case study. Particularly, this section describes the research perspective, research design, its limitations and validity. The focus will be placed on the subjects of study and on the research variables that will be analyzed using the most appropriate instruments and measures of data collection and data analysis. Part IV presents the results from this study and offers their interpretation in order to draw recommendations for future research and practice and on how to improve anti-corruption policy implementation and management in such environments. The comprehensive results deriving from the controlled comparison of the cases and from the process tracing analysis are systematically presented and the narratives deriving from the case analysis are analytically linked to the theoretical framework in order to evaluate the claims about its underlying causal pattern, as hypothesized to operate in the particular cases. Finally, it is laid out an interpretation of the results and their relationship to the research questions and hypotheses, along with a consideration of their implications and on the influence of the results on relevant theory or praxis, and the strengths, weaknesses and limitations of the study.

PART II REVIEW OF THE LITERATURE __________________________________________________________________________________

The purpose of this review is to contribute to the understanding of the previous research in the area of New Public Management (NPM) and corruption. To this account, the section begins with Chapter 2, providing a review of the literature on NPM - which addresses the origin and development of the movement, as well as, provides a critic. Next, in Chapter 3 the most accredited theories on corruption are presented and discussed, along with a particular consideration of the main globally implemented anti-corruption strategies. The scholarly debate on the effects that the spread of the New Public Management movement, and the inspired governmental practices deriving from it, are believed to have exerted on the problem of administrative corruption is also put forward in this section.

CHAPTER 2

FROM TRADITIONAL PUBLIC ADMINISTRATION TO NEW PUBLIC MANAGEMENT __________________________________________________________________________________

2.1. Public Administration And Public Management: The Origins

Public administration’s ancient origins are related both to the Orient than the Occident as a necessary but not sufficient condition for the survival and growth of successful sovereignties and armies and to assure efficient collection of revenues and internal controls in absolutist regimes. The history of the efforts to create and sustain effectively functioning states and institutions through government’s institutional design, practice and improvement is long and it is extensively considered able to explain the contemporary processes of reform and adaptation. Organized bureaucracies and systematic administrations already existed in Egyptian, Chinese, Greek, Roman and European feudalistic civilizations (Lynn 2006). The emergence of modern forms of public management in Europe is dependent on two historic developments such as the rise of absolutistic states after the Peace of Westphalia in 1648 and the diffusion of the idea of popular sovereignty in France and Continental Europe around 1789 (French Revolution). These two events boosted a gradual and secular steady separation between the private and public sphere as a pre-requisite for modern administration and for the creation of a modern public service.

The fists usages of the term “administration” in English language are attributed to Sir Henry Taylor (1958), John Stuart Mill (1861), Sheldon Amos (1874). However, many scholars at the beginning associated public administration with the emergent field of administrative law, such as Goodnow (1900) that, on the one side, widely intended administration as the entire activity of government, and White (1926) that, on the other side, indicated administration as the activity aimed at efficiently conduct the public business (Lynn 2006, p. 6). On the other hand, the term “bureaucracy” entered in the vocabulary as a pejorative expression within the Phisiocratic tradition in France (Lynn 2006). Generally, the term “bureaucracy” do not incorporates good or bad qualities, instead it denotes the general, formal structural elements of a type of human organization, particularly a governmental organization. In fact, governmental organizations have been the basic instrument to exercise traditional governance in Europe in the 18th century. At that times, monarchs substituted the barons, then after the French Revolution the administrative structures were formally separated from the person of the monarch, and the industrial revolution hereafter rationalized the administrative structures of the administration (ibid). From the early 19th century to the late 20th century the democratic states that were created needed bureaucracy as well, but intended as an organized non-political structure able to contribute to achieve some democratic goals, such as, those of creating an educational system,

controlling a vast empire, guaranteeing democratic procedures, conducting wars, establishing the welfare state and collecting taxes (Suleiman 2003, p.7). Bureaucracy became progressively institutionalized through the practices of the professionalized civil service, embodying values like loyalty, integrity, reliability, legal conduct, and responsibility to democratic political authority (Lynn 2006).

