Rational Judgement Revisited: Practices of Deliberation in Healthcare Funding Decisions

In this paper, we aim at exploring how rationality may become a practical accomplishment. We maintain that it is not known or adequately understood how organisational actors may actually produce ‘rational judgement’ in practice. We thus examined a context where actors seek to be purposefully rational when making healthcare funding decisions. Building on a focused ethnography of decision making in the English National Health Service (NHS), we provide an account of how rational judgement is dynamically pursued and accomplished in practice. We show that, for rational judgement to be constructed in this context, organisational actors perform three kinds of interrelated activities: performing procedural requirements, making sense of decision cases and deliberating the merits of cases on the basis of public reasons. Our paper makes an important contribution to our understanding of organisational knowledge and learning by unpacking how rationality is sought and performed in actual organisational situations, and by altering our existing image of rationality. Instead of treating rationality as a ‘grand concept’ or metaphysical logic, our paper elucidates how a specific form of rationality – grounded in common (political) convictions of fairness and the common good(s) – is produced in organisations through practices of deliberation. 1 We gratefully acknowledge the generous funding from the UK NIHR SDO programme on “Management Practice” (project SDO 08/1808/244). Neither the NIHR SDO nor the UK Department of Health are responsible for the content of and the ideas expressed in this article. Our special thanks are also to Dawn Coton for her ongoing support to our project. 2 Corresponding author. Email: [email protected], tel: 0044(0)7792947266