Who is involved in policy implementation

Policies are set at higher levels in a political process and are then communicated to subordinate levels which are charged with the technical, managerial, and administrative tasks of putting policy into practice. Political scientists have theorised that the top-down approach requires that certain conditions be in place for policy implementation to be effective including:.

Bottom-up approach: This approach recognises that individuals at subordinate levels are likely to play an active part in implementation and may have some discretion to reshape objectives of the policy and change the way it is implemented. 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. Planning for sustainability can involve programmatic, administrative, fiscal, and other key elements of the policy. This tool can help you assess capacity for approaches to preventing teen dating violence—but its framework can also be applied to other public health problems.

Capacity refers to the information, skills, resources, abilities, and supports needed to develop, evaluate, and sustain a public health initiative. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Office of the Associate Director for Policy and Strategy. Section Navigation. Facebook Twitter LinkedIn Syndicate. Policy Implementation Minus Related Pages.

You belong here if:. Legislation may be required before a policy can be fully implemented, or there may be a need to ensure coherence with existing domestic and international legislation. There may be synergies with, or divergence from other government policies or strategies. Policies may interact with each other, producing new, unplanned and sometimes unintended consequences.

More complex governance and accountability arrangements are required to oversee policy implementation. There are many similarities between implementing policies and other types of interventions. Implementation enablers are important for policy implementation. Examples include leadership, communication and feedback mechanisms.

Leadership is needed at all levels of the system for policy implementation. From a political perspective, the appropriate level of leadership is needed to reshape mandates, resources, structures and programmes. Consistency in leadership has also been suggested as an enabler of implementation, such as fixed-term positions for senior government department officials, to ensure continuity and strengthen relationships.

Communication plays an important role in facilitating successful implementation of a policy and should be a core part of policy development from the beginning and throughout the stages of implementation. Systematic communications are important to share information and feedback on how implementation is progressing across sites, and to share wins and important policy milestones to maintain buy-in and motivation of stakeholders.

Feedback mechanisms should be established between policymakers and front-line practitioners once implementation has begun, to ensure the policy is being implemented as intended, unplanned consequences are addressed efficiently and to support the learning capacity of the system.

Feedback mechanisms can include regular, standardised reporting arrangements from front-line services to oversight structures for the policy, and policy reviews carried out at key points in the policy life cycle, for example mid-term reviews.

Implementation of programme and policy initiatives: Making implementation matter Australian National Audit Office, is a better practice guide for public service managers, covering themes such as implementation planning and monitoring and review. Click here. There are a range of terms used when writing or talking about implementation and in implementation science.

This glossary provides a short definition for each of these terms. Elements of an intervention which may be tailored to local settings during implementation without undermining the integrity of the intervention itself. Factors which hinder the implementation process and reduce the probability of successful implementation. The ability or power to do, understand or absorb something. This can apply to an individual, a team, an organisation or a whole system. A formal, typically short-term, arrangement between a coach and an individual focused on developing work-related skills or behaviours.

A group of people living in an area or having characteristics in common e. The action or process of formally discussing something with stakeholders, generally asking stakeholders a relevant question and receiving answers to that question.

While the views of stakeholders may then be used to influence decisions, there is no commitment or requirement to do so. The set of circumstances or unique factors in which implementation takes place. This can refer to both the wider, systemic context, as well as the specific setting in which a specific intervention will be implemented.

Ongoing use of emerging data and evidence on outcomes and implementation, and using that information to learn from experience, inform future implementation and improve outcomes. Progress is, therefore, achieved in an incremental manner over time.

Indispensable elements of an intervention or implementation plan, which cannot be changed without undermining it. All core components should be delivered with fidelity.

Using processes for collecting and analysing different types of data to guide decisions with the aim of improving outcomes on an ongoing basis. A process by which an intervention is communicated through certain channels over time.

The spread of ideas through diffusion is generally a passive process, following an unpredictable, unprogrammed, emergent and self-organising path, e. Mental Health Strategy for Scotland — Coia D, Glassborow R. Mental health quality and outcome measurement and improvement in Scotland. Curr Opin Psychiatry. Thelen K. In: Mahoney J, Rueschemeyer D, editors. Comparative Historical Analysis in the Social Sciences.

