Publications

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Journal Articles

What Can Drive a Digital Governance Transformation? Greece, the Covid–19 crisis and “a jump–started Lamborghini”

Published in Policy and Internet, 2024

The COVID-19 pandemic tested state preparedness across the globe and exposed cross-sectoral deficiencies in infrastructure, resources and policymaking patterns. However, the prospects of the pandemic facilitating lasting institutional change have received limited attention. This study explores the drivers and resisting forces underpinning Greece’s ongoing digital governance transformation during conditions of crises through a Multiple Streams lens. The analysis is informed by original primary data from elite stakeholders across four policy areas and extends from policy adoption to implementation. The study concludes that the simultaneous surfacing of administrative deficiencies, the enhanced value acceptability for innovation and a series of cross-sectoral spillovers facilitated the introduction of digitization initiatives on an unprecedented scale. However, centralization and cultural resistance from both bureaucracies and the public during implementation pose strains to the completion of the transformative process. The paper’s insights contribute to the young but highly topical research agenda on digital governance transformation drivers.

Recommended citation: Karokis-Mavrikos, V. (2024). What can drive a digital governance transformation? Greece, the Covid-19 crisis and "a jump–started Lamborghini". Policy & Internet, 1, 1–22. https://doi.org/10.1002/poi3.428
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Advancing the Operationalization of National Policy Styles

Published in European Policy Analysis, 2023

While national policy styles have (re)gained academic attention in recent comparative public policy work, the concept still needs a widely accepted operationalization that can allow the collection and analysis of data across contexts while steering away from construct validity threats. We build on Tosun and Howlett’s (2022) work and employ a mixed-methods approach, which relies on exploratory factor analysis and hierarchical cluster analysis. We put forth an operationalization, using Bertelsmann’s Sustainable Governance Indicators (SGI) as proxies, that achieves conceptual clarity and distinctiveness, informational robustness, and statistical power. Ultimately, we construct two composite indicators—mode of problem-solving and inclusiveness—calculate them in 41 countries and present policy style classifications based on their combinations. We report the distribution of countries across four policy styles (administrative, managerial, accommodative, adversarial) and conclude with an analysis of the clusters, assessments of robustness, and comparison with other national policy style classification schemes.

Recommended citation: Zahariadis, N., Karokis-Mavrikos, V., Exadaktylos, T., Kyriakidis, A., Sparf, J., & Petridou, E. (2023). Advancing the operationalization of national policy styles. European Policy Analysis, 9(2), 200–218. https://doi.org/10.1002/epa2.1172
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The strategy of venue creation: Explaining health policy change in Greece

Published in International Review of Public Policy, 2022

How do policy entrepreneurs affect policy change in environments of institutional instability? The literature has predominantly explored policy entrepreneur strategizing in contexts with established institutional settings. In this paper, we argue that under conditions of institutional fluidity and a weak and politicized public administration, venue creation is the more frequently encountered and the more likely successful strategy. We define venue creation as the entrepreneurial strategy of setting-up institutional arrangements of finite duration, predominantly in the form of committees, delegated exclusively with designing reforms. We test our hypothesis in the Greek health policy sector. We explore two policy instances: the unsuccessful attempt at a public health reform in 1992 and the successful introduction of radical policy change for public health in 2003. We employ a process tracing approach spanning thirty years, processing primary data (elite interviews and documents) applying the Multiple Streams Framework (MSF). We find that under conditions of institutional fluidity and administrative weakness, policy entrepreneurs failed in their pursuit of change using venue shopping in 1992 but succeeded through venue creation in 2003, confirming our hypothesis. We conclude with insights for contingent policy entrepreneurship success, the MSF and patterns of policymaking in Greece.

Recommended citation: Mavrikou, M., Zahariadis, N., & Karokis-Mavrikos, V. (2022). The strategy of venue creation: Explaining health policy change in Greece. International Review of Public Policy, 4(3). https://doi.org/10.4000/irpp.3018
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Stakeholder Perceptions and Public Health System Performance Evaluation: Evidence from Greece during the Covid-19 pandemic

Published in Frontiers in Political Science, 2022

The COVID-19 pandemic has been challenging and testing of public health systems across the globe, engaging them in a prolonged scrutinization of their functions, capacity and resources. While in theory, this process can yield invaluable insights for future policy design and mitigate future adversity, it demands a suitable mode of evaluation. Often, innovative and ambitious legislative frames are a far cry from policymaking realities plagued with institutional and operational deficiencies. As a result, we decide to move past assessments of the de jure status quo and examine the de facto modus operandi through the eyes of the systems’ participating agents. We focus on the case of Greece, a country which boasts a modern public health systemic design, aligned with contemporary public health thought and international trends. We develop a new framework iteration for public health system performance evaluation, founded on prominent templates. We rely on elite surveying insights from 261 public health policy stakeholders in Greece, collected between 15.07.2020 and 13.12.2020. We capture the effect of the COVID-19 pandemic both in a latent fashion, through the timing of our survey, and in a direct one, through explicit inquiry. Our results show that the functions of the Greek Public Health System are disproportionally developed, relevant resources come to be narrow in scope and outcomes are suboptimal, failing to fulfill identified aims. Moreover, high centralization, the absence of public health expertise and undeveloped evaluative channels prevent failures from instigating adjustments. The COVID-19 pandemic has brought the system’s deficiencies to light forcefully and highlighted the essentiality of scientific inputs. Our conclusions point to an ill-alignment between the system’s mission and the ideational orientation of its stakeholders, which is likely to contain structural change if it remains unaddressed. We identify future research agendas and present policy directions for the Greek public health system.

