Views from Below: Inspectors’ Coping with Hybrid Accountabilities

• Published date: 01 September 2020
• Author: Tanja Klenk
• Date: 01 September 2020
• DOI: 10.1177/0002716220956587

956587ANN
THE ANNALS OF THE AMERICAN ACADEMYCoping with Hybrid Accountabilities
research-article2020
Regulation of long-term care service provision is a case
of hybrid accountabilities. How do inspectors who are
responsible for the implementation of regulations han-
dle the uncertainties arising from hybrid accountabili-
ties? While the prevailing scholarly consensus is that
hybridity creates tensions that have a negative impact
on the quality of regulation, this article shows that dif-
ferent accountabilities can reinforce each other.
However, situations in which inspectors can develop a
Views from
positive stance toward hybridity and integrate compet-
ing logics are rare. Hybrid professionalism among
Below:
inspectors requires training, education, and resources
as well as a joint regulatory culture with inspectees—
preconditions that are hardly present in recent institu-
Inspectors’
tional settings of long-term care regulation.
Coping with Keywords: regulatory welfare state; hybridity;
accountability; long-term care; quality
Hybrid
regulation inspectors
Accountabilities Accountability in the regulatory welfare state
is hybrid: providers are held accountable
for different, sometimes conflicting, goals. As a
result of the intentional mix of the logics of the
market, hierarchy, and professionalism, service
providers are, for instance, expected to deliver
By
services of high quality, but only for a minimum
TANJA KLENK
price to keep public healthcare spending sus-
tainable; service providers should also establish
efficient structures and processes without, how-
ever, compromising standards regarding the
quality of work and the participation of users.
This study analyzes the implementation

of a hybrid regulatory framework from the
inspectors’ perspective. The guiding research
Tanja Klenk is a professor of public administration and
public policy at the Helmut-Schmidt-University
Hamburg. Her research interests include institutional
and organizational change in public and social policy.
Recently, she has been working on the marketization and
managerialization of welfare state governance, as well as
accountability, quality, and performance management.
Correspondence: tanja.klenk@hsu-hh.de
DOI: 10.1177/0002716220956587
138
ANNALS, AAPSS, 691, September 2020

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COpINg WITH HyBRID ACCOuNTABILITIES
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question is: How do inspectors, who are responsible for the implementation and
enforcement of the regulatory framework, make sense of hybridity? In the litera-
ture, we find ample empirical evidence that hybridity creates tensions that are
difficult for inspectors to handle. Inspectors—and professionals in general—
might even reject the policy they are expected to implement because they cannot
make sense of it, a reaction pattern that Tummers (2011) described as policy
alienation. However, others are observing the evolution of hybrid professionalism
with professionals who have attained new skills and are able to go beyond tradi-
tional professionalism by integrating and blending different logics (Noordegraaf
2015). Inspectors who are open to hybrid professionalism are, for instance, will-
ing to learn managerial competences and improve their adaptation skills to navi-
gate contradictions between performance schemes and professional standards.
The article provides an empirical case study of quality inspection in the
german long-term care sector, which is a prime example of the regulatory wel-
fare state. The idea of delivering public goods with market means was a guiding
principle when the new social insurance for long-term care was introduced as a
fifth pillar of the german welfare state in 1995. In subsequent years, the sector
developed into a highly competitive field; although, in a parallel movement, we
could also observe the rise of a regulatory welfare state (Levi-Faur 2014). A com-
plex regulatory framework has been gradually set up to control clients’ access to
the services, audit structures, processes, and outcomes of service delivery. So far,
the scarce research on the regulation of the german long-term care market has
focused mainly on regulatory strategy, or on the tools and instruments and their
adjustments to an increasingly hybrid environment (Herr, Nguyen, and Schmitz
2016; Nies and Leichsenring 2018). Views from below, however, are missing: the
process of implementing the regulatory framework has remained a black box.
The article proceeds as follows. Section two presents the theoretical back-
ground of this study, which draws on three bodies of literature: accountability,
hybridity, and street-level bureaucracy. The bodies of literature are closely con-
nected to the research on the regulatory (welfare) state. The rise of the regulatory
(welfare) state has fueled an intense debate about accountability. While there
were strong concerns about declining accountability in the early years of the
regulatory welfare state, particularly with respect to public and democratic
accountability, it is today widely accepted in the literature that accountability in
regulation is not a question of more or less accountability but of multiple
accountabilities and the relationships among them (Benish and Mattei 2019).
This is where the literature on hybridity comes in, which acknowledges that
accountability in regulation is multifaceted, fluid, and—as a rule—full of ten-
sions. The literature on street-level bureaucracy, in turn, reminds us that inspec-
tors need to implement and enforce accountability mechanisms. Their discretion
and their (lack of) ability to cope with hybridity are crucial factors that have
substantial impacts on regulatory performance.
In the third section of the article, more information about the institutional
background of the german long-term care sector and recent reforms is provided.
I then go on to explain the methods for data collection (policy documents, semi-
structured expert interviews, and vignettes) and analysis (qualitative content

