The patient as a policy problem: Ambiguous perceptions of a critical interface in healthcare

The interface between the patient and the health service has changed, which constitutes a potential problem for various policy-makers. Using a critical policy perspective and drawing on the theory of problem framing, this paper explores how actor groups with different responsibilities perceive the patient as a constructed policy problem. This is a qualitative study where data consists of single episode interviews with healthcare politicians, senior administrators, service strategists, and unit mangers from one regional health authority in Sweden. A thematic content analysis of the interviews was carried out in accordance with “the framework approach”. The study illustrates how the actors interpret their reality using diverse problem frames. This becomes more visible when the framing is disentangled with regard to what perspective they employ in relation to different accounts: society or the individual, or the (healthcare) system or the (healthcare) professional. The actor groups are part of the same institutional context, which explains certain tendencies of similarities in terms of the accounts being used, but still they approach the constructed problem differently which is visible as shifts—scaling up and down—between different accounts. By analyzing and structuring the various problem frames (including its policy styles) we can enhance our knowledge about how those responsible for the governance of healthcare approach the patient as a policy problem, as something that concerns only the patient and/or the provider, or as something that needs to be addressed in broader strategic terms.

England's fresh approach to food waste: problem frames in the Resources and Waste Strategy

Coexisting and eye-watering levels of food abundance, waste, overconsumption and hunger are symptomatic of a broken food system punctuated by vested interests in systematic overproduction. Against that backdrop, this paper evaluates England's ‘new’ approach to food waste in light of concerns that policy-makers have framed food waste as a consumer behaviour problem, rather than a structural challenge. The Resources and Waste Strategy's acknowledgement of normalised overproduction is thus remarkable, but unexpected. However, frame critical analysis reveals how an apparent departure from preoccupations with economic growth, combined with promises of government action, obscure an ongoing reluctance to intervene against powerful interests and the causes (not symptoms) of food waste. Legislative proposals, rather than reducing surplus, shift the burden of redistributing food away from the state and retailers, on to charities and farmers. With England, perhaps wrongly, seen as a world-leader on food waste, this has implications for other jurisdictions, as well as forthcoming consultations.

Same Problem, Different Policies

Educators teaching policy analysis can choose from many available frameworks, varying in purpose and approach. These frameworks typically advise students to view policies as transient and context-sensitive, but to view the problems activating the policies as objective and static conditions. How problems are variably framed in policy relative to how students are advised to analyze them has not captured the profession’s interest. This article presents 1) an overview of policy analysis frameworks; 2) a summary of findings from a recent study investigating how social policy texts advise students to analyze problems and; 3) a social constructionist framework (matrix) that provides an historical and contextual view of social problems and policy responses. This Problem-to-Policy framework corrects the omissions in most frameworks by including the forces that contributed to a problem’s discovery and construction, while also identifying periods of silence when the problem endured yet faded from view. The author argues that this framework bolsters policy practice by 1) emphasizing those problem frames and contexts that historically led to progressive policies and 2) underscores the urgency for social workers to engage with affected populations in the initial (re)claiming and (re)framing of problems, rather than during the later policy-making stages when constructions have already presaged policy responses.

Meaning Frames: The Structure of Problem Frames and Solution Frames

In recent years, focus on the designer's ability to frame wicked problems has underlined the important positioning of the designer as a key player in the early phases of innovation. However, further clarification and development of the theory and terminology of framing are needed in order to understand and support the rather complex framing process that the design team engages in during the early phases of innovation. There is a need to understand how design teams move from an overall framing of the wicked problem, in literature termed the “ problem frame,” to creating a meaningful solution. Through in-depth case studies of the framing processes at five design companies, we learn how designers use the overall problem frame as a stepping-stone to constructing a set of “ solution frames” in order to move toward a meaningful solution that integrates different perspectives. Together with the problem frame these sets of additional solution frames constitute an overall framing of the meaningful product—a “ meaning frame.” This overall meaning frame clarifies and sets the boundaries, the values and goals, and the criteria for evaluation of a proposed solution. As such, the study sheds light on the otherwise hidden reasoning process of framing toward a meaningful solution, rather than framing the problem, which a majority of current literature discusses.