Cambridge: Cambridge University Press; Pierson P. When effect becomes cause: policy feedback and political change. World Polit. Campbell AL. Policy makes mass politics. Annu Rev Polit Sci. Weaver RK. The politics of blame avoidance. J Public Policy. Dismantling the Welfare State? Reagan, Thatcher and the Politics of Retrenchment. Book Google Scholar. Skocpol T. Protecting Soldiers and Mothers. Cambridge: Harvard University Press; Kingdon JW.

Agendas, Alternatives, and Public Policies. Updated Second Edition ed. Glenview: Longman Classics in Political Science; Peters J. Frontline: the community mental health and addiction sector at work in New Zealand. Platform Charitable Trust. Cooper A. Toronto: University of Toronto; Download references. The authors wish to thank Katherine Boothe for her feedback on an earlier version of this manuscript.

You can also search for this author in PubMed Google Scholar. HB conceived of the study, designed it, led the analysis and drafted the manuscript. JL contributed to the design and provided critical feedback on the manuscript. All authors read and approved the final manuscript. HB is currently completing her doctoral degree and plans to include this research as part of her dissertation.

Correspondence to Heather L. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions. Bullock, H. Understanding the supports needed for policy implementation: a comparative analysis of the placement of intermediaries across three mental health systems.

Health Res Policy Sys 17, 82 Download citation. Received : 01 March Accepted : 23 July Published : 22 August Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Research Open Access Published: 22 August Understanding the supports needed for policy implementation: a comparative analysis of the placement of intermediaries across three mental health systems Heather L.

Abstract Background Intermediaries are organisations or programmes that work between policy-makers and service providers to facilitate effective implementation of evidence-informed policies, programmes and practices. Methods Using a comparative case study approach, the analytic goal was to compare intermediaries across jurisdictions and explain differences in their placement using explanatory frameworks from political science.

Conclusions This research contributes to our growing understanding of policy-related intermediaries supporting implementation at scale and how we might build appropriate infrastructure in systems to support the implementation of policy and achieve better outcomes for citizens.

Background Governments are continually looking for better ways to achieve their policy goals. What are intermediaries? Implementation in mental health systems In the policy domain of mental health, a focus on implementation is particularly important in order to achieve change because of the complex and multi-faceted nature of the system. Study context This research builds on an ongoing collaboration regarding implementation infrastructure in mental health systems that has been taking place from a group of countries that are part of the International Initiative for Mental Health Leadership IIMHL — an international collaborative that focuses on improving mental health services and systems in eight countries: Australia, Canada, England, New Zealand, Republic of Ireland, Scotland, Sweden and the United States a ninth country, the Netherlands, has also recently joined.

Research question Our research seeks to understand this puzzling variation in the system placement of intermediaries supporting mental health policy implementation. Methods Design We used a comparative case study design [ 19 ] to explore the placement of intermediaries. Sampling We first looked for the presence of intermediaries in the mental health systems of the eight high-income countries that were part of the IIMHL at the time. Case selection and justification The criteria used to select cases for this analysis included 1 the presence of an intermediary that met our definition; 2 the intermediary ies was well-established with multiple data sources from which to draw; and 3 there was variation in the dependent variable the system placement of the intermediary.

Data collection Qualitative interviews One or two leaders from each jurisdiction were invited to participate in a brief phone interview with the study team. Analysis First, data relating to the placement of intermediaries, their role in systems, and the methods they use from the interview transcripts and documents were extracted using qualitative description [ 20 ].

Results I — Description of the intermediaries and their system placement Table 1 provides a summary description of the intermediaries in each jurisdiction. Discussion This analysis demonstrates that the system placement of intermediaries in these three jurisdictions is explained by their institutional landscapes and in particular, the mix of public—private mental health service delivery created by policy legacies and the differing administrative capacities of their systems.

Conclusions A better understanding of intermediaries is important for policy-makers who must consider the infrastructure required to support the implementation of policy. Availability of data and materials The data that support the findings of this study are available on request from the corresponding author [HB]. References 1. Article Google Scholar 2. Article Google Scholar 3. Article Google Scholar 4. Article Google Scholar 5. PubMed Article Google Scholar 6.

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