The role of meetings in building modern organisational governance systems - outlining a sociological approach to meetings

By relying on empirical and micro level analyses of the implementation of a Belgian reform of mental healthcare delivery, this paper shows that inter-organisational and interinstitutional meetings might be conceived as key sites for the realisation of public policy objectives; i.e. sites where both the meaning of policy objectives and the social systems through which they are enacted are (re)defined.
This paper is based on a case study on the implementation process of the ongoing Belgian reform of mental healthcare delivery, called “Reform 107”. Reform 107 is designed to shift mental healthcare organisation from the model of residential psychiatry, which is centred on medical hospital care, to community psychiatry that implies, instead, psychosocial home and/or ambulatory care. Policymakers conceived this shift through the development of local mental healthcare networks, which are defined as concrete partnerships between local, residential and ambulatory care providers and social and employment public services. The first stage in the implementation process consisted in four-year exploratory projects through which local actors were expected to refine the community care model proposed by policymakers. By asking local actors to participate in the adaptation of the model to local realities, policymakers intended to improve their own knowledge of local mental healthcare systems on the one hand, and to interest local actors in a reform that challenges their institutional interests on the other.
Our analyses of the implementation of Reform 107 focused on three local exploratory projects and their monitoring by federal public health authorities. The empirical material was collected through semi-structured interviews (N=62) with policymakers and local actors, direct observations of the meetings between local mental health practitioners responsible for the reform’s implementation (N=65) and documentary analyses, including policy and (local) organisational documents.
This material was first analysed by relying on a sociological frame of analysis based on the French sociology of organisations (Friedberg, 1997) and the interactionist sociology (Abbott, 2005; Bucher & Strauss, 1961; Corbin & Strauss, 2008). The resulting sociological account (Thunus, 2015) stressed that local models of governance, power struggles as well as professional knowledge significantly impacted on the development of mental healthcare networks. It also highlighted the use of new techniques by federal public health authorities to manage the reform implementation. Those techniques, including the multiplication of meetings with local actors, direct coaching of local projects’ leaders as well as training of front-line mental health professionals, were conceived as means to oppose strategies of resistance usually enacted by psychiatric hospitals (S Thunus & Schoenaers, 2012).
This paper offers to refine this analysis by focusing on the specific role played by meetings in policy implementation, based on a conception of “the practice of policy-making”(Richard Freeman, Griggs, & Boaz, 2011). It draws on the observation that, though researches on policy implementation increasingly evoke meetings as part of the policy process, they do not properly address the role played by meeting in influencing, orienting and possibly (re)defining policy reforms. Indeed, following the recognition of the need for dealing with complex and uncertain problems, or wicked problems (Roberts, 2000), by relying on procedural policy instruments (Howlett, 2000) and collaborative governance (Emerson, Nabatchi, & Balogh, 2011), numerous researches focused on policy networks, hybrid forums (Callon, Lascoumes, & Barthes, 2001) and special committees whose activities involve meetings. However, by considering meetings as a part of/a tool for larger processes as problems solving, crisis resolution or decision-making, those researches made them unproblematic means to achieve predefined and external objectives.
The problems resulting from a “meetings as a tool approach” (Schwartzman, 1989) are twofold. On the one hand, it seems to ignore that, by bringing different and specialised expertise together, meetings induce social, cognitive and technical challenges. Those challenges, including the sharing of specialised knowledge and harsh negotiations between actors defending institutional interests and professional jurisdictions, make meetings conflicting and problematic arenas (Cohen, March, & Olsen, 1972). On the other, when conceived as rational means to reach external objectives, meetings often appear as disappointing and pointless. Based on this observation, Schwartzman (1989) proposed to stop seeing meeting as part of larger processes as decision-making (as a tool), to focus on what meetings actually do to the organisation or social context in which they take place (i.e. to consider meetings as a topic).
By drawing on Schwartzman’s invitation to make meetings a research topic, we propose to ask the question of what inter-organisational and interinstitutional meetings actually did to the Belgian mental health care reform. We suggest addressing that question by relying on a conception of policy-making as a practice of a special kind (R Freeman, Griggs, & Boaz, 2011). This conception insists on the role played by policy practices as meeting and talks in determining policy objectives and creating groups supporting them. Accordingly, we will focus on social actions and interactions unfolding through meetings and talks, to see how they use and produce knowledge, instruments and relationships both embodying and reshaping their environment.
Finally, by inviting us to bracket the explicit objectives of the observed meetings (e.g. providing policymakers with an operational definition of care functions included in the proposed community model), this approach will enable us to see what inter-organisational and interinstitutional meetings actually do to policy reforms. That is, generating performances (Goffman, 1959) supporting collective enactments of new social and professional roles and artefacts that (re) constitute the meaning of the reform and the associated social system. Viewing meeting as a concrete policy practice thus helps to stress that they contribute to durable and deep change in their social environment, precisely by generating talks that largely exceed/displace their explicit mandate.