Abstract
Background
There is a growing need to establish new knowledge on healthcare policy implementation that is relevant for both research and practice. Many attempts fail to deliver implemented policy initiates effectively because of the lack of coordination between system levels and different actors own agendas. The aim of this paper is to propose and illustrate an analytical framework providing a multilevel and multi-actor perspective in order to uncover combined difficulties of policy implementation within the context of a public healthcare system.
Methods
A multiple case study approach for the implementation of disease prevention in four Swedish healthcare regions was used. The selection of cases – regions within Sweden – was made in order to reflect a broad variety of contextual factors that may influence the policy implementation effectiveness. Interviewees consisted of a strategic sample of respondents representing different system levels and logics from each region. The qualitative analysis was based on empirically identified translation strategies by building a logical chain of evidence of the whole implementation process.
Results
The translation of policy guidelines was theorized and empirically investigated as chains of steps from the evidence-based policy formulated in the national guidelines for disease prevention methods via regional administrative systems into clinical practices. The following thematic areas were investigated: the successive translation of the policy object, consequences of policy reprioritizations, the role of technology in translation and the embedding of policy in clinical practice.
Conclusions
In successful implementation chains, guidelines are translated by being received and transferred to healthcare administrative systems through various political administrative activities and are then realised in everyday clinical practice. Policy is translated into different parts of the systems successively within the context of a multi-actor, multi-logic framework. Each actor/logic may take on the policy idea, change the route, delay it or even cancel out efforts. Earlier steps in the policy translation chain thus have consequences for later activities.
Translating Policy Guidelines: A Multiple Case Study of Disease Prevention in Sweden