Street-level workers, managers and institutional tensions : a comparative ethnography of healthcare practices of in/exclusion in three Italian public organisations

Public organisations are fundamental actors in migrant incorporation processes, as they are in charge of assessing migrants’ entitlement and providing access to welfare services. While a lot has been written on the individual determinants of street-level decisions, the role of organisational and institutional factors in shaping implementation practices has received little attention so far. By linking the street-level bureaucracy approach and the neo-institutionalist perspective in organisational analysis, this article investigates how public organisations mediate migrant incorporation processes in the field of healthcare. Drawing on a comparative ethnographic study of three public health organisations in an Italian region, the paper suggests that, in times of institutional tensions, managers’ priorities and framings of the issue, the ways they respond to decision-makers’ goals and allocate resources for implementing them, orient - and lead to variation in - street-level healthcare practices of in/exclusion for migrants with irregular status.