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The Institutional Grammar Tool (IGT) is an important and relatively recent innovation in policy theory and analysis. It is conceptualized to empirically operationalize the insights of the Institutional Analysis and Development (IAD) framework. In the last decade, political scientists have offered a number of applications of the IGT, mainly focused on disclosing and scrutinizing in-depth the textual configurations of policy documents. These efforts, involving micro-level analyses of syntax as well as more general classifications of institutional statements according to rule types, have underpinned empirical projects mainly in the area of environmental and common-pool resources. Applications of IGT are still in their infancy, yet the growing momentum is sufficient for us to review what has been learned so far. We take stock of this recent, fast-growing literature, analyzing a corpus of 26 empirical articles employing IGTs published between 2008 and 2017. We examine them in terms of their empirical domain, hypotheses, and methods of selection and analysis of institutional statements. We find that the existing empirical applications do not add much to explanation, unless they are supported by research questions and hypotheses grounded in theory. We offer three conclusions. First, to exploit the IGT researchers need to go beyond the descriptive, computational approach that has dominated the field until now. Second, IGT studies grounded in explicit hypotheses have more explanatory leverage, and therefore, should be encouraged when adopting the tool outside the Western world. Third, by focusing on rules, researchers can capture findings that are more explanatory and less microscopic.

ABSTRACT: Regulators face an array of initiatives designed to boost the effectiveness of policy delivery and cut administrative burdens. A good deal of analytical attention is given to these governance tools, but we know much less about how regulators themselves understand and learn about them. We use a quasi-experiment to assess the effects of training on local government inspectors' understandings of the Primary Authority (PA) initiative. Established in 2009 by the UK's Better Regulation Delivery Organisation (BRDO), PA partnerships are legally binding agreements that provide businesses with a single point of regulatory contact and inspectors provide advice and reduce duplication of inspections and paperwork. The initiative is complex, and marks a significant departure from the existing inspection framework. Our findings suggest that, regardless of training, the regulatory innovation is well understood among local authority inspectors. Training may make a difference, however, in aspects of regulatory reform which are contentious or could be taken as counterintuitive to professional norms. The article also highlights the value of the quasi-experimental approach for policy-relevant public management research.

We compare the Narrative Policy Framework (NPF) and the Institutional Grammar Tool (IGT). Given the focus of this special issue on the NPF, we first theorize how the IGT can contribute to the development of NPF categories, but also how the former gains conceptual leverage from the latter. We argue that it is useful to consider jointly NPF and IGT as this expands the benefit of NPF usage for policy researchers—uncovering not only the stories policy actors tell but also what these stories mean in terms of institutional statements. We provide a demonstration of how the conversation between these two policy lenses may develop by analyzing original data on the design of consultation procedures in the European Union, Finland, Ireland, and Malta.

Consultation is a policy instrument geared toward stakeholder engagement in the formulation of primary and secondary legislation. It ensures certain categories of actors can access draft proposals, examine the evidence produced by government or regulators, provide comments and receive feedback. Using an original dataset of consultation design across the EU-28, we examine how variations in combinations of consultation design matter for perceptions of corruption. Using Ostrom's Institutional Grammar Tool (IGT), we develop expectations about the causal effects of combinations of formal consultation rules together with the condition of social capital, which captures important attributes of the context in which consultation operates. We test our expectations using set-theoretic techniques. Our findings indicate: formal consultation rules are rarely sufficient for mitigating perceptions of corruption, legally prescribed procedures are often replaced by informal rules, and the limited effect of formal consultation rules on perceptions of corruption is due to an incomplete design of the procedures.

Background Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them. Methods Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally-representative population surveys. Cancer incidence data for 2015 was sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country. Results Nearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3% respectively of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors. Conclusion Tobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure, or reduce exposure levels – both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors, and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable 'lifestyle' factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations. Keywords: cancer; risk factors; population attributable fractions; UK; tobacco; obesity; lifestyle; environmental

Objective To evaluate whether the implementation of the FAST‐M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low‐resource setting. Design A before‐and‐after design. Setting Fifteen government healthcare facilities in Malawi. Population Women suspected of having maternal sepsis. Methods The FAST‐M complex intervention consisted of the following components: the FAST‐M maternal sepsis treatment bundle and the FAST‐M implementation programme. Performance of selected process outcomes was compared between a 2‐month baseline phase and 6‐month intervention phase with compliance used as a proxy measure of feasibility. Main outcome result Compliance with vital sign recording and use of the FAST‐M maternal sepsis bundle. Results Following implementation of the FAST‐M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 [0%] versus 169/252 [67.1%], P < 0.001). Recognition of suspected maternal sepsis improved with more cases identified following the intervention (12/106 [11.3%] versus 107/166 [64.5%], P < 0.001). Sepsis management improved, with women more likely to receive all components of the FAST‐M treatment bundle within 1 hour of recognition (0/12 [0%] versus 21/107 [19.6%], P = 0.091). In particular, women were more likely to receive antibiotics (3/12 [25.0%] versus 72/107 [67.3%], P = 0.004) within 1 hour of recognition of suspected sepsis. Conclusion Implementation of the FAST‐M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low‐resource setting such as Malawi. Tweetable Abstract Implementation of a sepsis care bundle for low‐resources improved recognition & management of maternal sepsis.