Policy Sciences

, Volume 47, Issue 4, pp 367–386 | Cite as

Puzzling about problems: the ambiguous search for an evidence-based strategy for handling influx of health technology

  • Ann-Charlotte NedlundEmail author
  • Peter Garpenby


This paper focuses on problem frame differences among actors (members of an advisory body, senior administrators and clinical unit managers) who are concerned with the introduction of new health technology at the regional level in Sweden. It explores issues related to problem framing, puzzling, powering, participation and the various rationales articulated in the ambiguous search for an evidence-based strategy to handle the influx of new technologies. The Health Technology Advisory Committee (HTAC) was established in one Swedish county council in 2004 with the intention of controlling both the introduction of health technology and supporting policy decision and clinical practice by promoting the use of best evidence. The HTAC followed a scientific rationality dominated by one problem frame, although the problematic situation, as it was framed by all the actor groups, was highly complex and not solely a matter of evidence. This paper illustrates how problem frame differences shape the puzzling of a policy problem and how the different distinguishable policy styles are dependent on who is participating and who is not participating in the puzzling.


Evidence-based policy Problem frames Policy practice Policy style Health technology Sweden 



The article is based on research supported by the Vinnvård Research Program Grant no. A2008-017 "INTEGRAL" and by the County Council of Östergötland, Sweden.The Informants are acknowledged with gratitude. The authors also thank the organizers and the participants at the panel "Evidence and Meaning in Policy Practice", at the Interpretive Policy Analysis Conference 2012, in Tilburg, as well as the three anonymous reviewers for helpful comments and suggestions on earlier drafts.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Health Care Analysis, Department of Medical and Health SciencesLinköping UniversityLinköpingSweden

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