Unraveling the hindering factors of digital public service delivery at street-level: the case of electronic health records

Abstract

There are several elements as to why digitization of public services is progressing slowly. Many explanations center on structural aspects of public institutions and their capacity and capabilities to implement digital tools. Others highlight the uptake by citizens as key to making technical solutions in the public domain work. This paper draws attention to a third line of argumentation by focusing on the role of street-level bureaucrats. Based on the assumption that they are caught in between the technical details of digital public service delivery and the organizational context in which these tools are implemented, the goal is to identify some of the factors that hinder the use of digital applications by street-level bureaucrats. To unravel those hindering factors, we use the “failed” implementation of electronic health records in the United Kingdom as an example in order to link it to existing research on digital governance and street-level bureaucracy. We conclude that the disconnect between organizational structures and digital tools is magnified at street-level, which may threaten discretionary power and autonomy of public servants and can make daily tasks more complicated and time-consuming. Policy implications drawn from this include, paying special attention to the trade-off between local autonomy regarding the adjustment of digital tools and national guidance and standardization as well as the distinction between the potential inability of public servants to use the tools due to limited training or age and the unwillingness linked to a loss of power and discretion.