Recommended citation: Karokis-Mavrikos, V., Mavrikou, M., & Yfantopoulos, J. (2022). Stakeholder perceptions and public health system performance evaluation: Evidence from Greece during the Covid-19 pandemic. Frontiers in Political Science. https://doi.org/10.3389/fpos.2022.1067250
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Book Chapters

Shifting Ideational Paradigms in Public Health: the case of Greece

Published in A Modern Guide to the Multiple Streams Framework: Elgar Modern Guides, 2023

The Multiple Streams Framework (MSF) has long enjoyed prominence as an analytical tool for the study of policy change (Kingdon 1984). Scholarly applications have spanned contexts and policy fields (Jones et al. 2015) and have been highly successful in uncovering the mechanisms underpinning policy shifts, especially in the decision agenda (Herweg, Zahariadis and Zohlnhöfer 2018). As change is dynamic, recent accounts have extended the MSF’s focus to the implementation stage (Fowler 2019; Sager and Thomann 2017). An emerging challenge in the literature concerns connecting policy design and implementation (Fowler 2022; Zahariadis and Exadaktylos 2016) to understand why some bills provisioning radical change succeed in shifting policy trajectories but others do not. We intend to contribute to this research agenda through a longitudinal account of public health policy in Greece. We apply the MSF toolkit to the study of public health policy change, centering our analysis on two focusing events: the 2003 SARS outbreak and the Covid-19 pandemic. The first triggered the institutionalization of public health policymaking for the first time in Greece’s modern history (Bill 3172/2003) and the second tested the degree of entrenchment of the new paradigm nearly two decades later. In doing so, we evaluate the interrelation of policy design and implementation and uncover contextually-driven insights for the potential theoretical advancement of the framework.

Recommended citation: Karokis-Mavrikos, V., & Mavrikou, M. (2023). Shifting ideational paradigms in public health: The case of Greece. In N. Zahariadis, N. Herweg, R. Zohlnhöfer, & E. Petridou (Eds.), A Modern Guide to the Multiple Streams Framework (pp. 123–145). Edward Elgar. https://doi.org/10.4337/9781802209822.00016
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Centralization and Lockdown: The Greek Response

Published in Policy Styles and Trust in the Age of Pandemics: Global Threat, National Responses, Routledge, 2022

In this chapter, we have argued that policy style interacted with political trust to shape the Greek response to the crisis created by the COVID-19 pandemic. We showed that when the pandemic hit the country in February 2020, Greece exhibited an administrative style coupled with low trust in government and other relevant public institutions. Focusing on measures taken during the response phase, that is, reaction to the pandemic, we have confirmed our hypothesis. However, we have also uncovered a certain dynamism driven by feedback from earlier response measures. While we anticipated a more-or-less “fixed,” that is, centralized response, we also uncovered centrifugaltendencies during the second wave. Command and coordination remained firmly in central–national hands throughout the two waves. But the message changed as the trade-off between public health and economic performance became more visible, and politically pressing, while there were attempts at more regionally nuanced outcomes. To be sure, centralization is still the norm—after all, policy styles cast a long shadow onto the future— but trust and the direction of response appear to wax and wane, further buttressing our argument for an interactive effect of style and trust on national crisis response.

Recommended citation: Zahariadis, N., & Karokis-Mavrikos, V. (2022). Centralization and lockdown: The Greek response. In N. Zahariadis, E. Petridou, T. Exadaktylos, & J. Sparf (Eds.), Policy styles and trust in the age of pandemics: Global threat, national responses. Routledge.
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Working Papers

Policy Networks and Policy Entrepreneurship in the EU: Explaining Structural Policy Change in Pharmaceutical Innovation Incentives and HTA

Published in forthcoming, 2025

The EU is currently experiencing its longest period without a Treaty revision since Eurosclerosis, having evolved into a political system with a distinctive multi-level governance architecture. Therefore, EU-level policy change requires moving beyond the dichotomous focus of European integration theories and adapting the tools of policy process research to the EU level. This study applies a modified iteration of the Multiple Streams Framework—the EU-MSF—to two structural reforms in EU pharmaceutical policy: the revision of the General Pharmaceutical Legislation and the establishment of the new EU HTA framework. Drawing on primary data, the study examines the impact of policy network integration on the nature of favourable policy alternatives and the success of policy entrepreneurship strategies. The findings indicate that the level of policy network integration shapes the relative importance of technical feasibility and value acceptability and, in turn, informs policy entrepreneurship strategies, such as ‘snooker-tactics’ and ‘recoil-tactics’.

Recommended citation: Karokis–Mavrikos, V. (2025). Policy Networks and Policy Entrepreneurship in the EU: Explaining Structural Policy Change in Pharmaceutical Innovation Incentives and HTA. *Working Paper*, forthcoming.
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Vassilis Karokis-Mavrikos