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New ways to get policy into practice.

Peter Nugus1, Geetha Ranmuthugala2, Josianne Lamothe3

  • 1McGill University , Montreal, Canada.

Journal of Health Organization and Management
|October 10, 2018
PubMed
Summary
This summary is machine-generated.

This study explores how social-organizational context aligns health policy with practice, revealing that a supportive environment enables clinicians to better meet client needs. It redefines street-level bureaucracy as mutual influence to optimize care.

Keywords:
BureaucracyChangeMental healthOrganizational restructuringPolicyPolitics

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Area of Science:

  • Health Services Research
  • Organizational Psychology
  • Social Work

Background:

  • Misaligned objectives between policymakers and clinicians hinder health service effectiveness.
  • The concept of street-level bureaucracy often separates policymakers from frontline workers.
  • Understanding the social-organizational context is crucial for aligning policy with practice.

Purpose of the Study:

  • To investigate the role of social-organizational context in aligning health policy with clinical practice.
  • To explore how work environments influence the implementation of mental health strategies.
  • To offer a new conceptualization of street-level bureaucracy.

Main Methods:

  • Mixed-method participatory study involving client file audits, staff surveys, interviews, focus groups, and staff meeting observations.
  • Utilized a locally developed tool for an Australia-wide mental health strategy implementation.
  • Data analysis included content analysis, thematic analysis, and descriptive statistics.

Main Results:

  • A model of integration distinguishing "assimilist" and "externalist" positions was developed based on implementation successes and shortcomings.
  • The work environment's capacity to support clinician coordination is key to addressing clients' personal and social needs.
  • This was particularly evident for allied health clinicians and nurses in sub-acute settings.

Conclusions:

  • A new conceptualization of street-level bureaucracy as a process of mutual influence among interdependent actors is proposed.
  • This framework can evaluate the appropriateness and support for clinical discretion.
  • Optimizing client-defined needs requires supportive managers and policymakers.