Open and opaque? The performativity of open priorities in a Norwegian hospital

Abstract

Being open about priority-setting decisions is a central element of frameworks enhancing procedural fairness. While challenges in implementing priority-setting frameworks in general have been reported, few studies have empirically examined how the concept of openness is understood and enacted in the day-to-day functioning of hospitals. This paper explores the operationalisation of the policy of “open priorities”, based on long-term ethnographic fieldwork in a Norwegian hospital in 2022. Drawing on the concept of performativity, the study portrays how the ideal of open priorities translates into everyday practices related to why, for whom and which priorities are to be open. The paper shows how openness was portrayed as a central hospital policy, but was also seen as a source of conflicts, hindering effective governance and reducing public trust. Hence, hospital leaders transformed and diluted the ideal of openness into priority-setting decisions with multiple shields of opaqueness. Through omissions and rewritings of the notion of openness, health leaders enacted performativity. The paper adds to the growing body of knowledge of the multifaceted ways policy ideals are transformed by government institutions in the process of implementation and calls for further exploration of efforts to improve everyday and routinised procedural fairness.