Street-level bureaucrats implementing public policies have a certain degree of freedom – or discretion – in their work. Following the work of Lipsky, the concept of discretion has received wide attention in the policy implementation literature. However, scholars have not yet developed theoretical frameworks regarding the effects of discretion, which were subsequently tested these using large n samples. In this study, we develop a theoretical framework regarding two effects of discretion (client meaningfulness and willingness to implement), in order to increase our understanding of the mechanisms at work. The hypothesized relationships are tested using a Dutch nationwide survey among 1.317 psychologists, psychiatrists and psychotherapists implementing a new reimbursement policy. These are analysed using Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM). The results firstly show a positive effect of discretion on client meaningfulness. Next to this, discretion positively affected the willingness to implement a policy, and this is partially mediated by client meaningfulness. Hence, when street-level bureaucrats experience discretion, this positively influences the value they can deliver to clients, which in turn positively influences their willingness to implement a policy. Implications for policy implementation researchers are discussed.

discretion, health care, policy implementation, quality analysis
Erasmus School of Social and Behavioural Sciences

Tummers, L.G, & Bekkers, V.J.J.M. (2012). Discretion and its effects: Analyzing the experiences of street-level bureaucrats during policy implementation. Retrieved from