At a European level, the precursory theory at the basis of the modern administrative science is considered to be Cameralism, that raised in the Germany of 18th century (Lynn 2006, p. 5; Hood 2005). Historians of the social sciences consider it as a variant of mercantilism, therefore a precursor of scientific economics (Tribe 1984; Gordon 1995). The event that signed the beginning of Cameralism is the establishment of a chair for “Oeconomie, Policey und Kammer-Aschen” in 1727 by Friedrich Wilhelm at the University of Halle, to which followed a second chair at the University of Frankfurt upon Oden. The Cameralist science of government was aimed at managing human and natural resorces in the most remunerative and satisfying way respect to the ruler’s interests. It was primarily intended as a consolidation of the authoritative and hierarchical power, becoming an academic science taught to perspective state officials in Germany (Tribe 1984). At the base of Cameralism we found the values of meritocracy, standardized principles, formalism and professionalism; which are in contrast to the local particularity and traditionalism typical of the feudal rules associated with aristocracy (Lynn 2006, p. 48)1. The promotion of general happiness (Polizei) together with individual happiness (Oeconomie) merged into “Cameralwissenschaft” (Cameralism), that was synthesized as the promotion of good government (gute Polizei). No clear distinction was made between the administration of the State (Cameralism), the satisfaction of individual needs and the pursuit of individual happiness (economics/Oeconomie), and the prevailing order of the State (Polizei). In fact, this distinction can be made nowadays on the base of the modern conceptions of economy and polity that were not present in the 18th century (Tribe 1984, p. 266). Friedrich Von Stein is deemed as a key figure in the Germanic transition to modern public administration. He was considered as a liberal with a faith in the political education of the masses that revitalized local government by envisaging legal forms of cooperation of the citizenry within the administration of the interior and towards a responsible and effective bureaucracy for the citizens (Lynn 2006, p. 51). Then, the ideas of liberalism, political economy and the markets “consigned [Cameralism] to archaism” (Gordon, 1995, p. 432). Effectively, Cameralism disappeared around 1820 (Tribe 1984), under the gradual impact of Smithian political and economic theories, while polizei was crossed by the ideas of the own regulating laws of society under the Kantian idea of freedom and equality. Continental bureaucracy at that time was widely admired and bureaucrats were considered unselfish guarantors of the public well-being (Lorenz von Stein 1856 in Pankoke 1995). At the same time, while some scholars deemed bureaucracy as the means for a modern and equitable public administration, others

1 _{For Hood and Jackson (1992) the “New” Public Management that raised late in the 20th century can be}

somehow considered as a new form of Cameralism, but the subject will be more deeply confronted further in this chapter.

saw it as the cause of inequality of treatment and considered bureaucrats as guardians of power instead of the guarantors of public well being (Lynn 2006, p. 52). To this regard, Anderson and Anderson (1967 in Lynn 2006, p. 52.) describe the weaknesses of bureaucracy at that time trough the eyes of the German historian Otto Hintze (1861-1940) as “corruption and laziness, excessive ambition, servility toward superiors, brutality towards inferiors, conceitedness, and narrow-mindedness”.

A comprehensive classic formulation of bureaucracy is attributed to Max Weber (1864-1920). Weberian bureaucracy reflected the characteristics of governmental organizations at the beginning of the 19th century. Bureaucracies characterized by rules, duties, authority, but also definite powers and appropriate supervision. The Weberian concept of bureaucracy was directly connected to his interpretation of the evolution of civilization “from primitive and mystical to the rational and complex” (Stillman II 1996, p. 55). According to Weber, the struggle for power is the engine for change and “any system of domination undergoes change when the beliefs in its legitimacy and the practices of its administrative organizations are modified” (Bendix 1977, p. 431). According to this conceptual framework, bureaucracy was a way to exert authority that evolved throughout three “ideal-types”, which sought to explain the relationship between authority and rule making throughout history. These ideal-types are: “traditional” authority; “charismatic” authority; and “legal-rational” authority. “Traditional” authority is associated to primitive societies, where legitimacy depended from ancestry and affinity. “Charismatic” authority is exerted by “individuals whose heroic greats or miracles attract followers”, whereas the “legal-rational” form of authority is considered as the foundation of modern civilizations characterized by a set of legally established and impersonal rules (Stillman II 1996, pp. 54-55). The major elements that characterize legal/rational bureaucracy for Weber are those able to guarantee equity, societal development, efficiency and professionalism in government, leaving no spaces for arbitrariness and personal favoritisms. The means to achieve these goals are identified by the author with: 1) the division of labor, intended as rational partition of work in the performance of tasks in government; 2) the hierarchical order between superiors and subordinates, including different remuneration, recognition of authority, privileges and promotions; 3) the presence of impersonal rules based on law instead of acquiescence. The predominant administrative style was legal and rational and authority was enabled through the implementation of norms. Under this form of “legal domination” the struggle for power happens in accordance with bidding rules and different political responsibilities. After the win for power, the individual or group in charge of authority directly controls the apparatus of disciplines, retainers, patrimonial officials, vassals and bureaucrats whose are asked to carry out decisions on a daily basis. (Bendix 1977, p. 439). The execution of functions on a daily basis is bestowed to the officials, that exercise power of judgment and use their skills at the service of an higher authority (politics). The separation between the private and public spheres was clearly stated and opposed to the ‘traditional’ form of authority, where notables ruled on the basis of affiliation. Indeed, for Weber the management of the public office followed general stable and exhaustive rules. The knowledge of these rules represented a special technical learning involving jurisprudence, administrative management, and business management, which the officials possessed.

