Policy may change during implementation. Principal-agent theory: In each situation there will be a relationship between principals those who define policy and agents those who implement policy , which may include contracts or agreements that enable the principal to specify what is provided and check that this has been accomplished.
The amount of discretion given to the agents and the complexity of the principal-agent relationship are affected by:. Interpretation of policy directives requires the translation of knowledge on interventions into the particular local context. Factors to take into account when interpreting health policy include Jenkin et al :. Gunn in Hunter has identified ten common barriers to effective health policy implementation:.
Powell and colleagues have investigated problems of policy implementation in acute pain services in the UK. The report was followed by a number of government documents which endorsed and developed the recommendations. By the majority of hospitals did have an acute pain service in some form, but many services were struggling to embed the necessary improvements in postoperative pain management in routine practice across their hospitals, leading to continuing deficits in basic care.
Through qualitative case study interviews with health professionals and managers working in and around acute pain services in three hospitals, Powell and colleagues identified multiple factors undermining service change around postoperative pain management which they divided into three linked categories. Issues around the content of the change: what is an acute pain service and why have one here?
Issues around the context of the change: the idiosyncrasies of the local environment. Issues around the process of the change: service change challenges professional roles and identities. These factors did not just impact as single factors, but also worked in combination and impacted on each other in complex ways.
Precisely this behaviour can be observed among public-project sponsors and stakeholders. This results in disappointed stakeholders and the impression of failure even though the project has been delivered with near-optimum results. What is missing? What could be given more depth? Visit the Implementing Public Policy course website to learn more.
See the following: McConnell, A. What is policy failure? A primer to help navigate the maze. Public Policy and Administration , 30 , pp.
State failure, governance failure and policy failure: Exploring the linkages. Government project failure in Ghana: a multidimensional approach. International Journal of Managing Projects in Business , 10 1 , pp. Journal of Public Policy , pp. Politics and policy implementation in the Third World Vol. Princeton University Press; Huang, T. Mobilisation of public support for policy actions to prevent obesity.
The Lancet , , pp. Narrative review of models and success factors for scaling up public health interventions. Implementation Science , 10 1 , p. Policy capacity: A conceptual framework for understanding policy competences and capabilities. Policy and Society , 34 , pp. Jennifer Gold has noted that few countries have mechanisms in place to ensure more robust policy design. This is a startling omission. In the UK, the Civil Service Reform Plan requires permanent secretaries to warn before a political decision is taken if there are likely to be implementation concerns, but in practice the central machinery has only tended to be activated once an established policy is off track.
Indeed in the case of Brexit it seems likely that such warnings have been routinely given but widely ignored. These policies are defined as fitting one or more of several criteria: addresses a top government priority; has significant budget implications; makes major or complex changes to existing policies; involves significant cross-agency issues; is particularly sensitive; requires urgent implementation; involves new or complex delivery systems; and has been developed over a very short period.
In such cases a full implementation plan has to be developed during the drafting process covering seven domains: planning, governance, stakeholder engagement, risks, monitoring, review and evaluation, resource management and management strategy. There does not yet appear to be any evaluation of the effectiveness of these innovative arrangements. It is unclear how effective these different bodies have been. They tend to be based upon a linear-rational model of decision-making in which unambiguous objectives are established, action upon them flows in predictable ways through established implementation structures, and outcomes are monitored against them.
It is the realisation that implementation is complex, contextual and as much a bottom-up as a top-down imperative that has led to interest in an alternative approach — that of policy support. Tracking performance delivery alone is unlikely to be sufficient to avoid policy failure, especially where the policy is complex and long-term in nature. The question then arises as to whether some form of support might be better and, if so, what approach is appropriate.
All such approaches require close liaison with, and understanding of, the position of the implementing agencies. In a review of the components of service improvement for the Health Foundation, Allcock et al point out that those who work on the front line know more about the challenges of delivery than national policymakers; a crucial task for policy support is therefore to tap into the perceptions and experiences of those whose behaviour will shape the implementation process.
This is not so much about understanding legal obligations than about promoting the art and craft of policy implementation. It involves assessing existing capacity to deliver, knowing what is being done well, what needs improving and how best to build new capacity. The danger here is that policy support agencies try to straddle several strands of activity, some of which are at best in tension with each other, and at worst are contradictory.
Three purposes can be identified: managing and regulating; problem-solving; and capacity building. Combining all three of these functions — especially compliance and support — within one agency is problematic.
The way in which offers of implementation support are couched and perceived is vital in understanding their take-up and likely effectiveness. Acknowledging the frequency of policy failure, understanding the causes and accepting the need to put in place policy support mechanisms, would seem to be prudent steps yet they go largely unaddressed. As a useful new report from the Centre for Public Scrutiny points out, failure is not something to be feared but something to be embraced for the opportunity it gives to learn and, eventually, succeed.
It probably also requires a degree of political humility about what is achievable that is largely absent in the current climate. It really is time to talk more about policy failure and how we can avoid it.
0コメント