Governing through evidence. A study of technological innovation in healthcare.

The evidence-based paradigm is increasingly permeating the spheres of policymaking and management in healthcare, as it has in most other public domains. An emerging stream of research has investigated how different institutional arrangements are more or less conducive to an effective evidence-based policy. We contribute to this stream through a multiple case design on governing technological innovation. In particular, the study unpacks the dynamics through which policymakers have governed the adoption of the Da Vinci robot within the Italian healthcare system. The analysis leads to the elaboration of four archetypes for governing through evidence, the common mechanisms of which are systematized in an emerging theory. The framework developed here suggests that governing through evidence entails selecting or combining a variety of evidentiary bases, structuring a new relational arrangement among the actors involved and standardizing decisional criteria and procedures. The combination of these elements with the specific governing output sought by policymakers explains the different steering capabilities of institutional arrangements in practice.