(Weber 1946, p. 59). As Bendix (1977) noted Weberian organizations under the control of government always meant responsibility for the performance of assigned tasks and consequent disqualification for political action (p. 445). To this account, the bureaucratic organization had to be monocratic, almost an expression of “purely technical superiority over any other form of organization” equated to the large modern capital enterprises that also followed a bureaucratic organization (Weber 1946, p. 63-64). To differentiate them from the public business Weber explained that private businesses followed “bureaucratic management”, while public organizations followed the model of the “bureaucratic authority” (Weber 1946, p. 58). In fact, government officials were appointed to follow impersonal and functional purposes, and the loyalty to an office did not depended on personal relations. Rather, in Weber’s words “the more the bureaucracy is ‘dehumanized’, the more completely it succeeds in eliminating from official business love, hatred, and all purely personal, irrational, and emotional elements which escape calculation. This is the specific nature of bureaucracy and it is appraised as its special virtue” (Weber 1946, p. 64). Weber indeed recognized that the work of impersonally elected and expert bureaucrats could be damaged by political corruption (Behn 1998). Weber’s ideas of citizenship and ethical representation of society helped to identify the ethical status of the public sphere (Seligman 1992, p. 127). To this account, the good conduct of public officials was intended as a rational and objective execution of their public duties, without any contemplation of personal interest. Laws, hierarchy, expert training, and functional specialization of work ensured “an attitude-set for habitual and virtuoso-like mastery of single yet methodically integrated functions”; and the power position of bureaucracy was considered a necessary condition for the management of public offices (Weber 1946, p. 65).

Approximately at the same time, on the other side of the Atlantic, the American Constitution of 1776 was more concerned about the power and hierarchy relations between the President and the heads of Departments instead to focus on the nature or function of the executive branch of the new created governments, such as it was instead in Europe. In fact, it has been recognized that a discourse about bureaucracy, as that undergoing in Europe, was completely absent in the American public administration debate during the first 150 years of the rise of the American republic (Wilson, Q., J. 1975, p.78). Notwithstanding this difference, the first essay on public administration as a discipline and a science did not came from Europe, but from the USA. In fact it is attributed to whom became the ‘father’ of American public administration: Woodrow Wilson (1887), whom served as the 28th

President of the United States of America since 1913 to 1921. At that time, as seen, public administration was a well-established discipline in Europe but not yet in the USA (Stillman II 1996). For Wilson the study of administration was a fruit of the ancient study of the science of politics. It gained scholar attention in the USA only in the 19th century due to the complexity of the problems that government had to face, while until that time the political philosophy was more concerned with the issues of the constitution of the government, the nature of the state, the essence and seat of sovereignty, popular power and kindly prerogatives such as “the greatest meanings lying at the hearth of government, and the high ends set before the purpose of government by man’s nature and man’s

aims” (Wilson 1887, p. 6-7) . Public administration is “government in action” (Wilson 1887, p. 6) and it is intended as “the most obvious part of government” incarning the executive and operative parts of government which existed since its origin. The object of administrative study reflect the philosophy of any time and its fundamental objective is that “to discover, first, what government can properly and successfully do, and, secondly, how it can do these proper things with the utmost possible efficiency and the least possible cost either of money or of energy” (ibid, p.6). Wilson (1887) recognized the call for civil service and organizational reform, wishing for the improvement both in the personnel, than in the organization and methods of USA’s government offices at the end of 19th century. A series of issues remarkably permeated in public administration were the politics-administration dichotomy, the issue of authority and constitutional law, discretion and powers, and the role of public opinion2_{. Public}

administration was considered as the detailed and systematic execution of public law (Wilson 1887), indeed the discipline was associated to the study of the proper distribution of constitutional authority in terms of distribution of responsibility among officials. The ideas associated with the distribution of discretion and powers among government officials were considered by Wilson (1887) “indispensable conditions of responsibility”, since the most is the entrusted freedom of discretion on and the greater is public officials’ power the less likely are they to abuse it (Wilson 1887, p. 12). Thus, this unhampered discretion and large powers are considered by Wilson as sources of good behavior, while public opinion had to be intended as the reflection of the popular thought.

Some authors encompassed the role of bureaucrats and the problem of unrepresentativeness of bureaucracies, recognizing that the increasing power and influence in government by not elected and not politically removable officials chosen on the base of given criteria such as skills and competences especially due to the work conditions and specialization constituted a treat to the democratic nature of government (Mosher 1968). Although, others believed that to keep their legitimacy governments should be effective bureaucracies characterized by responsive, accountable, effective, and legitimate governments (Suleiman 2003). To this regard Svara (2001) echoes “early contributors to the development of public administration acknowledged a policy role for administrators that has often been ignored” (p. 176).

Subsequently, in the late 1860 in the USA with the civil service reform movement, which culminated with the Pendleton Act in 1883 introducing the career civil service some authors have identified the premises for a “New Public Administration” (Sayre 1958; Gruening 2001). At the base of this movement we find the call for a more interventionist state, separation of politics and administration, and introduction of the merit principles and sound financial management in government in order to prevent favoritism (Gruening 2001, p.3; Behn 1998). In fact, the context of this reforming movement was that of the American public administration of the late 19th century,

2 _{The “politics-administration dichotomy” is intendended as a perpetual conflict between the notions of}

constitutional democracy (i.e. popular control and participation) and the theories of efficient and professional administration (i.e. systematic rules and internal procedures distinct from democratic oversight and influence). The theorized solution to such polarity has been the advocacy of a clear separation between elected representatives charged with the definition of what government should do those non-elected bureaucrats