Discussion
The aim of this study was to examine the development of recommendations by the EAG for diabetes as an in- strumental case study of the health policy formulation process. This paper applied Kingdon’s Multiple Streams Theory to understand both the content and the context of the recommendations. Our analysis suggests that the problem stream and policy stream were on course to converge, as a result of agreement on the growing pro- blem of diabetes and accumulating national and inter- national evidence on how best to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, having been estab- lished by the HSE, which had the remit for policy imple- mentation. Many stakeholders also envisaged having a role in implementation following approval of the recom- mendations. However, in the politics stream, there was waning support from health service management, changes to the organisational structure, and seriously reduced financial capacity in the health system. According to Kingdon, early optimism and awareness of the need for change is often replaced by the realisation of the costs of action [21]. Thus, the politics stream in effect dried up and the policy window remained closed.
While alternative theories of the policy process were considered during analysis [40,41], the Multiple Streams Theory provided the best explanatory fit with the data [21]. The rational model of policy making did apply to decision making at a micro-level within the EAG group
Page 8 of 11
itself as the group followed a logical sequence: priority setting, evidence appraisal, analysis of alternative options in subgroups, and consensus on proposals to put for- ward to the HSE for approval. However, it fails to take into account external influences such as the barriers and opportunities presented within the wider health system. Walt and Gilson argue that the policy process occurs within particular contexts with which it interacts [28]. The EAG and its recommendations were embedded with- in a health system that was in a state of flux. While certain existing commitments in other priority areas were being met, for example the development of symptomatic breast services, there was little new investment of resources in the health system at the time. The emphasis was on cost saving, reducing staff numbers, and doing more with less [23]. The EAG process was ultimately superseded by these priorities.
Discussion
The aim of this study was to examine the development of recommendations by the EAG for diabetes as an in- strumental case study of the health policy formulation process. This paper applied Kingdon’s Multiple Streams Theory to understand both the content and the context of the recommendations. Our analysis suggests that the problem stream and policy stream were on course to converge, as a result of agreement on the growing pro- blem of diabetes and accumulating national and inter- national evidence on how best to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, having been estab- lished by the HSE, which had the remit for policy imple- mentation. Many stakeholders also envisaged having a role in implementation following approval of the recom- mendations. However, in the politics stream, there was waning support from health service management, changes to the organisational structure, and seriously reduced financial capacity in the health system. According to Kingdon, early optimism and awareness of the need for change is often replaced by the realisation of the costs of action [21]. Thus, the politics stream in effect dried up and the policy window remained closed.
While alternative theories of the policy process were considered during analysis [40,41], the Multiple Streams Theory provided the best explanatory fit with the data [21]. The rational model of policy making did apply to decision making at a micro-level within the EAG group
Page 8 of 11
itself as the group followed a logical sequence: priority setting, evidence appraisal, analysis of alternative options in subgroups, and consensus on proposals to put for- ward to the HSE for approval. However, it fails to take into account external influences such as the barriers and opportunities presented within the wider health system. Walt and Gilson argue that the policy process occurs within particular contexts with which it interacts [28]. The EAG and its recommendations were embedded with- in a health system that was in a state of flux. While certain existing commitments in other priority areas were being met, for example the development of symptomatic breast services, there was little new investment of resources in the health system at the time. The emphasis was on cost saving, reducing staff numbers, and doing more with less [23]. The EAG process was ultimately superseded by these priorities.
การแปล กรุณารอสักครู่..
Discussion
The aim of this study was to examine the development of recommendations by the EAG for diabetes as an in- strumental case study of the health policy formulation process. This paper applied Kingdon’s Multiple Streams Theory to understand both the content and the context of the recommendations. Our analysis suggests that the problem stream and policy stream were on course to converge, as a result of agreement on the growing pro- blem of diabetes and accumulating national and inter- national evidence on how best to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, having been estab- lished by the HSE, which had the remit for policy imple- mentation. Many stakeholders also envisaged having a role in implementation following approval of the recom- mendations. However, in the politics stream, there was waning support from health service management, changes to the organisational structure, and seriously reduced financial capacity in the health system. According to Kingdon, early optimism and awareness of the need for change is often replaced by the realisation of the costs of action [21]. Thus, the politics stream in effect dried up and the policy window remained closed.
While alternative theories of the policy process were considered during analysis [40,41], the Multiple Streams Theory provided the best explanatory fit with the data [21]. The rational model of policy making did apply to decision making at a micro-level within the EAG group
Page 8 of 11
itself as the group followed a logical sequence: priority setting, evidence appraisal, analysis of alternative options in subgroups, and consensus on proposals to put for- ward to the HSE for approval. However, it fails to take into account external influences such as the barriers and opportunities presented within the wider health system. Walt and Gilson argue that the policy process occurs within particular contexts with which it interacts [28]. The EAG and its recommendations were embedded with- in a health system that was in a state of flux. While certain existing commitments in other priority areas were being met, for example the development of symptomatic breast services, there was little new investment of resources in the health system at the time. The emphasis was on cost saving, reducing staff numbers, and doing more with less [23]. The EAG process was ultimately superseded by these priorities.
การแปล กรุณารอสักครู่..