By: Barrie Quappé MPA, RN, BSN – Consultant/Director:
How often do we find ourselves noting that a law has been passed but implementation has not happened? The leap from a new law to operationalization through policies, etc., has so many moving parts that it can appear to be the impossible dream. Policies are changelings in that it really depends on the context, the politicians or bureaucrats framing of said policy, the political urgency or not of implementation, the political posing to appear to be making efforts to remedy a public concern, and so much more. They are very difficult to define. My personal experiences as a civil servant have validated this. They inspire me to continue to study alternative ways of ‘getting the job done’ by educating myself on what has gone before (rather than re-invent the wheel).
Take for example the “1/2010-11—Human Organ and Tissue Transplant Bill” brought by then MLA Mr. Ellio A. Solomon. The resulting legislation which was passed was entitled: “Human Tissue Transplant Bill, 2013”. Have you heard of any updates on this?
Understanding the currents that shape or destruct new initiatives can go a long way to carving a new path forward. No matter how well constructed and implemented a policy may be, outside lobbying or emotive ranting can quickly derail this in a democracy. One quote that talks about personal value orientation sums up the individual’s potential for impact on any policy process. Their position may or may not give them a dominant vote to tip the way forward in the direction they prefer.
“…the results demonstrate that the Manager’s personal value orientations affect the participatory process when there is a lack of control and support from their commissioning organisation, and also in cases where policy is ambiguous.”(Aggestam, 2014)
The historical perspective of public policies shows the occurrence of the risk of public unrest due to public policy failures. In looking at rational policy models it can be quite complex. Sabatier attempts to break this into more digestible parts in his five “complex set of interacting elements over time.”(Sabatier, 2007, p.3-4) He further elaborates:
“In short, understanding the policy process requires knowledge of the goals and perceptions of hundreds of actors throughout the country involving possibly very technical scientific and legal issues over periods of a decade or more when most of those actors are actively seeking to propagate their specific “spin” on events.”
Policy models be they rational, modern positivist, or whatever they may be, can only serve as a framework on which the actors can customize for their purpose. Looking at a politician’s influence on policies, one recalls the ‘Yes, Minister’ quote:
“Sir Humphrey Appleby: A minister can do what he likes. James Hacker: It’s the people’s will. I am their leader. I must follow them.” (Jay, A. and Lynn J. (1980)
Think of how non-response (by the politician) or qualifying something as ‘technical’ are ways they employ to avoid responsibility. Note how the street-level bureaucrat can internally guide decision makers in a direction they prefer. Also consider how a bureaucrat could or whether they should not implement a policy as they do not believe it is for the greater good or national interest. What about how external groups can influence policy and when to employ whistle-blowing and/or the media to recruit public opinion in your favor?
From the ‘top-down and bottom-up’ approach in Hogwood and Gunn, we learn just how intricate implementation is and how 100 percent success is the impossible dream! Also consider the grey areas of law enforcement that highlights discretionary power and how that can challenge policies and implementation. It is also empowering to note that street-level bureaucrats are not helpless and do have opportunities to influence policies from time to time.
There is a tapestry of complexities that contribute to policy making and implementation. I know I have many more tools in my toolbox for helping in writing and implementing policies, which I have done for my clients. Perhaps Mosse’s ethnography description lets us all know that we will have “frustrations of experience” (Mosse, 2004) but while policies cannot be implemented it is imperative that we know how.
Coming from a medical background (I’m a nurse), I do believe that evidence-based quality improvement can help sort what works or not. Or, to be more specific, what part of the whole works and why. That is the information decision makers need in order to make more informed decisions. I also strongly believe in the realist suggestion at the end of this article:
“Unless we adjust our expectations, the continued quest for dramatic cures will result in missed opportunities to make consistent, incremental improvements in care.”(Shojania & Grimshaw, 2005)
Can the democratic world, based on electing officials based on their performance make the cultural shift to accepting incremental successes? It would be a massive leap of faith for most and I am curious what other medical practitioners in Cayman think of this?
The bottom line advantage for Cayman is that of being a set of three small islands. This means we can (and have in the past) quickly turn around, or even build from scratch, new opportunities. However, the politicians and the bureaucrats need to better understand government policy implementation, be more inclusive of private sector practitioners during the review and revise stages and find a genuinely new way forward instead of parading the same actors and the same type of policies.
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Relevant Links
- Aggestam, F., (2014) ‘Effects of the manager’s value orientation on stakeholder participation: at the front line of policy implementation’, Water Policy, 16(1), pp. 62-78[Online] Available from: http://www.iwaponline.com/wp/01601/0062/016010062.pdf
- Hogwood, B. W. & Gunn, L.A. (1984), Policy Analysis for the real world, Oxford: Oxford University Press, Chapter 11 ‘Implementation’ (pp.196-209) Available from: https://elearning.uol.ohecampus.com/bbcswebdav/institution/UKL1/201540_MARCH/MS_KMPA/KMPA_102/readings/UKL1_KMPA_102_Week06_Hogwood_ch11.pdf
- Howlett, M., Perl, A. and Ramesh, M.(2009) Studying public policy, 3rd edition. Oxford: Oxford University Press. Chapter 2, ‘Understanding Public Policy: Theoretical Approaches’ (pp. 17-49)[Online] Available from: https://elearning.uol.ohecampus.com/bbcswebdav/institution/UKL1/201540_MARCH/MS_KMPA/KMPA_102/reading/UKL1_KMPA_102_Week02_Howlett_ch2.pdf
- Jay & Lynn, 1980 Hughes, O. (2012) Public management and administration, 4th edition. New York: Palgrave Macmillan. Chapter 5, ‘Public Policy’ (pp.103-122).
- Jay, A. and Lynn J. (1980) Yes Minister: The Greasy Pole, British Broadcasting Corporation, [Online Video] Available from: https://www.youtube.com/watch?v=el1lIB6sy6A
- Mosse, D. (2004) Is Good Policy Unimplementable? Reflections on the Ethnography of Aid Policy and Practice, Development and Change, 35 (4) pp. 639-671. [Online] Available from: http://onlinelibrary.wiley.com.ezproxy.liv.ac.uk/doi/10.1111/j.0012-155X.2004.00374.x/pdf
- Sabatier, P.A. (2007) Theories of the Policy Process, University of California, Davis, [Online] Chapter 1: The Need for Better Theories, pp. 3-17 Available from: http://hum.ttu.ee/failid/oppematerjalid/Policy%20Skills/Sabatier%20theory%20of%20policy%20process.pdf
- Shojania K.G. & Grimshaw, J.M. (2005) ‘Evidence-based quality improvement: the state of the science’, Health Affairs, (24) 1 pp. 138-150,[Online] Available from: http://content.healthaffairs.org.ezproxy.liv.ac.uk/content/24/1/138.full.pdf+html