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THE ANNALS OF THE AMERICAN ACADEMy
analysis). Next, I present the empirical findings. The empirical analyses show that
inspectors fall into different groups. While one group shows active resistance to
hybridity, others are able to reconcile the hybrid regulatory framework with their
identity as a professional. However, their coping strategy is rather passive: they
let situations happen, without bothering about contradictions and dilemmas. The
most important finding is that no cases of hybrid professionalism were found.
Based on these findings, the discussion section suggests a refined analytical
framework: to understand how inspectors deal with hybridity, both the inspec-
tors’ attitudes toward hybridity (accepting or rejecting) and their willingness or
capacity to use a reflexive approach need to be taken into consideration. The
findings also allow us to reflect on the preconditions for hybrid professionalism
and to draw conclusions for the design of regulatory architecture. Lessons can be
learned from this study, for both quality regulation in the german long-term care
market and for accountability systems in the regulatory welfare state in general.
Theory: Hybridity, Accountability, and Street-Level
Bureaucracy
From an institutional perspective, quasi-markets are hybrid arrangements. They
deliver public goods—in our case, professional care services—with private means.
Hybridity results from the intentional mixture of different logics: market, hierar-
chy, and professionalism. How to hold providers in the service market accountable
for their actions is a central topic in the literature on regulatory welfare state gov-
ernance (Benish 2014; Jann and Lægreid 2015). The accountability literature
assumes that there is an elective affinity between different institutional logics and
different accountability mechanisms: hierarchies, markets, and professional net-
works do not only have their own goals, values, and typical modes of interaction but
also ideal typical mechanisms of accountability (Mashaw 2006). In hybrid govern-
ance arrangements, where the realms of the state, the market, and civil society
collide, accountability relations, too, are hybrid. providers of public services are
held accountable through competition, professional norms, and the hierarchical
interventions of regulatory agencies. Often there is not only one but several regula-
tory agencies to which service providers have to render account (Benish and Mattei
2019; Levi-Faur 2005), and often the accountability obligations of the different
regulatory agencies are in conflict. It may even be possible for one regulatory
agency to have accountability obligations that are themselves hybrid.
Accountability mechanisms need to be put into effect by some agent (Moore
2014). This is particularly true for laws and legal prescriptions that bear only the
potential for accountability but do not put it into effect by themselves. The
implementation and enforcement of regulatory policies are mainly the responsi-
bilities of inspectors who are what Lipsky (2010) has called “street-level bureau-
crats”—that is, actors who fulfill a public task and who are thereby in direct
interaction with the target group. Inspectors shadow the people they are inspect-
ing; let them explain how well daily operations are performed; check off boxes on

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inspection lists; and negotiate with...