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

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.